TNF and influenza: When queried about the effect of disease modifying anti-rheumatic drugs (DMARDs) on vaccine-efficacy, 83% (83/100) recognize that the efficacy of both influenza and pneumococcal vaccines may be reduced in patients receiving treatment with methotrexate and/or tumour necrosis factor (TNF) inhibitors; only 5% consider that reduced immunogenicity after vaccination is clinically significant; 17% are not at all concerned about reduced response to vaccinations in patients under methotrexate/anti-TNFs.