CURRENT RECOMMENDATIONS REGARDING VACCINATION OF PATIENTS WITH AUTOIMMUNE INFLAMMATORY RHEUMATIC DISEASES

Abstract

Background. Patients suffering from autoimmune inflammatory rheumatic diseases (AIIRD) are exposed to a higher risk of infections due to both their background and the immunosuppressant and immunomodulatory medications. This brings us to the question of what we can do to ensure the protection of our patients. And one of the answers should be vaccination. Methods. We performed a literature search in electronic database (PubMed) using keywords related to vaccination and rheumatic diseases. Also, relevant information concerning vaccination recommendations were collected form a website search of specific organizations dealing with management of autoimmune rheumatic disease in various countries. Results. Patients with AIIRD are at increased risk of infections and even if some of them could be prevented in part by vaccines, the rates of vaccination in this category of patients remains low. The 2015 American College of Rheumatology (ACR) guideline for the treatment of rheumatoid arthritis recommends the administration of influenza, pneumococcal, hepatitis B, human papilloma and shingles vaccines in patients requiring disease modifying antirheumatic drugs (DMARDs) or biologics, the first three being strongly recommended in patients with rheumatoid arthritis. The guideline does not recommend the administration of life attenuated vaccines, such as shingles vaccine, in patients under biologics. These are consistent with the recommendations from the Centers for Disease Control and Prevention (CDC) for vaccination of immunocompromised patients. In cases where live attenuated vaccines need to be used, the immunosuppressive therapy should be delayed by at least 4 weeks following vaccination. Conclusions. Despite important differences between different countries, there is a general consensus on the importance of immunizing AIIRD patients through vaccination. The most widely recommended vaccination regimens refer to influenza and pneumococcal vaccines, but other specific vaccines such as hepatitis B, human papilloma virus, herpes zoster, meningococcal, and Haemophilus influenzae type b should also be considered.

Keywords

• vaccination
• rheumatic disorders
• immunodeficiency