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Vaccination of patients with autoimmune inflammatory rheumatic diseases

Nature Reviews Rheumatology volume 11, pages 135–145 (2015)Cite this article

Subjects

Key Points

  • As patients with an autoimmune inflammatory rheumatic disease (AIRD) are at increased risk of infection, vaccination could be of paramount importance

  • Vaccination of patients with an AIRD is complicated by possible decreased efficacy of the vaccine and the risk of exacerbating underlying disease

  • Most vaccinations of patients with an AIRD seem to be effective; however, efficacy is dependent on the vaccine used, the type of AIRD and the medication regimen

  • Although some vaccines have been reported to induce autoimmune disorders, disease activity was not increased after vaccination in studies evaluating vaccination of patients with an AIRD

  • More research on vaccination of patients with an AIRD is needed, in particular regarding infections, adverse effects of vaccination and the influence of immunomodulatory therapies on vaccination efficacy

Abstract

Patients with autoimmune inflammatory rheumatic diseases (AIRDs) are at increased risk of infections. This risk has been further increased by the introduction of biologic agents over the past two decades. One of the most effective strategies to prevent infection is vaccination. However, patients with an AIRD have a compromised immune system, which is further impaired by medication. Another important issue is the possibility of triggering a broad nonspecific response by vaccination, potentially resulting in increased activity of the underlying autoimmune disease. In this Review, we provide an analysis of data on vaccination of patients with an AIRD. Both the efficacy and the safety of vaccination are addressed, together with the epidemiology of vaccine-preventable infectious diseases in different subgroups of adults with AIRDs. Special attention is given to vaccination of patients who are treated with biologic agents.

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Figure 1: Treatment-related RR of herpes zoster in RA.
Figure 2: Recommended vaccinations for patients with an AIRD.

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Authors and Affiliations

  1. Department of Rheumatology and Clinical Immunology, University Medical Center Groningen, University of Groningen, PO Box 30.001, Groningen, 9700 RB, Netherlands

    Johanna Westra & Christien Rondaan

  2. Department of Internal Medicine, Division of Infectious Diseases, University Medical Center Groningen, University of Groningen, PO Box 30.001, Groningen, 9700 RB, Netherlands

    Sander van Assen

  3. Department of Internal Medicine and Rheumatology, Martini Hospital, Van Swietenplein 1, PO Box 30.033, Groningen, 9700 RM, Netherlands

    Marc Bijl

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  1. Johanna Westra
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J.W. and S.v.A. researched data for the article. J.W., S.v.A. and M.B. substantially contributed to discussion of content and all authors contributed to writing and review/editing of the manuscript before submission.

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Correspondence to Marc Bijl.

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Westra, J., Rondaan, C., van Assen, S. et al. Vaccination of patients with autoimmune inflammatory rheumatic diseases. Nat Rev Rheumatol 11, 135–145 (2015). https://doi.org/10.1038/nrrheum.2014.206

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