Vaccinating the Autoimmune Patient

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Disease modifying anti-rheumatic drugs (DMARDs) for autoimmune inflammatory rheumatic diseases have both revolutionized treatment and increased the risk for infections. These patients should be considered for vaccination with the recommendation of a rheumatologist.

Writing in a review published in Best Practice & Research Clinical Rheumatology, Australian researchers Peter K.K.Wong and Patrick Hanrahan review vaccination recommendations for patients with autoimmune rheumatic conditions. The 

Without extensive published data on the efficacy of vaccine use in these patients, vaccinations should be considered in this population due to the greater risk of infection heightened by use of treatment standbys such as corticosteroids and DMARDs.

However, the authors note, vaccinations in this population may not work since the protective effect is created by the body mounting an immune response to the vaccine and then remembering how to fight it if it encounters the infection in full form.

Previously, live vaccines were considered to be contraindicated in severely immunocompromised patients due to the potential risk for vaccine-induced viral dissemination. Currently, vaccination frequency and consistency is markedly different from country to country. The writers state that a review of current evidence and education will encourage rheumatologists and other clinicians to identify and address gaps in vaccination before initiating disease modifying anti-rheumatic drugs leading to regular consideration for vaccination.

One reason vaccination practices in patients with autoimmune rheumatic disease vary so widely is that rheumatologists rarely give advice to primary care providers who administer the vaccines. The authors suggest that rheumatologists take the lead in this regard and advise general practitioners as to the timing and appropriateness of vaccinating immunocompromised patients.

For more information about the recommendations, see "Vaccine Recommendations for Rheumatic Patients."

REFERENCE

Peter K.K. Wong and Patrick Hanrahan. "Management of vaccination in rheumatic disease." Best Practice & Research Clinical Rheumatology 32 (2018) 720e734