Vaccinations in patients with immune-mediated inflammatory diseases

[DustyKat]

Abstract:

Patients with immune-mediated inflammatory diseases (IMID) such as RA, IBD or psoriasis, are at increased risk of infection, partially because of the disease itself, but mostly because of treatment with immunomodulatory or immunosuppressive drugs. In spite of their elevated risk for vaccine-preventable disease, vaccination coverage in IMID patients is surprisingly low. This review summarizes current literature data on vaccine safety and efficacy in IMID patients treated with immunosuppressive or immunomodulatory drugs and formulates best-practice recommendations on vaccination in this population. Especially in the current era of biological therapies, including TNF-blocking agents, special consideration should be given to vaccination strategies in IMID patients. Clinical evidence indicates that immunization of IMID patients does not increase clinical or laboratory parameters of disease activity. Live vaccines are contraindicated in immunocompromized individuals, but non-live vaccines can safely be given. Although the reduced quality of the immune response in patients under immunotherapy may have a negative impact on vaccination efficacy in this population, adequate humoral response to vaccination in IMID patients has been demonstrated for hepatitis B, influenza and pneumococcal vaccination. Vaccination status is best checked and updated before the start of immunomodulatory therapy: live vaccines are not contraindicated at that time and inactivated vaccines elicit an optimal immune response in immunocompetent individuals.

Full Article:

http://rheumatology.oxfordjournals.org/content/49/10/1815.full

Dusty.

 

[valleysangel92]

Interestingly, I've had all three of those, but none of them because of crohns or crohns related medications. The flu vaccine - mild asthma - Hepatitis - started a nursing course (only stayed 2 months tho ) - and Pneumococcal - because I have celiac. It always struck me as a little odd that I was given an extra vaccine for my celiac which has been well controlled and inactive for years but it is not widely offered to others with a much weaker immune system. Even if it won't generate the same strong immune response and therefore possibily less anti-bodies, surely some protection is better than none? Thanks for sharing Dusty!

 

[crohnsinct]

Haven't read the article yet Dusty but thanks. Especially since our whole family just had to have the rabies vaccines (bat in the house). The CDC site says that patients taking an immune suppressing drug should be tested for efficacy of the vaccine and that they may require another vaccine. Can't wait to see what this article says.

 

[Tesscorm]

That's also what the ID specialist told me, that those on immune suppressing drugs may need additional vaccination.

 

[DustyKat]

Be sure and open up the tables as they have some interesting info contained within them.

Table 2 lists whether the vaccines are live or not.