ACR/ARHP Annual Meeting 2012: Immunosuppressed Rheumatic Disease Patients Still Candidates for Vaccines

But in studies reviewing hundreds of people on biologics who got the zoster vaccine accidentally, there were either no infections, or infection rates were similar for those vaccinated and not vaccinated.^8,9

“I suspect we’re going to be breaking down that dogma of not using live virus vaccines in individuals who are on immunosuppressive therapy in certain cases where the risk of infection outweighs theoretical but unproven risk from vaccination with a live virus vaccine,” Dr. Melmed said.

Yellow Fever

“The CDC guidelines suggest that we should be discouraging these [immunosuppressed] individuals from going to highly endemic areas of yellow fever,” he said. “The risk from vaccination is potentially significant. There can be neurotoxic effects from yellow fever vaccination, particularly in somebody who’s immunocompromised, and yet the risk of infection in a highly endemic area is also significant. In somebody who’s immunocompromised, that infection may be even worse, or even fatal.”

Newborn Vaccination

Because of the active transport mechanism of antibodies from the mother to the fetus, increased levels of infliximab and adalimumab have been found in cord blood, so newborns should not be given live vaccinations in the first six months of life.

References

1. Bridges MJ, Coady D, Kelly CA, Hamilton J, Heycock C. Factors influencing uptake of influenza vaccination in patients with rheumatoid arthritis. Ann Rheum Dis. 2003;62:685.
2. Desai SP, Turchin A, Szent-Gyorgyi LE, et al. Routinely measuring and reporting pneumococcal vaccination among immunosuppressed rheumatology outpatients: The first step in improving quality. Rheumatology. 2011;50:366-372.
3. Borba EF, Pasoto SG, Calich AL, et al. Lupus disease activity severely impairs pandemic influenza A/H1N1 vaccine immune response in patients without therapy. Arthritis Rheum. 2012;64(10 Suppl.): S1109.
4. Melmed GY, Frenck R, Barolet-Garcia C, et al. TNF blockers and immunomodulators impair antibody responses to pneumococcal polysaccharide vaccine (Ppv) in patients with inflammatory bowel disease (IBD). Gastroenterology. 2008;134(4 Suppl.):A68.
5. Winthrop LK, Racewicz A, Lee EB, et al. Evaluation of influenza and pneumococcal vaccine responses in patients with rheumatoid arthritis receiving tofacitinib. Arthritis Rheum. 2012;64(10 Suppl.): S550.
6. Grimaldi L, Rossignol M, Aubrun E, et al. Human papillomavirus vaccine [types 6, 11, 16, 18] (Gardasil ) and autoimmune disorders: Safety assessment using the pharmacoepidemiologic general research extension system. Arthritis Rheum. 2012;64(10 Suppl.):774.
7. Pérez-Alvarez R, Díaz-Lagares C, García-Hernández F, et al. Hepatitis B virus (HBV) reactivation in patients receiving tumor necrosis factor (TNF)-targeted therapy: Analysis of 257 cases. Medicine. 2011;90:359-371.
8. Zhang J, Delzell E, Xie F, et al. The use, safety, and effectiveness of herpes zoster vaccination in individuals with inflammatory and autoimmune diseases: A longitudinal observational study. Arthritis Res Ther. 2011; 13:R174.
9. Zhang J, Xie F, Delzell E, et al. Association between vaccination for herpes zoster and risk of herpes zoster infection among older patients with selected immune-mediated diseases. JAMA. 2012;308:43-49.