Patients with rheumatic diseases are at a higher risk for infection as a function of the disease process. The immune system effects of biologic and steroid medications used in treatment can exacerbate this.
Because of this, the use of vaccines to prevent illness is an important intervention in these individuals. However, there is some concern among physicians that we don’t understand how vaccines, medications and the disease-related impacts on the immune system interact in most cases.
Prior to administering immunomodulatory therapy, it would probably be best if patients were given any needed vaccinations at least a month prior to the initial dose, especially for live viral vaccines,” says Camille Kotton, MD, clinical director of transplant infectious diseases at Massachusetts General Hospital in Boston.
She further suggests that rheumatologists may want to consider referring their patients for an evaluation by an infectious disease (ID) specialist prior to beginning the medication.
“As an immunocompromised host ID specialist, I believe such an evaluation can be very helpful when patients are about to undergo immunomodulatory therapy,” she says. “When I see such patients, they are assessed for latent infections, such as tuberculosis, and other endemic pathogens and prophylaxis issues are considered. I evaluate their vaccination and serologic status, and then administer the necessary vaccines.”
Timing Considerations
The Annals article suggested that timing of vaccinations can be important, may change depending on the type of medication being used and should be contemplated only during stable disease.