Vaccinations in patients with immune-mediated inflammatory diseases

JF Rahier, M Moutschen, A Van Gompel, M Van Ranst, E Louis, S Segaert, P Masson, F De Keyser

    Research output: Contribution to journalA1: Web of Science-article

    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
    Original languageEnglish
    JournalRheumatology
    Volume49
    Issue number10
    Pages (from-to)1815-1827
    Number of pages13
    ISSN1462-0324
    DOIs
    Publication statusPublished - 2010

    Keywords

    • B780-tropical-medicine
    • Noncommunicable diseases
    • Inflammatory reactions
    • Rheumatic diseases
    • Psoriasis
    • Susceptibility
    • Viral diseases
    • Infections
    • Treatment
    • Immunosuppression
    • Vaccines
    • Safety
    • Efficacy
    • Vaccination
    • Recommendations
    • Immunotherapy
    • Review of the literature

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