Vaccinations in adults with chronic inflammatory joint disease: Immunization schedule and recommendations for patients taking synthetic or biological disease-modifying antirheumatic drugs

• Published in: Joint, bone, spine : revue du rhumatisme bone, spine : revue du rhumatisme, 2016-03, Vol.83 (2), p.135-141
• Main Authors: Morel, Jacques, Czitrom, Séverine Guillaume, Mallick, Auriane, Sellam, Jérémie, Sibilia, Jean
• Format: Article
• Language: English
• Subjects: Antirheumatic Agents - adverse effects; Antirheumatic Agents - therapeutic use; Autoimmune Diseases - complications; Autoimmune Diseases - drug therapy; Bacterial Infections - etiology; Bacterial Infections - prevention & control; Biotherapies; Chronic Disease; Chronic inflammatory joint disease; Glucocorticoids; Human health and pathology; Humans; Immunization Schedule; Inflammation; Internal Medicine; Joint Diseases - complications; Joint Diseases - drug therapy; Life Sciences; Methotrexate; Rheumatic Diseases - complications; Rheumatic Diseases - drug therapy; Rheumatology; Rhumatology and musculoskeletal system; Streptococcus pneumoniae; Vaccination; Vaccination - standards; Vaccines - administration & dosage; Virus Diseases - etiology; Virus Diseases - prevention & control
• ISSN: 1297-319X; 1778-7254
• DOI: 10.1016/j.jbspin.2015.08.008

Abstract The risk of infection associated with autoimmune diseases is further increased by the use of biotherapies. Recommendations to minimize this risk include administering the full complement of vaccines on the standard immunization schedule, as well as the pneumococcal and influenza vaccines. Adults with chronic inflammatory joint disease (IJD) may receive a 13-valent pneumococcal conjugate vaccine, as well as a live attenuated vaccine against recurrent herpes zoster, recently licensed by European regulatory authorities. Live attenuated vaccines can be given only after an interval without immunosuppressant and/or glucocorticoid therapy. The effectiveness of vaccines, as assessed based on titers of protective antibodies, varies across vaccine types and disease-modifying antirheumatic drugs (DMARDs). Thus, methotrexate and rituximab are usually associated with decreased vaccine responses. The risks associated with vaccines are often considerably exaggerated by the media, which serve lobbies opposed to immunizations and make some patients reluctant to accept immunizations. Increasing immunization coverage may diminish the risk of treatment-related infections. A physician visit dedicated specifically to detecting comorbidities in patients with chronic IJD may result in improved immunization coverage. In this review, we discuss immunizations for adults with chronic IJD based on the treatments used, as well as immunization coverage. Many questions remain unanswered and warrant investigation by studies coordinated by the French networks IREIVAC (Innovative clinical research network in vaccinology) and IMIDIATE (Immune-Mediated Inflammatory Disease Alliance for Translational and Clinical Research).