Vaccination in Inflammatory Rheumatic Diseases

Chung-Il Joung

doi:10.4078/jrd.2013.20.4.218

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Joung: Vaccination in Inflammatory Rheumatic Diseases

Review Article

J Rheum Dis 2013;20(4):218-222.

Published online: 31 August 2013

DOI: https://doi.org/10.4078/jrd.2013.20.4.218

Vaccination in Inflammatory Rheumatic Diseases

Chung-Il Joung

Divison of Rheumatology, Konyang University Hospital, Daejeon, Korea

Corresponding to : Chung-Il Joung, Divison of Rheumatology, Konyang University Hospital, 685, Gasuwon-dong, Seo-gu, Daejeon 302-718, Korea. E-mail : cij1221@hanafos.com

Received 12 August 201323 August 2013 Accepted 24 August 2013

This is a Free Access article, which permits unrestricted non-commerical use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Infection is a critical and challenging situation encoun-tered in treatment of inflammatory rheumatic diseases (IRDs). It is associated with the disease activity itself and/or the immunosuppressant treatments. Vaccine pre-ventable infections could be controlled by use of a timely vaccination protocol. Immunosuppressed situations observed in IRDs require some modification of the recommendation for the general population in each national society. Live attenuated vaccines are generally contra-indicated in IRDs, except for varicella-zoster vaccination, which is solely permitted live vaccine and could be given on a case by case basis in autoimmune IRDs. Influenza and pneumococcal vaccines are strongly recommended due to increased mortality in patients with IRDs. The vaccination protocol reflects the current national medical envi-ronment and requirements; therefore, it could change with time. The Korean Rheumatology Society now requires that vaccination be recommended for patients with IRDs, with the possibility of both an adult and child version.

Keywords: Vaccination, Recommendation, Inflammatory Rheumatic diseases

References

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Table 1.

Vaccines currently available

Live attenuated vaccines	Inactivated vaccine
MMR (SQ)	Inactivated virus	Japanese encephalitis (SQ)
Varicella-zoster (SQ)		Poliovirus (SQ)
BCG (ID)		Hepatitis A (IM)
Yellow fever (SQ)	Inactivated viral subunits	Hepatitis B (IM)
Rotavirus (PO)		Influenza (IM)
	Inactivated bacterium	Pertussis WC or acellular (IM)
		Cholera (SQ)
		Typhoid (SQ)
	Toxoid	Diphtheria (IM)
		Tetanus (IM)
		DTaP, Td, TdaP
	Polysaccharide	Pneumococcal (SQ)
		Meningococcal (SQ)
	Conjugate of polysaccharide and protein	Hib (Hemophilus type b) (IM)

MMR: measles mumps and rubella, BCG: Bacille de Calmette Guerin, SQ: subcutaneous, PO: per os, ID: intradermal, IM: intramuscular, WC: whole cell.

Table 2.

Recommendations for vaccination in inflammatory rheumatic diseases (6)

Vaccine	Live vaccine	Mortality^∗	CDC	BSR	EULAR	Comment
Pneumococcal	No	↑	√	√	√	A booster, recommended 5 years later of the first shot.
Influenza	No	↑	√	√	√
Human papilloma virus	No	↑	−	−	√
Varicella zoster	Yes	↑	√	√	√	Not considered as contraindication in case of using low dose immunosuppressants.
Hepatitis B	No	↑	√	√	−	Recommended in high risk groups.
Hepatitis A	No	=		√	−	Recommended in high risk groups.

CDC: The Centers for Disease control, BSR: The British Society of Rheumatology. EULAR: The European League Against Rheumatism.

^∗ Infectious mortality in inflammatory rheumatic diseases.

Table 3.

The high risk groups for hepatitis A and B infections (adopted and translated from http://www.ksid.or.kr/file/2012_vaccine.pdf)

High risk groups for hepatitis A infection	High risk groups for hepatitis B infection
1) Patient having chronic liver disease	1) Male homosexual
2) Staff and worker in child care facility	2) People having multiple sexual partners
3) Health care personnel and researcher exposable to hepatitis A	3) HIV patient
4) Worker in restaurants dealing with foods	4) Intravenous drug abuser
5) People planning to travel or reside in the area endemic for hepatitis A	5) Spouse and family of hepatitis B carrier
	6) Patient having chronic kidney disease
6) People requiring repeated transfusions of blood products	7) Patient having chronic liver disease
7) Male homosexual	8) People having jobs exposable to hepatitis B
8) Intravenous drug abuser	9) Staff and residents of institutions for the mentally handicapped
9) Contact with hepatitis A patients within two weeks

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