J Rheum Dis.  2018 Apr;25(2):100-107. 10.4078/jrd.2018.25.2.100.

Vaccination for Patients with Rheumatic Diseases in the Era of Biologics

Affiliations
  • 1Division of Infectious Disease, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea. shhan74@yuhs.ac

Abstract

A large proportion of patients with rheumatic disease have an immunocompromised status resulting from disease pathogenesis itself and/or several immunosuppressive drugs including biologics. These conditions are closely related to a higher risk of a variety of infectious diseases. Therefore, a few vaccinations for vaccine"preventable pathogens should be considered in patients with rheumatic disease at the appropriate time. The quadrivalent inactivated influenza and pneumococcal vaccinations, including both 13"valent conjugate and 23"valent polysaccharide vaccines, are strongly recommended in all patients with rheumatic disease. The immunogenicity of influenza and pneumococcal vaccination have generally been demonstrated in patients with rheumatic disease on biologics except for rituximab and abatacept. Vaccines can be administered during therapy with tumor necrosis factor-α antagonists but may be more ideal during a stable or remission status without immunosuppressive therapy. In particular, vaccination should be done at least 6 months after an injection of rituximab as a B"lymphocyte"depleting biologic. Basically, all live-attenuated vaccines should be avoided in highly immunocompromised rheumatic disease patients. The vaccination for herpes zoster (HZ) can be taken carefully according to degree of immunosuppression because the currently available vaccine is only live"attenuated. The newly developed subunit HZ vaccine is promising in immunocompromised patients with rheumatic disease.

Keyword

Vaccination; Rheumatic disease; Biologic Agents; Influenza; Pneumococcal infections; Herpes zoster

MeSH Terms

Abatacept
Biological Factors
Biological Products*
Communicable Diseases
Herpes Zoster
Humans
Immunocompromised Host
Immunosuppression
Influenza, Human
Necrosis
Pneumococcal Infections
Rheumatic Diseases*
Rituximab
Vaccination*
Vaccines
Abatacept
Biological Factors
Biological Products
Rituximab
Vaccines

Cited by  1 articles

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Yoon-Kyoung Sung
J Rheum Dis. 2020;27(4):215-217.    doi: 10.4078/jrd.2020.27.4.215.


Reference

1. Westra J, Rondaan C, van Assen S, Bijl M. Vaccination of patients with autoimmune inflammatory rheumatic diseases. Nat Rev Rheumatol. 2015; 11:135–45.
Article
2. Favalli EG, Desiati F, Atzeni F, Sarzi-Puttini P, Caporali R, Pallavicini FB, et al. Serious infections during anti-TNFalpha treatment in rheumatoid arthritis patients. Autoimmun Rev. 2009; 8:266–73.
3. Falagas ME, Manta KG, Betsi GI, Pappas G. Infection-related morbidity and mortality in patients with connective tissue diseases: a systematic review. Clin Rheumatol. 2007; 26:663–70.
Article
4. Doran MF, Crowson CS, Pond GR, O'Fallon WM, Gabriel SE. Frequency of infection in patients with rheumatoid arthritis compared with controls: a population-based study. Arthritis Rheum. 2002; 46:2287–93.
Article
5. Keystone EC. Does anti-tumor necrosis factor-α therapy affect risk of serious infection and cancer in patients with rheumatoid arthritis?: a review of longterm data. J Rheumatol. 2011; 38:1552–62.
Article
6. Hohensinner PJ, Goronzy JJ, Weyand CM. Telomere dysfunction, autoimmunity and aging. Aging Dis. 2011; 2:524–37.
7. Listing J, Gerhold K, Zink A. The risk of infections associated with rheumatoid arthritis, with its comorbidity and treatment. Rheumatology (Oxford). 2013; 52:53–61.
Article
8. Germano V, Cattaruzza MS, Osborn J, Tarantino A, Di Rosa R, Salemi S, et al. Infection risk in rheumatoid arthritis and spondyloarthropathy patients under treatment with DMARDs, corticosteroids and TNF-α antagonists. J Transl Med. 2014; 12:77.
Article
9. Cobo-Ibáñez T, Descalzo MÁ, Loza-Santamaría E, Carmona L, Muñoz-Fernández S. Serious infections in patients with rheumatoid arthritis and other immunemediated connective tissue diseases exposed to anti-TNF or rituximab: data from the Spanish registry BIOBADASER 2.0. Rheumatol Int. 2014; 34:953–61.
Article
10. Curtis JR, Patkar N, Xie A, Martin C, Allison JJ, Saag M, et al. Risk of serious bacterial infections among rheumatoid arthritis patients exposed to tumor necrosis factor alpha antagonists. Arthritis Rheum. 2007; 56:1125–33.
11. Curtis JR, Yang S, Patkar NM, Chen L, Singh JA, Cannon GW, et al. Risk of hospitalized bacterial infections associated with biologic treatment among US veterans with rheumatoid arthritis. Arthritis Care Res (Hoboken). 2014; 66:990–7.
Article
12. Salliot C, Dougados M, Gossec L. Risk of serious infections during rituximab, abatacept and anakinra treatments for rheumatoid arthritis: meta-analyses of randomised place-bo-controlled trials. Ann Rheum Dis. 2009; 68:25–32.
Article
13. National Center for Immunization and Respiratory Diseases. General recommendations on immunization – recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2011; 60:1–64.
14. van Assen S, Agmon-Levin N, Elkayam O, Cervera R, Doran MF, Dougados M, et al. EULAR recommendations for vaccination in adult patients with autoimmune inflammatory rheumatic diseases. Ann Rheum Dis. 2011; 70:414–22.
Article
15. Fomin I, Caspi D, Levy V, Varsano N, Shalev Y, Paran D, et al. Vaccination against influenza in rheumatoid arthritis: the effect of disease modifying drugs, including TNF alpha blockers. Ann Rheum Dis. 2006; 65:191–4.
16. Elkayam O, Paran D, Caspi D, Litinsky I, Yaron M, Charboneau D, et al. Immunogenicity and safety of pneumococcal vaccination in patients with rheumatoid arthritis or systemic lupus erythematosus. Clin Infect Dis. 2002; 34:147–53.
Article
17. Elkayam O, Amir S, Mendelson E, Schwaber M, Grotto I, Wollman J, et al. Efficacy and safety of vaccination against pandemic 2009 influenza A (H1N1) virus among patients with rheumatic diseases. Arthritis Care Res (Hoboken). 2011; 63:1062–7.
Article
18. Ferreira I, Isenberg D. Vaccines and biologics. Ann Rheum Dis. 2014; 73:1446–54.
19. Müller-Ladner C, Müller-Ladner U. Vaccination and inflammatory arthritis: overview of current vaccines and recommended uses in rheumatology. Curr Rheumatol Rep. 2013; 15:330.
Article
20. Hak E, Nordin J, Wei F, Mullooly J, Poblete S, Strikas R, et al. Influence of high-risk medical conditions on the effectiveness of influenza vaccination among elderly members of 3 large managed-care organizations. Clin Infect Dis. 2002; 35:370–7.
Article
21. Nichol KL, Wuorenma J, von Sternberg T. Benefits of influenza vaccination for low-, intermediate-, and high-risk senior citizens. Arch Intern Med. 1998; 158:1769–76.
Article
22. Blumentals WA, Arreglado A, Napalkov P, Toovey S. Rheumatoid arthritis and the incidence of influenza and influenza-related complications: a retrospective cohort study. BMC Musculoskelet Disord. 2012; 13:158.
Article
23. Smitten AL, Choi HK, Hochberg MC, Suissa S, Simon TA, Testa MA, et al. The risk of herpes zoster in patients with rheumatoid arthritis in the United States and the United Kingdom. Arthritis Rheum. 2007; 57:1431–8.
Article
24. Winthrop KL, Baddley JW, Chen L, Liu L, Grijalva CG, Delzell E, et al. Association between the initiation of antitumor necrosis factor therapy and the risk of herpes zoster. JAMA. 2013; 309:887–95.
Article
25. Wolfe F, Michaud K, Chakravarty EF. Rates and predictors of herpes zoster in patients with rheumatoid arthritis and non-inflammatory musculoskeletal disorders. Rheumatology (Oxford). 2006; 45:1370–5.
Article
26. McDonald JR, Zeringue AL, Caplan L, Ranganathan P, Xian H, Burroughs TE, et al. Herpes zoster risk factors in a national cohort of veterans with rheumatoid arthritis. Clin Infect Dis. 2009; 48:1364–71.
Article
27. Strangfeld A, Listing J, Herzer P, Liebhaber A, Rockwitz K, Richter C, et al. Risk of herpes zoster in patients with rheumatoid arthritis treated with anti-TNF-alpha agents. JAMA. 2009; 301:737–44.
28. García-Doval I, Pérez-Zafrilla B, Descalzo MA, Roselló R, Hernández MV, Gómez-Reino JJ, et al. Incidence and risk of hospitalisation due to shingles and chickenpox in patients with rheumatic diseases treated with TNF antagonists. Ann Rheum Dis. 2010; 69:1751–5.
29. Ramiro S, Sepriano A, Chatzidionysiou K, Nam JL, Smolen JS, van der Heijde D, et al. Safety of synthetic and biological DMARDs: a systematic literature review informing the 2016 update of the EULAR recommendations for management of rheumatoid arthritis. Ann Rheum Dis. 2017; 76:1101–36.
Article
30. Ramiro S, Gaujoux-Viala C, Nam JL, Smolen JS, Buch M, Gossec L, et al. Safety of synthetic and biological DMARDs: a systematic literature review informing the 2013 update of the EULAR recommendations for management of rheumatoid arthritis. Ann Rheum Dis. 2014; 73:529–35.
Article
31. Merrill JT, Neuwelt CM, Wallace DJ, Shanahan JC, Latinis KM, Oates JC, et al. Efficacy and safety of rituximab in moderately-to-severely active systemic lupus erythematosus: the randomized, double-blind, phase II/III systemic lupus erythematosus evaluation of rituximab trial. Arthritis Rheum. 2010; 62:222–33.
Article
32. Chakravarty EF, Michaud K, Katz R, Wolfe F. Increased incidence of herpes zoster among patients with systemic lupus erythematosus. Lupus. 2013; 22:238–44.
Article
33. Mak A, Cheak AA, Tan JY, Su HC, Ho RC, Lau CS. Mycophenolate mofetil is as efficacious as, but safer than, cyclophosphamide in the treatment of proliferative lupus nephritis: a meta-analysis and meta-regression. Rheumatology (Oxford). 2009; 48:944–52.
Article
34. Wotton CJ, Goldacre MJ. Risk of invasive pneumococcal disease in people admitted to hospital with selected immunemediated diseases: record linkage cohort analyses. J Epidemiol Community Health. 2012; 66:1177–81.
Article
35. Naveau C, Houssiau FA. Pneumococcal sepsis in patients with systemic lupus erythematosus. Lupus. 2005; 14:903–6.
Article
36. Grabar S, Groh M, Bahuaud M, Le Guern V, Costedoat-Chalumeau N, Mathian A, et al. Pneumococcal vaccination in patients with systemic lupus erythematosus: A multicenter placebo-controlled randomized double-blind study. Vaccine. 2017; 35:4877–85.
Article
37. Lu TY, Ng KP, Cambridge G, Leandro MJ, Edwards JC, Ehrenstein M, et al. A retrospective seven-year analysis of the use of B cell depletion therapy in systemic lupus erythematosus at University College London Hospital: the first fifty patients. Arthritis Rheum. 2009; 61:482–7.
Article
38. Stojanovich L. Influenza vaccination of patients with systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA). Clin Dev Immunol. 2006; 13:373–5.
Article
39. Kobashigawa T, Nakajima A, Taniguchi A, Inoue E, Tanaka E, Momohara S, et al. Vaccination against seasonal influenza is effective in Japanese patients with rheumatoid arthritis enrolled in a large observational cohort. Scand J Rheumatol. 2013; 42:445–50.
Article
40. Kostianovsky A, Charles P, Alves JF, Goulet M, Pagnoux C, Le Guern V, et al. Immunogenicity and safety of seasonal and 2009 pandemic A/H1N1 influenza vaccines for patients with autoimmune diseases: a prospective, monocentre trial on 199 patients. Clin Exp Rheumatol. 2012; 30(1 Suppl 70):S83–9.
41. Saag KG, Teng GG, Patkar NM, Anuntiyo J, Finney C, Curtis JR, et al. American College of Rheumatology 2008 recommendations for the use of nonbiologic and biologic disease-modifying antirheumatic drugs in rheumatoid arthritis. Arthritis Rheum. 2008; 59:762–84.
Article
42. Del Porto F, Laganà B, Biselli R, Donatelli I, Campitelli L, Nisini R, et al. Influenza vaccine administration in patients with systemic lupus erythematosus and rheumatoid arthritis. Safety and immunogenicity. Vaccine. 2006; 24:3217–23.
43. Nii T, Kubota T, Nanki T, Komano Y, Harigai M, Kohsaka H, et al. Reevaluation of antibody titers 1 year after influenza vaccination in patients with rheumatoid arthritis receiving TNF blockers. Mod Rheumatol. 2009; 19:216–8.
Article
44. Kubota T, Nii T, Nanki T, Kohsaka H, Harigai M, Komano Y, et al. Anti-tumor necrosis factor therapy does not diminish the immune response to influenza vaccine in Japanese patients with rheumatoid arthritis. Mod Rheumatol. 2007; 17:531–3.
Article
45. Elkayam O. Safety and efficacy of vaccination against influenza in patients with rheumatoid arthritis. Clin Dev Immunol. 2006; 13:349–51.
Article
46. Kaine JL, Kivitz AJ, Birbara C, Luo AY. Immune responses following administration of influenza and pneumococcal vaccines to patients with rheumatoid arthritis receiving adalimumab. J Rheumatol. 2007; 34:272–9.
47. Kivitz AJ, Schechtman J, Texter M, Fichtner A, de Longueville M, Chartash EK. Vaccine responses in patients with rheumatoid arthritis treated with certolizumab pegol: results from a single-blind randomized phase IV trial. J Rheumatol. 2014; 41:648–57.
Article
48. Mori S, Ueki Y, Hirakata N, Oribe M, Hidaka T, Oishi K. Impact of tocilizumab therapy on antibody response to influenza vaccine in patients with rheumatoid arthritis. Ann Rheum Dis. 2012; 71:2006–10.
Article
49. Elkayam O, Bashkin A, Mandelboim M, Litinsky I, Coma-heshter D, Levartovsky D, et al. The effect of infliximab and timing of vaccination on the humoral response to influenza vaccination in patients with rheumatoid arthritis and ankylosing spondylitis. Semin Arthritis Rheum. 2010; 39:442–7.
Article
50. Kapetanovic MC, Saxne T, Nilsson JA, Geborek P. Influenza vaccination as model for testing immune modulation induced by anti-TNF and methotrexate therapy in rheumatoid arthritis patients. Rheumatology (Oxford). 2007; 46:608–11.
Article
51. Gelinck LB, van der Bijl AE, Beyer WE, Visser LG, Huizinga TW, van Hogezand RA, et al. The effect of anti-tumour necrosis factor alpha treatment on the antibody response to influenza vaccination. Ann Rheum Dis. 2008; 67:713–6.
52. Salemi S, Picchianti-Diamanti A, Germano V, Donatelli I, Di Martino A, Facchini M, et al. Influenza vaccine administration in rheumatoid arthritis patients under treatment with TNFalpha blockers: safety and immunogenicity. Clin Immunol. 2010; 134:113–20.
53. van Assen S, Holvast A, Benne CA, Posthumus MD, van Leeuwen MA, Voskuyl AE, et al. Humoral responses after influenza vaccination are severely reduced in patients with rheumatoid arthritis treated with rituximab. Arthritis Rheum. 2010; 62:75–81.
Article
54. Oren S, Mandelboim M, Braun-Moscovici Y, Paran D, Ablin J, Litinsky I, et al. Vaccination against influenza in patients with rheumatoid arthritis: the effect of rituximab on the humoral response. Ann Rheum Dis. 2008; 67:937–41.
Article
55. Gelinck LB, Teng YK, Rimmelzwaan GF, van den Bemt BJ, Kroon FP, van Laar JM. Poor serological responses upon influenza vaccination in patients with rheumatoid arthritis treated with rituximab. Ann Rheum Dis. 2007; 66:1402–3.
Article
56. Kapetanovic MC, Kristensen LE, Saxne T, Aktas T, Mörner A, Geborek P. Impact of anti-rheumatic treatment on immunogenicity of pandemic H1N1 influenza vaccine in patients with arthritis. Arthritis Res Ther. 2014; 16:R2.
Article
57. Kapetanovic MC. Further evidence for influenza and pneumococcal vaccination in patients treated with disease modifying antirheumatic drugs and anti-tumor necrosis factor agents. J Rheumatol. 2014; 41:626–8.
Article
58. Ribeiro AC, Laurindo IM, Guedes LK, Saad CG, Moraes JC, Silva CA, et al. Abatacept and reduced immune response to pandemic 2009 influenza A/H1N1 vaccination in patients with rheumatoid arthritis. Arthritis Care Res (Hoboken). 2013; 65:476–80.
Article
59. Arad U, Tzadok S, Amir S, Mandelboim M, Mendelson E, Wigler I, et al. The cellular immune response to influenza vaccination is preserved in rheumatoid arthritis patients treated with rituximab. Vaccine. 2011; 29:1643–8.
Article
60. Holvast A, van Assen S, de Haan A, Huckriede A, Benne CA, Westra J, et al. Studies of cell-mediated immune responses to influenza vaccination in systemic lupus erythematosus. Arthritis Rheum. 2009; 60:2438–47.
Article
61. Centers for Disease Control and Prevention (CDC). Use of 13-valent pneumococcal conjugate vaccine and 23-valent pneumococcal polysaccharide vaccine for adults with im-munocompromising conditions: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Morb Mortal Wkly Rep. 2012; 61:816–9.
62. Kraicer-Melamed H, O'Donnell S, Quach C. The effectiveness of pneumococcal polysaccharide vaccine 23 (PPV23) in the general population of 50 years of age and older: A systematic review and meta-analysis. Vaccine. 2016; 34:1540–50.
Article
63. Andrews NJ, Waight PA, George RC, Slack MP, Miller E. Impact and effectiveness of 23-valent pneumococcal polysaccharide vaccine against invasive pneumococcal disease in the elderly in England and Wales. Vaccine. 2012; 30:6802–8.
Article
64. Cillóniz C, Amaro R, Torres A. Pneumococcal vaccination. Curr Opin Infect Dis. 2016; 29:187–96.
Article
65. Bonten MJ, Huijts SM, Bolkenbaas M, Webber C, Patterson S, Gault S, et al. Polysaccharide conjugate vaccine against pneumococcal pneumonia in adults. N Engl J Med. 2015; 372:1114–25.
Article
66. Tomczyk S, Bennett NM, Stoecker C, Gierke R, Moore MR, Whitney CG, et al. Use of 13-valent pneumococcal conjugate vaccine and 23-valent pneumococcal polysaccharide vaccine among adults aged ≥ 65 years: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Morb Mortal Wkly Rep. 2014; 63:822–5.
67. Crnkic Kapetanovic M, Saxne T, Truedsson L, Geborek P. Persistence of antibody response 1.5 years after vaccination using 7-valent pneumococcal conjugate vaccine in patients with arthritis treated with different antirheumatic drugs. Arthritis Res Ther. 2013; 15:R1.
Article
68. Kapetanovic MC, Saxne T, Sjöholm A, Truedsson L, Jönsson G, Geborek P. Influence of methotrexate, TNF blockers and prednisolone on antibody responses to pneumococcal polysaccharide vaccine in patients with rheumatoid arthritis. Rheumatology (Oxford). 2006; 45:106–11.
Article
69. Kapetanovic MC, Roseman C, Jönsson G, Truedsson L. Heptavalent pneumococcal conjugate vaccine elicits similar antibody response as standard 23-valent polysaccharide vaccine in adult patients with RA treated with immunomodulating drugs. Clin Rheumatol. 2011; 30:1555–61.
Article
70. Gelinck LB, van der Bijl AE, Visser LG, Huizinga TW, van Hogezand RA, Rijkers GT, et al. Synergistic immunosuppressive effect of anti-TNF combined with methotrexate on antibody responses to the 23 valent pneumococcal polysaccharide vaccine. Vaccine. 2008; 26:3528–33.
Article
71. Cohen JI. Strategies for herpes zoster vaccination of immunocompromised patients. J Infect Dis. 2008; 197(Suppl 2):S237–41.
Article
72. Yun H, Yang S, Chen L, Xie F, Winthrop K, Baddley JW, et al. Risk of Herpes Zoster in Autoimmune and Inflammatory Diseases: Implications for Vaccination. Arthritis Rheumatol. 2016; 68:2328–37.
Article
73. Winthrop KL, Wouters AG, Choy EH, Soma K, Hodge JA, Nduaka CI, et al. The safety and immunogenicity of live zoster vaccination in patients with rheumatoid arthritis before starting tofacitinib: a randomized phase II trial. Arthritis Rheumatol. 2017; 69:1969–77.
Article
74. Morrison VA, Johnson GR, Schmader KE, Levin MJ, Zhang JH, Looney DJ, et al. Long-term persistence of zoster vaccine efficacy. Clin Infect Dis. 2015; 60:900–9.
Article
75. Oxman MN, Levin MJ, Johnson GR, Schmader KE, Straus SE, Gelb LD, et al. A vaccine to prevent herpes zoster and postherpetic neuralgia in older adults. N Engl J Med. 2005; 352:2271–84.
76. Cunningham AL, Lal H, Kovac M, Chlibek R, Hwang SJ, Díez-Domingo J, et al. Efficacy of the herpes zoster subunit vaccine in adults 70 years of age or older. N Engl J Med. 2016; 375:1019–32.
Article
77. Lal H, Cunningham AL, Godeaux O, Chlibek R, Diez-Domingo J, Hwang SJ, et al. Efficacy of an adjuvanted herpes zoster subunit vaccine in older adults. N Engl J Med. 2015; 372:2087–96.
Article
78. Boudes P, Sobel A, Deforges L, Leblic E. Disseminated Mycobacterium bovis infection from BCG vaccination and HIV infection. JAMA. 1989; 262:2386.
Article
79. Davis LE, Bodian D, Price D, Butler IJ, Vickers JH. Chronic progressive poliomyelitis secondary to vaccination of an im-munodeficient child. N Engl J Med. 1977; 297:241–5.
Article
80. Redfield RR, Wright DC, James WD, Jones TS, Brown C, Burke DS. Disseminated vaccinia in a military recruit with human immunodeficiency virus (HIV) disease. N Engl J Med. 1987; 316:673–6.
Article
81. Hales CM, Harpaz R, Ortega-Sanchez I, Bialek SR. Update on recommendations for use of herpes zoster vaccine. MMWR Morb Mortal Wkly Rep. 2014; 63:729–31.
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