For individuals managing rheumatic conditions, vaccination plays a significant role in preventing serious infections and maintaining overall health. These conditions, often involving an overactive immune system, make individuals more susceptible to various illnesses. The American College of Rheumatology (ACR) develops specific vaccination guidelines. These guidelines provide evidence-based recommendations tailored to the unique needs of people with rheumatic diseases, aiming to reduce their risk of infection and improve health outcomes.
Understanding ACR Vaccination Guidelines
The ACR vaccination guidelines are developed for individuals with autoimmune and inflammatory rheumatic diseases, such as rheumatoid arthritis, lupus, psoriatic arthritis, and ankylosing spondylitis. These conditions, and the immunosuppressive medications often used to treat them, can compromise the immune system. This increases susceptibility to infections and can affect the body’s response to vaccines. The guidelines provide evidence-based recommendations on vaccine use, considering these altered immune responses and heightened infection risks.
Timely vaccination is emphasized, ideally before starting immunosuppressive therapy. This proactive approach helps ensure an adequate immune response before the immune system is dampened by medication. The guidelines also provide guidance on adjusting medication schedules around vaccination, such as holding methotrexate for two weeks after an influenza vaccine if disease activity allows. This careful timing aims to maximize vaccine effectiveness while minimizing disease flares.
Recommended Vaccinations
The ACR recommends several vaccinations for individuals with rheumatic diseases:
The annual influenza (flu) vaccine is strongly encouraged for all patients with rheumatic and musculoskeletal diseases (RMDs). For those aged 65 years and older, or individuals aged 18 to 65 years taking immunosuppressive medication, a high-dose or adjuvanted influenza vaccine is conditionally recommended over a regular-dose vaccine. Any available influenza vaccine is preferred over no vaccination.
Pneumococcal vaccines are also strongly recommended, particularly for RMD patients taking immunosuppressive medication, as they face an increased risk of pneumococcal infection. The guidelines suggest either the pneumococcal conjugate vaccine (PCV13 or PCV15) followed two months later by the pneumococcal polysaccharide vaccine (PPSV23), or the single-dose PCV20 vaccine.
The tetanus, diphtheria, and pertussis (Tdap) vaccine is another important recommendation, providing protection against these potentially serious bacterial infections.
The human papillomavirus (HPV) vaccine is conditionally recommended for patients with rheumatic disease between 26 and 45 years old who are taking immunosuppressive medication and have not been previously vaccinated. This is because immunosuppressed patients may have an increased risk of cervical dysplasia and cancer.
The recombinant zoster (shingles) vaccine (Shingrix) is strongly recommended for RMD patients older than 18 who are on immunosuppressive medication, as this group has a higher risk of shingles compared to the general population.
Vaccinations to Approach with Caution
Certain vaccines require careful consideration or are generally not recommended for individuals with rheumatic diseases, especially those undergoing immunosuppressive therapies. Live attenuated vaccines (LAVs) contain a weakened form of the live virus or bacteria. These include vaccines for measles, mumps, and rubella (MMR), varicella (chickenpox), and yellow fever.
The primary concern with LAVs in immunocompromised individuals is the potential for the weakened vaccine strain to cause an actual infection, as their immune system may not be strong enough to control it. Therefore, patients with RMDs on immunosuppressive medications should generally defer live attenuated vaccines. If a live vaccine is considered, immunosuppressive medications may need to be held for a period, typically four weeks, after vaccination.
Personalized Medical Advice
While the ACR guidelines provide a comprehensive framework, each patient’s situation is distinct. Factors such as the specific rheumatic disease diagnosis, the type and dosage of current medications, the level of disease activity, and overall health status all influence the most appropriate vaccination strategy. For instance, the timing of vaccinations relative to medication cycles, especially for therapies like rituximab, needs careful planning.
It is highly recommended that individuals with rheumatic conditions discuss their personalized vaccination plan with their rheumatologist or primary care physician. These healthcare providers can assess individual risks and benefits, interpret the guidelines in the context of the patient’s unique medical history, and ensure the vaccination schedule aligns with their specific health needs and ongoing treatment plan. This discussion helps optimize protection against infections while minimizing potential risks.