How should patients with rheumatic diseases be vaccinated?

In winter, the number of patients with respiratory tract infections in hospitals increases. People around me often say, "I recently had influenza A," or "I tested positive again," or "Doctor, I am mycoplasma positive." Some patients with rheumatism say with a worried look on their faces, "I have rheumatism. Everyone is getting vaccinated to prevent influenza, but I don't know if I can get it. I am so anxious." Can patients with rheumatism only tremble in the face of respiratory infections? How can we enhance the defense ability of patients with rheumatism against viruses and bacteria? Which vaccines are suitable for patients with rheumatic immune diseases? Next, let's uncover the mystery and talk about vaccines!

First, let us understand the concepts of inactivated vaccines and live attenuated vaccines.

Inactivated vaccine: A vaccine that is only immunogenic but not antigenic, and has better safety.

Live attenuated vaccine: A vaccine with antigenicity, which has a relatively longer-lasting effect in enhancing immunity, or "better effect", but it is possible for the "virulence" to be restored in the body and cause illness.

In general, considering the special immune status of rheumatic diseases, patients can be vaccinated with inactivated vaccines, while live attenuated vaccines need to be used with caution under the guidance of a doctor.

Common inactivated vaccines and attenuated vaccines: hepatitis A virus, hepatitis B virus, human papillomavirus (HPV), influenza, whooping cough, diphtheria, pneumococcus, tetanus toxin, rabies, new coronavirus, influenza virus vaccine, etc.

Live vaccines: oral polio vaccine, oral typhoid vaccine, smallpox, chickenpox, measles-mumps-rubella vaccine, BCG vaccine.

(I) Several common vaccines that are relatively safe for patients with rheumatic immune disease:

1. Hepatitis B vaccine;

2. Inactivated influenza vaccine and pneumococcal vaccine;

3. Human papillomavirus (HPV) vaccine;

4. Haemophilus influenzae type b vaccine, meningococcal vaccine, rabies vaccine, tetanus-diphtheria toxoid, and hepatitis A vaccine.

(2) How should patients with rheumatic autoimmunity diseases get vaccinated?

In July 2022, the American College of Rheumatology (ACR) updated the vaccination guidelines for patients with rheumatic and musculoskeletal diseases, providing evidence-based recommendations for vaccination for children and adults with rheumatic and musculoskeletal diseases: For patients with rheumatic diseases, regardless of the activity of their disease, inactivated vaccines are conditionally recommended. For patients receiving glucocorticoid treatment, inactivated vaccination recommendations are shown in Table 1.

Table 1 Recommendations for inactivated vaccine in patients receiving glucocorticoid therapy

*Or an equivalent dose of any other glucocorticoid, or an equivalent pediatric dose.

3. Management of immunosuppressants during inactivated vaccine/live attenuated vaccine administration

When patients are treated with immunosuppressants such as methotrexate and rituximab, the recommendations for inactivated vaccine administration are as shown in Table 2.

Table 2 Recommendations for inactivated vaccine in patients receiving immunosuppressive therapy

For patients with rheumatic diseases, it is conditionally recommended to stop using immunosuppressants before and 4 weeks after receiving live attenuated vaccines. See Table 3 for details.

Table 3 Recommendations for live attenuated vaccine administration in patients receiving immunosuppressive therapy

Regular vaccination for patients with rheumatic autoimmune diseases is an important means of preventing infection. Before vaccination, they need to consult a specialist to assess their condition, the type of vaccine to be injected, and guide the use of medication after the injection.