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Vaccinations in patients with immune-mediated inflammatory diseases

(2010) RHEUMATOLOGY. 49(10). p.1815-1827
Author
Organization
Abstract
Patients with immune-mediated inflammatory diseases (IMID) such as RA, IBD or psoriasis, are at increased risk of infection, partially because of the disease itself, but mostly because of treatment with immunomodulatory or immunosuppressive drugs. In spite of their elevated risk for vaccine-preventable disease, vaccination coverage in IMID patients is surprisingly low. This review summarizes current literature data on vaccine safety and efficacy in IMID patients treated with immunosuppressive or immunomodulatory drugs and formulates best-practice recommendations on vaccination in this population. Especially in the current era of biological therapies, including TNF-blocking agents, special consideration should be given to vaccination strategies in IMID patients. Clinical evidence indicates that immunization of IMID patients does not increase clinical or laboratory parameters of disease activity. Live vaccines are contraindicated in immunocompromized individuals, but non-live vaccines can safely be given. Although the reduced quality of the immune response in patients under immunotherapy may have a negative impact on vaccination efficacy in this population, adequate humoral response to vaccination in IMID patients has been demonstrated for hepatitis B, influenza and pneumococcal vaccination. Vaccination status is best checked and updated before the start of immunomodulatory therapy: live vaccines are not contraindicated at that time and inactivated vaccines elicit an optimal immune response in immunocompetent individuals.
Keywords
Immune-mediated inflammatory disease, Infection, Vaccine-preventable disease, Vaccination, Rheumatoid arthritis, Inflammatory bowel disease, Psoriasis, Review, HEPATITIS-B VACCINATION, JUVENILE IDIOPATHIC ARTHRITIS, SYSTEMIC-LUPUS-ERYTHEMATOSUS, IMMUNIZATION PRACTICES ACIP, GUILLAIN-BARRE-SYNDROME, ENVIRONMENTAL RISK-FACTORS, POPULATION-BASED COHORT, RHEUMATOID-ARTHRITIS, BOWEL-DISEASE, CROHNS-DISEASE

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Citation

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MLA
Rahier, Jean-François, Michel Moutschen, Alfons Van Gompel, et al. “Vaccinations in Patients with Immune-mediated Inflammatory Diseases.” RHEUMATOLOGY 49.10 (2010): 1815–1827. Print.
APA
Rahier, J.-F., Moutschen, M., Van Gompel, A., Van Ranst, M., Louis, E., Segaert, S., Masson, P., et al. (2010). Vaccinations in patients with immune-mediated inflammatory diseases. RHEUMATOLOGY, 49(10), 1815–1827.
Chicago author-date
Rahier, Jean-François, Michel Moutschen, Alfons Van Gompel, Marc Van Ranst, Edouard Louis, Siegfried Segaert, Pierre Masson, and Filip De Keyser. 2010. “Vaccinations in Patients with Immune-mediated Inflammatory Diseases.” Rheumatology 49 (10): 1815–1827.
Chicago author-date (all authors)
Rahier, Jean-François, Michel Moutschen, Alfons Van Gompel, Marc Van Ranst, Edouard Louis, Siegfried Segaert, Pierre Masson, and Filip De Keyser. 2010. “Vaccinations in Patients with Immune-mediated Inflammatory Diseases.” Rheumatology 49 (10): 1815–1827.
Vancouver
1.
Rahier J-F, Moutschen M, Van Gompel A, Van Ranst M, Louis E, Segaert S, et al. Vaccinations in patients with immune-mediated inflammatory diseases. RHEUMATOLOGY. 2010;49(10):1815–27.
IEEE
[1]
J.-F. Rahier et al., “Vaccinations in patients with immune-mediated inflammatory diseases,” RHEUMATOLOGY, vol. 49, no. 10, pp. 1815–1827, 2010.
@article{1095486,
  abstract     = {Patients with immune-mediated inflammatory diseases (IMID) such as RA, IBD or psoriasis, are at increased risk of infection, partially because of the disease itself, but mostly because of treatment with immunomodulatory or immunosuppressive drugs. In spite of their elevated risk for vaccine-preventable disease, vaccination coverage in IMID patients is surprisingly low. This review summarizes current literature data on vaccine safety and efficacy in IMID patients treated with immunosuppressive or immunomodulatory drugs and formulates best-practice recommendations on vaccination in this population. Especially in the current era of biological therapies, including TNF-blocking agents, special consideration should be given to vaccination strategies in IMID patients. Clinical evidence indicates that immunization of IMID patients does not increase clinical or laboratory parameters of disease activity. Live vaccines are contraindicated in immunocompromized individuals, but non-live vaccines can safely be given. Although the reduced quality of the immune response in patients under immunotherapy may have a negative impact on vaccination efficacy in this population, adequate humoral response to vaccination in IMID patients has been demonstrated for hepatitis B, influenza and pneumococcal vaccination. Vaccination status is best checked and updated before the start of immunomodulatory therapy: live vaccines are not contraindicated at that time and inactivated vaccines elicit an optimal immune response in immunocompetent individuals.},
  author       = {Rahier, Jean-François and Moutschen, Michel and Van Gompel, Alfons and Van Ranst, Marc and Louis, Edouard and Segaert, Siegfried and Masson, Pierre and De Keyser, Filip},
  issn         = {1462-0324},
  journal      = {RHEUMATOLOGY},
  keywords     = {Immune-mediated inflammatory disease,Infection,Vaccine-preventable disease,Vaccination,Rheumatoid arthritis,Inflammatory bowel disease,Psoriasis,Review,HEPATITIS-B VACCINATION,JUVENILE IDIOPATHIC ARTHRITIS,SYSTEMIC-LUPUS-ERYTHEMATOSUS,IMMUNIZATION PRACTICES ACIP,GUILLAIN-BARRE-SYNDROME,ENVIRONMENTAL RISK-FACTORS,POPULATION-BASED COHORT,RHEUMATOID-ARTHRITIS,BOWEL-DISEASE,CROHNS-DISEASE},
  language     = {eng},
  number       = {10},
  pages        = {1815--1827},
  title        = {Vaccinations in patients with immune-mediated inflammatory diseases},
  url          = {http://dx.doi.org/10.1093/rheumatology/keq183},
  volume       = {49},
  year         = {2010},
}

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