By Dr. Brittany Panico, DO
Living with an autoimmune condition has its challenges. Immunosuppressive medications that are used to treat the underlying disorder can significantly reduce disease activity and improve quality of life. But these medications can also make the individual taking them more susceptible to infections and have a harder time recovering from these illnesses.
The last week of April is World Immunization Week. This week highlights the role that immunizations have in the prevention of illness and the reduction of disease transmission. By now, we understand that vaccines help prevent death from diseases such as diphtheria, tetanus, pertussis, influenza, measles and hepatitis B. The World Health Organization (WHO) estimates that vaccines help prevent roughly 2-3 million deaths in the United States each year. This estimate is most likely higher with the use of the COVID-19 vaccine and better technologies to track illness and vaccination rates via electronic medical records.
Vaccines and Immunosuppressive Medications
The conversation of when to recommend vaccines to a patient with a rheumatologic diagnosis should exist beyond the celebratory week in April—there are some important vaccines that you may want to discuss with your rheumatologist during an upcoming visit.
Many medications for autoimmune diseases are immunosuppressants, meaning the immune system’s function is decreased. While this is effective at combating inflammation caused by the immune system’s misfiring, it also may make patients more susceptible to certain illnesses. For immunosuppressed rheumatology patients, vaccines are especially important. For instance, individuals with an autoimmune disease and a covid vaccine lower their risk of becoming seriously ill.
The American College of Rheumatology (ACR) revises vaccine recommendations annually based on the most up-to-date evidence-based practices and the infection landscape. The 2022 guidelines also discuss when to potentially hold certain medications so that a patient can safely receive a vaccine, with the most likely outcome that their immune system will make desired antibodies to that potential infection.
Vaccines are a safe and effective way to protect yourself against a variety of illnesses, including the flu, pneumonia, shingles, and most recently, COVID-19.
Here’s what you need to know about autoimmune disease and the covid vaccine, and the other latest vaccine recommendations for people with autoimmune conditions.
Autoimmune Disease and the Covid Vaccine
The COVID-19 vaccine is a new vaccine that was developed specifically to protect against the COVID-19 virus. The vaccine has been shown to be safe and effective and is recommended for everyone, including people with autoimmune conditions.
People with autoimmune conditions are at an increased risk of developing severe illness if they contract the COVID-19 virus, and getting vaccinated is an important way to protect yourself. The vaccine has been shown to be highly effective at preventing severe illness, hospitalization, and death. There is not a current consensus of how often to get the COVID-19 vaccine and the American College of Rheumatology is updating this information frequently. For the most up-to-date guidelines on autoimmune disease and covid vaccines, please visit the American College of Rheumatology.
The flu vaccine is recommended for everyone, especially for people with autoimmune conditions. The flu can be particularly dangerous for people with weakened immune systems, and getting the flu vaccine is a safe and effective way to protect yourself. In fact, research has shown that people with autoimmune conditions who receive the flu vaccine have a lower risk of developing flu-related complications, such as pneumonia, hospitalization, and death.
It’s important to get the flu vaccine every year, as the flu virus changes from year to year. Most rheumatologists recommend the flu vaccine in the fall so that you still have benefit from the immunity for the late cases of flu that can occur in the spring. Some pharmacies start to carry the flu vaccine in the late summer, and this may be too early to receive it if you are on medication that may decrease your immune system’s response to making antibodies to the virus.
The pneumonia vaccine is recommended for people with autoimmune conditions. People with autoimmune conditions are at an increased risk of developing pneumonia, which can be a serious and potentially life-threatening illness. This is especially true because patients may not have all the typical warning signs of illness until the infection has progressed.
There are two types of pneumonia vaccines: the pneumococcal conjugate vaccine (PCV13) and the pneumococcal polysaccharide vaccine (PPSV23). Both vaccines are recommended for people with autoimmune conditions, but the timing and frequency of the vaccinations may vary depending on your specific condition and treatment plan. Be sure to talk to your rheumatologist and primary care provider about which vaccine is right for you.
The shingles vaccine, Shingrix, is also recommended for people with autoimmune conditions. This vaccine is now available for adults 18 years of age and older with an autoimmune condition or those on treatment with immunosuppressive medications.
Shingles is a painful skin rash that is caused by the varicella-zoster virus, which is the same virus that causes chickenpox. People with autoimmune conditions are at an increased risk of developing shingles because certain medications used to treat autoimmune conditions can make a person more susceptible. Getting vaccinated is a safe and effective way to prevent the illness.
Even if you have been vaccinated against chickenpox or have never had chickenpox, the Shingrix vaccine is still recommended, as the antibodies against chicken pox may decrease over time. Shingrix is a two-dose vaccine that is highly effective at preventing shingles and its complications and is given 2-6 months apart.
The HPV vaccine is recommended for everyone, including people with autoimmune conditions. HPV is a common virus that can cause cervical cancer, anal cancer, and other types of cancer located in the neck lymph nodes.
People with weakened immune systems, including those with autoimmune conditions, are at an increased risk of developing HPV-related cancers. The HPV vaccine is a safe and effective way to protect against these cancers, and is recommended for both men and women up to age 45.
Hepatitis B Vaccine
The Hepatitis B vaccine is also recommended for people with autoimmune conditions. Hepatitis B is a viral infection that is spread through blood and bodily fluids, and it can cause symptoms such as fatigue, nausea, and abdominal pain. Chronic Hepatitis B infection can lead to liver damage, liver cancer, and liver failure. Your rheumatologist will also be checking your immunization status to hepatitis B if you are prescribed certain medications like biologics or infusions.
The Hepatitis B vaccine is a three-dose series that is highly effective at preventing the virus. It is recommended for people with autoimmune conditions who are at an increased risk of exposure to the virus, such as those who receive blood transfusions, healthcare workers, volunteers, or patients on dialysis.
Rheumatology Vaccine Recommendations
It is important to talk to your rheumatologist about your specific condition and treatment plan, and to discuss the most current recommendations for vaccines. In some cases, your rheumatologist may recommend delaying certain vaccines or adjusting your treatment plan to accommodate vaccines. The vaccines mentioned in this article, as well as the Tdap (tetanus, diphtheria, pertussis) vaccine and hepatitis A vaccine are all considered safe for patients with an autoimmune illness. Live vaccines, such as the MMR (measles, mumps, rubella) and the yellow fever vaccines are not recommended for patients who are taking certain rheumatologic or immunosuppressive medications, but can still be given before starting these medications, or during periods that the medications are held.
Summit’s Arizona Rheumatology Specialists are now accepting new patients with autoimmune conditions. Give us a call at (480) 494-2770 or send us a message to schedule an appointment.