[Vaccination in adult rheumatology]

Abstract

Patients with rheumatic diseases who are undergoing immunosuppressive therapy have a substantially increased risk of infection compared to the normal population, and are thus candidates for preventive measures. In accordance with the recommendations of the Standing Vaccination Commission of the Robert Koch Institute (Ständigen Impfkommission, STIKO), these individuals, in analogy with other patients with chronic diseases, belong to a risk group for which vaccination against pneumococci and influenza is recommended. Published studies indicate that a limited immune response is possible for patients undergoing immunosuppressive therapy. Here, methotrexate in particular appears to interfere with the success of vaccination against pneumococci. However, a limited immune response against influenza antigens was observed under immunosuppression with mycophenolate mufti, cyclosporine und azathioprine. Consideration must be given to the fact that a patient under continual immunosuppression has a reduced duration of protective immune response. New studies on tumor necrosis factor (TNF) inhibitors indicate that there should be no interference with pneumococcus infection. The possibly variable vaccination success of patients undergoing TNF inhibitor treatment is qualified by the fact that all published results show that the expected immune response after an influenza vaccination is very good. Vaccination strategies in cases in which the use of rituximab and abatacept is planned are currently unclear.