Vaccination and auto-immune rheumatic diseases:  lessons learnt from the 2009 H1N1 influenza virus vaccination campaign.
OBJECTIVE
To determine the safety and efficacy of adjuvant and nonadjuvant influenza A/H1NI vaccination in patients with rheumatic diseases.


RESULTS
Due to immune abnormalities and the use of steroids and immunosuppressant treatment, patients with rheumatic diseases are susceptible to infections including influenza. Infections continue to be one of the leading causes of morbidity and mortality in rheumatic diseases, partly due to the disease processes and partly due to medications. Viral infections are particularly an issue, so vaccinations would be advisable. However, because of the abnormalities in immune mechanisms in many rheumatic diseases, it is not clear whether vaccinations are well tolerated and effective. A number of studies confirmed the efficacy and safety of adjuvant and nonadjuvant influenza A/H1NI vaccination in patients with rheumatic diseases. The potential side effects associated with H1N1 vaccines were not different from those observed with seasonal influenza vaccine. The use of steroids and immunosuppressant therapies may alter the efficacy of the vaccines. Adjuvant and nonadjuvant influenza A/H1NI vaccinations have no clinically important effect on production or levels of autoantibodies in patients with rheumatic diseases.


CONCLUSIONS
H1N1 vaccination should be given to patients with rheumatic diseases.
University of Toronto, Toronto Western Research Institute, University of Toronto Lupus Clinic, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada.
Zahi
Z
Touma
Dafna D
DD
Gladman
Murray B
MB
Urowitz
D000276:Adjuvants, Immunologic / Q000008:administration & dosage; D000914:Antibodies, Viral / Q000096:biosynthesis; D018501:Antirheumatic Agents / Q000009:adverse effects; D001327:Autoimmune Diseases / Q000150:complications / Q000276:immunology* / Q000628:therapy; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects; D053118:Influenza A Virus, H1N1 Subtype / Q000276:immunology; D007252:Influenza Vaccines / Q000008:administration & dosage / Q000009:adverse effects*; D007251:Influenza, Human / Q000453:epidemiology / Q000276:immunology / Q000517:prevention & control*; D058873:Pandemics; D012216:Rheumatic Diseases / Q000150:complications / Q000276:immunology* / Q000628:therapy; D016896:Treatment Outcome; D014611:Vaccination / Q000009:adverse effects
D000276:Adjuvants, Immunologic; D000914:Antibodies, Viral; D018501:Antirheumatic Agents; D007166:Immunosuppressive Agents; D007252:Influenza Vaccines