title: Influenza and pneumococcal vaccinations of patients with systemic lupus erythematosus: current views upon safety and immunogenicity.
abstract: Systemic lupus erythematosus (SLE) is a chronic immune-mediated inflammatory multisystem disease. The onset of viral and bacterial infections may favor the exacerbation of the disease, amplify autoimmune processes and contribute to mortality and morbidity. The prevention of influenza and Streptococcus pneumoniae infections with vaccination should receive particular attention in SLE patients considering their elevated incidence, their high attack rate in epidemic periods, their potentially severe complications as well as the immunocompromised state of the host. The use of non-adjuvanted vaccine preparations should be preferred in order to avoid the onset of the "Autoimmune (auto-inflammatory) Syndrome Induced by Adjuvants" or "ASIA". In this review, we report that influenza and pneumococcal vaccinations in SLE patients are: 1) recommended to reduce the risk of development of these infections; 2) strongly suggested in elderly subjects and in those receiving high dose immunosuppressive treatments; 3) efficacious, even if specific immune responses may be lower than in the general population, as generally the humoral response fulfills the criteria for vaccine immunogenicity; and 4) safe in inactive disease although may favor a transient increase in autoantibody levels and rarely disease flares.
authors.affiliation: Department of Internal Medicine, Clinical Immunology Unit, University of Genova, Genova, Italy. Electronic address: Giuseppe.Murdaca@unige.it.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Murdaca
authors.forename: Andrea
authors.initials: A
authors.lastname: Orsi
authors.forename: Francesca
authors.initials: F
authors.lastname: Spanò
authors.forename: Francesco
authors.initials: F
authors.lastname: Puppo
authors.forename: Paolo
authors.initials: P
authors.lastname: Durando
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Icardi
authors.forename: Filippo
authors.initials: F
authors.lastname: Ansaldi
mesh_terms: D006801:Humans; D016867:Immunocompromised Host; D007252:Influenza Vaccines / Q000009:adverse effects / Q000276:immunology / Q000627:therapeutic use*; D007251:Influenza, Human / Q000453:epidemiology / Q000276:immunology / Q000517:prevention & control; D008180:Lupus Erythematosus, Systemic / Q000150:complications* / Q000188:drug therapy / Q000276:immunology*; D022242:Pneumococcal Vaccines / Q000009:adverse effects / Q000276:immunology / Q000627:therapeutic use*; D017410:Practice Guidelines as Topic
chemical_list: D007252:Influenza Vaccines; D022242:Pneumococcal Vaccines
keywords: Influenza vaccine; Pneumococcal vaccine; Systemic lupus erythematosus