title: Vaccinations in adults with chronic inflammatory joint disease: Immunization schedule and recommendations for patients taking synthetic or biological disease-modifying antirheumatic drugs.
abstract: The risk of infection associated with autoimmune diseases is further increased by the use of biotherapies. Recommendations to minimize this risk include administering the full complement of vaccines on the standard immunization schedule, as well as the pneumococcal and influenza vaccines. Adults with chronic inflammatory joint disease (IJD) may receive a 13-valent pneumococcal conjugate vaccine, as well as a live attenuated vaccine against recurrent herpes zoster, recently licensed by European regulatory authorities. Live attenuated vaccines can be given only after an interval without immunosuppressant and/or glucocorticoid therapy. The effectiveness of vaccines, as assessed based on titers of protective antibodies, varies across vaccine types and disease-modifying antirheumatic drugs (DMARDs). Thus, methotrexate and rituximab are usually associated with decreased vaccine responses. The risks associated with vaccines are often considerably exaggerated by the media, which serve lobbies opposed to immunizations and make some patients reluctant to accept immunizations. Increasing immunization coverage may diminish the risk of treatment-related infections. A physician visit dedicated specifically to detecting comorbidities in patients with chronic IJD may result in improved immunization coverage. In this review, we discuss immunizations for adults with chronic IJD based on the treatments used, as well as immunization coverage. Many questions remain unanswered and warrant investigation by studies coordinated by the French networks IREIVAC (Innovative clinical research network in vaccinology) and IMIDIATE (Immune-Mediated Inflammatory Disease Alliance for Translational and Clinical Research).
authors.affiliation: Département de rhumatologie, CHRU, université de Montpellier, 371, avenue du Doyen-Gaston-Giraud, 34295 Montpellier cedex 5, France. Electronic address: j-morel@chu-montpellier.fr.
authors.forename: Jacques
authors.initials: J
authors.lastname: Morel
authors.affiliation: Service de médecine des adolescents, CHU Bicêtre, AP-HP, 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France.
authors.forename: Séverine Guillaume
authors.initials: SG
authors.lastname: Czitrom
authors.affiliation: Service de rhumatologie, UMR_S1109, FMTS, université de Strasbourg, 4, rue Blaise-Pascal, 67081 Strasbourg, France.
authors.forename: Auriane
authors.initials: A
authors.lastname: Mallick
authors.affiliation: Service de rhumatologie, hôpital Saint-Antoine, AP-HP, Inserm UMRS_938, université Paris 6, DHU i2B, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France.
authors.forename: Jérémie
authors.initials: J
authors.lastname: Sellam
authors.affiliation: Service de rhumatologie, UMR_S1109, FMTS, université de Strasbourg, 4, rue Blaise-Pascal, 67081 Strasbourg, France.
authors.forename: Jean
authors.initials: J
authors.lastname: Sibilia
mesh_terms: D018501:Antirheumatic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001327:Autoimmune Diseases / Q000150:complications / Q000188:drug therapy; D001424:Bacterial Infections / Q000209:etiology / Q000517:prevention & control; D002908:Chronic Disease; D006801:Humans; D007115:Immunization Schedule; D007249:Inflammation; D007592:Joint Diseases / Q000150:complications / Q000188:drug therapy*; D012216:Rheumatic Diseases / Q000150:complications / Q000188:drug therapy*; D014611:Vaccination / Q000592:standards; D014612:Vaccines / Q000008:administration & dosage; D014777:Virus Diseases / Q000209:etiology / Q000517:prevention & control
chemical_list: D018501:Antirheumatic Agents; D014612:Vaccines
keywords: Biotherapies; Chronic inflammatory joint disease; Glucocorticoids; Methotrexate; Vaccination