Vaccination in SLE: A Review of the Guidelines

December 4, 2018

How to ensure your patients with lupus receive the vaccines they need.

Vaccination is often skipped in patients with systemic lupus erythematosus (SLE) because of their immunocompromised state. Concerns include fears of infection and flares, the possible induction of autoimmunity, and the generation of autoantibodies. However, immunocompromise makes vaccination important for patients with SLE.¹

This review covers guidelines for vaccination in adults with SLE. Sources for the recommendations include the Centers for Disease Control and Prevention (CDC), professional societies, review articles, and expert opinion.

Scroll through the slides for specific recommendations on the pneumococcal, influenza, hepatitis B, diphtheria, pertussis, tetanus, Haemophilus influenzae type B, rabies, and human papillomavirus vaccines, as well as the live-attenuated vaccines: herpes zoster, measles, mumps, and rubella.

EULAR, European League Against Rheumatism; HBV, hepatitis B virus.

DTaP, diphtheria, tetanus, and pertussis; Td, tetanus and diphtheria; Tdap, tetanus, diphtheria, and pertussis.

Hib, Haemophilus influenzae type b.

HDCV, human diploid cell culture rabies vaccine; PCEV, purified chicken embryo cell rabies vaccine.

HPV, human papillomavirus.

MMR, measles, mumps, and rubella; MMRV, measles, mumps, rubella, varicella.

References1. Garg M, Mufti N, Palmore T, et al. Recommendations and barriers to vaccination in systemic lupus erythematosus. Autoimmun Rev. 2018 Aug 10. pii: S1568-9972(18)30178-2. doi: 10.1016/j.autrev.2018.04.006.
2. Tomczyk S, Bennett NM, Stoecker C, et al, Centers for Disease Control and Prevention. Use of 13-valent pneumococcal conjugate vaccine and 23-valent pneumococcal polysaccharide vaccine among adults aged ≥65 years: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Morb Mortal Wkly Rep. 2014;63:822-825.
3. Centers for Disease Control and Prevention. Use of 13-valent pneumococcal conjugate vaccine and 23-valent pneumococcal polysaccharide vaccine for adults with immunocompromising conditions: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Morb Mortal Wkly Rep. 2012;61:816-819.
4. Centers for Disease Control and Prevention. Epidemiology and Prevention of Vaccine-Preventable Diseases. 13th ed. Atlanta, GA: Centers for Disease Control and Prevention; 2015.
5. van Assen S, Agmon-Levin N, Elkayam O, et al. EULAR recommendations for vaccination in adult patients with autoimmune inflammatory rheumatic diseases. Ann RheumDis. 2011;70:414-422.
6. Centers for Disease Control and Prevention. Updated recommendations for use of tetanus toxoid, reduced diphtheria toxoid and acellular pertussis (Tdap) vaccine from the Advisory Committee on Immunization Practices. MMWR Morb Mortal Wkly Rep. 2011;60:13-15.
7. Briere EC, Rubin L, Moro PL, et al. Division of bacterial diseases and CDC respiratory diseases, prevention and control of Haemophilus influenzae type b disease: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2014;63:1-14.
8. Rupprecht CE, Briggs D, Brown CM, et al. Use of a reduced (4-dose) vaccine schedule for postexposure prophylaxis to prevent human rabies: recommendations of the advisory committee on immunization practices. MMWR Recomm Rep. 2010;59:1-9.
9. Petrosky E, Bocchini JA Jr, Hariri S, et al. Use of 9-valent human papillomavirus (HPV) vaccine: updated HPV vaccination recommendations of the advisory committee on immunization practices. MMWR Morb Mortal Wkly Rep. 2015;64:300-304.
10. Harpaz R, Ortega-Sanchez IR, Seward JF, et al. Advisory Committee on Immunization Practices Centers for Disease and Prevention. Prevention of herpes zoster: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2008;57:1-30.
11. McLean HQ, Fiebelkorn AP, Temte JL, et al. Centers for Disease and Prevention, prevention of measles, rubella, congenital rubella syndrome, and mumps, 2013: summary recommendations of the advisory committee on immunization practices. MMWR Recomm Rep. 2013;62:1-34.