Treatment guidelines published by the Infectious Diseases Society of America in December remind doctors and patients that people with a chronic inflammatory disease, even those who take immune-suppressing medications, should not shy away from getting flu and pneumonia vaccine shots.
People with rheumatoid arthritis (RA), lupus, psoriatic arthritis and other autoimmune forms of arthritis face an elevated risk of infections, including influenza (the flu) and pneumonia. The increased risk may be due to the disease, which changes how the immune system functions, as well the medications used to control the disease, many of which suppress the immune system.
And while the flu is miserable – and potentially dangerous – for anyone, it’s especially so for people with inflammatory arthritis, who may get infections more severe than those who don’t have an autoimmune condition. If you have an inflammatory arthritis condition and you get the flu, you’re more likely to have complications, including pneumonia.
The guidelines suggest that people with a chronic inflammatory condition who take immunosuppressive medications – including methotrexate and various biologic drugs – get the flu shot according to the Center for Disease Control and Prevention (CDC) annual schedule, as well as the pneumonia vaccine. Others in the household should also be vaccinated.
A flu shot will not give you the flu or increase your risk of a flare, says Elaine Husni, MD, PhD, director of the Arthritis & Musculoskeletal Treatment Center at Cleveland Clinic. There’s no reason to skip it.
“The non-live vaccines like the flu and pneumonia shot are very needed and necessary for patients who are immunocompromised because they are more susceptible to flu and pneumonia,” says Dr. Husni.
Although the guidelines recommend the flu shot, they advise against getting the flu vaccine in nasal spray form (FluMist). It contains a live, though weakened, virus and can therefore be dangerous to people whose immune systems are weak. The virus in the injected form of the vaccine is inactivated (killed).
Other live vaccines include the chicken pox (varicella) and shingles (zoster) vaccines. Live vaccines are not advisable for people who take a biologic drug, says Dr. Husni, or for people who take high doses of methotrexate. But according to the guidelines, people who take a low dose of an immunosuppressant such as methotrexate and aren’t immune to the chicken pox should ask their doctors whether they should get vaccinated. People who aren’t taking an immunosuppressant and aren’t immune should get the vaccine.
As far as the shingles vaccine goes, the guidelines say you should get one if you’re 60 or older and you are taking no immunosuppressant or a low dose of one. You should also get the vaccination if you’re 50 to 59, you aren’t taking an immunosuppressant or you’re taking a low dose, and you’re varicella positive. That means you’ve had chicken pox or shingles in the past or you test positive for the varicella-zoster virus even though you haven’t gotten the varicella vaccine before, in which case, you’re susceptible to shingles.
The guidelines also underscore this important point: If you haven’t yet started on medication that suppresses your immune system, now is the time to make sure you’ve gotten all the vaccinations you need. “Before you get on a biologic, it’s important to talk with your doctor about vaccinations and making sure you’re up to date,” says Dr. Husni.
Even after you get your flu shot, it’s still important to take all the steps you can, such as washing your hands frequently, to avoid getting the flu. One reason is that, depending on which medications you’re taking for your condition, your response to the flu vaccine may not be as strong as that of healthier people, and therefore your protection from the flu may not be as great. A recent literature review that examined 12 studies on the subject found that methotrexate decreases the response to the pneumonia vaccine and possibly the flu vaccine, and rituximab decreases the response to both.