Advances in our understanding of immunization and vaccines for patients with systemic lupus erythematosus

Abstract

Systemic lupus erythematosus (SLE) is a chronic systemic autoimmune disease. In SLE, immune system dysfunction is postulated to result by virtue of the disease itself as well as by the impact of treatment modalities employed. A myriad of immune dysregulations occur including complement system dysfunction among others. Infectious agents are known to complicate the disease course in close to 25-45% of SLE patients. Areas covered: In this review a discussion of the immunogenicity and safety of viral and bacterial vaccinations in SLE was performed. The search included ISI Web of Science (WoS), Scopus, MEDLINE/PubMed, Google-Scholar, DOAJ, EbscoHOST, Scirus, Science Direct, Cochrane Library and ProQuest. Proper string made up of a key-words including 'SLE', 'vaccination', 'safety' and 'efficacy' was used. Expert commentary: Vaccination of SLE patients is proven to be immunogenic. Concerns regarding vaccine safety are postulated, yet no direct relationship between vaccination and disease exacerbation were established. While live virus vaccines are generally contraindicated in immunosuppressive states, generally live attenuated vaccinations are recommended in SLE patients on a case-to-case basis. In SLE patients, clinical parameters such as vaccination during disease exacerbations have not been intensively studied and therefore while apparently safe, vaccination is generally recommended while disease is quiescent.

Immunogenicity, safety and tolerability of anti-pneumococcal vaccination in systemic lupus erythematosus patients: An evidence-informed and PRISMA compliant systematic review and meta-analysis

“…After the screening of the title and/or abstract, 8,850 items were discarded. The fulltext of 60 investigations was assessed and 14 texts were excluded with reasons (as reported in Table 2) (21,26,27,(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40). Finally, 22 articles were included (4 studies had overlapping populations) in the present systematic reviews.…”

Systemic Lupus Erythematosus in Primary Care: An Update and Practical Messages for the General Practitioner

“…Live virus vaccines are contraindicated when patients are receiving immunosuppressive treatments (including prednisolone at a dose >20 mg/day), however, live attenuated vaccinations are permitted on a case-to-case basis. Vaccinations should generally be administered while the disease is under control ( 161 ). Patients with lupus who are as young as age 40 years could potentially benefit from herpes zoster vaccines ( 162 ).…”

From Superficial Damage to Invasion of the Nucleosome: Ranking of Morbidities by the Biosemiotic Depth Hypothesis

“…In allergies and in the deeper level autoimmune disorders, disrupting factors such as radiant energy, toxicity, pathogenic impact from viruses, for instance, and their interactions, seem to be involved in causation [144], [200]- [202]. Even something as subtle as seasonal changes in the external environment seem to be impactful in these types of disorders [200].…”