Immunizations in immunocompromised patients: a guide for dermatologists

Abstract

The increasingly frequent use of immunomodulatory agents in dermatology requires the observance of specific recommendations for immunization. These recommendations are developed and regularly updated by the German Standing Committee on Vaccination (STIKO), an independent advisory group at the Robert Koch Institute. Dermatological patients on immunosuppressive treatment should ideally receive all vaccinations included in the standard immunization schedule. Additionally, it is recommended that they also undergo vaccination against the seasonal flu, pneumococci, and herpes zoster (inactivated herpes zoster subunit vaccine for patients ≥ 50 years). Additional immunizations against Haemophilus influenzae type B, hepatitis B and meningococci may be indicated depending on individual comorbidities and exposure risk. Limitations of use, specific contraindications and intervals to be observed between vaccination and immunosuppression depend on the immunosuppressive agent used and its dosing. Only under certain conditions may live-attenuated vaccines be administered in patients on immunosuppressive therapy. Given its strong suppressive effect on the humoral immune response, no vaccines -except for flu shots -should be given within six months after rituximab therapy.This CME article presents current recommendations on immunization in immunocompromised individuals, with a special focus on dermatological patients. Its goal is to enable readers to provide competent counseling and to initiate necessary immunizations in this vulnerable patient group.

Vaccinations in Patients Receiving Systemic Drugs for Skin Disorders: What Can We Learn for SARS-Cov-2 Vaccination Strategies?

“…Higher affinity and avidity IgG antibodies can be detected after 10–14 days, with maximum titers taking up to 4–6 weeks [ 21 ]. A minimum period of 2 weeks, up to 4 weeks, is generally recommended before (re-)initiation of the immunosuppressive/immunomodulatory treatment [ 69 ]. For drugs given in dosage intervals of ≥4 weeks, administration of vaccines midcycle or 2 weeks before the next dose seems a reasonable option [ 21 ].…”

Toward a COVID-19 vaccine strategy for patients with pemphigus on rituximab

“…1 Additionally, these studies indicate that rituximab recipients are not at increased risk of inactivated vaccine-related adverse effects. 3 Recently, a prospective clinical trial evaluated the effect of ocrelizumab (humanized anti-CD20 antibody) on the immunogenicity of several vaccines that were administered 12 weeks after infusion. 4 This study showed increased seroprotection rates across all studied vaccines in ocrelizumab recipients, although these conversion rates are lower than those observed in control individuals.…”

“…Consensus guidelines recommend administering routine vaccinations (eg, tetanus, diphtheria, and pertussis [TDaP]) at least 4 weeks before rituximab initiation. 3 Notably, they recommend administering inactivated influenza vaccine even in individuals undergoing active treatment with rituximab, because patients face imminent risk of contracting influenza, which outweighs the minimal risks associated with vaccination. 3 Importantly, there are no studies addressing the immunogenicity of live attenuated vaccines, given theoretical safety concerns regarding the use of live attenuated vaccines in rituximab recipients.…”

“…3 Notably, they recommend administering inactivated influenza vaccine even in individuals undergoing active treatment with rituximab, because patients face imminent risk of contracting influenza, which outweighs the minimal risks associated with vaccination. 3 Importantly, there are no studies addressing the immunogenicity of live attenuated vaccines, given theoretical safety concerns regarding the use of live attenuated vaccines in rituximab recipients. 3 Additionally, there are no studies that have evaluated the safety and immunogenicity of messenger RNA vaccines or viral vector vaccines, which are among the leading COVID-19 vaccine candidates, because no vaccines in these classes are commercially available.…”

“…3 Importantly, there are no studies addressing the immunogenicity of live attenuated vaccines, given theoretical safety concerns regarding the use of live attenuated vaccines in rituximab recipients. 3 Additionally, there are no studies that have evaluated the safety and immunogenicity of messenger RNA vaccines or viral vector vaccines, which are among the leading COVID-19 vaccine candidates, because no vaccines in these classes are commercially available.…”