Immunogenicity and Safety of Pneumococcal Vaccination in Patients with Rheumatoid Arthritis or Systemic Lupus Erythematosus

Abstract

Prevention of bacterial infection, which is a leading cause of morbidity in patients with rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE), is a priority. However, the safety and immunogenicity of the pneumococcal vaccine in such patients remain controversial. We evaluated the currently available pneumococcal vaccine in patients with RA or SLE. Pneumococcal vaccination was not associated with an appreciable deterioration in any clinical or laboratory measure of disease activity in either group. One month after vaccination, patients in both groups had significant increases in geometric mean concentrations of pneumococcal polysaccharide-specific IgG to all 7 serotypes tested, as did control subjects. However, 14 (33.3%) of 42 patients with RA and 5 (20.8%) of 24 patients with SLE responded either to none or to only 1 of the 7 polysaccharides. Pneumococcal vaccination is generally safe and immunogenic in patients with RA or SLE, but a subset of patients may remain unprotected by the currently available vaccine.

Influenza and pneumococcal vaccination as a model to assess C-reactive protein response to mild inflammation

“…Pozzetto et al showed a non-significant increase in CRP 28 days after influenza vaccination while Elkayam et al found no change at all when measuring CRP one month after pneumococcal vaccination [16,17]. According to our observations, increase in CRP is highest 2 days after vaccination and it decreases in the following days.…”

“…Several vaccines have been used in in vivo models to induce a mild inflammatory response [5,12,14,15]. It is not clear whether influenza and pneumococcal vaccines increase serum CRP concentrations [16][17][18][19].…”

Prevention of Infection in Lupus Patients

“…It seems not to favor the clinical exacerbation of SLE [28]. The response rate of SLE patients to pneumococcal vaccination is only 47%.…”

Infecciones en pacientes reumatológicos asociadas a corticosteroides y antagonistas del factor de necrosis tumoral α

“…Para pacientes que reciben corticosteroides u otros fármacos inmunosupresores, la respuesta a la vacuna 23-valente polisacárida es inferior respecto a controles sanos y restringida a algunos serotipos 81 . La vacunación contra S. pneumoniae no se acompaña de una activación de la enfermedad basal 81 .…”

“…La vacunación contra S. pneumoniae no se acompaña de una activación de la enfermedad basal 81 . La vacuna conjugada 13-valente ofrece protección para aproximadamente 55 a 77% de los serotipos circulantes en el país y la vacuna polisacárida 23 valente para 77 a 95% de los serotipos circulantes en el país 82 .…”