Vaccine-preventable infections in Systemic Lupus Erythematosus

Abstract

Systemic Lupus Erythematosus (SLE) is characterized by abnormal autoantibody production and clearance. Infections are among the most important causes of morbidity and mortality in SLE patients; they have an increased frequency of severe bacterial and viral infections possibly due to inherited genetic and immunologic defects and to immunosuppressive therapies. In addition, infectious agents can switch on lupus disease expression and activity. Among the strategies to reduce the risk of infection, vaccination can be considered the most reliable option. Most vaccines are effective and safe in SLE patients, although in certain cases immunogenicity may be sub-optimal and vaccination can trigger a flare. Although these issues are currently unresolved, the risk benefit balance is in favor for vaccination to reduce the risk of infection in SLE patients. In the present review we discuss the preventive strategies currently recommended to reduce bacterial and viral infections in SLE.

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.…”

“…It should be, however, noticed, that some of these studies are follow-up studies and investigated, at least partially, overlapping patients cohorts. Table 3 provides a list of these redundant investigations (18,21,(37)(38)(39)(40)(41)(42), that have been utilized in the systematic review part but excluded in the meta-analysis.…”

Pneumococcal Polysaccharide Vaccine Ameliorates Murine Lupus

“…Additional concerns that anti-pneumococcal vaccination might worsen disease severity have proven obstructive to enacting guideline recommendations. Although a study of 24 SLE patients showed no significant change in autoantibody titers or C3/C4 serum levels 2 months after anti-pneumococcal vaccination (17), onset of SLE has been described after immunization against tetanus (18, 19), hepatitis B (18, 20), and other vaccines (21), providing cause for concern.…”

Systemic lupus erythematosus: what should family physicians know in 2018?

“…Non-live vaccines such as influenza and pneumococcal vaccines are generally well tolerated in SLE, although they are less immunogenic than in age-matched individuals. 32 Although there is conflicting evidence on whether influenza vaccine exacerbates SLE activity, 33 seasonal influenza vaccination according to national guidelines is recommended. 34,35 Influenza and pneumococcal vaccination is particularly recommended for patients with SLE before rituximab therapy.…”