Systemic lupus erythematosus

Immunisations have implications for people who have SLE.

• Tetanus toxoid, pneumococcal, and Haemophilus influenzae B vaccines have been demonstrated to be safe and effective when given to patients with SLE.[198]Battafarano DF, Battafarano NJ, Larsen L et al. Antigen specific antibody responses in lupus patients following immunization. Arthritis Rheum. 1998 Oct;41(10):1828-34. http://www.ncbi.nlm.nih.gov/pubmed/9778224?tool=bestpractice.com

• The influenza vaccine and pneumococcal vaccine have been shown to be safe but have reduced efficacy.[199]Holvast A, Huckriede A, Wilschut J, et al. Safety and efficacy of influenza vaccination in systemic lupus erythematosus patients with quiescent disease. Ann Rheum Dis. 2006 Jul;65(7):913-8. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1798193 http://www.ncbi.nlm.nih.gov/pubmed/16322083?tool=bestpractice.com [200]Mathian A, Pha M, Amoura Z. Lupus and vaccinations. Curr Opin Rheumatol. 2018 Sep;30(5):465-70. http://www.ncbi.nlm.nih.gov/pubmed/29889693?tool=bestpractice.com  The immunogenicity of influenza vaccine in patients with SLE appears to vary with viral strain.[201]Huang Y, Wang H, Wan L, et al. Is systemic lupus erythematosus associated with a declined immunogenicity and poor safety of influenza vaccination? A systematic review and meta-analysis. Medicine (Baltimore). 2016 May;95(19):e3637. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4902520 http://www.ncbi.nlm.nih.gov/pubmed/27175678?tool=bestpractice.com [202]Pugès M, Biscay P, Barnetche T, et al. Immunogenicity and impact on disease activity of influenza and pneumococcal vaccines in systemic lupus erythematosus: a systematic literature review and meta-analysis. Rheumatology (Oxford). 2016 Sep;55(9):1664-72. https://academic.oup.com/rheumatology/article/55/9/1664/1744676 http://www.ncbi.nlm.nih.gov/pubmed/27160278?tool=bestpractice.com

• Several case reports document concerns that hepatitis B vaccination may lead to an exacerbation of SLE, so it is not recommended.[203]Senecal JL, Bertrand C, Coutlee F. Severe exacerbation of systemic lupus erythematosus after hepatitis B vaccination and importance of pneumococcal vaccination in patients with autosplenectomy. Arthritis Rheum. 1999 Jun;42(6):1307-8. http://www3.interscience.wiley.com/journal/79503289/abstract http://www.ncbi.nlm.nih.gov/pubmed/10366133?tool=bestpractice.com

• Live vaccines (shingles, yellow fever, intranasal influenza) are not to be used because of underlying or imposed immunosuppression.