Zeitschrift für Rheumatologie

, Volume 69, Issue 9, pp 803–812

Impfungen in der Rheumatologie

CME Weiterbildung · Zertifizierte Fortbildung
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Zusammenfassung

Patienten mit Autoimmunerkrankungen besitzen ein erhöhtes Risiko für die Entwicklung einer infektiösen Erkrankung. Dies ist zum einen der immunsuppressiven Therapie, zum anderen aber auch der rheumatologischen Grunderkrankung geschuldet. Bisher war der konsequente Einsatz von Impfungen bei dieser Patientengruppe wegen Bedenken hinsichtlich der Sicherheit wie auch der immunologischen Effektivität limitiert. Die mittlerweile vorliegenden Studien belegen allerdings weder ein Risiko für die Auslösung von Autoimmunerkrankungen im Zusammenhang mit Impfungen noch für die Verschlechterung einer bereits bestehenden Erkrankung, wobei die Datenlage immer noch als unzureichend anzusehen ist (kleine Studien, nur Patienten in Remission). Gemäß dem aktuellen Kenntnisstand kann die Vakzinierung mit Totimpfstoffen bei immunsupprimierten Patienten als sicher und relativ effektiv angesehen werden. Der Impferfolg variiert allerdings in Abhängigkeit von der Erkrankung wie auch der verwendeten immunsuppressiven Therapie. Die Überwachung und Pflege des Impfstatus sollte fester Bestandteil der Betreuung rheumatologischer Patienten sein.

Schlüsselwörter

Autoimmunerkrankungen Impfung Immunsuppression Rheumatoide Arthritis Systemischer Lupus erythematodes 

Abkürzungsverzeichnis

RA

Rheumatoide Arthritis

SLE

Systemischer Lupus erythematodes

DMARD

„Disease modifying anti-rheumatic drugs“

STIKO

Ständige Impfkommission (Robert Koch-Institut)

WHO

„World Health Organisation“

CDC

„Centers for Disease Control“

Vaccinations in rheumatology

Abstract

Patients with autoimmune or rheumatic diseases are at increased risk for infectious complications due to immunosuppressive therapy and/or the underlying immunological disease itself. To date, the consistent use of vaccinations in this patient group has been limited due to concerns about flair-ups or lack of efficacy. In prospective studies neither an increased risk of disease flair-ups nor of initiation of autoimmune disorders was found as yet; however, the data is still considered insufficient (small studies including only patients in remission). Vaccination with non-live vaccines can generally be regarded as safe and relatively effective, even in patients on immunosuppressive therapy. Since the immune response to vaccination may be markedly impaired depending on the medication used and the underlying autoimmune disease, monitoring of both serum titers and of patients’ vaccination schedules should form an integral part of rheumatological care.

Keywords

Autoimmune diseases Vaccination Immunosuppression Rheumatoid arthritis Systemic lupus erythematosus 

Literatur

  1. 1.
    Fahy WA, Farnworth E, Yeldrem KP et al (2006) Pneumococcal and influenza vaccination in patients with rheumatic conditions and receiving DMARD therapy. Rheumatology (Oxford) 45:912–913Google Scholar
  2. 2.
    Older SA, Battafarano DF, Enzenauer RJ, Krieg AM (1999) Can immunization precipitate connective tissue disease? Report of five cases of systemic lupus erythematosus and review of the literature. Semin Arthritis Rheum 29:131–139CrossRefPubMedGoogle Scholar
  3. 3.
    Geier DA, Geier MR (2005) A case-control study of serious autoimmune adverse events following hepatitis B immunization. Autoimmunity 38:295–301CrossRefPubMedGoogle Scholar
  4. 4.
    Doran MF, Crowson CS, Pond GR et al (2002) Frequency of infection in patients with rheumatoid arthritis compared with controls: a population-based study. Arthritis Rheum 46:2287–2293CrossRefPubMedGoogle Scholar
  5. 5.
    Bernatsky S, Hudson M, Suissa S (2007) Anti-rheumatic drug use and risk of serious infections in rheumatoid arthritis. Rheumatology (Oxford) 46:1157–1160Google Scholar
  6. 6.
    Listing J, Strangfield A, Kary S et al (2005) Infections in patients with rheumatoid arthritis treated with biologic agents. Arthritis Rheum 52:3403–3412CrossRefPubMedGoogle Scholar
  7. 7.
    Peters T, Weiss JM, Sindrilaru A et al (2009) Reactive oxygen intermediate-induced pathomechanisms contribute to immunosenescence, chronic inflammation and autoimmunity. Mech Ageing Dev 130:564–587CrossRefPubMedGoogle Scholar
  8. 8.
    Meisel R, Kuypers L, Dirksen U et al (2007) Pneumococcal conjugate vaccine provides early protective antibody responses in children after related and unrelated allogeneic hematopoietic stem cell transplantation. Blood 109:2322–2326CrossRefPubMedGoogle Scholar
  9. 9.
    Cush et al., Herpes zoster (shingles) vaccine guidelines for immunosuppressed patients: http://www.rheumatology.org (Zugriff 29.12.2009)Google Scholar
  10. 10.
    Borte S, Liebert UG, Borte M, Sack U (2009) Efficacy of measles, mumps and rubella revaccination in children with juvenile idiopathic arthritis treated with methotrexate and etanercept. Rheumatology (Oxford) 48:144–148Google Scholar
  11. 11.
    Gelinck LB, van der Bijl AE, Beyer WE et al (2008) The effect of anti-tumour necrosis factor alpha treatment on the antibody response to influenza vaccination. Ann Rheum Dis 67:713–716CrossRefPubMedGoogle Scholar
  12. 12.
    Gelinck LB, van der Bijl AE, Visser LG et al (2008) Synergistic immunosuppressive effect of anti-TNF combined with methotrexate on antibody responses to the 23 valent pneumococcal polysaccharide vaccine. Vaccine 26:3528–3533CrossRefPubMedGoogle Scholar
  13. 13.
    Kapetanovic MC, Saxne T, Sjöholm A et al (2006) Influence of methotrexate, TNF blockers and prednisolone on antibody responses to pneumococcal polysaccharide vaccine in patients with rheumatoid arthritis. Rheumatology (Oxford) 45:106–111Google Scholar
  14. 14.
    Kapetanovic MC, Saxne T, Nilsson JA, Geborek P (2007) Influenza vaccination as model for testing immune modulation induced by anti-TNF and methotrexate therapy in rheumatoid arthritis patients. Rheumatology (Oxford) 46:608–611Google Scholar
  15. 15.
    Kaine JL, Kivitz AJ, Birbara C, Luo AY (2007) Immune responses following administration of influenza and pneumococcal vaccines to patients with rheumatoid arthritis receiving adalimumab. J Rheumatol 34:272–279PubMedGoogle Scholar
  16. 16.
    Tsuru T, T.K., Suzaki M (2007) Immune response to influenza vaccine in patients with rheumatoid arthritis under IL-6 signal blockade therapy with tocilizumab. Ann Rheum Dis 66 (Suppl II):439Google Scholar
  17. 17.
    Tay L, Leon F, Vratsanos G et al (2007) Vaccination response to tetanus toxoid and 23-valent pneumococcal vaccines following administration of a single dose of abatacept: a randomized, open-label, parallel group study in healthy subjects. Arthritis Res Ther 9:R38CrossRefPubMedGoogle Scholar
  18. 18.
    Emery P, Fleischmann R, Filipowicz-Sosnowska A et al (2006) The efficacy and safety of rituximab in patients with active rheumatoid arthritis despite methotrexate treatment: results of a phase IIB randomized, double-blind, placebo-controlled, dose-ranging trial. Arthritis Rheum 54:1390–1400CrossRefPubMedGoogle Scholar
  19. 19.
    Gelinck LB, Teng YK, Rimmelzwaan GF et al (2007) Poor serological responses upon influenza vaccination in patients with rheumatoid arthritis treated with rituximab. Ann Rheum Dis 66:1402–1403CrossRefPubMedGoogle Scholar
  20. 20.
    Oren S, Mandelboim M, Braun-Moscovici Y et al (2008) Vaccination against influenza in patients with rheumatoid arthritis: the effect of rituximab on the humoral response. Ann Rheum Dis 67:937–941CrossRefPubMedGoogle Scholar
  21. 21.
    Bingham CO 3rd, Looney RJ, Deodhar A et al (2009) Immunization responses in rheumatoid arthritis patients treated with rituximab: Results from a controlled clinical trial. Arthritis Rheum 62:64–74CrossRefGoogle Scholar
  22. 22.
    van Assen S, Holvast A, Benne CA et al (2009) Humoral responses after influenza vaccination are severely reduced in patients with rheumatoid arthritis treated with rituximab. Arthritis Rheum 62:75–81Google Scholar
  23. 23.
    Elkayam O, Paran D, Caspi D et al (2002) Immunogenicity and safety of pneumococcal vaccination in patients with rheumatoid arthritis or systemic lupus erythematosus. Clin Infect Dis 34:147–153CrossRefPubMedGoogle Scholar
  24. 24.
    Tarjan P, Sipka S, Maródi L et al (2002) No short-term immunological effects of pneumococcus vaccination in patients with systemic lupus erythematosus. Scand J Rheumatol 31:211–215CrossRefPubMedGoogle Scholar
  25. 25.
    Abu-Shakra M, Press J, Varsano N et al (2002) Specific antibody response after influenza immunization in systemic lupus erythematosus. J Rheumatol 29:2555–2557PubMedGoogle Scholar
  26. 26.
    Del Porto F, Laganà B, Biselli R et al (2006) Influenza vaccine administration in patients with systemic lupus erythematosus and rheumatoid arthritis. Safety and immunogenicity. Vaccine 24:3217–3223CrossRefGoogle Scholar
  27. 27.
    Holvast A, Huckriede A, Wilschut J et al (2006) Safety and efficacy of influenza vaccination in systemic lupus erythematosus patients with quiescent disease. Ann Rheum Dis 65:913–918CrossRefPubMedGoogle Scholar
  28. 28.
    Abu-Shakra M, Press J, Sukenik S, Buskila D (2002) Influenza virus vaccination of patients with SLE: effects on generation of autoantibodies. Clin Rheumatol 21:369–372CrossRefPubMedGoogle Scholar
  29. 29.
    Holvast A, van Assen S, de Haan A et al (2009) Studies of cell-mediated immune responses to influenza vaccination in systemic lupus erythematosus. Arthritis Rheum 60:2438–2447CrossRefPubMedGoogle Scholar
  30. 30.
    Holvast A, van Assen S, de Haan A et al (2009) Effect of a second, booster, influenza vaccination on antibody responses in quiescent systemic lupus erythematosus: an open, prospective, controlled study. Rheumatology (Oxford) 48:1294–1299Google Scholar
  31. 31.
    Holvast A, de Haan A, van Assen S et al (2010) Cell-mediated immune responses to influenza vaccination in Wegener’s granulomatosis. Ann Rheum Dis 69:924–927CrossRefPubMedGoogle Scholar
  32. 32.
    de Roux A, Schmidt N, Rose M et al (2004) Immunogenity of the pneumococcal polysaccharide vaccine in COPD patients. The effect of systemic steroids. Respir Med 98:1187–1194CrossRefGoogle Scholar
  33. 33.
    Dengler TJ, Strnad N, Bühring I et al (1998) Differential immune response to influenza and pneumococcal vaccination in immunosuppressed patients after heart transplantation. Transplantation 66:1340–1347CrossRefPubMedGoogle Scholar
  34. 34.
    Hayney MS, Welter DL, Francois M et al (2004) Influenza vaccine antibody responses in lung transplant recipients. Prog Transplant 14:346–351PubMedGoogle Scholar
  35. 35.
    Sanchez-Fructuoso AI, Prats D, Naranjo P et al (2000) Influenza virus immunization effectivity in kidney transplant patients subjected to two different triple-drug therapy immunosuppression protocols: mycophenolate versus azathioprine. Transplantation 69:436–439CrossRefPubMedGoogle Scholar
  36. 36.
    Gea-Banacloche JC (2010) Rituximab-associated infections. Semin Hematol 47:187–198CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  1. 1.Medizinische Klinik und Poliklinik II (ZIM), Schwerpunkt Rheumatologie und Klinische ImmunologieKlinikum der Julius-Maximilians-Universität WürzburgWürzburgDeutschland
  2. 2.Medizinische Klinik 3Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-NürnbergErlangenDeutschland
  3. 3.Klinik für Innere Medizin II, Rheumatologie und Klinische ImmunologieKlinikum Südstadt RostockRostockDeutschland

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