A Review of the Efficacy of Influenza Vaccination in Autoimmune Disease Patients.

Mandi Abdelahad,Marc M Kesselman,Michelle Demory Beckler,Elizabeth Ta

doi:10.7759/cureus.15016

Abstract

Patients suffering from autoimmune diseases appear to be at greater risk for developing infections with the influenza virus compared to healthy controls due to their immunosuppressive treatment, suggesting the importance of vaccination. Within this literature review, we highlight the importance, efficacy, and safety of influenza vaccination in individuals with autoimmune diseases, including systemic lupus erythematosus (SLE), Sjogren syndrome (SS), rheumatoid arthritis (RA), and inflammatory bowel disease (IBD) in both vaccinated and unvaccinated individuals. Overall, vaccination is generally well tolerated by SLE patients and the literature recommends the inactivated influenza vaccine to SLE patients according to the recommendations and schedules for the general population and annually against seasonal influenza viruses. While the data are still unclear in patients with SS, there does seem to be a general consensus to vaccinate these individuals to prevent harmful risks of influenza disease. In patients with RA and IBD, vaccination efficacy with the inactivated influenza vaccine should be determined on a case-by-case basis, taking patient therapy into account. In light of the current pandemic and global coronavirus disease 2019 (COVID-19) crisis, it is crucial to emphasize the safety and immunogenicity of influenza vaccination in vulnerable individuals suffering from autoimmune diseases. Public health measures are recommended to protect these individuals with vaccinations, keeping in mind the possibility of the multiple COVID-19 vaccines that are currently available.

Highlights

These results suggest that TNFalpha inhibitors impair serological and immune response in inflammatory bowel disease (IBD) patients vaccinated with the inactivated influenza vaccine [40]
Studies have shown that the inactivated influenza vaccine is safe and efficacious in patients with systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), and IBD
There have been studies with mixed results establishing the safety of the influenza vaccine in Sjogren syndrome (SS) patients

Summary

Introduction

Autoimmune diseases such as rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), and multiple sclerosis (MS)have been shown to be associated with dysregulated immune system activity [1]. This likely results from an individual’s own immune system attacking its own healthy cells. Modifications in the selection, regulation, and/or death of T-cells or B-cells, and/or abnormal responses to antigens appear to be associated with the onset and progression of many autoimmune diseases [1]. While immune mechanisms play a vital part in the pathogenesis of autoimmune diseases, onset and progression are thought to be multi-factorial [2]. Due to the immunosuppressive nature of these treatment strategies, there may be an increased risk of infection and an associated increased risk in morbidity and mortality in patients with autoimmune diseases [2,3,4]

Background

Conclusions

Findings

Disclosures