Safety and Efficacy of Vaccination Against Influenza in Patients With Rheumatoid Arthritis

Ori Elkayam

doi:10.1080/17402520600589613

Abstract

Vaccination against influenza is currently recommended for patients with rheumatoid arthritis (RA). The safety and efficacy of vaccination in patients suffering from rheumatic diseases is still a matter of debate. This review summarizes the studies performed on the safety and immunogenicity of influenza vaccination in patients with RA as well as the rheumatic complications of the vaccine in otherwise healthy persons. Several trials have shown that the vaccine induces an adequate humoral response and does not induce clinical exacerbation of RA. Rheumatic complications (mainly vasculitis) following influenza vaccination in the general population are scarce.

Highlights

Vaccination against influenza is currently recommended for patients with rheumatoid arthritis (RA)
Influenza vaccination is currently recommended for patients with rheumatoid arthritis (RA) (Center for Disease Control and Prevention 2002)
The principal reason seems not to be a lack of awareness of the need of vaccination by the patient, but the fact that they have not been offered it (Bridges et al 2003). This reluctance to vaccinate RA patients is based on sporadic case reports on the onset or exacerbation of RA following vaccination with influenza, tetanus, hepatitis and other vaccines (Older et al 1999, Maillefert et al 1999)

Summary

Adult RA patients

The first study on the safety and efficacy of influenza vaccination was reported in 1979 (Herron et al 1979). Seroconversion to A/New Jersey/76 developed in 62 – 87% of all individuals and to A/Victoria/75 in 62 – 69% Administration of this vaccine induced an adequate antibody response in both healthy and rheumatic patients (Herron et al 1979). Our group has studied the effect of influenza vaccination in 82 RA patients and 30 healthy controls using a split-virion inactivated vaccine containing 15 mcg hemagglutinin (HA)/dose of each of B/Hong Kong/330 (hk), A/Panama/2007/99 (pan) and A/New Caledonian /20/90 (nc) (Fomin et al 2006). Our study clearly showed that influenza virus vaccine generated a good humoral response in RA patients, lower than in healthy controls (Fomin et al 2006)

Children with chronic arthritis

Rheumatic complications of influenza vaccination

Findings

Conclusion