Background/Purpose: : Infection is one of the main causes of morbidity and increased mortality in patients with systemic lupus erythematodes (SLE). Information about vaccination history and updating vaccinations on a regular basis is an economical way to avoid complications of various infections. Ideally vaccinations should be done prior to starting immunosuppressive treatment.  Influenza, pneumococcal and tetanus vaccines are safe and do not lead to SLE flares while the majority of patients develop protective antibodies. Recommendations for hepatitis B and varicella herpes zoster (VZV) vaccination have not yet been validated in SLE patients. The purpose of study was to assess the vaccination rates against common infections and to determine the incidence of hepatitis B and VZV infections in patients with SLE attending a rheumatology outpatient clinic. 

Methods: Data collected included age, duration of disease and treatment (systemic corticosteroids, methotrexate, azathioprine, hydroxychloroquine). According to the recommendations for vaccination in patients with rheumatic diseases derived from The European League against Rheumatism (EULAR) and the German Robert Koch Institute for Infection Control vaccination history was taken for MMR (measles, mumps and rubella), poliomyelitis, pertussis, diphtheria, influenza, human papillomavirus, hepatitis A, hepatitis B, tetanus, meningococcal and pneumococcal vaccines. A simple questionnaire was designed and 68 SLE patients were asked to provide their vaccination records. Patients were also tested for hepatitis B (anti-HBc, anti-HBs) and VZV (IgG) status.

Results: 95.6 % of SLE patients presented a vaccination card. Of interest, 75 % patients did not receive the influenza vaccine in the previous year. Only 12 patients (19 %) in total and 30 % in the age group > 60 years have ever received the pneumococcal vaccination. The vaccination rate for tetanus (combined vaccination with diphtheria and pertussis) was 51 %. For the remaining vaccinations the following picture emerged: vaccination was complete for 66 % against poliomyelitis, 11.8 % for hepatitis A, 1.5 % for meningococcus, 2.6 % for MMR. Only 1.6 % of SLE patients were vaccinated against human papillomavirus (only 12.5 % of the patients < 27 years).  Patients with SLE do not have an increased incidence of hepatitis B and we did not detect any patient with an active hepatitis B.  Only 14.7 % patients with SLE had a vaccination against hepatitis B. 2 SLE patients (3.6 %) exhibited an abnormal hepatitis serology (increase of anti-HBc + anti-HBs-Titre, or anti-HBc) and only one of them had a moderate increase of liver enzymes. 97 % SLE patients were positive for VZV IgG and 23 SLE patients (33.8 %) had a history of VZV infection with postherpetic neuralgia. Therefore, 60 % of SLE patients may be considered for herpes zoster vaccination; however, no patient was vaccinated against VZV.

Conclusion: In SLE patients with stable disease the vaccination rate was low. More careful monitoring of SLE patients concerning vaccination is necessary. In particular with new therapies being directed against B-lymphocytes a timely update of the vaccination status is mandatory for every individual patient with SLE.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/monitoring-patients-with-systemic-lupus-erythematosus-in-clinical-practice-have-you-already-checked-the-vaccination-status-in-your-patients/