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Immunizations and Lupus

August is recognized as National Immunization Month, and with Summer coming to an end, children heading back to school, and the cooler months just around the corner, we, at More Than Lupus, thought it would be appropriate to take the opportunity to shed light on immunizations, including the various types, what they do, and why they are important to think about this time of year- not just for those with lupus, but for those of all health backgrounds.


There is no denying that the subject of vaccines can be a touchy one, particularly when it comes to debates pertaining to early childhood immunizations and possible outcomes. Recently, Lupus Research Alliance posted an article that featured an interview with their Chief Scientific Officer Dr. Teodora Staeva. Her comments addressed the background of vaccines and immunization recommendations for those living with lupus. Here is an excerpt of what she said:


“Vaccines help to develop immunity, in other words protect against disease, by imitating an infection,” notes Dr. Staeva. “Most vaccines contain small amounts of the germs (or parts of them) that cause disease but are either killed or weakened. The vaccine prompts the immune system to produce T cells and antibodies against these germs, and thus allows the body to learn how to fight these microbes in the future. However, several rounds of vaccinations are often required to achieve optimal protection.”

“People with lupus are at greater risk for infections due to immunosuppression, so vaccines are very important,” noted Dr. Staeva. “But speak to your doctor before getting any vaccine to determine which are right for you and when.” - www.lupusresearch.org Aug 15, 2019


In the U.S., vaccines have greatly reduced or eliminated many infectious diseases that at some time had commonly harmed (and even killed) infants, children, and adults. Though many of these diseases have been controlled, the viruses and bacteria that cause these diseases still exist and you are still at risk for contracting these diseases if you aren’t vaccinated. In fact, according to the CDC every year thousands of adults in the U.S. become seriously ill and are hospitalized because of diseases that vaccines can help prevent.


There are currently four main types of vaccines available:

  • Inactivated vaccines: An inactivated vaccine (or killed vaccine) is a vaccine consisting of virus particles, bacteria, or other pathogens that have been grown in culture and then lose disease producing capacity. These are considered safe and effective for people with lupus. Inactivated vaccines are used to protect against: Hepatitis A, Flu (shot only), Polio (shot only) and Rabies. However, inactivated vaccines usually don’t provide protection forever, so you may need several doses over time (booster shots) in order to get ongoing immunity against diseases.

  • Live-attenuated vaccines: In contrast, live vaccines use pathogens that are still alive (but are almost always weakened or “attenuated.”) Because they contain a small amount of the weakened live virus, people with lupus should discuss with their health care provider before receiving them. However, live vaccines are used to protect against: measles, mumps, rubella (MMR combined vaccine), rotavirus, smallpox, chickenpox, yellow fever

  • Subunit, recombinant, polysaccharide, and conjugate vaccines: These use only specific pieces of the germ and often combine a weak antigen with a strong antigen. This allows the immune system to have a stronger response to the weak antigen. This type of vaccine is used quite often, even on those with weakened immune systems. Some examples are: Hepatitis B, Influenza (injection), Haemophilus influenza type b (Hib) ,Pertussis (part of DTaP combined immunization), Pneumococcal ,Meningococcal

  • Toxoid vaccines use a toxin or chemical made of a virus or bacteria. They made you immune to the harmful effects of the disease. Diphtheria, tetanus (part of DTaP combined immunization) are considered toxoid vaccines.



Which Vaccines Are Recommended for Those With Lupus?

The U.S. Department of Health & Human Services suggests that the following vaccines are typically safe for those living with lupus:

  • The flu shot (not nasal spray which contains a live form of the flu virus)

  • Pneumonia vaccine

  • Human papillomavirus (HPV) vaccine

  • Tetanus, diphtheria, and acellular pertussis (Td/Tdap) vaccine

Vaccines with live viruses that you should talk to your doctor about BEFORE receiving:

  • Nasal spray vaccine for the flu

  • Varicella (chickenpox) vaccine

  • Herpes Zoster (Shingles) vaccine

  • Measles, Mumps, Rubella (MMR) vaccine

  • Live typhoid vaccine (oral)

Note: Even if you received the vaccines you needed as a child, the protection from some vaccines can wear off. You may also be at risk for other diseases due to your job, lifestyle, travel, or additional health conditions. Find out what vaccines you may need based on different risk factors.


Why Are Those With Lupus At Greater Risk To Develop These Diseases If Not Vaccinated?

As Dr. Staeva noted above, those with lupus are at a greater risk due to increased immunosuppression. Immunosuppression is a reduction in the efficacy and activation of the immune system. This can occur naturally in some parts of the immune system, as well as from other conditions and medications.


Many lupus patients are treated with immunosuppressive or “immune modulator” medications in order to control inflammation and the overactive immune system that lupus causes. These medications are often used when steroids are either not tolerated or not effective.


Some of these include:

  • Cyclophosphamide (Cytoxan®)

  • Methotrexate (Rheumatrex™)

  • Azathioprine (Imuran®)

  • Mycophenolate mofetil (Cellcept)

  • Cyclosporine (Neoral, Sandimmune, Gengraf)

  • Methotrexate (Rheumatrex)

  • Leflunomide (Arava)

  • Chlorambucil (Leukeran) *Note: though corticosteroids (prednisone, deltasone, millipred, orasone) are technically in a different class of medications, they can also suppress a person's immune system over time.

In addition to the increased risk of immunosuppression from medication, it is important to remember that with lupus, the body is spending a large amount of energy attacking the wrong cells by mistake, leaving you more susceptible to viruses and bacteria - which can lead to infections. Infections are the number two cause of death with those living with lupus. A flu bug can turn deadly for those who have lupus and are on immunosuppressant medications. That is why it is very important to speak with your doctor about what vaccines are the right ones for you, and to make sure you comply with those recommendations.


Conclusion

We hope this information will be able to assist you in communicating any concerns you may have regarding vaccines to your healthcare professionals, schools, and family during National Immunization Month and throughout the rest of the year.


Article By:

Kelli Roseta




**All resources provided by this blog are for informational purposes only, not to replace the a

advice of a medical professional. Kelli encourages you to always contact your medical provider with any specific questions or concerns regarding your illness. All intellectual property and content on this site and in this blog is owned by morethanlupus.com. This includes materials protected by copyright, trademark, or patent laws. Copyright, More Than Lupus 2019.


Sources:

https://www.cdc.gov/vaccines/events/niam/index.html

https://www.lupusresearch.org/take-the-right-shots-for-lupus/?fbclid=IwAR02rRMPaHUS08fBQnMen2xGjZylQdIBBKjSK47dZ7rwfdL_wqzfmRklAu8

https://www.vaccines.gov/basics/types

https://www.lupus.org/resources/medications-used-to-treat-lupus

https://www.hss.edu/conditions_vaccinations-lupus-update.asp

https://www.historyofvaccines.org/content/articles/different-types-vaccines

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