Should My Patient With Lupus Get Vaccinated?

The question about the safety and efficacy of vaccinations is very important for everyone but especially for patients with lupus. Because of the underlying disease, as well as many (but not all) of the medications for lupus, people with lupus can be more susceptible to infections than other people. Patients with lupus also have a higher risk of more-serious complications from those infections.

Yes, it is safe for patients with lupus to receive vaccinations. And they should get vaccinated but with a few caveats. To maximize the efficacy of any vaccine, it is optimal to administer vaccinations when lupus is in remission, and patients are on the lowest doses of immunosuppressive medications. This does not mean that a patient should stop all of his or her medications just to get vaccinated. However, if your patient has lupus and is having a severe flare that requires intensive medications, it may be best to advise him or her to delay vaccinations until the disease activity slows.

This process gets trickier with the seasonal influenza vaccine, which is recommended annually. It is important for patients to get vaccinated against influenza as soon as possible and before the infection hits their local area. The other side to that issue is that if a patient is experiencing a disease-free interval and his or her medications have been tapered to the lowest possible doses, it might be a good time to review his or her vaccination history to be sure all vaccinations are up to date. Studies have shown that some people with lupus may have lower immunological responses to vaccines compared with otherwise healthy people of the same age.

It is important to remember that no vaccine is 100% protective, so there is always a chance that a vaccinated person will still get the infection they were vaccinated against. But often in these cases, patients are infected with a somewhat milder form of the disease and are sick for fewer days and with less severity. This is all to say that an imperfect response is better than not getting vaccinated at all.

The overwhelming majority of routine vaccinations these days are not made from live viruses, so there is no way to become infected with the disease from the vaccine itself. This includes the seasonal influenza vaccine, pneumonia vaccines, hepatitis B virus infection vaccine, human papillomavirus vaccines, and even the new shingles vaccine.  

Eliza Chakravarty, MD, is an associate member of the Arthritis & Clinical Immunology Research Program at Oklahoma Medical Research Foundation in Oklahoma City, Oklahoma.