Questioning immunizations with lupus

by Paul Sufka, M.D.

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Many people with lupus question having immunizations, thinking it may cause a flare. Here Paul Sufka, M.D., addresses those concerns:

The decision to receive any medical intervention should come down to evaluation of the potential risks and benefits. 

Patients with lupus have a higher baseline risk of infection due to impaired immune response. These types of infection are mostly bacterial, followed by viral and fungal. Additionally, many patients with lupus are treated with prednisone or other immunosuppressive medications, which may further increase risk of infection. Interestingly, antimalarials such as hydroxychloroquine have a protective effect against infection, in addition to other benefits in controlling lupus activity. 

Fortunately, evidence suggests that receiving vaccinations, especially the most common inactivated vaccines such as influenza and pneumococcus, is safe and studies have not shown a strong link suggesting risk of lupus flare. For these vaccines, the benefit of potential prevention of infection is felt to outweigh any significant risk. Typically, patients are not given vaccinations during a lupus flare, but it is not felt that vaccinations make lupus more active.

Due to the risk of infection, patients that are receiving immunosuppression do need to avoid live vaccines, such as the shingles vaccine (Zostavax), the live attenuated influenza vaccine (the nasal spray flu vaccine), and others such as the measles, mumps, rubella, and yellow fever vaccines. 

About the Author
Paul Sufka, M.D., is a rheumatologist and rheumatology department chair with HealthPartners and Regions Hospital in St. Paul. He serves on the American College of Rheumatology communications and marketing committee, is involved in fellowship education with the University of Minnesota, and is one of the co-founders of the Rheumatology Journal Club on Twitter (#RheumJC). He has also been involved in the use of technology in medicine as a health-tech startup advisor.