Vaccinations in Adults

Featured in the April, 2013 Scleroderma, Vasculitis & Myositis eNewsletter

Michael W. Henry, MD

Michael W. Henry, MD

Assistant Attending Physician, Hospital for Special Surgery
Assistant Professor of Clinical Medicine, Weill Cornell Medical College

There are currently 17 diseases for which there are vaccines available. The Centers for Disease Control makes specific recommendations regarding when and to whom these vaccines should be given.

Vaccine-Preventable Infections

A vaccine-preventable infection is an infection for which there is a vaccination available that can help keep a patient from developing the infection. In some cases, as with the influenza vaccine, the vaccine can at least reduce the symptoms and severity of an illness, even if the disease itself cannot always be fully prevented.

The following is a list of commonly administered vaccines, and the infections they protect against:

  • Influenza: Since the influenza vaccines changes every year, the influenza vaccine needs to be given every year.
  • Pneumovax: This vaccine prevents infections caused by Streptococcus pneumonia, which is a common cause of pneumonia and meningitis in adults.
  • TdaP: This protects again three infections: Tetanus, diphtheria, and pertussis (the bacteria known to cause Whooping Cough).
    • Over the past decade, doctors have seen a sharp rise in the number of children and adults diagnosed with Whooping Cough in the United States.
  • Zostavax: This vaccine prevents shingles, a painful rash that is caused by the same virus that causes chicken pox.
  • MMR: This vaccine protects against measles, mumps, and rubella (German measles). MMR is often administered during childhood. However, as an adult, you may need a booster. Your physician can determine this by sending blood work.

Vaccinations in Adults with Rheumatologic Diseases

Patients with rheumatologic disease have an increased risk for vaccine-preventable infections. This includes patients with scleroderma, myositis, and vasculitis. This is in part due to the effect of the rheumatologic disease on the immune system. Mostly, however, this risk is a result of the immunosuppressive or immunomodulary medications used to treat these illnesses.

Immunosuppressive and immunomodulary medications treat rheumatologic disease by altering or damping the patientís immune system. This weakening of the immune system can be highly beneficial in treating many rheumatologic diseases. However, it can increase the risk of developing infections, many of which are vaccine-preventable. 

The following is a list of immunosuppressive medications that are commonly used to treat rheumatologic illness:

  • High dose Prednisone 
  • Humira (brand), Adalimumab (generic)
  • Orencia (brand), Abadacept (generic)
  • High dose Methotrexate
  • Rituxan (brand), Rituximab (generic)
  • Remicade (brand), Infliximab (generic)
  • Cellcept (brand), Mycophenolate mofetil (generic)
  • Imuran (brand), Azathioprine (generic)
  • Arava (brand), Leflunomide (generic)
  • Enbrel (brand), Etanercept (generic)
  • Cytoxan (brand), Cyclosphosphamide (generic)
  • Kineret (brand), Anakinra (generic)

The effectiveness of a vaccine depends greatly on the recipientís ability to develop an immune response to the vaccine. If the immune system is not properly functioning, the body cannot develop an immune response to the vaccine, and all benefits are lost.

Types of Vaccines:

Vaccines can be divided into two basic groups: Inactivated vaccines and Live vaccines.

  • An Inactivated vaccine does NOT contain any living virus or bacteria. A person receiving an inactivated vaccine cannot become infected by the vaccine.
  • A Live vaccine contains a living, but weakened, form of a virus or bacteria. The risk of developing an actual infection from a live vaccine is extremely low. However, this risk does increase in patients who are taking medications which suppress the immune system. In some instances, a live vaccine will need to be withheld because of this risk. This can be an important consideration in patients being treated for rheumatologic disease.

It is important to remember that the vast majority of vaccines given to adults are Inactivated vaccines, and therefore cannot cause infection.

It is also important to remember that rheumatologic illness by themselves do not make anyone ineligible to receive a vaccine. This includes live vaccines. All currently available vaccines are safe in patients with rheumatologic disease. It is only in cases where patients with rheumatologic disease are taking immunosuppressive medications, that there is cause for concern.

Who Gets Which Vaccines and When?

The types of vaccine you will need will be based on the following elements:

  • age
  • prior medical history, especially your history of prior infections
  • current pregnancy status
  • current medications, especially if you are taking immunosuppressive or immunomodulatory medications

Your doctor may wish to vaccinate before immunosuppressive treatment is started, or they may wish to wait until the treatment is completed. Choosing the right time to vaccinate will both reduce the potential of infection from a live vaccine and increase the likelihood that you will develop a good response to both live and inactivated vaccines.

Be sure to review which vaccines you should be receiving with your doctor and when they should be administered. A considerable amount information regarding vaccinations is available on the CDCís website.

Important Facts About Vaccines to Remember

  • Each vaccine has a schedule. Some vaccines, like the influenza vaccine, need to be administered every year. Other vaccines may only need to be given once, and yet others will require boosters, or additional doses, periodically.
  • You can receive a vaccination even if you are taking an antibiotic.
  • It is safe to receive more than one vaccine in a single visit.
  • If you are planning to travel abroad, consult your physician regarding any pre-travel vaccines you might need to take. Different countries may recommend different vaccines before visiting. The CDCís website provides very comprehensive information regarding what vaccines are recommended depending on the countries you are planning to visit.
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