LONDON — Patients with systemic lupus erythematosus who don't get the influenza vaccine risk getting pneumonia or bronchitis—or making their underlying disease worse, a new study suggested.
Influenza vaccination for patients with autoimmune disease has long been a subject of contention. For lupus patients, the concerns have been that the vaccine could make their disease worse and that antibody responses might be inadequate. There also have been reports of lupus flares following pneumococcal immunization and a report of a patient who developed diffuse proliferative glomerulonephritis after receiving the vaccine during a lupus flare.
But the safety and efficacy of the vaccine were confirmed in a study presented in a poster session at the Sixth European Lupus Meeting. The study included 69 patients with stable disease and whose prednisone dose was 10 mg/day or less. Of these patients, 13 were in remission and given the vaccine (Vaxigrip); the other 56 did not receive the vaccine. The patients, aged 19–73 years, were followed throughout the next year for disease activity and respiratory tract infections.
Among patients who received the vaccine, 2 (15.4%) developed acute bronchitis that required antibiotic treatment, as did 17 (30.4%) of those who had not been immunized, said Ljudmila Stojanovich, M.D., of Bezhanijska Kosa University Medical Center, Belgrade, Serbia and Montenegro.
None of the vaccinated patients developed pneumonia or showed worsening of their SLE symptoms. Among the unvaccinated patients, one developed pneumonia, and two experienced worsening of their SLE symptoms following respiratory tract infections, she said at the meeting, sponsored by the British Society for Rheumatology.
Other infections, including herpes zoster and infections caused by Staphylococcus aureus, also occurred significantly more often in unvaccinated patients, and particularly in patients older than 30 years. The U.S. Advisory Committee on Immunization Practices recommends influenza vaccination for patients 2–64 years old who are at increased risk for pneumococcal infection due to chronic illnesses.