The European League Against Rheumatism (EULAR) recommendations for vaccination in adult patients with autoimmune inflammatory rheumatic diseases (AIIRD) have been recently published. These evidence-based recommendations were based on existing literature in combination with expert opinion. Although patients with AIIRD are at increased risk of suffering from (complicated) infectious diseases – and vaccination seems a tool to reduce this risk – still many questions and controversies remain for the individual patient. In this overview, taking influenza as an example, the background of the recommendations, their clinical implications, and the direction of future research are discussed. The increase in knowledge on vaccine-preventable infections will allow us to further improve vaccination strategies.
van AssenSAgmon-LevinNElkayamO. EULAR recommendations for vaccination in adult patients with autoimmune inflammatory rheumatic diseases. Ann Rheum Dis2011; 70: 414–422.
Treanor JJ. Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Influenza virus. 7th ed. Elsevier, 2008.
4.
BautistaEChotpitayasunondhTGaoZ. Clinical aspects of pandemic 2009 influenza A (H1N1) virus infection. N Engl J Med2010; 362: 1708–1719.
5.
KimYJBoeckhMEnglundJA. Community respiratory virus infections in immunocompromised patients: hematopoietic stem cell and solid organ transplant recipients, and individuals with human immunodeficiency virus infection. Semin Respir Crit Care Med2007; 28: 222–242.
6.
HakENordinJWeiF. Influence of high-risk medical conditions on the effectiveness of influenza vaccination among elderly members of 3 large managed-care organizations. Clin Infect Dis2002; 35: 370–377.
7.
NicholKLWuorenmaJvon SternbergT. Benefits of influenza vaccination for low-, intermediate-, and high-risk senior citizens. Arch Intern Med1998; 158: 1769–1776.
8.
de JongJCPalacheAMBeyerWERimmelzwaanGFBoonACOsterhausAD. Haemagglutination-inhibiting antibody to influenza virus. Dev Biol (Basel)2003; 115: 63–73.
9.
KroonFPvan DisselJTde JongJCZwindermanKvan FurthR. Antibody response after influenza vaccination in HIV-infected individuals: a consecutive 3-year study. Vaccine2000; 18: 3040–3049.
10.
KroonFPvan DisselJTde JongJCvan FurthR. Antibody response to influenza, tetanus and pneumococcal vaccines in HIV-seropositive individuals in relation to the number of CD4+ lymphocytes. AIDS1994; 8: 469–476.
11.
ThompsonWWShayDKWeintraubE. Mortality associated with influenza and respiratory syncytial virus in the United States. JAMA2003; 289: 179–186.
12.
KunisakiKMJanoffEN. Influenza in immunosuppressed populations: a review of infection frequency, morbidity, mortality, and vaccine responses. Lancet Infect Dis2009; 9: 493–504.
13.
McElhaneyJEXieDHagerWD. T cell responses are better correlates of vaccine protection in the elderly. J Immunol2006; 176: 6333–6339.
14.
GravensteinSDrinkaPDuthieEH. Efficacy of an influenza hemagglutinin-diphtheria toxoid conjugate vaccine in elderly nursing home subjects during an influenza outbreak. J Am Geriatr Soc1994; 42: 245–251.
15.
McElhaneyJEEwenCZhouX. Granzyme B: correlates with protection and enhanced CTL response to influenza vaccination in older adults. Vaccine2009; 27: 2418–2425.
ForrestBDPrideMWDunningAJ. Correlation of cellular immune responses with protection against culture-confirmed influenza virus in young children. Clin Vaccine Immunol2008; 15: 1042–1053.
18.
HolvastAvan AssenSde HaanA. Effect of a second, booster, influenza vaccination on antibody responses in quiescent systemic lupus erythematosus: an open, prospective, controlled study. Rheumatology (Oxford)2009; 48: 1294–1299.
19.
HolvastAvan AssenSde HaanA. Studies of cell-mediated immune responses to influenza vaccination in systemic lupus erythematosus. Arthritis Rheum2009; 60: 2438–2447.
20.
AradUTzadokSAmirS. The cellular immune response to influenza vaccination is preserved in rheumatoid arthritis patients treated with rituximab. Vaccine2011; 29: 1643–1648.
21.
GelinckLBTengYKRimmelzwaanGFvan den BemtBJKroonFPvan LaarJM. Poor serological responses upon influenza vaccination in patients with rheumatoid arthritis treated with rituximab. Ann Rheum Dis2007; 66: 1402–1403.
22.
OrenSMandelboimMBraun-MoscoviciY. Vaccination against influenza in patients with rheumatoid arthritis: the effect of rituximab on the humoral response. Ann Rheum Dis2008; 67: 937–941.
23.
van AssenSHolvastABenneCA. Humoral responses after influenza vaccination are severely reduced in patients with rheumatoid arthritis treated with rituximab. Arthritis Rheum2009; 62: 75–81.
24.
SaadCGBorbaEFAikawaNE. Immunogenicity and safety of the 2009 non-adjuvanted influenza A/H1N1 vaccine in a large cohort of autoimmune rheumatic diseases. Ann Rheum Dis2011; 70: 1068–1073.
25.
BridgesMJCoadyDKellyCAHamiltonJHeycockC. Factors influencing uptake of influenza vaccination in patients with rheumatoid arthritis. Ann Rheum Dis2003; 62: 685–685.
26.
PradeepJWattsRClunieG. Audit on the uptake of influenza and pneumococcal vaccination in patients with rheumatoid arthritis. Ann Rheum Dis2007; 66: 837–838.
27.
DoeSPathareSKellyCAHeycockCRBindingJHamiltonJ. Uptake of influenza vaccination in patients on immunosuppressant agents for rheumatological diseases: a follow-up audit of the influence of secondary care. Rheumatology (Oxford)2007; 46: 715–716.
28.
FeuchtenbergerMKleinertSSchwabS. Vaccination survey in patients with rheumatoid arthritis: a cross-sectional study. Rheumatol Int2011. [Epub ahead of print].
29.
MeynaarIA‘t WoutJWVandenbrouckeJPvan FurthR. [Implementation of influenza vaccination in 3 hospitals]. Ned Tijdschr Geneeskd1992; 136: 180–183.
30.
JordanMBMillsDMKapplerJMarrackPCambierJC. Promotion of B cell immune responses via an alum-induced myeloid cell population. Science2004; 304: 1808–1810.
31.
DurandoPIcardiGAnsaldiF. MF59-adjuvanted vaccine: a safe and useful tool to enhance and broaden protection against seasonal influenza viruses in subjects at risk. Expert Opin Biol Ther2010; 10: 639–651.
32.
AnsaldiFCanepaPParodiV. Adjuvanted seasonal influenza vaccines and perpetual viral metamorphosis: the importance of cross-protection. Vaccine2009; 27: 3345–3348.
33.
OriESharonAEllaM. The efficacy and safety of vaccination against pandemic 2009 influenza a (H1N1) virus among patients with rheumatic diseases. Arthritis Care Res (Hoboken)2011; 63: 1062–1067.
34.
McElhaneyJE. Influenza vaccination in the elderly: seeking new correlates of protection and improved vaccines. Aging Health2008; 4: 603–613.
35.
Saurwein-TeisslMZistererKSchmittTLGluckRCryzSGrubeck-LoebensteinB. Whole virus influenza vaccine activates dendritic cells (DC) and stimulates cytokine production by peripheral blood mononuclear cells (PBMC) while subunit vaccines support T cell proliferation. Clin Exp Immunol1998; 114: 271–276.
36.
BungenerLHuckriedeAde MareAVries-IdemaJWilschutJDaemenT. Virosome-mediated delivery of protein antigens in vivo: efficient induction of class I MHC-restricted cytotoxic T lymphocyte activity. Vaccine2005; 23: 1232–1241.
37.
HerzogCHartmannKKunziV. Eleven years of Inflexal V-a virosomal adjuvanted influenza vaccine. Vaccine2009; 27: 4381–4387.
38.
HuckriedeABungenerLTer VeerW. Influenza virosomes: combining optimal presentation of hemagglutinin with immunopotentiating activity. Vaccine2003; 21: 925–931.
39.
HuckriedeABungenerLStegmannT. The virosome concept for influenza vaccines. Vaccine2005; 23(Suppl 1): S26–S38.
40.
SongJMVan RooijenNBozjaJCompansRWKangSM. Vaccination inducing broad and improved cross protection against multiple subtypes of influenza A virus. Proc Natl Acad Sci U S A2011; 108: 757–761.
41.
GeeraedtsFGoutagnyNHornungV. Superior immunogenicity of inactivated whole virus H5N1 influenza vaccine is primarily controlled by Toll-like receptor signalling. PLoS Pathog2008; 4: e1000138–e1000138.
42.
TaylorDNTreanorJJStroutC. Induction of a potent immune response in the elderly using the TLR-5 agonist, flagellin, with a recombinant hemagglutinin influenza-flagellin fusion vaccine (VAX125, STF2.HA1 SI). Vaccine2011; 29: 4897–4902.
43.
GelinckLBvan den BemtBJMarijtWA. Intradermal influenza vaccination in immunocompromised patients is immunogenic and feasible. Vaccine2009; 27: 2469–2474.
