At this time of year, patients with lupus, rheumatoid arthritis, and other autoimmune diseases always ask, “Should I get a flu vaccination?” At this time in our history, many patients are also asking, “Should I get a smallpox vaccination?” These questions are really about three more general questions: 

• Are patients with autoimmune diseases unusually susceptible to flu or smallpox?
• Can patients with autoimmune diseases be adequately protected if they do receive a vaccination?
• Is the vaccine safe, in the sense that it can either cause autoimmune disease to worsen or can cause complications by itself?

The brief answers, which are different depending on the disease and vaccine, are:

1. Patients taking immunosuppressive drugs, including prednisone or other corticosteroids, and those with lung and/or kidney disease, are unusually susceptible to flu.

Although little is known about susceptibility to smallpox, based on what happens with the related varicella virus (which causes chickenpox and shingles), patients on immunosuppressive drugs will likely be at high risk for severe disease if they are exposed to smallpox.

For both diseases, the increased risk includes patients taking: corticosteroids, such as prednisone and methylprednisolone (Medrol); immunosuppressive drugs, such as methotrexate (Rheumatrex, Trexall), azathioprine (Imuran), mycophenolate mofetil (CellCept), cyclophosphamide (Cytoxan), leflunomide (Arava), cyclosporine (Sandimmune, Neoral) and similar drugs; and biologics, such as the TNF-alpha inhibitors infliximab (Remicade) and etanercept (Enbrel) and the IL-1 inhibitor anakinra (Kineret).

2. Flu vaccine successfully protects patients with rheumatic disease, if they are not taking high doses of immunosuppressive drugs.

3. Flu vaccine does not worsen rheumatic disease and is generally well tolerated by rheumatic disease patients.

See the complete article on the Hospital for Special Surgery’s web site