What are the recommended vaccinations for patients with SLE, especially those on immunosuppressive therapy?

Patients with systemic lupus erythematosus (SLE), especially those receiving immunosuppressive therapy, are recommended to receive inactivated vaccines to reduce the risk of infections, which they are more susceptible to due to both disease and treatment-related immunosuppression. The key vaccinations include annual influenza vaccination, pneumococcal vaccines (both PCV13 and PPSV23 as per schedule), and hepatitis B vaccination if not already immune. Additionally, vaccination against human papillomavirus (HPV) is advised for eligible patients to prevent HPV-related complications. Live attenuated vaccines are generally contraindicated during immunosuppressive therapy but may be considered before starting such treatment if clinically appropriate and safe. Vaccination timing should ideally be before initiation of immunosuppression to maximize immunogenicity and safety. Close monitoring for vaccine response and adverse effects is important in this population. These recommendations align with UK immunisation guidelines for immunocompromised patients and are supported by recent rheumatology literature emphasizing tailored vaccination strategies in SLE to balance infection risk and vaccine safety ¹ (Xibillé-Friedmann et al., 2019; Rao and Mikdashi, 2023; Mucke and Aringer, 2024).