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 NICE NG218 Xibillé-Friedmann et al. 2019Rao & Mikdashi 2023Mucke & Aringer 2024.
Key References
- NG218 - Vaccine uptake in the general population
- NG103 - Flu vaccination: increasing uptake
- (Xibillé-Friedmann et al., 2019): Clinical practice guidelines for the treatment of systemic lupus erythematosus by the Mexican College of Rheumatology.
- (Rao and Mikdashi, 2023): A Framework to Overcome Challenges in the Management of Infections in Patients with Systemic Lupus Erythematosus.
- (Mucke and Aringer, 2024): [EULAR recommendations 2023 on the treatment of systemic lupus erythematosus -Implications for treatment in Germany].