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Year : 2012  |  Volume : 7  |  Issue : 1  |  Page : 21-28

Common anti-infective prophylaxis and vaccinations in autoimmune inflammatory rheumatic diseases

Associate Professor, Department of Medicine, St John's Medical College Hospital, Sarjapur Road, Bengaluru - 560034, Karnataka, India

Correspondence Address:
Vineeta Shobha
Associate Professor, Department of Medicine, St John's Medical College Hospital, Sarjapur Road, Bengaluru - 560034, Karnataka
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Source of Support: None, Conflict of Interest: None

DOI: 10.1016/S0973-3698(12)60005-3

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An exhilarating era for autoimmune inflammatory rheumatic diseases (AIRD) has arrived; new therapeutics are emerging that not only control symptoms, but also may allow a chance for remission. However, enthusiasm must be tempered with judicious caution as gaps in our knowledge remain regarding long-term safety data especially with respect to new onset infections and reactivation of latent infections such as tuberculosis (TB). Chronic vigilance and appropriate anti-infective measures such as trimethoprim/sulphamethaxozole and TB chemoprophylaxis should be instituted whenever indicated to minimise risk. Vaccination is an appropriate choice to prevent substantial number of these infections. In this context, pneumococcal and influenza vaccines are the best evaluated and are recom- mended by standard vaccination guidelines by most of experts. Some studies have found mildly impaired immune responses to vaccines among patients receiving long-term immunosuppressive therapy and tumour necrosis factor (TNF) antagonists, but post vaccination antibody titres are frequently adequate to provide shield for the majority of immunised individuals. The accumulated data on the safety and effectiveness of vaccines warrant immunisation with the majority of vaccines for patients with AIRD with the exception of live vaccines. In India, however there is a con- cern about futility of influenza vaccine, as it is feared that the serotypes targeted in this vaccine may not be the prevailing in our geographic area. Vaccination status assessment as soon as diagnosis of any of AIRDs is estab- lished and updating to appropriate vaccination status should compulsorily be implemented in daily clinical practice by rheumatologists.

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