Rheumatism: vaccination is particularly important
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More about the experts All content is checked by medical journalists.MunichPatients with chronic rheumatic diseases easily catch an infection. Not only are they weakened because of their illness, they also often have to take drugs that suppress the immune system (immunosupressants). In addition: in the event of an infection, they struggle more often with serious complications, which in the worst case can even be fatal. Vaccinations can protect them from this.
Complete vaccination protection
Correspondingly important for rheumatics is an optimal vaccination status, especially before starting what is known as immunosuppressive therapy. The patients receive these in phases because their immune system attacks the body's own structures.
Before starting therapy, you should check whether all so-called regular vaccinations have taken place or whether they have been refreshed. These include whooping cough (pertussis), diphtheria, tetanus, polio, mumps, measles, and rubella. Young girls should also be vaccinated against human papillomavirus (HPV), if possible before their first sexual intercourse.
In addition to the regular vaccinations, the Standing Vaccination Commission (STIKO) at the Robert Koch Institute (RKI) recommends that patients with immunosuppression, regardless of age, have a standard vaccination to protect against influenza, pneumonia (pneumococci) and meningococci. Even rheumatics in whom the doctor cannot detect antibodies against chickenpox (varicella) in the blood, experts advise vaccination.
Patients at risk, in particular, should be vaccinated against hepatitis B, especially those who have close contact with infected people, medical staff and people with chronic liver disease.
Vaccination against Haemophilus influenza type b infection is useful after contact with sick people. This infection is caused by bacteria that infest the nasopharynx and ears, causing acute bronchitis or otitis media. In severe cases, the pathogens can also affect the lungs and brain.
Live vaccines are problematic
Once immunosuppressive therapy has started, every vaccination is no longer possible and a few things have to be considered: Vaccinations with dead vaccines - i.e. with inactivated pathogens, with fragments or with detoxified harmful substances from the pathogens - are generally tolerable.
However, it can be problematic with live vaccines in which weakened, replicable viruses or bacteria are administered. Because if the patient's immune system is too weak, the vaccinated pathogens can possibly spread and the person becomes ill. Live vaccines are used against measles, mumps, rubella, rotaviruses and varicella, for example. These vaccinations are only useful in very rare cases during immunosuppressive therapy. The same applies to the travel vaccinations against jaundice, cholera and the oral vaccination against typhus. Experts do not recommend vaccination with live vaccines until three to six months after discontinuing immunosuppressive therapy.
During systemic therapy with glucocorticoids of no more than 20 milligrams per day and with external application of cortisone ointments or creams, however, live vaccines are considered harmless.
When the vaccination fails
In some rheumatism patients, the vaccination response is reduced, which means that their body produces fewer antibodies against the pathogen in question than that of healthy people. If the number of antibodies is too low, the patient is not protected against the pathogen - doctors also speak of a too low vaccination titer.
How well a vaccination works depends on the severity of the underlying rheumatic disease, the vaccination itself and the immunosuppressive therapy. Patients with an increased risk of vaccination failure should have specific antibody titers checked some time after the vaccination to determine whether their protection is adequate.
One way to protect patients from infections who are unresponsive to vaccination or who are not allowed to receive live vaccines is to vaccinate people with whom they have close daily contact. In this case, the STIKO recommends vaccination against influenza, pneumococci, varicella, measles, mumps and rubella.
Affected young and old
Rheumatism is an umbrella term for various diseases in which the immune system attacks the body's own tissue and thus causes inflammation. Doctors speak of the "rheumatic diseases". Both old and young are affected. The most common chronic joint inflammation is rheumatoid arthritis. In Germany alone, around 800,000 people suffer from it. Rheumatic diseases are chronic, often in phases. They cause severe, often long-lasting pain.
Sources:
Robert Koch Institute. Epidemiological Bulletin. August 25, 2014 / No 34.
Robert Koch Institute. Epidemiological Bulletin. September 30, 2005 / No 39.
Goldacker S. et al .: Vaccinations in adult patients with chronic inflammatory rheumatic diseases. Z Rheumatol. DOI 10.1007 / s00393-013-1155-4
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