Mercado reviewed reasons why some physicians are reluctant to vaccinate a patient with systemic lupus erythematosus (SLE). The author is from Hospital General de Mexicali and Universidad Autonoma de Baja California in Mexico.
Reasons why a physician may be reluctant to vaccinate a patient with SLE:
(1) the possibility of inducing a flare-up of disease activity or stimulating autoantibody formation
(2) the possibility that the patient will not develop protective antibodies
Another reason is that there may be concern about the risk of using a live vaccine in an immunosuppressed patient.
Observations:
(1) A significant disease flare-up is uncommon following vaccination.
(2) The vast majority of patients develop a protective immune response.
(3) Infection is a major source of morbidity and mortality in a patient with SLE.
(4) Many vaccines are now prepared with recombinant antigens.
Antibody titers should be monitored annually since the antibodies may fall sooner than in a normal patient, but this is responsive to revaccination.
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