Update on Smallpox and Flu Vaccinations

[Guest guest]

Special Report

December 16, 2002

Update on Smallpox and Flu Vaccinations

D Lockshin, MD

Attending Rheumatologist

Hospital for Special Surgery

Professor of Medicine

Weill Medical College of Cornell University

Director, Barbara Volcker Center for Women and Rheumatic Disease

At this time of year, patients with lupus, rheumatoid arthritis, and

other autoimmune diseases always ask, " Should I get a flu vaccination? "

At this time in our history, many patients are also asking, " Should I

get a smallpox vaccination? " These questions are really about three more

general questions:

1.. Are patients with autoimmune diseases unusually susceptible to flu

or smallpox?

2.. Can patients with autoimmune diseases be adequately protected if

they do receive a vaccination?

3.. Is the vaccine safe, in the sense that it can either cause

autoimmune disease to worsen or can cause complications by itself?

The brief answers, which are different depending on the disease and

vaccine, are:

1.. Patients taking immunosuppressive drugs, including prednisone or

other corticosteroids, and those with lung and/or kidney disease, are

unusually susceptible to flu.

Although little is known about susceptibility to smallpox, based on

what happens with the related varicella virus (which causes chickenpox

and shingles), patients on immunosuppressive drugs will likely be at

high risk for severe disease if they are exposed to smallpox.

For both diseases, the increased risk includes patients taking:

corticosteroids, such as prednisone and methylprednisolone (Medrol);

immunosuppressive drugs, such as methotrexate (Rheumatrex, Trexall),

azathioprine (Imuran), mycophenolate mofetil (CellCept),

cyclophosphamide (Cytoxan), leflunomide (Arava), cyclosporine

(Sandimmune, Neoral) and similar drugs; and biologics, such as the

TNF-alpha inhibitors infliximab (Remicade) and etanercept (Enbrel) and

the IL-1 inhibitor anakinra (Kineret).

2.. Flu vaccine successfully protects patients with rheumatic disease,

if they are not taking high doses of immunosuppressive drugs.

3.. Flu vaccine does not worsen rheumatic disease and is generally

well tolerated by rheumatic disease patients.

However, the smallpox vaccine now is use is a live virus vaccine. This

virus will spread rapidly in the bodies of patients whose immune systems

are weakened by drugs or disease, and in patients with skin rashes. The

currently available smallpox vaccine will be dangerous to patients with

immune system disease, to those taking immunosuppressive drugs, to those

with severe skin rashes, and to those whose spleens have been removed.

Such patients should not receive this vaccine. (Other smallpox vaccines

now in development do not contain live viral particles and may be safer,

but this cannot be confirmed until clinical trials are completed.)

Another important point is that the vaccination site sheds virus for up

to two weeks; people in close contact with persons vaccinated, for

instance family members, can become ill. Thus people living in the same

house as persons with suppressed immune systems, if vaccinated, are

potentially dangerous to their housemates.

http://www.hss.edu/Conditions/Rheumatic-Diseases---Therapeutics/Vaccinations

I'll tell you where to go!

Mayo Clinic in Rochester

http://www.mayoclinic.org/rochester

s Hopkins Medicine

http://www.hopkinsmedicine.org