Systemic Lupus Erythematosus, Immunosuppression, and Vaccinations: Focus on Human Papillomavirus Vaccination

Introduction

The relation between autoimmune diseases and vaccines is controversial. Several case studies have reported that vaccination triggered or aggravated autoimmune disease.1–4 Despite these case reports, no study so far has established a definite relation between vaccinations and the development of autoimmune diseases.5–8 In addition, the safety and efficacy of vaccinations in patients with established autoimmune disease is a matter of debate. Most nonlive composite vaccines, however, do not seem to aggravate established autoimmune diseases. The immunogenicity of vaccines may be impaired when the immune system is suppressed by medication, depending on the type and dose of the immunosuppressive drug.4, 5, 9 Significant developments in the treatment with these immunosuppressive drugs in patients with autoimmune diseases have greatly improved their outcome. One of the obvious downsides of such treatments is the elevated risk of bacterial and viral infections due to therapy-induced immunosuppression.10–13 Of course, some of these infections can be prevented through vaccination.

Abstract

Patients with systemic lupus erythematosus (SLE) may be at higher risk of infections, due to the underlying disease or immunosuppressive treatment. Vaccinations against several pathogens may prevent these infections. The vaccine against human papillomavirus (HPV) serotype 16 and 18 has been developed to prevent chronic HPV infections, one of the causative agents for cervical cancer and its premalignant lesions. The purpose of this study is to review the safety and efficacy of vaccination in SLE patients, especially the pneumococcal and influenza vaccines. In addition, we wanted to assess whether vaccination against HPV in women with SLE prevents cervical cancer and premalignant lesions. A literature search in Medline (PubMed) was performed. We pound that nonlive vaccines can be used safely in SLE, but several drugs used for control of the disease can reduce the immunogenicity. Cervical cancer and premalignant lesions are more prevalent in patients with SLE. This underlines the necessity of prevention of chronic HPV infections in these patients. The HPV vaccine has proven to be immunogenic and safe in the general population, although long-term efficacy in preventing cancer is still unknown. No studies have been performed on HPV vaccination in SLE patients. Circumstantial evidence in favor of HPV vaccination is that most nonlive composite vaccines appear to be immunogenic and safe in patients with quiescent SLE in conclusion. Vaccination of SLE patients with the HPV vaccine may be recommended. Studies on short-term safety and immunogenicity of the HPV vaccine in SLE patients are necessary. Subsequently, a long-term cohort study has to prove whether the HPV vaccine actually reduces the incidence of cervical cancer and premalignant lesions in patients with SLE.

Keywords

vaccination, systemic lupus erythematosus, human papillomavirus, cervical cancer