Vaccinations Strategies in Autoimmune and Inflammatory Diseases Save

Infection remains an important threat to patients with autoimmune and inflammatory diseases. Mitigating this risk is a core duty of the rheumatologist—one that requires us to actively educate patients and advocate for timely vaccination strategies. This article reviews important highlights on the session, “Prevention and treatment of Infections in rheumatic diseases” during the APLAR 2026 Congress. 

In his talk, Prof. Chang-Hee Suh illustrated the increasing burden of infection in rheumatic disease with serious infections making up the tip of the iceberg while a significant number are non-serious infections. However, serious or not, infections are a leading cause of mortality among patients with rheumatic disease with bacteria, viruses (HBV/HCV/VZV), tuberculosis and NTM and P. pneumocystis as the most important pathogens implicated. He also reiterated the fact that targeted therapies exhibit distinct pathogen signatures i.e. TNFis triggering latent tuberculosis reactivation and JAKis driving herpes zoster reactivation, therefore, baseline screening and prophylaxis is essential in targeted therapy. 

Meanwhile, by discussing the importance of preventing infections through vaccinations, Prof. Joon Young Song established reasons why this is an important component of AIRD management: patients are at increased risk of infection and confers significantly severe outcomes leading to higher risk of hospitalizations, ICU admissions and mortality. 

In his talk, he presented core vaccination principles and revisited both the EULAR and ACR guidelines for vaccination of patients with AIRD. As a clinician, one of the relevant and practical points that I want to share from his talk was on vaccination schedule particularly: (a) Influenza – give annually, ideally before the influenza season; (b) Pneumococcal – PCV21 or PCV20 once, early after diagnosis of AIRD; (c) recombinant herpes zoster – 2 doses at month 0 then 2-6 months after, to be given prior to immunosuppression and (d) HPV  - 3 doses at months 0, 1-2, and 6, given prior to immunosuppression. 

Concluding the session, Prof. Jin Kyun Park discussed optimizing vaccine responses in rheumatic diseases. 

One focus of his presentation was the use of methotrexate and vaccination in RA. His talk anchored on an earlier RCT (Park JK et al, ARD 2017) which he co-authored that investigated whether temporary discontinuation of methotrexate (MTX) improves the efficacy of seasonal influenza vaccination in patients with RA. Participants on a stable dose of methotrexate were randomly assigned to: group 1 – continue MTX, group 2 – suspend MTX 4 weeks before vaccination, group 3 – suspend MTX for 2 weeks before and 2 weeks after vaccination or group 4 – suspend MTX for 4 weeks after vaccination. All the patients were vaccinated with trivalent influenza vaccine. Their results showed that group 3 exhibited the highest vaccine response concluding that the temporary discontinuation of methotrexate (particularly 2 weeks after vaccination) improved the immunogenicity of seasonal influenza vaccination. Prof. Jin Kyun Park adds that vaccine response (to influenza and COVID-19) can be improved by the temporary withdrawal of DMARDs, increasing antigen dose or performing frequent boosting. Ultimately, driving home a clear call to action: for vaccines to work, we must use them. 

The burden of infections carries profound clinical and societal consequences for patients with AIRDs. With the expanding evidence of the benefits of vaccinations and vaccine-preventable diseases, rheumatologists should initiate vital conversations with their patients to ensure vaccinations are embedded into a truly comprehensive care plan.