Vaccination strategies for the rheumatologist Save
Dr. Sheila Reyes reports from the 2026 EULAR Congress in London
Transcription
Hi, I'm Sheila Reyes from the Philippines reporting here in London for EULAR 2026. Dr. Pedro Machado's talk on vaccination strategies in autoimmune and immunosuppressed populations was very informative and relevant. So I decided to share my key takeaways from his lecture in this video.
Vaccinate and protect. That's the main message. This is the modern evidence-based approach, especially with data supporting the fact that non-live vaccines do not trigger worsening of underlying disease. Upon disease diagnosis, make a baseline assessment of the patient's vaccination status.
Dr. Machado presented a quick guide to vaccination highlighting three categories. The first category includes the universally indicated vaccines and should be of top priority, and these include the influenza, pneumococcal vaccines, SARS-CoV-2 vaccines, and the recombinant zoster vaccines.
Meanwhile, the second category consisted of vaccines against hepatitis A, B, HPV, and tetanus toxoid, and giving these vaccines should be dictated by epidemiologic risk and should be context dependent. So for example, for hepatitis B vaccination, it is critical to assess post-vaccination anti-HBs titers because an HBs booster is required for documented nonresponders.
Now the third category in that vaccination guide involves vaccines that are contraindicated and generally avoided during immunosuppression, and these vaccines include yellow fever, MMR, oral polio, and the live attenuated zoster vaccine.
Finally, through a vaccination program, Dr. Machado emphasized that the timing of vaccination relative to immunosuppression kinetics is a stronger determinant of success than baseline disease activity. For methotrexate, for example, a one to two week hold post-vaccination based on flare tolerance is recommended, and for patients on B cell depleters, timing should not be based on fixed calendar intervals but rather through alignment with B cell repopulation kinetics.
Now due to a high risk of herpes zoster infection, administration of recombinant vaccine prior to therapy is highly recommended. Patients with autoimmune and inflammatory diseases carry a high burden of risk for infections. And as rheumatologists, we carry this responsibility of educating our patients and advocating for timely and effective vaccination.
Follow me on X at RheumNow and tune in to RheumNow.com for more updates on EULAR 2026.
Vaccinate and protect. That's the main message. This is the modern evidence-based approach, especially with data supporting the fact that non-live vaccines do not trigger worsening of underlying disease. Upon disease diagnosis, make a baseline assessment of the patient's vaccination status.
Dr. Machado presented a quick guide to vaccination highlighting three categories. The first category includes the universally indicated vaccines and should be of top priority, and these include the influenza, pneumococcal vaccines, SARS-CoV-2 vaccines, and the recombinant zoster vaccines.
Meanwhile, the second category consisted of vaccines against hepatitis A, B, HPV, and tetanus toxoid, and giving these vaccines should be dictated by epidemiologic risk and should be context dependent. So for example, for hepatitis B vaccination, it is critical to assess post-vaccination anti-HBs titers because an HBs booster is required for documented nonresponders.
Now the third category in that vaccination guide involves vaccines that are contraindicated and generally avoided during immunosuppression, and these vaccines include yellow fever, MMR, oral polio, and the live attenuated zoster vaccine.
Finally, through a vaccination program, Dr. Machado emphasized that the timing of vaccination relative to immunosuppression kinetics is a stronger determinant of success than baseline disease activity. For methotrexate, for example, a one to two week hold post-vaccination based on flare tolerance is recommended, and for patients on B cell depleters, timing should not be based on fixed calendar intervals but rather through alignment with B cell repopulation kinetics.
Now due to a high risk of herpes zoster infection, administration of recombinant vaccine prior to therapy is highly recommended. Patients with autoimmune and inflammatory diseases carry a high burden of risk for infections. And as rheumatologists, we carry this responsibility of educating our patients and advocating for timely and effective vaccination.
Follow me on X at RheumNow and tune in to RheumNow.com for more updates on EULAR 2026.
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