Bühler Silja, Eperon Gilles, Ribi Camillo, Kyburz Diego, van Gompel Fons, Visser Leo G, Siegrist Claire-Anne, Hatz Christoph
Department of Public Health, Division of Infectious Disease / Travel Clinic, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland.
Service de Médecine Tropicale et Humanitaire, Geneva University Hospitals, Geneva, Switzerland.
Swiss Med Wkly. 2015 Jul 28;145:w14159. doi: 10.4414/smw.2015.14159. eCollection 2015.
The number of individuals with autoimmune inflammatory rheumatic diseases (AIIRDs) treated with immunosuppressive drugs is increasing steadily. The variety of immunosuppressive drugs and, in particular, biological therapies is also rising. The immunosuppressants, as well as the AIIRD itself, increase the risk of infection in this population. Thus, preventing infections by means of vaccination is of utmost importance. New Swiss vaccination recommendations for AIIRD patients were initiated by the Swiss Federal Office of Public Health and prepared by a working group of the Federal Commission for Vaccination Issues as well as by consultation of international experts.
A literature search was performed in electronic databases (Cochrane, Medline, PubMed, Embase). In addition, unpublished literature was identified through a targeted website search of relevant organisations and international conferences dealing with vaccination, infectious diseases and rheumatology.
Although data are scarce, the following main points were retrieved from the literature. Inactivated vaccines are safe, but their immunogenicity may be reduced in AIIRD patients, especially if they are under immunosuppressive therapy. Rituximab and abatacept appear to reduce significantly immune responses after vaccination. Live vaccines are generally contraindicated under immunosuppressive therapy owing to safety concerns. Specific exceptions, as well as time intervals for the administration of live vaccines after interruption of an immunosuppressive therapy, have been formulated in this article.
More evidence regarding the immunogenicity and safety of vaccinations in AIIRD patients under various therapies is needed. Vaccination recommendations should be updated on a regular basis, as more scientific data will become available.
接受免疫抑制药物治疗的自身免疫性炎性风湿性疾病（AIIRDs）患者数量在稳步增加。免疫抑制药物的种类，尤其是生物疗法也在增多。免疫抑制剂以及AIIRD本身都会增加该人群的感染风险。因此，通过接种疫苗预防感染至关重要。瑞士联邦公共卫生局发起了针对AIIRD患者的新疫苗接种建议，并由疫苗接种问题联邦委员会的一个工作组以及咨询国际专家后制定。
在电子数据库（Cochrane、Medline、PubMed、Embase）中进行文献检索。此外，通过对处理疫苗接种、传染病和风湿病的相关组织及国际会议的目标网站搜索，识别未发表的文献。
尽管数据匮乏，但从文献中检索到以下要点。灭活疫苗是安全的，但其免疫原性在AIIRD患者中可能会降低，尤其是在接受免疫抑制治疗的患者中。利妥昔单抗和阿巴西普似乎会显著降低接种疫苗后的免疫反应。由于安全问题，活疫苗在免疫抑制治疗期间通常是禁忌的。本文已制定了特定的例外情况以及免疫抑制治疗中断后接种活疫苗的时间间隔。
需要更多关于接受各种治疗的AIIRD患者接种疫苗的免疫原性和安全性的证据。随着更多科学数据的出现，疫苗接种建议应定期更新。
