The rheumatological patient with systemic autoimmune disease is a fragile and immunosuppressed patient and must therefore be vaccinated with all the vaccines recommended for this category of people, such as those against Covid, flu, herpes zoster, pneumococcus. For rheumatological patients all vaccines are recommended except those with live attenuated germs, which is why, as reported by the recommendations of the Italian Society of Rheumatology, the recombinant vaccine is preferable for Herpes zoster. In general, for all vaccinations, the recommendation is to administer them in the disease remission phase or in any case a few weeks before the start of immunosuppressive therapies.
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Vaccinations have the function of protecting us from infections or their serious consequences and they do so by stimulating the immune system. This stimulus can in rare cases lead to an exacerbation of the disease, usually very mild, which can be resolved in a short time with the appropriate pharmacological interventions.
That said, in the assessment to be made it is necessary to balance the risks and benefits deriving from vaccination. And, in the face of a very low probability of exacerbation, getting vaccinated offers undoubted benefits against the complications of the infectious diseases for which one gets vaccinated, especially for fragile patients such as those with rheumatological diseases. The risk-benefit ratio must be evaluated in the individual patient, in relation to various factors, including disease activity, drugs, comorbidities, age, habits, work activity. Furthermore, for those with rheumatological diseases it is very important to protect themselves by using personal protective equipment, such as masks, and washing their hands often.
* Gian Domenico Sebastiani is President of the Italian Rheumatology Society (SIR)