Journal Information
Vol. 8. Issue 4.
Pages 229 (July - August 2012)
Vol. 8. Issue 4.
Pages 229 (July - August 2012)
Letter to the Editor
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Pneumococcal Vaccine in Patients With Rheumatoid Arthritis
Vacuna frente al neumococo en pacientes con artritis reumatoide
Ignacio Hernández-García
Corresponding author

Corresponding author.
, Alfonso Escribano Hernández
Servicio de Medicina Preventiva y Salud Pública, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
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Mr. Editor:

We read with interest the article by López Garrido et al. on vaccines and chemoprophylaxis in patients with rheumatoid arthritis (RA). In it the authors present a vaccination schedule that included the 23-valent pneumococcal polysaccharide vaccine with booster shots every 3–5 years.1

RA patients are treated with immunosuppressive drugs and this fact determines that such persons are already included in the population group that has the indication for the administration of this vaccine in our country.2 However, revaccination is not routinely recommended, so the Ministry of Health2 has established only 1 booster dose in persons vaccinated more than 5 years prior under the following circumstances: (a) people over 65, who received the first dose before age 65, (b) people at high risk of serious pneumococcal infection (asplenia, chronic renal failure, nephrotic syndrome, or other conditions associated with immunosuppression). Similarly, various international institutions such as the Advisory Committee on Immunization Practices recommended revaccination no more than once because there is insufficient data regarding its clinical benefit, the degree and duration of protection, and safety of administering this vaccine on more than 3 occasions.3

In the studies reviewed by Lopez Garrido on pneumococcal vaccination in patients with RA4-10, 1 of the exclusion criterion considered was having previously received the vaccine without specifying the number of years4 and the receipt in the 35 and 5 years prior to beginning of the study6,7; there was also had 3 studies where such vaccination history was not described as an exclusion criteria.8–10 In any case, none of the works provide specific results in terms of immunogenicity and safety of the pneumococcal vaccine in patients with a history of receiving such a vaccination.4–10 Therefore, and in the absence of evidence from the literature reviewed by Lopez Garrido on the efficacy and safety of pneumococcal vaccination administered every 3–5 years in patients with RA, the authors consider it necessary to modify the proposed immunization schedule and assume the current official recommendations to administer a single booster dose 5 years after being given the first.2

B.C. Garrido López, M.V. Navarro Compain, F. Navarro Sarabia.
Vacunas y quimioprofilaxis en artritis reumatoide: ¿podría plantearse un calendario de vacunación?.
Reumatol Clin, 7 (2011), pp. 412-416
Grupo de trabajo de vacunación de adultos de la ponencia de programas, registro de vacunaciones.
Vacunación en adultos.
1.a ed., Ministerio de Sanidad y Consumo, (2004),
Centers for Disease Control and Prevention (CDC); Advisory Committee on Immunization Practices.
Updated recommendations for prevention of invasive pneumococcal disease among adults using the 23-valent pneumococcal polysaccharide vaccine (PPSV23).
MMWR Morb Mortal Wkly Rep, 59 (2010), pp. 1102-1106
O. Elkayam, D. Paran, D. Caspi, I. Litinsky, M. Yaron, D. Charboneau, et al.
Immunogenicity and safety of pneumococcal vaccination in patients with rheumatoid arthritis or systemic lupus erythematosus.
Clin Infect Dis, 34 (2002), pp. 147-153
C.O. Bingham 3rd, R.J. Looney, A. Deodhar, N. Halsey, M. Greenwald, C. Codding, et al.
Immunization responses in rheumatoid arthritis patients treated with rituximab: results from a controlled clinical trial.
Arthritis Rheum, 62 (2010), pp. 64-74
J.L. Kaine, A.J. Kivitz, C. Birbara, A.Y. Luo.
Immune responses following administration of influenza and pneumococcal vaccines to patients with rheumatoid arthritis receiving adalimumab.
J Rheumatol, 34 (2007), pp. 272-279
S. Visvanathan, G.F. Keenan, D.G. Baker, A.I. Levinson, C.L. Wagner.
Response to neumococcal vaccine in patients with early rheumatoid arthritis receiving infliximab plus methotrexate or methotrexate alone.
J Rheumatol, 34 (2007), pp. 952-957
M. Schiff, A. Kaell, G. Vratsanos, K. Bahrt.
Response to pneumococcal vaccine in rheumatoid arthritis patients with an inadequate response to anti-TNF therapy treated with abatacept in the ARRIVE trial.
Ann Rheum Dis, 66 (2007), pp. 437
M.C. Kapetanovic, T. Saxne, J.A. Nilsson, P. Geborek.
Influenza vaccination as model for testing immune modulation induced by anti-TNF and methotrexate therapy in rheumatoid arthritis patients.
Rheumatology, 46 (2007), pp. 608-611
T. Tsuru, K. Terao, M. Suzaki, H. Nakashima, T. Amamoto, A. Akiyama, et al.
Immune response to pneumococcal vaccine in patients with rheumatoid arthritis under IL-6 receptor inhibition therapy with tocilizumab.
Arthritis Rheum, 56 (2007), pp. S423

Please cite this article as: Hernández-García I, Escribano Hernández A. Vacuna frente al neumococo en pacientes con artritis reumatoide. Reumatol Clin. 2012;8:229.

Copyright © 2011. Elsevier España, S.L.. All rights reserved
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