Review
From the Medical Board of the National Psoriasis Foundation: Vaccination in adult patients on systemic therapy for psoriasis

https://doi.org/10.1016/j.jaad.2013.06.046Get rights and content

Patients with moderate to severe psoriasis often require systemic immunomodulatory medications that place them at risk for infection. Vaccination is a proven strategy to reduce infections. However, vaccination rates among patients with inflammatory autoimmune conditions, including psoriasis, remain low. We review the literature regarding vaccine-preventable illness and vaccinations commonly used in the United States in patients older than 18 years on immunosuppressive therapies that are used in the treatment of psoriasis. The medical board of the National Psoriasis Foundation recommends that dermatologists counsel patients on updating vaccinations in accordance with recommendations of the Advisory Committee for Immunization Practices as any measures taken to prevent infection can increase the safety of immunomodulatory therapies.

Section snippets

Types of vaccines

Key points

  1. Live vaccines are relatively contraindicated in patients on immunosuppressive therapy. However, early data suggest that some live vaccines may be safe. Further studies are needed and may alter recommendations.

  2. Although inactivated vaccines are safe for patients on immunomodulatory therapy, vaccine response may be suboptimal.

  3. Additional personal and medical risk factors are important to consider in vaccine counseling.

The 2 categories of immunizations are live vaccines and inactivated vaccines (

Therapy-specific recommendations

Key points

  1. Infections are a major cause of morbidity and mortality in immunosuppressed patients.

  2. Vaccination status and advising should be incorporated in treatment of patients with moderate to severe psoriasis when immunosuppressive therapy is anticipated.

  3. Further studies are needed regarding the safety and efficacy of vaccines in patients with psoriatic disease on immunomodulatory medications to provide accurate therapy-specific immunization recommendations.

Immunization status and vaccine-preventable

Immunization of household contacts

Key points

  1. Immunization of household contacts is strongly recommended to decrease exposure to infections.

  2. Smallpox and oral polio vaccines are contraindicated in household contacts of patients on immunomodulatory medications. However, risks and benefits must be weighed when counseling on administration of other live vaccines in household contacts of profoundly immunosuppressed patients.

  3. Other live vaccines are generally recommended in household contacts of moderately immunosuppressed patients as preventing

Summary

Advances in therapeutic options for patients with psoriatic disease will hopefully continue to be a reality. Initial trials may not fully elucidate the risk of vaccine-preventable illness in patients on these emerging therapies. Postmarketing data often take time to bring such associations to light. Thus, when approaching patients with moderate to severe psoriasis, early discussion and counseling may prevent treatment delays. Dermatologists should familiarize themselves with general vaccine

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    Funding sources: None.

    Disclosure: Dr Van Voorhees has served on advisory boards for Amgen, Abbvie, Genentech, Warner Chilcott, Janssen, Novartis, and LEO Pharma; has been an investigator and consultant for Amgen and Abbvie; and has been a speaker for Amgen, Abbvie, and Janssen Biotech. She also has owned stock and stock options for Merck. Drs Wine-Lee, Keller, Wilck, and Gluckman have no conflicts of interest to declare.

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