Vaccination for patients with rheumatoid arthritis: a pressing need

EDITORIAL

Vaccination for patients with rheumatoid arthritis: a pressing need

Claiton Viegas Brenol; Gecilmara Salviato Pileggi

^IAdjunct professor, Department of Internal Medicine, Medical School, Universidade Federal do Rio Grande do Sul - UFRGS; Coordinator of the Rheumatoid Arthritis Outpatient Clinic, Rheumatology Service, Hospital de Clínicas de Porto Alegre - HCPA

^IIPhysician, Pediatric Rheumatology Sector, Pediatric Department, Hospital das Clínicas, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo - HC-FMRP-USP

In the city of Rio de Janeiro, at the beginning of the 20th century, the physician Oswaldo Cruz, a Brazilian science pioneer, conducted the fi rst vaccination campaign in Brazil.¹ In his fi ght to promote mass vaccination against smallpox, the sanitarian faced innumerous obstacles, such as the population's ignorance about the vaccine and a fierce political opposition originated from several sectors of the society, including his medical colleagues. The dissemination of rumors against the vaccine collaborated with the almost total lack of adhesion of the population of the city of Rio de Janeiro to the vaccination campaign. That, along with several protests against the government, generated a social convulsion that culminated with the Vaccine Revolt, a true urban battle with dozens of deaths and hundreds of wounded people. Thousands of other victims of the Vaccine Revolt would appear in the following years, with the suspension of obligatory vaccination and advance of the epidemic.

More than 100 years after the Oswaldo Cruz's initiative, the lessons learned over the decades led to the development of a successful and internationally recognized immunization program in Brazil. However, a significant part of the population with chronic inflammatory diseases, despite being more susceptible to infections, still remains unprotected.^2,3 That is the case of patients with rheumatoid arthritis (RA).

Based on the current scientific knowledge, one can state that patients with RA, in addition to being at higher risk for infections,⁴ have an increased infection-related mortality, up to ten times that of the general population.⁵ Of the factors implicated in the susceptibility to infections, the earlier and more intense exposure to immunosuppressive drugs and biologics stands out.^6,7

Considering that vaccination is the preventive measure with the greatest impact on reducing the occurrence of infection at any age group, it is mandatory to review and update the vaccine chart of patients with rheumatic disorders. In addition, knowing that the specific prescription of vaccines during the clinical follow-up of those patients has a positive impact on the increase of vaccine coverage, work groups of specialists have been formed to establish vaccine guidelines in rheumatology, reflecting an increasing concern worldwide in recent years.^8,9

The Rheumatoid Arthritis Committee of the Brazilian Society of Rheumatology has developed the consensus published in this journal¹⁰ aimed at summarizing the recommendations for vaccinating patients with RA, considering the epidemiological scenario of endemic diseases in Brazil, such as yellow fever. Thus, the 2012 Brazilian Society of Rheumatology Consensus on vaccination of patients with rheumatoid arthritis was aimed at standardizing and encouraging the indication of immunization by rheumatologists and other professionals who manage those patients.

Finally, we believe that the implementation of those recommendations is perfectly feasible in Brazil. Therefore, it is fundamental to promote continuous medical education and patients' instruction, and to review the subject periodically, so that an updated approach based on scientific evidence can be incorporated into clinical practice.

REFERENCES

1. Scliar M. Oswaldo Cruz: entre micróbios e barricadas. Rio de Janeiro: RelumeDumará; 1996.

2. Desai SP, Turchin A, Szent-Gyorgyi LE, Weinblatt M, Coblyn J, Solomon DH, et al. Routinely measuring and reporting pneumococcal vaccination among immunosuppressed rheumatology outpatients: the first step in improving quality. Rheumatology (Oxford) 2011;50(2):366-72.

3. Marchand-Janssen C, Loulergue P, Mouthon L, Mahr A, Blanche P, Deforges L, et al. Patients with systemic inflammatory and autoimmune diseases are at risk of vaccine-preventable illnesses. Rheumatology (Oxford) 2011;50(6):1099-105.

4. Falagas ME, Manta KG, Betsi GI, Pappas G. Infection-related morbidity and mortality in patients with connective tissue diseases: a systematic review. ClinRheumatol 2007;26(5):663-70.

5. Naz SM, Symmons DP. Mortality in established rheumatoid arthritis. Best Pract Res ClinRheumatol 2007;21(5):871-83.

6. Tak PP, Kalden JR. Advances in rheumatology: new targeted therapeutics. Arthritis Res Ther 2011;13(Suppl 1):S5.

7. da Mota LM, Cruz BA, Brenol CV, Pereira IA, Rezende-Fronza LS, Bertolo MB, et al. 2012 Brazilian Society of Rheumatology Consensus for the treatment of rheumatoid arthritis. Rev Bras Reumatol 2012;52(2):152-74.

8. Silva CAA, Terreri MT, Barbosa CM, Hilário MO, PIllegi GS, et al. Consenso de imunização para crianças e adolescentes com doenças reumatológicas. Rev Bras Reumatol 2009; 49(5):562-89.

9. van Assen S, Agmon-Levin N, Elkayam O, Cervera R, Doran MF, et al. EULAR recommendations for vaccination in adult patients with autoimmune inflammatory rheumatic diseases.Ann RheumDis 2011;70(3):414-22.

10. Brenol CV, da Mota LMH, Cruz BA, Pileggi GS, Pereira IA, Rezende LS, et al. Consenso 2012 da Sociedade Brasileira de Reumatologia sobre vacinação em pacientes com artrite reumatoide. Rev Bras Reumatol 2013;53(1):XX-XX

Publication Dates

• Publication in this collection
  09 Apr 2013
• Date of issue
  Feb 2013