Flu Vaccine and Scleroderma
By Thomas Medsger, M.D. (originally
published in "Best of the Beacon" 1999)
A number of questions with regard
to flu occur to patients with scleroderma and other
diseases affecting the immune system. Will getting the
flu activate scleroderma? Will a flu shot prevent the
flu and other infections? Is there any risk of a scleroderma
flare from getting a flu shot? Which scleroderma patients
should consider getting a flu shot?
 |
| Thomas
Medsger, Jr., M.D. |
In patients with systemic lupus erythematosus,
there is some evidence that infections can trigger a
disease flare. This is not the case in persons with
scleroderma, so there is no particular risk that a flu
shot will worsen scleroderma. The vaccine is safe since
it is composed of killed rather than live virus particles.
Persons with egg allergy should not receive the flu
vaccine, since the virus used to prepare the vaccine
is grown in eggs. Also, if you have or suspect that
you have an infection, it is best to wait until the
infection has passed before receiving a flu shot. Some
patients develop a low-grade fever and muscle aching,
particularly at the site of the shot, during the first
several days after the flu injection, but serious reactions
are extremely rare.
The flu vaccine is newly prepared
each year, based on the particular types or "strains"
of flu that caused the largest number of cases in the
previous year. Thus, the most common 1994-1995 "flu
bugs" are used to prepare the 1995-1996 vaccine.
Patients may therefore still develop flu caused by a
strain of virus not included in the vaccine. The best
time to get the flu shot is in the fall of each year
(late September or early October), when the vaccine
becomes available. Even January or February is not too
late to receive protection for the end of the flu season.
It is recommended that all patients
with chronic systemic diseases get flu shots. Therefore,
all persons with systemic sclerosis (not localized forms
of scleroderma) should receive an annual flu vaccination.
The primary problem with getting the flu is that it
is capable of causing pneumonia. Scleroderma patients
with any form of pre-existing lung disease are especially
at risk. Furthermore, viral infections such as influenza
are frequently followed by bacterial infections, which
can be even more damaging. Patients who produce watery,
clear phlegm during a viral illness are at risk to next
develop thick/discolored (green, yellow, brown, or gray)
phlegm, which may be a sign of bacterial infection.
If you have a cold or other respiratory infection that
results in discolored phlegm, be sure to ask your physician
if you need antibiotic treatment.
The most common bacterial pneumonia
is pneumococcal pneumonia. A specific vaccine (Pneumovax)
is available, which is capable of producing immunity
to many common strains of Pneumococcus. This protection
lasts a minimum of five years after which time re-vaccination
is necessary. All patients with scleroderma lung disease
should also get Pneumovax, especially if they are receiving
medications that are recognized to dampen the immune
system's capability to respond to infections. Such medications
include cortisone, methotrexate, Imuran, Cytoxan, and
a number of others.
For each scleroderma patient, a physician
must make a decision about whether the flu and Pneumovax
vaccines should or should not be given and must order
the vaccinations. I have provided general guidelines
above, but each physician has his/her own approach to
this issue. You should discuss this topic with your
rheumatologist or primary care physician. |
