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?

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.