Screening and Vaccinations in Patients Requiring Systemic Immunosuppression: An Update for Dermatologists

Abstract

Immunomodulatory agents are becoming an increasingly important tool in the dermatologist's armamentarium against autoimmune and auto-inflammatory conditions. This review addresses the guidelines for vaccination and screening studies prior to the initiation of immunomodulatory agents. Included are discussions of vaccination schedules, hepatitis vaccination and screening, tuberculosis screening, and specific screening recommendations for antimalarials, azathioprine, cyclosporine, methotrexate, mycophenolate mofetil, tumor necrosis factor-α inhibitors, and newer medications like apremilast and tofacitinib.

Vaccination in neuromyelitis optica spectrum disorders: Friend or enemy?

“…However, immunocompromised patients are particularly vulnerable to bacteria and viruses existing in live-attenuated vaccines. Therefore, live-attenuated vaccines are usually contraindicated in patients taking immunosuppressive agents or some immunomodulating agents (Goyal et al, 2015). The safety of virus-vector vaccines in immunocompromised patients remains unclear so far.…”

“…Candidate COVID-19 vaccines include viral protein and nucleic acid vaccines, artificial antigen-presenting cell vaccines, surrogate viral vector vaccines, and live-attenuated vaccines (Prompetchara et al, 2020;Thanh Le et al, 2020;Wang et al, 2020). We can assume that it is safe to administer viral or immunotherapy-inactivated protein vaccines to NMOSD patients, whereas we advise those who receive immunomodulators to avoid all types of live vaccines (Goyal et al, 2015). The safety of NMOSD patients using viral vector vaccines, RNA vaccines, and (Huang et al, 2018).…”

Vaccinations in dermatology

“…Die Durchführung von Impfungen bei vorbestehenden Hautkrankheiten und insbesondere gleichzeitiger immunsuppressiver oder -modulierender Medikation muss im Einzelfall kritisch erwogen werden [4,10,13,15,21,34,37]. Vorherige Impfungen sollten erfragt werden, bestenfalls sind sie schriftlich im Impfpass dokumentiert.…”

Inmunosupresores no biológicos en dermatología

“…La mayoría de los inmunosupresores no biológicos causan algún grado de compromiso inmunológico y pueden asociarse con la reactivación de enfermedades infecciosas como estrongiloidiasis, herpes zóster, tuberculosis, hepatitis B (HBV) y hepatitis C (HCV), además de complicaciones en pacientes portadores del virus de la inmunodeficiencia humana (HIV) 31,32 . El dermatólogo debe evaluar los factores de riesgo en cada paciente y considerar realizar una tamización para estas enfermedades (tabla 6).…”