Rheumatoid Arthritis and Vaccines

I recently got a new job in a hospital setting and as a result all of my immunizations had to be checked to make sure I was not susceptible to any infectious diseases. As a child, I was vaccinated by my pediatrician with the Hep B series, MMR and all the other childhood vaccinations. I have always been vigilant about receiving my yearly flu shots and occasional pneumococcal vaccinations as well. As a person with an autoimmune disease, who is also on immunosuppressant medications (Enbrel),  I have always been on time with my vaccinations and very careful about washing my hands or my contact with people with infections.

So needless to say, I was surprised when I was found to be susceptible to Hepatitis B and Rubella. As I mentioned, whenever you work in hospitals, you need to demonstrate immunity to Hepatitis B in case you have contact with a patient who may carry it. In 2011, I worked in a long-term acute care setting and was found to be susceptible to Hepatitis B. After conversations with my rheumatologist, I received a Hep B booster (one shot) and never really throughout about it again. Until recently..

I was again found susceptible to Hepatitis B in January, only 4 years after my original booster. After more conversations, it was concluded that once again there is not a lot of research about people on immunosuppressant medications and their antibody response to vaccinations. It is thought that the immunosuppressant treatment (biologic medications, chemotherapy, etc.) may decrease their bodies ability to effectively make antibodies to protect themselves from infection from the diseases. Furthermore, even if their body is able to make the appropriate antibodies, the level of protective antibodies may decline quicker than their non-immunosuppressed peer, thus resulting in more frequent need for additional vaccination boosters. (Medscape, 2001)

Fortunately, Hepatitis B is not a live vaccine and only carries part of the disease thus weakening side effects or chance of infection, (vaccine types) and is therefore safe for people on immunosuppressant therapies. So I am once again completing the series of shots in hope to boost my immune response.

However, two weeks later, my test for Rubella (or German Measles) came back “Equivocal” or inconclusive. Meaning they were unable to determine if I had protection or not from this disease. Now I was starting to be worried. Why was my body losing all of it’s immunity! After discussing with my rheumatologist again, we decided it may be time to see an infectious disease specialist for further advice. The MMR vaccine (which I had received as an infant) is a live vaccine, which mean it contains much more of the active virus than a inactivated vaccination. Live vaccines do not make healthy people sick or cause any diseases such as Autism (a post for another day!) However, people with weaker immune systems may demonstrate more symptoms or illnesses.

So, receiving the Rubella vaccine would mean not taking my Enbrel for up to a month! This was not something, I wanted to do unless absolutely necessary. At my next medical appointment, I asked to have my immunity to Rubella re-checked, since the initial test was not clear. None of my health professionals had mentioned this even as an option, but I wanted to make absolutely sure it was negative before pursuing more specialists. And it came back positive this time! Fortunately, this means I did not have to stop my Enbrel or see another specialist, for now…

I wanted to share this story because I’m sure some of you have had similar experiences! There definitely needs to be more research on vaccinations and their effect in people with autoimmune diseases. Especially now that some people are choosing to not vaccinate their children, thus exposing many people to potential infections, outbreaks and serious illnesses.

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