Speakers to Outline Vaccination Strategies for the Immunocompromised

Rates of vaccination against preventable diseases are declining in the general population. As a result, vaccines are an important part of caring for patients living with autoimmune diseases or recipients of organ transplants — patients already at high risk of infections. Yet immunosuppressive medications can significantly decrease the effectiveness of many vaccines.

In the Sunday, October 26, session Strength in Numbers: Using New Vaccines and Data to Protect the Immunocompromised, 9–10 a.m. in Room W190A-B of McCormick Place, Jin Kyun Park, MD, and Olivia Kates, MD, MA, will discuss the strategies researchers are developing to improve vaccine response in immunocompromised patients, and the ways recently developed and existing vaccines can be used in the preventative care of those patients.

With vaccination rates in decline across the country and potentially across the world, session moderator Amit Saxena, MD, MSc, Associate Professor and Director of the Rheumatology Clinical Research Program at NYU Grossman School of Medicine, said clinicians are afraid of the re-emergence of diseases such as measles, mumps, rubella, and polio. Yet the vaccines typically used against childhood diseases can cause infections in patients being treated with immunosuppressive medicines.

“Strategies to optimize vaccine response in this vulnerable population are essential,” said Dr. Park, Professor of Medicine, Division of Rheumatology, Seoul National University College of Medicine, and Division Chief, Division of Rheumatology, Seoul National University Hospital, South Korea. “While intrinsic factors, such as the disease-associated immune dysfunction, cannot be easily modified, vaccine responses can be improved by altering immunosuppressive treatment and optimizing vaccine antigens.”

Immunosuppressive medications must usually be paused during or after the administration of vaccines, but timing is critical.

Illustrating that fact, Dr. Park will discuss a series of randomized clinical trials of methotrexate, which is known to significantly reduce immunogenicity to vaccines, including seasonal influenza vaccines. The trials demonstrated that, after vaccination, a temporary one- or two-week interruption of methotrexate treatment markedly restored influenza vaccine responses to levels comparable to healthy individuals. By contrast, suspending methotrexate before vaccination had no such benefit.

Durability of vaccine protection is also of concern. Patients with systemic lupus erythematosus (SLE), for example, may have a decreased vaccine response due to profound intrinsic immune dysregulation, Dr. Park said.

“We recently demonstrated that the recombinant herpes zoster subunit vaccine induces both humoral and cellular immunity in SLE patients with an acceptable safety profile,” Dr. Park said. “However, cell-mediated immunity waned more rapidly than expected, raising concerns about the durability of protection in this population. If confirmed, this may necessitate earlier or more frequent booster vaccinations for sustained protection.”

A lot of what has been learned about vaccine protocols in the immunocompromised population comes from work done with organ transplant patients because of their need for multiple immunosuppressants when having a transplant, such as a kidney transplant, Dr. Saxena noted. During the session, Dr. Kates, Assistant Professor of Medicine in the Division of Infectious Diseases at Johns Hopkins School of Medicine, whose area of interest is patients with infectious complications of immunosuppression from transplantation and chemotherapy, will discuss the use of vaccines in the care of these patients.

The key takeaway from this session will be the importance of vaccinations to immunocompromised patients and why it is important for rheumatologists to understand the use of vaccines.

“We are all busy when we see patients and tend to focus on our disease. Sometimes we might want to leave things like vaccinations and that type of healthcare maintenance to the primary care doctors. But it’s very much part and parcel of the medicines that we use,” Dr. Saxena said.

On-demand access to recorded presentations will be available to registered attendees of ACR Convergence following the annual meeting through October 31, 2026.