Ask the Expert: Is the Flu Shot Recommended If You Have Sjögren’s?

Is the flu shot recommended if you have Sjögren's?

As a patient with Sjögren’s you are wondering about whether or not you should receive a flu vaccine this year. I do believe it is important to gain some knowledge about the flu.

First let’s learn about last year’s flu season. The 2018- 2019 influenza season was moderately severe, with activity beginning to increase in November, peaking in mid-February, and returning to below baseline in mid-April.

The 21-week season was the longest in 10 years. CDC estimates that from October 1, 2018 through May 4, 2019, there have been 531,000– 647,000 flu-related hospitalizations and 36,400–61,200 flu deaths.

People with flu can spread it to others up to about 6 feet away. Most experts think that flu viruses spread mainly by droplets made when people with flu cough, sneeze or talk and less commonly from surfaces. People with flu are most contagious in the first 3 to 4 days after the illness began. Most healthy adults may be able to infect others beginning one day before symptoms develop and up to 5 to 7 days after becoming sick. Children and some people with weakened immune system may pass the virus for longer than 7 days.

Antiviral drugs can lessen symptoms and shorten the time you are sick by 1 or 2 days. They also can prevent serious flu complications, like pneumonia. For people at high risk of serious flu complications, treatment with antiviral drugs can mean the difference between milder or more serious illness possibly resulting in a hospital stay. CDC recommends prompt treatment for people who have influenza infection or suspected influenza infection and who are at high risk of serious flu complication.

An annual seasonal flu vaccine is the best way to help protect against flu. Vaccination have been shown to have many benefits including reducing the risk of flu illness, hospitalizations and even risk of flu reiterated complications. Flu vaccine cause antibodies to develop in the body about 2 weeks after vaccination. These antibodies provide protection against infection with the viruses that are in the vaccine.

The seasonal flu vaccine protects against the influenza viruses that research indicates will be the most common during the upcoming season. Traditional flu vaccine (called “trivalent” vaccines) are married to protect against three flu viruses and influenza A (H1N1) virus, and influenza A (H3N2) virus, and an influenza B virus. There are also flu vaccines made to protect against four flu viruses (called “quadrivalent” vaccines). These vaccines protect against the same viruses as the trivalent vaccine and an additional B virus. Patient’s over age 65 need high-dose vaccine.

Annual vaccination against seasonal influenza is recommended for all U.S. persons aged ≥6 months. Effectiveness of seasonal influenza vaccine varies by season.

A paper by Wahren-Herlenius and colleagues, published in 2017 addressed the effect of H1N1 flu vaccine in patients with Sjögren’s. Untreated Sjögren’s patients had an exaggerated response with higher IgG levels to H1N1 flu vaccine, hydroxychloroquine-treated patients did not show any exaggerated response.

To summarize, I strongly recommend inactivated injectable flu vaccines for Sjögren’s patients but caution is warranted when considering vaccination in non-treated Sjögren’s patients who have really active disease with multi-organ involvement. The patients on immunosuppressive medications (like prednisone, methotrexate, azathioprine, mycophenolate mofetil, rituximab) should not receive live attenuated influenza vaccine (the nasal spray flu vaccine).”

Mehrnaz Maleki Fischbach, MD

This information was first printed in the Foundation's patient  newsletter for members.