Vaccinations

When you come into contact with infection, your body’s immune system springs into action by producing special proteins called antibodies. Antibodies help your body recognise and kill the foreign organisms (usually viruses or bacteria) causing the infection.

当你的免疫系统遇到一定的梵us or bacteria for the first time, it takes a few days to produce an antibody specifically to deal with that infection. These antibodies and the cells that create them remain in your body. This means that if you come into contact with the same organism again, your body is rapidly able to make large quantities of the antibody that deals with it so that the infection is removed quickly, often before you develop any symptoms.

疫苗接种是将您的身体介绍给有机体的一种方式，因此，如果您再次遇到它，它可以准备好。

What types of vaccination are there?

大多数疫苗含有一部分有机体或已被杀死或灭活的整个生物体。当引入您的身体时，这些生物会激活您的免疫系统，从而在不引起疾病的情况下产生抗体。

对于几种疾病，该疫苗是一种已改变（衰减）病毒的形式，它会被改变，以激活您的免疫系统，但通常不足以引起疾病，除非您的免疫系统受到疾病或疾病的影响药物治疗。实时疫苗的例子是：

• yellow fever
• 麻疹，腮腺炎和风疹（MMR）
• BCG, which is used to vaccinate against tuberculosis (TB)
• chickenpox and shingles.

Studies have shown that people with most rheumatic diseases are at a higher risk of infection and that infections may be more severe, for example, in people with rheumatoid arthritis. This can be due to the condition itself or its treatment, such asdisease-modifying anti-inflammatory drugs (DMARDS)要么steroids。

Other non-disease factors may increase the risk of infection further, such as:

• having diabetes
• 喝太多酒
• old age.

Rheumatoid arthritis，，，，lupusand血管炎are examples of an autoimmune disease, which means your immune system attacks your body’s own tissues rather than foreign bacteria or viruses. Because of their effect on the immune system, these conditions can make you more at risk of infection.

在这种情况下，药物可用于调节免疫系统并控制疾病。但是，由于药物抑制了免疫系统，它们也可以使您更容易感染。

The medical term used to describe an increased risk of infection due to drugs or disease is immunosuppression.

Find out the most up-to-date answers to your questions on theCOVID-19疫苗和关节炎

There are a number of vaccinations routinely offered to everyone in the UK, most of which are given when you’re a child. For a full list of the current UK vaccinations schedule and the ages they’re given, see theNHS Vaccination Schedule website。

If you're over the age of 65, or if you're pregnant or have a long-term health condition, then you'll fall into a high-risk group for infections. This includes people with rheumatic diseases (autoimmune or otherwise) and people on the following drug treatments:

• abatacept
• adalimumab
• 硫唑嘌呤
• certolizumab pegol
• 环磷酰胺
• Etanercept
• golimumab
• 英夫利昔单抗
• leflunomide
• mercaptopurine
• methotrexate
• 霉酚酸盐mofetil
• prednisolone (steroid tablets)
• 利妥昔单抗
• tocilizumab。

If in doubt, it’s important to check with your rheumatologist or rheumatology nurse to see whether your treatment is immunosuppressive. Talk to your localrheumatology team或GP，如果您不确定是否应该进行一定的疫苗接种。关于谁应该和不应该接受疫苗接种的建议正在不断变化，因此，如果邀请您进行疫苗接种，则应始终与GP或风湿病团队进行双重检查。

人在高危人群应该接种ag)ainst flu and pneumococcus (bacteria that can cause a certain type of pneumonia and meningitis). Some immunosuppressed patients over the age of 70 may be suitable for the shingles vaccine, but you should check with your rheumatology team that it’s suitable for you before agreeing to the injection.

流感and swine flu

The symptoms of flu (influenza) can be worse for anyone with a weakened immune system. If you have a long-term rheumatic disease or are taking steroids or disease-modifying anti-rheumatic drugs (DMARDs) you should have a flu vaccination. Carers of people falling into high-risk groups can also be vaccinated to reduce the risk of passing on infection.

如果您受到治疗利妥昔单抗，，，，you should try to have the flu vaccine either before an infusion or 6 months after an infusion. This is because rituximab affects the cells which produce antibodies for about 6 months after each infusion. If the flu vaccine is given within 6 months of a rituximab infusion you may not be fully protected against flu.

每年更改季节性流感疫苗，以防止当年最有可能引起感染的流感病毒。您的全科医生将建议该季节性流感疫苗是否会提供足够的猪流感覆盖，或者将来可能开发的任何其他新流感病毒。

Pneumococcus

如果您属于高危人群，则针对肺炎球菌的疫苗接种很重要。该疫苗旨在保护您免受败血病和脑膜炎等疾病的影响，尽管主要作用是针对肺炎。

如果您在上面接种了肺炎球菌。methotrexate，，，，you might not respond as well to the vaccine as someone not on that medication. However, this doesn’t mean you should stop methotrexate because there will still be some level of protection from the vaccination. If you do get a pneumococcal infection, you can be treated with antibiotics.

如果您接受了肺炎球菌的疫苗接种，并且您的病情需要通过生物疗法治疗，则风湿病学家可能会首先检查身体对疫苗接种的反应状况。这是通过检查血液测试来测量抗巨球菌抗体水平来完成的。如果发现抗体水平较低，则可能建议您在开始生物疗法之前进行促进疫苗接种。这是因为有关生物疗法的人似乎更容易患有肺炎球菌感染。

Shingles

Shingles is a painful skin disease caused by the chickenpox virus. From 2013, people aged between 70 and 79 will be offered the shingles vaccination. Although it’s a live vaccine and so wouldn’t normally be suitable for immunosuppressed patients, it’ll be recommended for some people depending on a number of different factors.

You should NOT receive the vaccination if you’re on:

• 生物疗法
• 环磷酰胺
• more than 10 mg per day of prednisolone
• more than 0.4 mg/kg/week of methotrexate
• 超过3 mg/kg/天硫唑嘌呤
• more than 1.5 mg/kg/day mercaptopurine.

As biological therapies, cyclophosphamide and methotrexate aren’t usually prescribed by your GP, they may not appear on your records with your GP and they may not know that you take them, so it’s always worth speaking with them about your drug treatment before you have the vaccination.

如果您也不应接受疫苗接种：

• 有其他疾病引起严重的免疫抑制（例如白血病，淋巴瘤，艾滋病毒/艾滋病）
• 具有主动结核
• are pregnant.

At the time of writing there’s no consistent advice on whether the vaccination is safe for people taking霉酚酸盐，，，，ciclosporinandleflunomide。

There don’t appear to be any factors that mean the vaccine can’t be given if you’re takingsulfasalazineandhydroxychloroquine，，，，which aren’t considered to be immunosuppressive DMARDs.

If you do have a shingles vaccination and find out afterwards that you shouldn’t have had it, you should seek urgent advice from your GP or rheumatology department. If you’re felt to be at very high risk your doctor may suggest you stop your arthritis treatment and start taking acyclovir, an antiviral drug which is used to treat chickenpox. This drug should also be prescribed straight away if you develop a rash after immunisation.

大多数风湿病学部门建议停止DMARDs and biological therapies if you develop shingles or chickenpox. This is because when you’re unwell your kidneys and liver may not work as well and stop the drugs being washed out from the body. This can cause immunosuppressive drugs to build up in your system, which makes it harder for your immune system to fight off infection.

If the policy at your local rheumatology department is to stop the drugs, you can normally restart treatment as soon as you feel better. You should contact your rheumatologist for further advice on the policy in your area.

Before you have a vaccination, your doctor or nurse will check that it’s safe to give it to you. They’ll also go through the possible side-effects with you. Common side-effects for all viral vaccinations may include:

• a mild fever
• pain at the injection site (this can be treated with paracetamol).

许多患有风湿病的人担心疫苗接种会导致症状大肆抨击。但是，试验发现事实并非如此。例如，一项研究表明，任何特定的疫苗（流感，破伤风，白喉，tick传播脑炎，肝炎，脊髓灰质炎，肺炎球菌）之间没有任何联系。rheumatoid arthritis。

There’s also no evidence that people with rheumatic conditions or who are onDMARDs副作用的风险更高，对于大多数人来说，疫苗接种的优势大于风险。

The flu jab is given every year. This is because the flu virus is constantly changing and your body needs to produce new antibodies to keep you fully protected. The advice that you’re given may change depending on strains of flu that are most common during that year.

H1N1猪流感疫苗将成为您年度流感注射的一部分。如果您尽管疫苗接种了猪流感的症状，则应与GP讨论是否应该使用抗病毒药物，例如Oseltamivir（Tamiflu）。如果您陷入高危人群，请每年秋天与您的GP练习联系，以提醒他们您应该有戳戳。

肺炎球菌疫苗接种仅一次，如果您有资格获得带状疱疹疫苗，则只需进行一次即可。

There are a few people who can’t be vaccinated. This could be because of:

• 确认对先前含有某些灭活病毒或细菌的疫苗的严重过敏反应（过敏反应）
• a confirmed allergic reaction to another substance contained in the vaccine
• an egg allergy (which means you shouldn’t have flu or yellow fever vaccines)
• 严重的乳胶过敏 - 某些疫苗含有乳胶（但是可能无乳胶疫苗）
• infection (some vaccines may be delayed until you’re over an infection).

No vaccine offers 100% protection. They can fail in two ways:

• 原发性失败，这是当人体无法产生抗体和预期的疫苗时。
• secondary failure, which is when the body produces the antibodies as expected but the protective antibody level in the blood falls over time.

Seasonal flu vaccination will prevent flu in 70–80% of those vaccinated and pneumococcal vaccination is effective in up to 70%. The shingles vaccination reduces the risk of shingles by around 50%.

If symptoms of flu or pneumococcal infection develop, there are effective treatments that can be used. However, it's still a good idea to take steps to reduce your risk of picking up infections.

实时疫苗，DMARD和生物疗法

The small dose of a live organism in live vaccines may be enough to cause symptoms of the disease in people who are immunosuppressed. For this reason, live vaccines aren’t recommended if you’re on certainDMARDs要么生物疗法as these are immunosuppressive drugs.

你的医生或rheumatologist会告诉您是否可以安全接种现场疫苗。通常，只有在接种疫苗接种前至少3个月停止免疫抑制药物时，才能进行活疫苗。

如果您接受了治疗leflunomide,you may need to take a drug called cholestyramine to help wash the leflunomide from your system before being given a live vaccine, as it can take many months to completely flush the drug from your body.

有时，在开始免疫抑制药物之前，将进行活疫苗。接种现场疫苗后，至少不应在至少2周内开始进行免疫抑制药物，最好是4周。

Live vaccines and steroid treatment

Live vaccination must not be given if you’ve been taking moderate or high-dosesteroidsfor more than 2 weeks. The guidelines from the British Society for Rheumatology (BSR) suggest that you can have live vaccines while on steroids if:

• you’ve been on steroid treatment for less than 2 weeks
• the steroid is only applied to the skin in the form of a cream or given via an inhaler
• the steroid has been given into or around the joint by injection
• you’re on replacement therapy (for example hydrocortisone), which is given when your adrenal glands, the small glands above your kidneys, aren’t making enough steroids – this can happen with conditions such as Addison’s disease or if you’ve been on long-term steroids
• you’re on low-dose steroids, which the BSR defines as 10 mg per day or less.

Moderate or high-dose steroids must be stopped 3 months before a live vaccine can be given.

Oral vaccines

使用吸入器给予口服疫苗。以前，小儿麻痹症是一种活疫苗，但现在通常通过注射非活性疫苗给予。口服疫苗通常仅在暴发期间使用，不应用于免疫抑制的患者或与之同住的任何人。

The vaccinations you'll need if you’re travelling vary depending on where you’re going and on the type of travel. You can get up-to-date advice from theNHS Choices website要么you can discuss it with your GP. You should take advice in the early stages of making your travel plans, but don't let your medications put you off travelling.

The risks of getting infections when you’re abroad depend on the type of travel. You’ll be at much less risk on a business trip or holiday in a top-class tourist hotel than a long trip to the countryside in some less industrialised countries.

Travel to countries where there's a high risk of catching yellow fever, such as central Africa, should be avoided if you’re on an immunosuppressive drug because you shouldn't have a yellow fever or any other live vaccines.

To enter some countries you need a certificate of vaccination against yellow fever even if there’s no risk of contracting yellow fever in that country. If this is required you’ll need an exemption certificate from your GP, but you should check before you travel if this is acceptable.

您可以做一些一般的日常工作，以降低接收感染的风险，包括：

• 经常洗手
• being careful with the food you eat and water you drink, especially when you’re abroad
• avoiding unpasteurised foods (e.g. Brie, feta and blue cheeses) if you’re on immunosuppressive drugs
• contacting your doctor or the hospital early if you get a fever (temperature).

As well as simple measures like these, there are some specific ways in which certain infections can be avoided.

How can the risk of infection be reduced if I’m taking DMARDs?

即使您确实有疫苗接种，如果您正在接受治疗DMARDsyour blood count should be checked to make sure that your body is producing enough white blood cells. This is because a low white blood cell count will decrease your body’s ability to fight infection. If your white blood cells are low, this can normally be reversed by stopping the drug and in some cases taking other drugs to improve the production of white blood cells. Examples include folic acid if you’re onmethotrexate要么use of a cholestyramine washout if you’re onleflunomide。This will increase your body’s ability to fight infection.

What can be done if I’m exposed to an infection?

免疫球蛋白

可以给您免疫球蛋白，以阻止某些类型的感染发展。免疫球蛋白的作用像身体的抗体。如果您认为自己已经接触到：

• 伤人
• hepatitis B (for example, treatment would be considered after stabbing yourself with a needle from someone who may be carrying hepatitis B)
• rabies (for example, if you get bitten by an animal in a country which still has rabies)
• 水痘或带状疱疹。

水痘和带状疱疹

Chickenpox vaccination is normally given in childhood. Because it’s a live vaccination, it’s not currently recommended for people who are immunosuppressed, but most adults will have been exposed to the virus and will be immune to it.

Immunoglobulin treatment would be considered for if you’ve never had chickenpox or if you’re on immunosuppressive drugs and have had close contact (in the same room for 15 minutes or more or face-to-face contact) with someone with chickenpox. Your doctor will check your immunity (the level of antibodies in your body) and if it's low may recommend immunoglobulin treatment or aciclovir (an antiviral drug) to stop the infection developing.

Shingles can develop if you've previously had chickenpox. The shingles vaccine is currently recommended only for some people on immunosuppressive drugs. If others within the same household as someone with shingles haven’t previously had chickenpox or been vaccinated against it, it may be worth suggesting that they also have the vaccination.

You should tell yourrheumatologist无论您是否以前有水痘，这对于知道您是否暴露于病毒很有用。

如果我有疫苗接种，我应该注意什么？

流感

流感疫苗应提供足够的保护，但是如果您确实会产生类似流感的症状，尤其是在开启疫苗的情况下利妥昔单抗，，，，please speak to your doctor about antiviral treatment, which should be started within the first 48 hours of symptoms.

Pneumococcus

Pneumococcal vaccination will only provide protection against pneumococcal pneumonia. If you develop a high fever, breathlessness, and a cough with green spit, seek medical help immediately as it’s likely that you’ll need antibiotics to stop the infection developing.