Vaccination in systemic lupus erythematosus

Despite advancement in anti-microbial therapies, infection remains the leading cause of mortality in systemic lupus erythematosus (SLE). Vaccination is a major strategy in reducing infection risk. Recent studies suggest most SLE patients are able to mount an adequate immune response to the SARS-CoV2 vaccines but lower immunogenicity is observed with influenza and pneumococcal vaccination. Current evidence does not indicate an increased risk of SLE flares after administration of common vaccines. Live vaccines are less preferred to inactivated or recombinant vaccines in SLE patients receiving immunosuppression. However, the decision to vaccinate should be individualized according to risk and benefit evaluation. Vaccination in patients with SLE should best be performed during periods of low disease activity or remission. In patients receiving intense immunosuppression or biologic/targeted therapies, particularly B-cell depletion, vaccine responses are expected to be attenuated. Adjunctive measures such as booster dose of vaccines, passive immunization and microbial prophylaxis may be considered.