From the Guidelines
Vaccines are not associated with an increased risk of flaring interstitial lung disease (ILD) in patients, and their administration is considered safe. The relationship between vaccines and ILD flares is not well-established, and the current evidence suggests that inactivated vaccines, including those with adjuvants, do not exacerbate ILD activity 1. Several studies have evaluated the safety of inactivated vaccines, such as influenza, pneumococcal, and hepatitis B, and have found that they are safe and not associated with exacerbation of disease activity 1. Additionally, inactivated messenger RNA (mRNA) COVID-19 primary vaccine series or boosters have not been associated with disease flares or increased adverse events compared with the general population 1. Patients with pre-existing ILD should discuss their vaccination plans with their pulmonologist or rheumatologist, especially if they have experienced previous vaccine-related symptoms. Some key points to consider when administering vaccines to patients with ILD include:
- Vaccines should be administered at the earliest opportunity and preferably when the patient is off corticosteroids or at the lowest tolerable corticosteroid dose 1.
- The most opportune times to provide vaccines are during the transition of care to a new provider or during periods of remission at routine visits 1.
- Vaccines should be administered before the commencement of immune-modifying therapy, as certain agents may diminish the immune response to vaccines 1. However, vaccination should not delay the initiation of appropriate immune-modifying therapy.
From the Research
Vaccine-Associated ILD Flare-Ups
- There is evidence to suggest that vaccines can potentially flare up Interstitial Lung Disease (ILD) in some cases, although this is rare 2.
- A study reported two cases of interstitial pneumonia that developed after influenza vaccination, highlighting the need for clinicians to be aware of this potential complication 2.
- However, other studies have found that vaccination can be safe and effective in patients with ILD, with some showing improved response rates to pneumococcal vaccines in ILD patients undergoing immunosuppressive treatment 3.
- Influenza vaccination has been shown to have a positive effect on all-cause mortality in patients with ILD, although the evidence is not consistent across all studies 4.
Vaccine Response in ILD Patients
- ILD patients undergoing immunosuppressive treatment can still respond to pneumococcal vaccines, although the response rate may be lower in some cases 3.
- Influenza vaccination has been found to be effective in reducing all-cause mortality and hospitalization in patients with ILD, although vaccination rates are often low 4, 5.
- The use of pneumococcal and influenza vaccines in patients with ILD is important for preventing infections and reducing the risk of flare-ups, and clinicians should educate patients on the benefits and potential risks of vaccination 5, 2.
ILD Management and Vaccination
- ILD management typically involves a combination of pharmacological and non-pharmacological interventions, including antifibrotic therapy, immunomodulatory therapy, and oxygen therapy 6.
- Vaccination is an important aspect of ILD management, and clinicians should consider the potential benefits and risks of vaccination in patients with ILD 3, 4, 5, 2.
- Further research is needed to fully understand the relationship between vaccination and ILD flare-ups, and to develop effective strategies for managing ILD in patients who receive vaccines 3, 4, 2.