What is the safety of the pneumococcal vaccine for a 62-year-old male with psoriatic arthritis?

Safety of Pneumococcal Vaccination in a 62-Year-Old Male with MOGAD and Psoriatic Arthritis

Pneumococcal vaccination is safe and strongly recommended for a 62-year-old male with MOGAD and psoriatic arthritis, as the benefits of preventing pneumococcal infection significantly outweigh any potential risks in this immunocompromised population. 1, 2

Safety Profile and Recommendations

• The 2022 American College of Rheumatology (ACR) guidelines strongly recommend pneumococcal vaccination for patients with rheumatic and musculoskeletal diseases who are taking immunosuppressive medications 1
• Pneumococcal vaccines are inactivated (non-live) vaccines and are considered safe for immunocompromised patients 1
• Patients with autoimmune inflammatory conditions like psoriatic arthritis are at increased risk for pneumococcal infections, making vaccination particularly important 2, 3

Specific Vaccination Recommendations

For a 62-year-old patient with psoriatic arthritis:

1. Preferred vaccination strategy (per current CDC recommendations):

   • Either PCV20 as a single dose
   • OR PCV15 followed by PPSV23 one year later 1, 2

2. No need to temporarily discontinue immunosuppressive medications for vaccination:

   • Inactivated vaccines like pneumococcal vaccines can be safely administered while continuing immunosuppressive therapy 1
   • Unlike live vaccines which are contraindicated in immunosuppressed patients, pneumococcal vaccines pose no risk of infection 1

Efficacy Considerations

While safety is excellent, efficacy may be somewhat reduced:

• Patients on certain immunosuppressive medications may have a diminished antibody response:
  • Methotrexate has been shown to reduce antibody response to pneumococcal vaccination 4, 5, 6
  • TNF inhibitors alone do not significantly impair antibody response 4, 5
  • Despite potentially reduced response, most patients still achieve sufficient protection 3

Common Pitfalls and Considerations

1. Undervaccination risk:

   • Studies show pneumococcal vaccination rates are low (14.4%) in patients with psoriasis despite clear indications 7
   • The most common reason for non-vaccination is lack of physician recommendation 7

2. Timing considerations:

   • If the patient has received pneumococcal vaccination within the last 5 years, revaccination may result in reduced antibody response 6
   • For patients over 65 who received their first dose before age 65, a second dose is recommended if 5+ years have elapsed since the first dose 1

3. Monitoring for side effects:

   • Most common: Local injection site reactions (pain, redness)
   • Systemic reactions are rare and similar to those in the general population
   • No evidence of disease flares with pneumococcal vaccination in patients with psoriatic arthritis 4

Conclusion

For this 62-year-old male with MOGAD and psoriatic arthritis, pneumococcal vaccination is not only safe but strongly recommended. The inactivated nature of the vaccine eliminates concerns about vaccine-induced infection, and the potential benefits in preventing serious pneumococcal disease significantly outweigh any risks.