Is arachnoiditis an autoimmune disease

What pre-existing conditions can you get vaccinated with?

People whose immune system is less effective due to previous illnesses and medication are more exposed to infections. You need our special protection. We can help by vaccinating ourselves and our children and thereby preventing pathogens that are difficult or impossible to treat from circulating. Especially people in close contact with people at risk should be aware of this responsibility.

Many people with previous illnesses are unsettled when it comes to vaccination. Can I or not? Should I or better not? Are there any recommendations? The reassuring news: Chronic diseases of the heart, kidneys or lungs, for example, are not a contraindication for a vaccination, on the contrary.

According to the recommendations of the STIKO, people who suffer from it should take particularly good care of booster vaccinations and vaccinations in old age. There are exceptions above all for diseases of the immune system and coagulation disorders. When it comes to diseases of the immune system, some vaccinators hesitate and do not know when to vaccinate and when not. It is therefore recommended that vaccinators and practitioners from the specialist centers work closely with one another for these patients.

The situation is complex

For a long time, glucocorticoids, methotrexate, azathioprine and calcineurin antagonists such as cyclosporine and tacrolimus, which are used in organ transplants, psoriasis and neurodermatitis, or mTOR inhibitors such as sirolimus, which reduces the activity of white blood cells, were the few pillars of therapy regulate the immune system. That has changed fundamentally in the last decade. For example, in rheumatic diseases or chronic inflammatory bowel diseases, various biologicals are used today that inhibit the immune response in a very specific way.

At the same time, a whole new field of genetic defects has opened up through molecular genetics, which leads to an increased discovery of innate immunodeficiencies. In addition, people who have an immune system disease or whose immune system is influenced by drugs are less vaccinated than healthy people. These are the most common reasons:

  • There is concern that vaccinations will not work because the immune system is not responding adequately.
  • Vaccinations with live vaccines could miss infections or vaccine reactions.
  • The vaccination may worsen the disease by a) increasing the viral load in people infected with HIV, b) causing an organ to be rejected after an organ transplant, or c) triggering a flare-up in an underlying inflammatory disease.

With whom should vaccination recommendations be adjusted?

In certain situations, experts recommend not getting vaccinated or postponing the vaccination until later. There are specific instructions for other situations. This is especially the case with diseases that weaken the immune system. The problem: Often these people are precisely those who need the protection of a vaccination particularly. Therefore, it is important to check every time anew and adapted to the course of the disease whether a vaccination is possible or not.

Patients with a coagulation disorder or a tendency to bleed

For them, the problem is not the vaccine or the physical response to it, but the injection into the muscle. If a vessel is hit, this could lead to bleeding into the tissue. These may then not be easy to stop. The Robert Koch Institute (RKI) therefore recommends that this group of patients be given vaccinations into the fatty tissue under the skin. The vaccinator should inform those affected that the vaccination may not work as well and that local vaccination reactions may increase.

Patients with autoimmune diseases and chronic inflammatory diseases

Autoimmune diseases and chronic inflammatory diseases are increasing steadily. The immune system becomes the enemy of your own body. In autoimmune diseases, the immune system can no longer differentiate between the body's own cells and foreign substances such as viruses or bacteria. The immune cells overreact, attack the skin, bones, organs or nerve cells. Healthy tissue is damaged, and affected areas, organs or organ systems are permanently inflamed. Chronic inflammatory diseases are the result.

For example, chronic inflammatory diseases caused by an autoimmune disease are

In recent years, new drugs such as biologics have significantly improved the prognosis and therapeutic success of these diseases. Treatment with therapies that suppress or at least dampen the immune system, but also partly because of the disease itself, increases the risk of those affected for numerous infectious diseases. Infections with hepatitis B, pneumococci, or influenza can be more severe in people with compromised immune systems than in people whose physical defenses are working properly. Infections can also worsen such illnesses and lead to a disease flare-up. Comprehensive vaccination protection is therefore particularly important for these people.

In the best case, those affected are completely vaccinated before they start immunosuppressive therapy. If this is not the case, there are a few things to consider: Inactivated vaccines may also be administered during immunosuppressive therapy. Inactivated vaccines do not increase the risk of adverse effects. However, the vaccination may not work as well as it does in healthy people. This is the case, for example, when patients take drugs that reduce the number of certain immune cells. The effectiveness of vaccinations can be determined by laboratory tests. In contrast, these patients should not receive live vaccines during the entire immunosuppressive therapy. An exception to this is, for example, therapy with low-dose glucocorticoid or low-dose methotrexate.

Patients with a restricted immune system (immunodeficiency)

This group includes patients with cancer and diseases of the hematopoietic system who, for example, receive chemotherapy or a stem cell transplant. People who have had an organ transplant or who do not have a spleen (asplenia) also have a compromised immune system. They are all at increased risk of infectious diseases. Some of these viral and bacterial infections can be prevented with vaccinations.

Both the diseases themselves and the drugs and possible vaccines used are very heterogeneous. Therefore it is hardly possible to make general statements about this. In general, these patients should also be protected against infectious diseases as far as possible by vaccinations. If you have any questions, the vaccinator should contact the treating doctor or, if necessary, a special immunological outpatient clinic. In 2020, an expert working group from the responsible specialist societies, the Robert Koch Institute and the STIKO issued a publication with instructions for use for this group of patients. It deals with the various immunological situations and takes numerous different treatment approaches and vaccines into account.

Patients with HIV

Untreated HIV disease severely restricts the function of the immune system. Even with successful basic immunization, the defense against infection decreases if the disease is not treated. How well a current vaccination works in HIV patients depends on the state of the immune system. Vaccinations often have a weaker effect on them and last less long than in people who are not infected with HIV. It is therefore best for HIV-positive people to get vaccinated when their immune status is well built up through antiviral therapy. How good a vaccination is can be checked by measuring antibodies in the blood.

The viral load of HIV viruses occasionally increases after a vaccination. This is only temporary and usually does not worsen your health. The circumstance should not deter vaccination. Inactivated vaccines can generally be used safely in HIV-infected people in all stages of the disease, even if the immune system is in poor condition. Vaccinations with live vaccines are only recommended if the immune system is in good condition. When this is the case, the practitioner and the vaccinator should discuss with each other.

People with congenital immunodeficiency

Infections are a common reason for people with congenital immune deficiencies to become ill or even die. Vaccinations can protect them from this. The diseases are very different and can affect different areas of the body's defense. Therefore, the patient and the vaccinator should agree with the treating doctors from the special outpatient department about individual vaccinations. In general, vaccination with dead vaccines is usually not a problem. However, how well such a vaccination works depends on the type of immune disorder. However, this can be checked using laboratory diagnostic methods.

Why do we need herd protection?

Anyone who is healthy can protect people without adequate vaccination protection: by having themselves and their children vaccinated. Because: From a certain vaccination rate in the general population, a pathogen that can be transmitted from person to person can no longer circulate. In the best case, it will be eliminated. Experts also speak of herd immunity. Your own protection helps to protect the rest of the population, especially people who are not allowed to be vaccinated due to previous illnesses or for whom vaccinations do not work well enough. The level of immunity in the population in order to protect others effectively depends on how infectious a pathogen is.

  • For measles and whooping cough, 92 to 94 percent of the population must be immune.
  • In the case of diphtheria, community protection can be achieved from around 83 to 85 percent.
  • With the novel coronavirus SARS-Cov2, experts assume that 60 to 70 percent of the population must be immune to stop the virus.

Especially people in close private or professional contact should have solid vaccination protection.