Vaccination for immune deficiency

People with weak immune systems need protection. But not every vaccination is suitable for them

Stress, too little sleep, nicotine, lack of exercise. There are many things that affect our immune system. Some diseases or their treatment weaken it even more seriously. "In this way, chemotherapy against cancer can completely block the immune system," explains Professor Hendrik Schulze-Koops, President of the German Society for Rheumatology.

Attack on your own body

Autoimmune diseases such as rheumatism damage the immune system in two ways: On the one hand, it is distracted because it is directed against the body's own structures. On the other hand, the drugs suppress the misdirected defense: "Just five milligrams of cortisone as a long-term therapy for rheumatism double the probability that someone will get sick with a bacterial infection and need antibiotics," says Schulze-Koops.

It is important for affected patients to protect themselves from infections as well as possible. "Your risk of getting sick from viruses or bacteria is two to three times higher," says Dr. Sabine Vygen-Bonnet from the Infection Epidemiology Department at the Robert Koch Institute in Berlin.

In addition, illnesses like the flu are often more severe in people with weakened immune systems. In rheumatism patients, there is also the fact that pathogens can cause a renewed attack of the underlying disease: "An infection triggers an alarm in our defense system. In rheumatism, the immune system not only attacks the intruders, but also its own body," explains expert Schulze-Koops.

Dead or live vaccine?

Vaccinations are therefore particularly important for people with weakened immune systems. Rheumatism doctor Schulze-Koops, for example, makes sure that his patients have as complete protection as possible, for example against chickenpox and measles.

If a disease such as rheumatism has already broken out, you should discuss with your doctor what should be considered when vaccinating: Because some Pikser may not work reliably, other vaccines sometimes trigger exactly the disease they are supposed to protect against. According to the recommendations of the Standing Vaccination Commission (STIKO), a distinction has to be made between dead and live vaccines in patients with a weak immune system.

Imitated infections

The former only contain components of killed pathogens or other weakened substances. "They cannot cause infection in immunocompromised people and are therefore very safe," explains Vygen-Bonnet. A vaccination with it can be done at any time.

However, it happens that the response of the defense is not strong enough. If not enough antibodies are formed, there may not be complete protection. With some vaccinations, such as against hepatitis B, a blood test can then be used to check whether the patient has responded adequately to the immunization.

Vaccines available in Germany

For some diseases there are only live vaccines, for others only dead vaccines. For some there are both variants, for example against flu, shingles, cholera and typhoid.

Live vaccines

They consist of weakened viruses and bacteria.

Live vaccines only:

Chickenpox, measles, mumps, rubella, rotavirus, yellow fever

Dead vaccines

They contain killed pathogens or weakened components.

Only dead vaccines:

Tetanus, diphtheria, whooping cough, Haemophilus influenzae, hepatitis A and B, meningococci, HPV, pneumococci, TBE, polio

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Live vaccines, on the other hand, consist of weakened viruses or bacteria. "These mimic the infection, but do not lead to disease if the immune system is intact," says Vygen-Bonnet. In rare cases, however, this can happen to people with weak immune systems. Therefore, they should only receive these vaccines in accordance with the recommendations of the STIKO.

Discuss therapy with the doctor

Both live and dead vaccines are available for some infections, such as shingles. If there is a risk that an unvaccinated patient has had contact with a pathogen, doctors sometimes inject antibodies against the germ directly. For example, they give immunoglobulins against measles to children with immunodeficiency.

If a therapy that inhibits the immune system is planned, the doctor should check the vaccination status of the patient beforehand and catch up on any missing vaccinations before starting treatment.

If the therapy is already being carried out, it can make sense to pause for a few weeks and then vaccinate. Rheumatologist Schulze-Koops: "The attending physician coordinates this procedure with each patient individually, since therapy interruption is not always possible."

Protect the environment with vaccination - and do not endanger it

If someone cannot be protected at all due to a weak immune system, it is all the more important to reduce the risk of infection in the environment. "Particularly close contact persons such as family members or work colleagues should be vaccinated", says infection expert Vygen-Bonnet.

Schulze-Koops also makes sure that his rheumatism patients are not endangered by vaccinating a relative with a live vaccine. "When the children of a family man treated by me were supposed to receive a vaccination with live, weakened chickenpox viruses, I stopped his medication for a short time and first vaccinated him myself." This protected the man against the risk of catching the children's vaccine viruses.

Patients with weak immune systems should definitely get a flu vaccination in the fall and winter seasons. Protection against pneumococci and meningococci is also strongly recommended. The RKI also recommends immunization with the dead vaccine from the age of 50 for patients with chronic diseases that increase the risk of shingles. If someone has had chickenpox in the past or was vaccinated against it.

Further recommendations of the Standing Vaccination Commission can be found at www.rki.de