TY - JOUR T1 - Pneumococcal Vaccination Strategies in the Real World of Chronically Ill Patients JF - The Journal of Rheumatology JO - J Rheumatol SP - 255 LP - 257 DO - 10.3899/jrheum.151289 VL - 43 IS - 2 AU - NICO M. WULFFRAAT AU - MARLOES W. HEIJSTEK Y1 - 2016/02/01 UR - http://www.jrheum.org/content/43/2/255.abstract N2 - Throughout the world vaccination strategies are widely applied because they are cheap and cost-effective. The World Health Organization (WHO) provides recommendations for routine immunizations1. These recommendations are primarily based on vaccine studies performed in healthy children or elderly persons without significant comorbidity. For instance, the CAPITA study (Community-Acquired Pneumonia Immunization Trial in Adults) on about 85,000 adults aged 65 years and older is seen as a landmark study, demonstrating that a pneumococcal conjugate vaccine prevents a significant proportion of pneumococcal community-acquired pneumonia in adults2. The study is of considerable public health significance. However, in the real world the pneumococcal vaccine is not administered to the entire healthy elderly population. In contrast, this and other vaccines are given especially to protect chronically ill patients. In the above-mentioned CAPITA study, adults were excluded if they resided in nursing homes, had significant comorbidity that could result in an immune-suppressed state, or had medications that could affect the immune response. As a result, the decision to vaccinate these chronically ill patients is left to the discretion of the doctor. In the rheumatology field this has led to numerous investigator-initiated studies in adult and pediatric rheumatic diseases. Several reviews were published with immunization recommendations for adults and children with rheumatic conditions3,4,5. These immunization recommendations take into account the 2 main issues that play a role in patients with rheumatic diseases using immunosuppressive drugs: the safety and the efficacy of vaccines.Regarding safety, the product labels of most vaccines state that concomitant use of immunosuppressive drugs such as methotrexate (MTX) or biological disease-modifying antirheumatic drugs (DMARD) are a contraindication for … Address correspondence to Dr. N.M. Wulffraat. E-mail: n.wulffraat{at}umcutrecht.nl ER -