Key Insights: Vaccines and Infectious Diseases

During their session, “Ask the Expert: Infectious Diseases,” presented at the Interdisciplinary Autoimmune Summit, Alexis Ogdie, MD, MSCE, and Kevin Winthrop, MD, MPH, held a discussion on vaccinations in relation to infectious diseases and how to optimize care for patients susceptible to these diseases.

To start, Dr Ogdie asked the question, “Should patients get another COVID vaccine?” The Centers for Disease Control and Prevention guidance notes that patients who are aged 65 years and older with risk factors or those who are immunocompromised should get an additional bivalent vaccine dose.

“Certainly, if you have not had [the bivalent vaccine] before, you would fall into the recommendation of getting it, particularly if you are in the high-risk groups,” Dr Winthrop stated. He also noted that it would be reasonable to wait a few months until respiratory season comes back because there will likely be upticks in COVID in the fall similar to other respiratory infections.

Next, Dr Ogdie addressed Paxlovid by asking Dr Winthrop what type of patient it should be prescribed for and when it should be prescribed. Dr Winthrop shared that any patient who is of older age or immunocompromised, especially those with underlying conditions who are more likely to have severe COVID, can be considered for Paxlovid.

He added that he believes COVID has made physicians think about vaccines a lot more, so they are now asking routinely about vaccinations. “As I sit down with a new patient with psoriatic arthritis, let's say, I go through what are their vaccines as I am going through their social history, what kinds of vaccines should I be prioritizing for them, and so on,” he said.

Dr Ogdie continued with another question: Should physicians withhold methotrexate before vaccination in their patients who have been on methotrexate for a while? Additionally, how much benefit does that really add compared with not holding it? At this, Dr Winthrop shared his advice to patients, which is to not take methotrexate for at least 1 week after today. He added that it does not matter where they are; for example, he noted if a patient says they took it 2 days ago as their weekly administration then that means they are not going to take it the next 7 days and they will be off it for 9 days, or 7 days from the time of vaccination. He added that what this could mean is a lot of patients will be effectively off between 1 and 2 weeks; however, 1 week is likely good enough.

He concluded this portion by addressing the pneumococcal vaccine. He also noted that although it is possible that withholding methotrexate does make sense, especially for the pneumococcal vaccine, there have not been any conclusive studies on this yet. He compared this with the data surrounding COVID and the flu vaccines, noting that based on the observational data around pneumococcal vaccine responsiveness being lower in patients on methotrexate, at least there is a theoretical reason to go ahead and hold it.

Reference
Ogdie A Winthrop K. Ask the expert: infectious diseases. Presented at: Interdisciplinary Autoimmune Summit; April 26–28, 2023; Virtual.