What Are Tetanus, Diphtheria, and Pertussis?
Tetanus is caused by Clostridium tetani bacteria which is from soil and rusty objects such as old wire fences, nails, etc. Tetanus can cause death.
Diphtheria is a bacterial infection that can cause throat swelling, breathing problems, and rarely death.
Pertussis (whooping cough) is a highly contagious lung infection with prolonged coughing and pneumonia.
Why Are These Vaccines Important in Lupus?
Adults with SLE are immunocompromised due to disease and treatment, and they may have a worse infections. Pertussis especially can cause prolonged illness in adults, and tetanus remains a risk after contaminated wounds. Vaccination reduces severe complications.
Which Vaccines Are Used?
Tdap (Tetanus, Diphtheria, Acellular Pertussis)
Given once in adulthood if not previously received, then every 10 years as a booster. Usually, you should be vaccinated at age 15, 25, 35 and every mid-decade thereafter. If you have a dirty wound and are at least 5 years after your last booster, you will likely be given the shot in the emergency room.
Td (Tetanus, Diphtheria)
Used for booster doses every 10 years if Tdap has already been given.
DPT/DTP (Childhood Formulation)
The childhood formulation; adults receive Tdap/Td instead.
Because these are NOT lives vaccines, they are safe to even if on strong immunosuppression.
Special Considerations in SLE:
Patients on rituximab or obintuzimab may have a reduced antibody response; ideally vaccinate before B-cell–depleting therapy when possible.
If not vaccinated prior to treatment, consider vaccination at approximately 5 months after one of these therapies and 1 month or more before the next dose so that an optimal immune response may occur.
For any vaccines, if SLE is stable, then some immunosuppressives can be held for 1 to 2 weeks AFTER being vaccinated to improve the vaccine response. This is likely true for methotrexate, azathioprine and mycophenolate mofetil.
It is fine to continue taking hydroxychloroquine. If there is a high risk of flaring such as holding Rx in past has caused a flare, then don’t hold the medication for as long or even at all.
Adults with lupus should consider:
Receiving a Tdap booster at least once in adulthood (if never given before).
Continue with TD or Tdap every 10 years thereafter.
Considerations during pregnancy:
Receive Tdap in each pregnancy, regardless of prior vaccination history, to protect newborns from pertussis.
Can It Cause Lupus To Flare?
There is no evidence that tetanus or pertussis vaccines flare lupus.
Authors: Daniel Tingey and Doctor Janet Pope
Note: Please consult your healthcare provider or local health authorities for up-to-date vaccine recommendations.