Autoimmune diseases (e.g. myasthenia gravis, multiple sclerosis) or chronic inflammatory diseases (e.g. rheumatoid arthritis, chronic inflammatory bowel disease) are generally not a contraindication for vaccination. So far, studies have not been able to prove a causal relationship between a vaccination and a new autoimmune disease or a chronic inflammatory disease or a relapse of an already existing disease.
Vaccine-preventable infections, on the other hand, can increase morbidity and mortality in non-vaccinated individuals with autoimmune diseases or chronic inflammatory diseases and, for example, trigger an attack. These individuals also have an increased risk of a severe course due to the underlying disease and/or its therapy. Vaccinations can thus reduce the risk of symptomatic illnesses caused by the respective pathogens and of infection-triggered relapses of the underlying disease.
With regard to the indication for vaccination, a fundamental distinction must be made between courses of disease with and without immunosuppressive therapy.
In these persons,inactivated vaccines can be used independently of immunosuppressive therapy. Live vaccines can be given regularly without or up to 4 weeks before the start of immunosuppressive therapy. An exception is myasthenia gravis, in which yellow fever vaccination is always contraindicated. Since live vaccines contain potentially replicable vaccine viruses and can cause disease and/or severe to fatal complications during immunosuppressive therapy, their use is contraindicated during immunosuppressive therapy.