Vaccination Update and Specific Concerns for RA.

Abstract

Purpose of review: We present information on the burden of vaccine-preventable diseases in people with rheumatoid arthritis (RA), the latest evidence on vaccine immunogenicity in disease-modifying antirheumatic drug (DMARD) users, and expert and guideline-based immunization recommendations. We focus on infections with the highest morbidity and mortality, and those relevant due to new developments or current outbreaks.

Recent findings: Following the license expansion for two respiratory syncytial virus (RSV) vaccines, GSK's Arexvy and Pfizer's Abrysvo, the Advisory Committee for Immunization Practices (ACIP) expanded the recommendation for vaccination in adults at increased risk of severe RSV disease. In the spring of 2025, the Center for Disease Control lowered the cutoff for immunization in high-risk groups from ≥ 60 to ≥ 50 years. There are new 2024-2025 SARS-CoV-2 vaccines and updated ACIP recommendations for SARS-CoV-2 immunization that address new viral strains and the known waning immunity from vaccines. All individuals who are moderately to severely immunocompromised (including those with RA) should receive at least one additional vaccine dose compared to the general population. The ACIP has updated its recommendations for pneumococcal immunization, aiming to lower pneumococcal disease incidence in adults. Following the approval of the 21-valent pneumococcal conjugate vaccine, designed to target the serotypes commonly affecting adults, the cutoff for vaccination in the general population changed from ≥ 65 to ≥ 50 years. Recommendations for vaccination in RA patients (everyone age ≥ 18 years) remain unchanged. Vaccine recommendations for RA patients constantly evolve as new DMARDs and vaccines are developed, and our understanding of their interaction with DMARDs vis a vis immunogenicity improves. It is essential to stay current with the latest recommendations from the ACIP and rheumatologic society guidelines.