Question
My wife (age 62) has had moderate to severe RA for 10 years. Symptoms have been largely alleviated in the past 8 months by concomitant biologic treatment (Humira) with methotrexate (25 mg). Previous treatments, including Enbrel/MTX and Orencia/MTX all had some success but ultimately failed. She has been taking seasonal influenza vaccinations every year since 2002, including this year. She wishes to get immunized for H1N1 with unadjuvanted vaccine, but it is not clear whether she can do so here in Canada, where only limited amounts of unadjuvanted vaccine are available, and which are targeted for pregnant women only. The adjuvanted vaccine, produced by GSK, contains the adjuvant AS03, made up of squalene, vitamin E and Polysorbate 80. It also contains 1/5 of the amount of antigen contained in the unadjuvanted vaccine. What are the known and unknown risks of this adjuvant, and would she be wise to forego the H1N1 vaccinations altogether? What are the chances that she already has some immunity to H1N1? She is concerned that the adjuvant might trigger further uncontrolled auto-immune responses. She is also very nervous to venture out in public without a face mask and hand sanitizer for fear of contracting H1N1 flu. Her family doctor (new) and rheumatologist have been unable to offer any definitive advice.
Answer
Hi Greg,
I am not familiar with the two types of H1N1 vaccine. I am only aware of one type in the U.S. I would recommend that you ask an Infectious Disease expert, so they can guide you with more information than I can. I can say that in the U.S. we do recommend all of our patients on TNF inhibitors and methotrexate to get the H1N1 vaccine, since they are immunocompromised both from the disease and from the treatments. Good luck.
