Vaccination Recommendations for Patients with Rheumatic Heart Disease

Core Vaccinations

The American College of Rheumatology recommends that patients with rheumatic heart disease receive influenza, pneumococcal, and recombinant varicella-zoster virus vaccinations, with influenza vaccination being strongly recommended annually regardless of immunosuppressive therapy 1, 2, 3
High-dose or adjuvanted influenza vaccination is conditionally recommended over regular-dose influenza for patients with rheumatic diseases who are ≥65 years or >18 years and <65 years taking immunosuppressive medications 1, 3
Influenza vaccination should be administered annually and on schedule, even for patients on immunosuppressive therapies including rituximab 4, 5
Pneumococcal vaccination is strongly recommended for patients with rheumatic diseases who are <65 years and taking immunosuppressive medications 1, 2
Recombinant VZV vaccine is strongly recommended for patients with rheumatic diseases >18 years who are taking immunosuppressive medication 1, 6

The American College of Rheumatology recommends considering holding methotrexate for 2 weeks after influenza vaccination if disease activity allows 5
For patients on rituximab, administer influenza vaccination on schedule regardless of rituximab timing, but delay any subsequent rituximab dosing for at least 2 weeks after vaccination if disease activity allows 4, 5
For patients on prednisone ≥20 mg daily, administer influenza vaccination, but consider deferring other non-live vaccinations until glucocorticoids are tapered to <20 mg daily 4, 7

The American College of Cardiology recommends secondary prevention of rheumatic fever with antibiotic prophylaxis in all patients with rheumatic heart disease 8
For patients with rheumatic heart disease and residual valvular disease, prophylaxis should continue for at least 10 years or until age 40 (whichever is longer) 8
Non-live vaccinations are conditionally recommended regardless of disease activity 7
Multiple vaccinations can be administered on the same day rather than on different days 9