Are anti-infectious vaccinations safe and effective in patients with autoimmunity?

Vaccinations have been traditionally considered a risk factor for the induction/reactivation of autoimmune diseases. A Medline search through key words "vaccinations and autoimmune diseases" from 1947 through December 2009 was conducted. Until now, vaccination effects in autoimmune diseases have only been studied in over 5000 patients. Vaccinations generally did not induce worsening of disease activity in patients with multiple sclerosis, systemic lupus erythematosus, rheumatoid arthritis, insulin-dependent-diabetes-mellitus, chronic arthritis in children, vasculitides, and myasthenia gravis, whereas immunogenicity, although protective, was generally lower than in normal controls, depending on disease severity and immunosuppressive therapy. Data are very poor on the efficacy.