Psoriatic Disease and Vaccination
Even though the focus has been on COVID-19 vaccination, staying up-to-date on all appropriate vaccinations can help maintain a patient’s overall health. Because of that, the NPF Medical Board is updating their guidance for vaccinating adult patients on systemic therapy for psoriasis, a project in which Dr. Ellebrecht is heavily involved. “This updated paper aims to use the heightened vaccine awareness to encourage providers and patients to engage in a conversation about their current vaccine status and give them up-to-date recommendations on what to do when you start or already are on systemic psoriatic disease treatment.”
As it stands now, vaccination in patients with psoriatic disease is generally recommended. However, it should be noted that live vaccines are contraindicated in patients on immunosuppressive therapy generally.  As infections are a major cause of morbidity and mortality in patients on chronic immunosuppression, vaccine status and advising should be discussed early in the management of patients with moderate-to-severe psoriasis.  NPF’s Medical Board reviewed the vaccines available at the time of writing and examined whether they should be recommended for patients on systemic therapies. According to that paper, certain vaccines should be given prior to starting systemic therapy, such as chickenpox, zoster, and specific pneumococcal vaccines. 
“Live vaccines should be given before starting systemic psoriasis treatment. Some therapies make vaccines less effective, which is why patients should talk to their provider about updating their vaccination status prior to starting such therapies,” says Dr. Ellebrecht. He continues, “ideally, age-appropriate vaccines should be given prior to starting systemic psoriatic disease therapy. Killed/inactivated vaccinations are generally safe while on treatment. They seem in most cases to still be effective in patients on treatment.”
Additionally, the NPF COVID-19 Task Force has updated their Guidance Statements to include the use of COVID-19 vaccines in patients with psoriatic disease. The new guidance statements in this update include:
- Patients with psoriatic disease, who do not have contraindications to vaccination, should receive a mRNA-based COVID-19 vaccine as soon as it becomes available to them based on federal, state, and local guidance. Systemic medications for psoriasis or psoriatic arthritis are not a contraindication to the mRNA-based COVID19 vaccine. If vaccine supply is limited, the Task Force recommends following CDC’s prioritization guidelines for early vaccination for selected groups based on their comorbidities and work setting.
- It is recommended that patients who are to receive a mRNA-based COVID-19 vaccine continue their biologic or oral therapies for psoriasis and/or psoriatic arthritis in most cases. Shared decision-making between clinician and patient is recommended to guide discussions about use of systemic therapies during the pandemic.
Health care providers can read more about the NPF Covid-19 Task Force efforts and the guidance statements at the COVID-19 Resource Center.
 Vaccine Types. Vaccines. https://www.vaccines.gov/basics/types. Accessed December 13, 2020.
 Vaccine Types. National Institute of Allergy and Infectious Diseases. https://www.niaid.nih.gov/research/vaccine-types. Accessed December 13, 2020.
 Centers for Disease Control and Prevention. Epidemiology and Prevention of Vaccine-Preventable Diseases. Hamborsky J, Kroger A, Wolfe S, eds. 13th ed. Washington D.C. Public Health Foundation, 2015.
 Akpan N. Moderna's mRNA vaccine reaches its final phase. Here's how it works. National Geographic. https://www.nationalgeographic.com/science/2020/05/moderna-coronavirus-vaccine-how-it-works-cvd/. Published July 28, 2020. Accessed December 13, 2020.
 Pfizer-BioNTech COVID-19 Vaccine. U.S. Food and Drug Administration. https://www.fda.gov/emergency-preparedness-and-response/coronavirus-disease-2019-covid-19/pfizer-biontech-covid-19-vaccine. Published December 11, 2020. Accessed December 13, 2020.
 The Advisory Committee on Immunization Practices' Interim Recommendation for Allocating Initial Supplies of COVID-19 Vaccine - United States, 2020. Centers for Disease Control and Prevention. https://www.cdc.gov/mmwr/volumes/69/wr/mm6949e1.htm. Published December 10, 2020. Accessed December 13, 2020.
 Pfizer and BioNTech Celebrate Historic First Authorization in the U.S. of Vaccine to Prevent COVID-19. Pfizer. https://www.pfizer.com/news/press-release/press-release-detail/pfizer-and-biontech-celebrate-historic-first-authorization. Published December 11, 2020. Accessed December 13, 2020.
 FDA Statement on Vaccines and Related Biological Products Advisory Committee Meeting. U.S. Food and Drug Administration. https://www.fda.gov/news-events/press-announcements/fda-statement-vaccines-and-related-biological-products-advisory-committee-meeting. Published December 11, 2020. Accessed December 13, 2020.
 Pfizer and BioNTech Receive FDA Advisory Committee Vote Supporting Potential First Emergency Use Authorization for Vaccine to Combat COVID-19 in the U.S. Pfizer. https://www.pfizer.com/news/press-release/press-release-detail/pfizer-and-biontech-receive-fda-advisory-committee-vote. Published December 10, 2020. Accessed December 13, 2020.
 Polack FP, Thomas SJ, Kitchin N, et al. Safety and Efficacy of the BNT162b2 mRNA Covid-19 Vaccine [published online ahead of print, 2020 Dec 10]. N Engl J Med. 2020;10.1056/NEJMoa2034577. doi:10.1056/NEJMoa2034577
 Moderna Announces Primary Efficacy Analysis in Phase 3 COVE Study for Its COVID-19 Vaccine Candidate and Filing Today with U.S. FDA for Emergency Use Authorization. Moderna, Inc.