While it is important to receive your flu shot, some studies indicate that flu vaccines may not work as well in people with lupus as in people without the disease. It is best to re- ceive the high dose flu vaccine if it is available. Thus, avoiding contact with someone who is sick, washing your hands well and frequently, remain key to prevention. Pneumococcal Infections Pneumococcal infections are caused by bacteria and include infections of the brain (meningitis), bloodstream (bacteremia), lungs (pneumonia) and middle ear (otitis media). They occur more frequently in people with lupus, but may be prevented with the pneu- mococcal vaccine which Health Canada recommends for anyone with a chronic disease. This vaccine is very effective for most people with lupus. Although there have been some reports of lupus flares following pneumococcal immunization, large studies have not demonstrated a relationship between the two. In order to maintain optimal protection, you should be revaccinated after five years. Hemophilus Influenza Type B (Hib) and Meningococcal Vaccine Hemophilus influenza (Hib) and meningococcus pose significant threat to anyone who cannot properly produce specific antibodies against invading bacteria or other organ- isms. People whose spleen has been removed or is not fully functional, are at particular risk. In a study of people with lupus immunized against Hib, there were no serious side ef- fects or lupus flares, and most people developed protective antibodies. However, there are no studies demonstrating the safety or efficacy of the meningococcal vaccine in peo- ple with lupus. If your spleen has been removed or it is not fully functional, vaccination against organ- isms such as Hemophilus influenza is very important. In a study of people with lupus immunized against Hib, there were no serious side ef- fects or lupus flares, and most people developed protective antibodies. However, there are no studies demonstrating the safety or efficacy of the meningococcal vaccine in peo- ple with lupus. If your spleen has been removed or it is not fully functional, vaccination against organ- isms such as Hemophilus influenza is very important. Hepatitis B Vaccine Hepatitis B is a serious liver disease that is transmitted by infected blood and other body fluids. Two vaccines against hepatitis B are available in Canada and are strongly recom- mended for adults in high-risk categories, such as people on dialysis or organ transplant recipients. Thus, individuals with lupus who require dialysis and/or transplant could con- sider getting this immunization. No studies have been done to assess the role of the hepatitis B vaccine in triggering or exacerbating disease activity in lupus. Gardisil This vaccination, against human papilloma virus (HPV), is an option for both males and females before they become sexually active. It prevents HPV infection, which is a sex- ually transmitted disease without symptoms, that can be difficult to eradicate and can lead to cervical cancer. 19