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People with autoimmune disease
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DEAR DR. ROACH: I am a 39-year-old male with systemic lupus. I read your article on artificial and natural immunity and how getting the flu shot helps “prime” the immune system. I have been told by some that priming the immune system with any vaccine is not a good idea in my case, since I could develop antibodies that attack my own body.

What I want to know: Is it a good idea to get the vaccine? -- D.S.

ANSWER: I often see advertisements for products claiming to “boost” the immune system, but in someone with autoimmune disease, that could be a disaster, since increasing the immune and inflammatory systems overall could lead to worsening of the autoimmune disease. In systemic lupus, it could lead to a flare-up of the disease, in any of its many manifestations, such as arthritis, kidney disease or swelling of the brain.

Fortunately, none of the products touted to “boost” the immune system actually do so. Vaccines are very specific antigens (usually proteins purified from bacteria or viruses) presented to the body, which then prepares cells that can respond to invaders with these antigens. They should not increase autoimmune disease, and the majority of evidence suggests that vaccines are safe for most people with autoimmune disease and that, again, for most people, the proven benefits of vaccination outweigh the small and theoretical risk of worsening the autoimmune disease.

I say “most” because there are some exceptions in which the risk may be too high. Anyone with a history of Guillain-Barre syndrome within six weeks of previous influenza vaccination should not get the flu vaccine. People with autoimmune disease taking medication that compromises the immune system should not take live vaccines. Some physicians recommend against vaccinating patients with severe autoimmune disease, and my comments cannot be a replacement for the advice of a physician who knows you.

DEAR DR. ROACH: I was on a cruise where I shared a bathroom with my daughter. She and I both had urinary-tract infections. She has had several recurrences, and is now going to a urologist. Is it possible that we were reinfecting each other? Is it possible to contract a UTI by using the same toilet? -- B.V.O.

ANSWER: It is not at all likely. Virtually all urinary tract infections are caused by bacteria entering the bladder and not being eliminated by the body. This may be due to the bacteria being particularly virulent, or to the person having a susceptibility to infection. The bacteria that enter the bladder generally are those that colonize the lower intestine.

No matter how carefully we clean ourselves, there are always bacteria on our body, and their numbers are particularly large in the perineum (genitals and anus). In women, these can gain entry through the urethra, the tube that drains the bladder.

  Toilet seats are relatively free from bacteria (compared with many other surfaces, such as the floor or sinks), and a flushed toilet has very little bacteria, so it’s extremely unlikely that a family member is the source of a UTI.