Introduction: Ankylosing spondylitis (AS) and the closely related axial spondyloarthritis (axSpA) represents the chronic rheumatic diseases of the immune system hyperactive and including inflammation of the spine, inflammation of the sacroiliac joints, and diverse extraarticular phenomena like acute anterior uveitis, psoriasis, and inflammatory bowel disease. The multifactorial pathogenesis of AS includes a element of HLA-B27, immune system regulation, and the AS is the immune-mediated rheumatic disease patients suffer the most in the world from AS. Infections like influenza, pneumococcal pneumonia, herpes zoster, and hepatitis B virus (HBV) reactivation are major causes of illness and death that can be avoided in people with AS. Consequently, preventive measures, especially vaccination, have become essential elements of AS management. The American College of Rheumatology (ACR) and the European League Against Rheumatism (EULAR) have recently stressed the need for regular checks of immunization status, the use of inactivated vaccines first, the avoidance of live attenuated vaccines during immunosuppressive therapy, and the best timing of vaccines in relation to medication use.

Methods: This long abstract is derived from a systematic review of peer-reviewed literature with emphasis on infection risk, immunopathogenesis, and vaccination in AS. The inclusion criteria were clinical trials, observational studies, meta analyses, and key international guidelines.

Findings: These patients are susceptible to infections because of a combination of factors. Immune dysregulation in AS, through changes in T-cell subsets and cytokine signaling, results in higher vulnerability to viral as well as bacterial pathogens. In addition, biologic agents—specifically, TNF-α inhibitors—have been associated with heightened risks of respiratory infection, reactivation of latent tuberculosis, and herpes zoster.

Discussion: Incorporation of vaccination into standard AS management is imperative to diminish infection burden. According to guideline recommendations, real-world research illustrates that vaccination coverage among AS patients is still suboptimal because of physician supervision, patient reluctance, and logistical challenges.

KEYWORDS: Ankylosing Spondylitis, Axial Spondyloarthritis, Vaccination, Biologics, Immunogenicity, and Prevention of Infections.