TY - JOUR
T1 - EULAR/PRES recommendations for vaccination of paediatric patients with autoimmune inflammatory rheumatic diseases
T2 - update 2021
AU - Jansen, Marc H A
AU - Rondaan, Christien
AU - Legger, Geertje E
AU - Minden, Kirsten
AU - Uziel, Yosef
AU - Toplak, Natasa
AU - Maritsi, Despoina
AU - van den Berg, Lotte
AU - Berbers, Guy A M
AU - Bruijning, Patricia
AU - Egert, Yona
AU - Normand, Christophe
AU - Bijl, Marc
AU - Foster, Helen E
AU - Koné-Paut, Isabelle
AU - Wouters, Carine
AU - Ravelli, Angelo
AU - Elkayam, Ori
AU - Wulffraat, Nicolaas M
AU - Heijstek, Marloes W
N1 - Funding Information:
This study was funded by European League against Rheumatism (EULAR).
Publisher Copyright:
© 2022 BMJ Publishing Group. All rights reserved.
PY - 2022/1
Y1 - 2022/1
N2 - OBJECTIVES: Recent insights supporting the safety of live-attenuated vaccines and novel studies on the immunogenicity of vaccinations in the era of biological disease-modifying antirheumatic drugs in paediatric patients with autoimmune/inflammatory rheumatic diseases (pedAIIRD) necessitated updating the EULAR recommendations.METHODS: Recommendations were developed using the EULAR standard operating procedures. Two international expert committees were formed to update the vaccination recommendations for both paediatric and adult patients with AIIRD. After a systematic literature review, separate recommendations were formulated for paediatric and adult patients. For pedAIIRD, six overarching principles and seven recommendations were formulated and provided with the level of evidence, strength of recommendation and Task Force level of agreement.RESULTS: In general, the National Immunisation Programmes (NIP) should be followed and assessed yearly by the treating specialist. If possible, vaccinations should be administered prior to immunosuppressive drugs, but necessary treatment should never be postponed. Non-live vaccines can be safely given to immunosuppressed pedAIIRD patients. Mainly, seroprotection is preserved in patients receiving vaccinations on immunosuppression, except for high-dose glucocorticoids and B-cell depleting therapies. Live-attenuated vaccines should be avoided in immunosuppressed patients. However, it is safe to administer the measles-mumps-rubella booster and varicella zoster virus vaccine to immunosuppressed patients under specific conditions. In addition to the NIP, the non-live seasonal influenza vaccination should be strongly considered for immunosuppressed pedAIIRD patients.CONCLUSIONS: These recommendations are intended for paediatricians, paediatric rheumatologists, national immunisation agencies, general practitioners, patients and national rheumatology societies to attain safe and effective vaccination and optimal infection prevention in immunocompromised pedAIIRD patients.
AB - OBJECTIVES: Recent insights supporting the safety of live-attenuated vaccines and novel studies on the immunogenicity of vaccinations in the era of biological disease-modifying antirheumatic drugs in paediatric patients with autoimmune/inflammatory rheumatic diseases (pedAIIRD) necessitated updating the EULAR recommendations.METHODS: Recommendations were developed using the EULAR standard operating procedures. Two international expert committees were formed to update the vaccination recommendations for both paediatric and adult patients with AIIRD. After a systematic literature review, separate recommendations were formulated for paediatric and adult patients. For pedAIIRD, six overarching principles and seven recommendations were formulated and provided with the level of evidence, strength of recommendation and Task Force level of agreement.RESULTS: In general, the National Immunisation Programmes (NIP) should be followed and assessed yearly by the treating specialist. If possible, vaccinations should be administered prior to immunosuppressive drugs, but necessary treatment should never be postponed. Non-live vaccines can be safely given to immunosuppressed pedAIIRD patients. Mainly, seroprotection is preserved in patients receiving vaccinations on immunosuppression, except for high-dose glucocorticoids and B-cell depleting therapies. Live-attenuated vaccines should be avoided in immunosuppressed patients. However, it is safe to administer the measles-mumps-rubella booster and varicella zoster virus vaccine to immunosuppressed patients under specific conditions. In addition to the NIP, the non-live seasonal influenza vaccination should be strongly considered for immunosuppressed pedAIIRD patients.CONCLUSIONS: These recommendations are intended for paediatricians, paediatric rheumatologists, national immunisation agencies, general practitioners, patients and national rheumatology societies to attain safe and effective vaccination and optimal infection prevention in immunocompromised pedAIIRD patients.
KW - Arthritis, Juvenile
KW - Autoimmune Diseases
KW - Biological Therapy
KW - Immune System Diseases
KW - Vaccination
UR - https://www.scopus.com/pages/publications/85134498367
U2 - 10.1136/annrheumdis-2022-222574
DO - 10.1136/annrheumdis-2022-222574
M3 - Article
C2 - 35725297
SN - 0003-4967
VL - 82
SP - 35
EP - 47
JO - Annals of the Rheumatic Diseases
JF - Annals of the Rheumatic Diseases
IS - 1
ER -