EULAR immunization guidelines for children with autoimmune rheumatic disease

Netherlands: A recent article in Annals of the Rheumatic Diseases, reports updated EULAR/PRES recommendations for vaccination of pediatric patients with autoimmune inflammatory rheumatic diseases.

According to EULAR vaccine recommendations, pediatric patients who have received B-cell depleting medication within the last six months should get passive immunization when tetanus toxoid vaccination is necessary. 

Recent findings supporting the safety of live-attenuated vaccines, as well as unique studies on the immunogenicity of immunizations in the era of biological disease-modifying antirheumatic medications in pediatric patients with autoimmune/inflammatory rheumatic disorders (pedAIIRD), warranted an update to the EULAR recommendations. These updated EULAR recommendations are intended for use by health care providers involved in the management and vaccination of pedAIIRD patients, such as pediatric rheumatologists, pediatricians, general practitioners, nurses, pharmacists, and primary healthcare professionals involved in the NIPs' implementation. These recommendations also attempt to educate patients and their families as part of informed/shared decision-making.

The EULAR standard operating procedures were used to create the recommendations. Two international specialist committees were organized to update immunization recommendations for AIIRD patients, both pediatric and adult. Following a systematic evaluation of the literature, specific recommendations for pediatric and adult patients were developed. Six overarching principles and 7 recommendations were developed for pedAIIRD and were given the level of evidence, strength of recommendation, and Task Force level of agreement.

The recommendations are as follows: 

1. Non-live seasonal influenza vaccination should be strongly considered for pedAIIRD on immunosuppressive therapies

2. Pneumococcal vaccination with PCV10 or PCV13 is recommended in all non-vaccinated pedAIIRD

3. Tetanus vaccination should be administered in accordance with recommendations for the general population. In case of an indication for TT vaccination, passive immunization is recommended for patients receiving B-cell depleting therapy in the past 6 months

4. HPV vaccination should be strongly considered in non-vaccinated jSLE patients

5. (a) MMR booster vaccination can be administered to patients on MTX; (b) MMR booster can be considered in patients treated with low-dose glucocorticosteroids TNFi, anti-IL1, and anti-IL6 therapy

6. (a) VZV vaccination should be strongly considered in varicella vaccination/infection naïve patients on MTX (b) VZV vaccination can be considered in varicella vaccination/infection naïve patients on low-dose glucocorticosteroids, TNFi, anti-IL1, and anti-IL6 therapy

7. YF vaccination should be avoided in all immunosuppressed patients

Reference: 

Jansen, M. H. A., Rondaan, C., Legger, G. E., Minden, K., Uziel, Y., Toplak, N., Maritsi, D., van den Berg, L., Berbers, G. A. M., Bruijning, P., Egert, Y., Normand, C., Bijl, M., N. M., & Heijstek, M. W. (2022). EULAR/PRES recommendations for vaccination of paediatric patients with autoimmune inflammatory rheumatic diseases: update 2021. In Annals of the Rheumatic Diseases (p. annrheumdis-2022-222574). BMJ. https://doi.org/10.1136/annrheumdis-2022-222574