Vaccination of children with autoimmune inflammatory rheumatic diseases: EULAR/PRES recommendations
Netherlands: An article, published in Annals of the Rheumatic Diseases, reports updated EULAR/PRES recommendations for vaccination of pediatric patients with autoimmune inflammatory rheumatic diseases.
Recent studies supporting the safety of live-attenuated vaccines and novel research on the immunogenicity of vaccinations in the era of biological disease-modifying antirheumatic drugs in pediatric patients with autoimmune/inflammatory rheumatic diseases (pedAIIRD) call for updating the EULAR recommendations.
The EULAR standard operating procedures were used for developing the recommendations. To update the vaccination recommendations for both pediatric and adult patients with AIIRD, the formation of two international expert committees was done. After a systematic literature review, separate recommendations were formulated for pediatric 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.
Recommendations for non-live vaccines
· Non-live seasonal influenza vaccination should be strongly considered for pedAIIRD on immunosuppressive therapies.
· Pneumococcal vaccination with PCV10 or PCV13 is recommended in all non-vaccinated pedAIIRD.
· 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.
· Human papillomavirus (HPV) vaccination should be strongly considered in non-vaccinated juvenile-onset systemic lupus erythematosus (jSLE) patients.
Recommendations for live-attenuated vaccines
· (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.
· (a) Varicella-zoster virus (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.
· Primary yellow fever (YF) vaccination should be avoided in all immunosuppressed patients.
The researchers wrote in their conclusion, "these recommendations are intended for pediatricians, pediatric rheumatologists, national immunization agencies, general practitioners, patients, and national rheumatology societies to attain safe and effective vaccination and optimal infection prevention in immunocompromised pedAIIRD patients."
Reference:
Jansen MHA, Rondaan C, Legger GE, et alEULAR/PRES recommendations for vaccination of paediatric patients with autoimmune inflammatory rheumatic diseases: update 2021Annals of the Rheumatic Diseases Published Online First: 20 June 2022. doi: 10.1136/annrheumdis-2022-222574
