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Updated EULAR recommendations for children with pedAIIRD
People with autoimmune or autoinflammatory rheumatic diseases are at increased risk of infection. This may be due to the underlying disease itself or may be caused by treatment with immunomodulatory or immunosuppressive drugs. Vaccinations play an important role in preventing infection. However, children with pedAIIRD need a vaccination schedule that takes into account their disease activity, current treatment and risk of infection, and vaccine effectiveness and safety. EULAR first developed recommendations for vaccinating children with pedAIIRD in 2011. Since then, the volume of evidence has doubled – and the power of that evidence has increased. During the same period, new treatments for pedAIIRD are available...
Updated EULAR recommendations for children with pedAIIRD
People with autoimmune or autoinflammatory rheumatic diseases are at increased risk of infection. This may be due to the underlying disease itself or may be caused by treatment with immunomodulatory or immunosuppressive drugs. Vaccinations play an important role in preventing infection. However, children with pedAIIRD need a vaccination schedule that takes into account their disease activity, current treatment and risk of infection, and vaccine effectiveness and safety.
EULAR first developed recommendations for vaccinating children with pedAIIRD in 2011. Since then, the volume of evidence has doubled – and the power of that evidence has increased. During the same period, new treatments for pedAIIRD have become available.
The updated EULAR recommendations were developed by a multidisciplinary task force from 9 European countries. Participants had expertise in pediatric and adult rheumatology, biology, epidemiology and immunology. The group also included patient representatives. The work was carried out in accordance with EULAR standardized operating procedures.
The paper, developed by EULAR and published in the June 2022 issue of the Annals of the Rheumatic Diseases, contains six overarching principles and seven recommendations.
The principles state that the vaccination status must be checked annually by the treating specialist and should ideally be administered during a dormant illness. If possible, vaccinations should be given 2-4 weeks before starting immunosuppression - but be careful that necessary treatment should never be postponed. In general, vaccinations should follow the national vaccination program and travel vaccination guidelines. Furthermore, this excludes live attenuated vaccines in immunocompromised patients, with a notable exception of measles-mumps-rubella (MMR) booster vaccinations and varicella vaccination under certain conditions.
The recommendations are simplified compared to the 2011 version. Previously, recommendations were grouped based on the use of immunosuppressants, non-live vaccines and live attenuated vaccines - but this resulted in overlap between individual recommendations. The updated version therefore summarizes some recommendations and moves others to the overarching principles. The resulting recommendations relate to vaccination against seasonal influenza, pneumococcus, tetanus, human papillomavirus and yellow fever as well as MMR and chickenpox.
EULAR hopes that these recommendations will assist pediatricians, rheumatologists, national immunization agencies, family physicians, patients and national societies to achieve safe and effective vaccinations and optimal infection prevention in immunocompromised children with AIIRDs.
Source:
European Alliance of Rheumatology Associations (EULAR)
Reference:
Jansen, MHA, et al. (2022) EULAR/PRES recommendations for vaccination of pediatric patients with autoimmune inflammatory rheumatic diseases: 2021 update. Annals of the Rheumatic Diseases. doi.org/10.1136/annrheumdis-2022-222574.
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