2019 update of EULAR recommendations for vaccination in adult patients with autoimmune inflammatory rheumatic diseases

Victoria Furer*, Christien Rondaan, Marloes W. Heijstek, Nancy Agmon-Levin, Sander van Assen, Marc Bijl, Ferry C. Breedveld, Raffaele D'Amelio, Maxime Dougados, Meliha Crnkic Kapetanovic, Jacob M. van Laar, A. de Thurah, Robert B. M. Landewe, Anna Molto, Ulf Mueller-Ladner, Karen Schreiber, Leo Smolar, Jim Walker, Klaus Warnatz, Nico M. WulffraatOri Elkayam

*Corresponding author for this work

    Research output: Contribution to journalReview articlepeer-review

    123 Citations (Scopus)

    Abstract

    To update the European League Against Rheumatism (EULAR) recommendations for vaccination in adult patients with autoimmune inflammatory rheumatic diseases (AIIRD) published in 2011. Four systematic literature reviews were performed regarding the incidence/prevalence of vaccine-preventable infections among patients with AIIRD; efficacy, immunogenicity and safety of vaccines; effect of anti-rheumatic drugs on the response to vaccines; effect of vaccination of household of AIIRDs patients. Subsequently, recommendations were formulated based on the evidence and expert opinion. The updated recommendations comprise six overarching principles and nine recommendations. The former address the need for an annual vaccination status assessment, shared decision-making and timing of vaccination, favouring vaccination during quiescent disease, preferably prior to the initiation of immunosuppression. Non-live vaccines can be safely provided to AIIRD patients regardless of underlying therapy, whereas live-attenuated vaccines may be considered with caution. Influenza and pneumococcal vaccination should be strongly considered for the majority of patients with AIIRD. Tetanus toxoid and human papilloma virus vaccination should be provided to AIIRD patients as recommended for the general population. Hepatitis A, hepatitis B and herpes zoster vaccination should be administered to AIIRD patients at risk. Immunocompetent household members of patients with AIIRD should receive vaccines according to national guidelines, except for the oral poliomyelitis vaccine. Live-attenuated vaccines should be avoided during the first 6 months of life in newborns of mothers treated with biologics during the second half of pregnancy. These 2019 EULAR recommendations provide an up-to-date guidance on the management of vaccinations in patients with AIIRD.

    Original languageEnglish
    Pages (from-to)39-52
    Number of pages14
    JournalAnnals of the Rheumatic Diseases
    Volume79
    Issue number1
    DOIs
    Publication statusPublished - Jan-2020

    Keywords

    • SYSTEMIC-LUPUS-ERYTHEMATOSUS
    • HUMAN PAPILLOMA-VIRUS
    • PNEUMOCOCCAL POLYSACCHARIDE VACCINE
    • MODIFYING ANTIRHEUMATIC DRUGS
    • JUVENILE IDIOPATHIC ARTHRITIS
    • HERPES-ZOSTER INFECTION
    • A H1N1 VACCINE
    • INFLUENZA A/H1N1 VACCINATION
    • NECROSIS FACTOR-ALPHA
    • IMMUNE-RESPONSE

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