EULAR: immunizations in autoimmune inflammatory rheumatic disease

  • Furer V & al.
  • Ann Rheum Dis
  • 14/08/2019

  • Liz Scherer
  • Clinical Essentials
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Takeaway

  • Updated European League Against Rheumatism (EULAR) recommendations for vaccination in adults with autoimmune inflammatory rheumatic diseases (AIIRDs) highlight:
    • Education.
    • A flexible approach to use of live-attenuated vaccines (measles, mumps, rubella; herpes zoster).
    • Tailoring of prevention/antimicrobial prophylaxis.

Why this matters

  • AIIRD population has historically been linked to suboptimal vaccination despite infection, related hospitalizations, emergency department visits, invasive infectious diseases risks.
  • Annual vaccine status assessment, shared decision-making, and timing of vaccination highlighted.

Key updates

  • 2011 recommendations have been expanded/divided into 6 overarching principles:
    • Annually assess vaccination status.
    • Focus patient education, shared decision-making.
    • Target vaccination during quiescent disease periods.
    • Administer vaccines before preplanned immunosuppression (especially B cell depleting therapy).
    • Consider nonlive vaccine administration to AIIRDs patients on disease-modifying antirheumatic drugs, glucocorticoids.
    • Cautiously consider live-attenuated vaccines.
  • Specific vaccines:
    • Influenza: all patients.
    • Pneumococcal: majority of patients.
    • Tetanus toxoid: consider passive immunization in patients on B cell depleting therapy.
    • Hepatitis A, B: at-risk patients.
    • Yellow fever: avoid; see guidance for traveling patients.
    • HPV: vaccinate in accordance with general population recommendations, especially in patients with systemic lupus erythematosus.
  • Vaccinate immunocompetent household members.
  • Avoid use of live-attenuated vaccine for first 6 months in newborns of mothers treated with biologics in the second half of pregnancy.