- Updated European League Against Rheumatism (EULAR) recommendations for vaccination in adults with autoimmune inflammatory rheumatic diseases (AIIRDs) highlight:
- 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 hospitalisations, emergency department visits, invasive infectious diseases risks.
- Annual vaccine status assessment, shared decision-making, and timing of vaccination highlighted.
- 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 immunisation 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.