EULAR: immunisations in autoimmune inflammatory rheumatic disease

  • Furer V & al.
  • Ann Rheum Dis
  • 14 Aug 2019

  • International Clinical Digest
Access to the full content of this site is available only to registered healthcare professionals. Access to the full content of this site is available only to registered healthcare professionals.

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 hospitalisations, 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 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.