The European League Against Rheumatism (EULAR) has published updated recommendations for vaccination of patients with autoimmune inflammatory rheumatic diseases (AIIRD).
The update includes six overarching principles as follows:
- Rheumatology team should assess vaccination status yearly.
- Rheumatology team should explain individualised vaccination programmes to patients and implement programmes jointly with the primary care physician and the patient.
- Preferably administer vaccination during quiescent disease.
- Preferably, vaccinate prior to planned immunosuppression, especially B-cell depleting therapy.
- Non-live vaccines can be administered during treatment with glucocorticoids and disease-modifying antirheumatic drugs (DMARDs).
- Consider live-attenuated vaccines with caution.
The updated recommendations are:
- Consider influenza vaccination for most patients.
- Consider pneumococcal vaccination for most patients.
- Tetanus toxoid vaccination as per recommendations for the general population. Consider passive immunisation with B-cell depleting therapy.
- At-risk patients should receive hepatitis A and B vaccination.
- Consider herpes zoster vaccination in high-risk patients.
- Generally, avoid yellow fever vaccination.
- Administer human papillomavirus vaccination, especially in patients with systemic lupus erythematosus, as per recommendations for the general population.
- Immunocompetent household members should be encouraged to be vaccinated according to national guidelines, except oral polio vaccines.
- Avoid live-attenuated vaccines during the first six months of life in newborns of mothers treated with biologics during the second half of pregnancy.