The European League Against Rheumatism (EULAR) has updated its 2011 recommendations for vaccination in adult patients with autoimmune inflammatory rheumatic diseases (AIIRD).
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 members of AIIRDs patients.
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 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 HPV 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 at-risk AIIRD patients.
Immunocompetent household members of AIIRD patients should receive vaccines according to national guidelines, except for the oral poliomyelitis vaccine.
Live-attenuated vaccines should be avoided in newborns (under six months) of mothers treated with biologics during the second half of pregnancy.