2019 update of EULAR recommendations for vaccination in adult patients with autoimmune inflammatory rheumatic diseases

Abstract

To update the European League Against Rheumatism (EULAR) recommendations for vaccination in adult patients with autoimmune inflammatory rheumatic diseases (AIIRD) published in 2011. 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 of AIIRDs patients. Subsequently, recommendations were formulated based on the evidence and expert opinion. 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 the 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 human papilloma virus 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 AIIRD patients at risk. Immunocompetent household members of patients with AIIRD should receive vaccines according to national guidelines, except for the oral poliomyelitis vaccine. Live-attenuated vaccines should be avoided during the first 6 months of life in newborns of mothers treated with biologics during the second half of pregnancy. These 2019 EULAR recommendations provide an up-to-date guidance on the management of vaccinations in patients with AIIRD.

Low Influenza, Pneumococcal and Diphtheria–Tetanus–Poliomyelitis Vaccine Coverage in Patients with Primary Sjögren’s Syndrome: A Cross-Sectional Study

“…Indeed, in the COMORA study conducted in 17 countries, optimal influenza vaccination was associated with low disease activity defined by a Disease Activity Score of <3.2 in 28 joints (OR 1.37, 95% CI 1.13-1.65). This finding was in agreement with the EULAR recommendations, suggesting that patients with autoimmune and rheumatic diseases should ideally be vaccinated when the disease is stable [17].…”

“…This fear, which is not justified in the general population, could be more understandable in autoimmune diseases. However, all the available data and the recently reviewed EULAR recommendations are very reassuring and do not suggest a significant risk of relapse in patients with autoimmune diseases [17]. In Sjögren's syndrome, increases in IgG, anti-SSA, and anti-SSB titers patients' sera after influenza vaccination without any increase in flare-ups were recently reported [24].…”

“…To prevent infection, two vaccinations are recommended for immunocompromised patients, i.e., the influenza vaccine and the pneumococcal vaccine [16,17]. Recommendations for the diphtheriatetanus-poliomyelitis (DTP) vaccine vary across the institutions from which they originate.…”

“…Recommendations for the diphtheriatetanus-poliomyelitis (DTP) vaccine vary across the institutions from which they originate. Indeed, the European recommendations issued by EULAR for this vaccination are identical to those applicable to the general population [17]. According to French recommendations, the DTP booster should be performed every 10 years in all patients with autoimmune diseases [16].…”

Cytokine Release Syndrome in COVID-19 Patients, A New Scenario for an Old Concern: The Fragile Balance between Infections and Autoimmunity

“…This registry could give useful information to clarify the above hypothesis and be of crucial help for therapeutic decision-making in this particular group of patients. Whatever these results will show, one should keep in mind that co-infection can often be lethal, and thus, the use of anti-influenza and anti-pneumococcal vaccinations, already recommended in these patients [125], assumes even more importance in this new scenario of the COVID-19 pandemic.…”