Immunogenicity of Influenza Vaccine in Children With Pediatric Rheumatic Diseases Receiving Immunosuppressive Agents

Ogimi, Chikara; Tanaka, Risa; Saitoh, Akihiko; Oh‐ishi, Tsutomu

doi:10.1097/inf.0b013e3181f7ce44

Cited by 46 publications

(62 citation statements)

References 15 publications

(16 reference statements)

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“…This study design provided strong evidence that the immunoresponse to influenza A H1N1/2009 vaccine was impaired in the juvenile ARD population, in contrast to previous studies on seasonal influenza vaccination 6,7,8 . In this regard, Malleson, et al evaluated 34 children with chronic arthritis (91% JIA) and observed similar seasonal vaccine immunogenicity in patients and 13 controls, independent of the use of prednisone or immunosuppressive agents 7 .…”

Section: Discussioncontrasting

confidence: 45%

“…The preimmunization rate cannot account for this finding because it was similar to that of the control group. In contrast, previous reports suggest apparently adequate vaccine responses for seasonal influenza 8 and hepatitis 27 in persons with JIA. The inclusion of patients or controls younger than age 9 years 8,27 and 3 years old 8 precludes a definitive conclusion about their findings, as vaccine responses in these 2 age brackets are expected to be much lower than in older children.…”

Section: Discussioncontrasting

confidence: 43%

“…On the other hand, in the study of Ogimi, et al, the 49 patients with rheumatic disease and 36 with juvenile chronic diseases in the control group had unexpectedly low immunoresponses to the seasonal influenza, although it was comparable between groups 8 . Again, the inclusion of infants and the vaccination protocol used in that study may account for the impaired response that was observed 8 .…”

Section: Discussionmentioning

confidence: 99%

“…All patients who agreed to participate were included regardless of disease activity status or current treatment, to closely represent the real-life situation. Also, all patients fulfilled the international criteria for juvenile ARD, and the study benefited from the inclusion of a large patient population, an essential requirement to accurately define vaccine immunoresponse and safety, which was not met by previous studies of seasonal influenza vaccine 6,8 . Moreover, age-matching of the control group is essential because effectiveness of vaccine has a distinct pattern in children and adolescents 19 .…”

Section: Discussionmentioning

confidence: 99%

“…To date, no study had evaluated the efficacy and safety of the influenza A H1N1/2009 vaccine in patients with juvenile ARD. A few studies with small populations evaluated the immune response to other vaccines in these patients 6,7,8 . Kanakoudi-Tsakalidou, et al showed a satisfactory antibody response to the seasonal influenza immunization in patients with juvenile rheumatic diseases under immunosuppressive therapies 6 .…”

mentioning

confidence: 99%

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Glucocorticoid: Major Factor for Reduced Immunogenicity of 2009 Influenza A (H1N1) Vaccine in Patients with Juvenile Autoimmune Rheumatic Disease

Aikawa

Campos²,

Silva³

et al. 2011

J Rheumatol

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Objective.To assess the immunogenicity and safety of non-adjuvanted influenza A H1N1/2009 vaccine in patients with juvenile autoimmune rheumatic disease (ARD) and healthy controls, because data are limited to the adult rheumatologic population.Methods.A total of 237 patients with juvenile ARD [juvenile systemic lupus erythematosus (JSLE), juvenile idiopathic arthritis (JIA), juvenile dermatomyositis (JDM), juvenile scleroderma, and vasculitis] and 91 healthy controls were vaccinated. Serology for anti-H1N1 was performed by hemagglutination inhibition assay. Seroprotection rate, seroconversion rate, and factor-increase in geometric mean titer (GMT) were calculated. Adverse events were evaluated.Results.Age was comparable in patients and controls (14.8 ± 3.0 vs 14.6 ± 3.7 years, respectively; p = 0.47). Three weeks after immunization, seroprotection rate (81.4% vs 95.6%; p = 0.0007), seroconversion rate (74.3 vs 95.6%; p < 0.0001), and the factor-increase in GMT (12.9 vs 20.3; p = 0.012) were significantly lower in patients with juvenile ARD versus controls. Subgroup analysis revealed reduced seroconversion rates in JSLE (p < 0.0001), JIA (p = 0.008), JDM (p = 0.025), and vasculitis (p = 0.017). Seroprotection (p < 0.0001) and GMT (p < 0.0001) were decreased only in JSLE. Glucocorticoid use and lymphopenia were associated with lower seroconversion rates (60.4 vs 82.9%; p = 0.0001; and 55.6 vs 77.2%; p = 0.012). Multivariate logistic regression including diseases, lymphopenia, glucocorticoid, and immunosuppressants demonstrated that only glucocorticoid use (p = 0.012) remained significant.Conclusion.This is the largest study to demonstrate a reduced but adequate immune response to H1N1 vaccine in patients with juvenile ARD. It identified current glucocorticoid use as the major factor for decreased antibody production. The short-term safety results support its routine recommendation for patients with juvenile ARD. ClinicalTrials.gov; NCT01151644.

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Section: Discussioncontrasting

confidence: 45%

Section: Discussioncontrasting

confidence: 43%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Glucocorticoid: Major Factor for Reduced Immunogenicity of 2009 Influenza A (H1N1) Vaccine in Patients with Juvenile Autoimmune Rheumatic Disease

Aikawa

Campos²,

Silva³

et al. 2011

J Rheumatol

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High Disease Activity: An Independent Factor for Reduced Immunogenicity of the Pandemic Influenza A Vaccine in Patients With Juvenile Systemic Lupus Erythematosus

Campos

Silva

Aikawa

et al. 2013

Arthritis Care & Research

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Objective. Recent findings demonstrated a reduced immunogenicity of the influenza A H1N1/2009 vaccine in juvenile rheumatic diseases. However, a point of concern is whether the vaccine could induce disease flares. The aim of this study was to assess the disease safety of and the possible influence of disease parameters and therapy on nonadjuvant influenza A H1N1 vaccine response of juvenile systemic lupus erythematosus (SLE) patients. Methods. One hundred eighteen juvenile SLE patients and 102 healthy controls of a comparable age were vaccinated. Seroprotection rate, seroconversion rate, and factor increase in geometric mean titer (GMT) were calculated and effective immune response was defined by the Food and Drug Administration and the European Committee for Proprietary Medicinal Products vaccine immunologic standards. Disease parameters, treatment, and adverse events were evaluated. Results. Age was comparable in juvenile SLE patients and controls (mean ؎ SD 16.0 ؎ 3.5 versus 15.9 ؎ 4.5 years; P ‫؍‬ 0.26). Three weeks after immunization, seroprotection rate (73.7% versus 95.1%; P < 0.001), seroconversion rate (63.6% versus 91.2%; P < 0.001), GMT (90.8 versus 273.3; P < 0.001), and factor increase in GMT (8.1 versus 19.9; P < 0.001) were significantly lower in juvenile SLE patients versus controls. Nonseroconversion was associated with a higher frequency of patients with a Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K) score >8 (48.8% versus 24%; P ‫؍‬ 0.008) and a higher mean ؎ SD current glucocorticoid dosage (18 ؎ 21.4 versus 10.5 ؎ 12.5 mg/day; P ‫؍‬ 0.018). Multivariate logistic regression including a SLEDAI-2K score >8 revealed that only the SLEDAI-2K remained a significant factor for nonseroconversion (odds ratio 0.42, 95% confidence interval 0.18 -0.98; P ‫؍‬ 0.045). Disease parameters remained stable throughout the study and no severe vaccine adverse events were observed. Conclusion. The present study demonstrated adequate disease safety and is the first to discriminate that high disease activity impairs influenza A H1N1/2009 vaccine antibody production in juvenile SLE, in spite of an overall immune response within recommended levels.

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2021 American College of Rheumatology Guideline for the Treatment of Juvenile Idiopathic Arthritis: Recommendations for Nonpharmacologic Therapies, Medication Monitoring, Immunizations, and Imaging

Onel

Horton

Lovell

et al. 2022

Arthritis Care & Research

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Objective To provide recommendations for the management of juvenile idiopathic arthritis (JIA) with a focus on nonpharmacologic therapies, medication monitoring, immunizations, and imaging, irrespective of JIA phenotype. Methods We developed clinically relevant Patient/Population, Intervention, Comparison, and Outcomes questions. After conducting a systematic literature review, the Grading of Recommendations Assessment, Development and Evaluation approach was used to rate the quality of evidence (high, moderate, low, or very low). A Voting Panel including clinicians and patients/caregivers achieved consensus on the direction (for or against) and strength (strong or conditional) of recommendations. Results Recommendations in this guideline include the use of physical therapy and occupational therapy interventions; a healthy, well‐balanced, age‐appropriate diet; specific laboratory monitoring for medications; widespread use of immunizations; and shared decision‐making with patients/caregivers. Disease management for all patients with JIA is addressed with respect to nonpharmacologic therapies, medication monitoring, immunizations, and imaging. Evidence for all recommendations was graded as low or very low in quality. For that reason, more than half of the recommendations are conditional. Conclusion This clinical practice guideline complements the 2019 American College of Rheumatology JIA and uveitis guidelines, which addressed polyarthritis, sacroiliitis, enthesitis, and uveitis, and a concurrent 2021 guideline on oligoarthritis, temporomandibular arthritis, and systemic JIA. It serves as a tool to support clinicians, patients, and caregivers in decision‐making. The recommendations take into consideration the severity of both articular and nonarticular manifestations as well as patient quality of life. Although evidence is generally low quality and many recommendations are conditional, the inclusion of caregivers and patients in the decision‐making process strengthens the relevance and applicability of the guideline. It is important to remember that these are recommendations. Clinical decisions, as always, should be made by the treating clinician and patient/caregiver.

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Immunogenicity of Influenza Vaccine in Children With Pediatric Rheumatic Diseases Receiving Immunosuppressive Agents

Cited by 46 publications

References 15 publications

Glucocorticoid: Major Factor for Reduced Immunogenicity of 2009 Influenza A (H1N1) Vaccine in Patients with Juvenile Autoimmune Rheumatic Disease

Glucocorticoid: Major Factor for Reduced Immunogenicity of 2009 Influenza A (H1N1) Vaccine in Patients with Juvenile Autoimmune Rheumatic Disease

High Disease Activity: An Independent Factor for Reduced Immunogenicity of the Pandemic Influenza A Vaccine in Patients With Juvenile Systemic Lupus Erythematosus

2021 American College of Rheumatology Guideline for the Treatment of Juvenile Idiopathic Arthritis: Recommendations for Nonpharmacologic Therapies, Medication Monitoring, Immunizations, and Imaging

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