Managing varicella zoster virus contact and infection in patients on anti-rheumatic therapy

Cates, Matthew; Donati, Matthew; Gillet, Sophie; Ustianowski, Andrew; Galloway, James

doi:10.1093/rheumatology/kex189

Cited by 13 publications

(14 citation statements)

References 71 publications

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“…In significantly immunosuppressed patients, the severity of VZV infections can be mitigated by VZV immunoglobulins, if given within 24 hours (up to 72 hours at most) post exposure. For this purpose, an immunoglobulin preparation that can be administered intravenously should be given preference (e.g., Varitect ® ) . Immunosuppressed patients exposed to varicella may also receive chemoprophylaxis with acyclovir starting on day 7–9 post exposure (6(–80) mg/kg/day PO for 5–7 days).…”

Section: Vaccinationsmentioning

confidence: 99%

S2k guidelines for the treatment of psoriasis in children and adolescents – Short version part 2

Eisert

Augustin

Bach

et al. 2019

J Deutsche Derma Gesell

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Summary The present guidelines are aimed at residents and board‐certified physicians in the fields of dermatology, pediatrics, pediatric dermatology and pediatric rheumatology as well as policymakers and insurance funds. They were developed by dermatologists and pediatric dermatologists in collaboration with pediatric rheumatologists using a formal consensus process (S2k). The guidelines highlight topics such as disease severity, quality of life, treatment goals as well as problems associated with off‐label drug therapy in children. Trigger factors and diagnostic aspects are discussed. The primary focus is on the various topical, systemic and UV‐based treatment options available and includes recommendations for use and treatment algorithms. Other aspects addressed herein include vaccinations in children and adolescents with psoriasis as well as various disease subtypes such as guttate psoriasis, diaper psoriasis, pustular psoriasis and psoriatic arthritis. Finally, we also provide recommendations for imaging studies and the diagnostic workup to rule out tuberculosis prior to initiating systemic treatment. Note: This article constitutes part 2 of the Sk2 guidelines for the treatment of psoriasis in children and adolescents. Part 1 was published in last month's issue. It contained introductory remarks and addressed aspects of diagnosis and topical treatment.

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Section: Vaccinationsmentioning

confidence: 99%

S2k guidelines for the treatment of psoriasis in children and adolescents – Short version part 2

Eisert

Augustin

Bach

et al. 2019

J Deutsche Derma Gesell

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“…72 Stunden) nach Exposition verabreicht wird. Es sollte nach Möglichkeit ein intravenös zu applizierendes Immunglobulinpräparat eingesetzt werden (zum Beispiel Varitect ® ) . Bei Varizellen‐Exposition unter Immunsuppression kann ab Tag 7–9 auch eine Chemoprophylaxe mit Aciclovir (6(–80) mg/kg KG/d per os über 5–7 Tage) erfolgen.…”

Section: Impfungenunclassified

S2k‐Leitlinie zur Therapie der Psoriasis bei Kindern und Jugendlichen – Kurzfassung Teil 2

Eisert

Augustin

Bach

et al. 2019

J Deutsche Derma Gesell

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Zusammenfassung Diese Leitlinie richtet sich an Assistenz‐ und Fachärzte der Dermatologie, Pädiatrie, Kinderdermatologie und Kinderrheumatologie sowie an Kostenträger und politische Entscheidungsgremien. Die Leitlinie wurde im formellen Konsensusverfahren (S2k) von Dermatologen und Kinderdermatologen unter Einbindung von Kinderrheumatologen erstellt. Die Leitlinie stellt einen Überblick über Schweregrad, Lebensqualität und Therapieziele mit Erläuterung der Off‐Label‐Problematik im Kindesalter dar. Es werden Diagnosestellung und Triggerfaktoren erläutert. Der Schwerpunkt der Leitlinie liegt auf der Darstellung der verschiedenen topischen Therapien, UV‐Therapien und systemischen Therapieoptionen mit Abbildung der Empfehlungen zur Anwendung der Therapien sowie Therapiealgorithmen. Darüber hinaus wird im Kontext auf Impfungen bei Psoriasis im Kindesalter sowie auf verschiedene Sonderformen wie Psoriasis guttata, Windelpsoriasis, Psoriasis pustulosa und Psoriasisarthritis eingegangen. Auch werden Empfehlungen zu Tuberkulosediagnostik und Röntgenuntersuchung vor Systemtherapie gegeben.

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“…As an example, varicella vaccine was found to be safe in patients with inflammatory bowel disease on immunosuppressive therapies (51,52), in juvenile rheumatic patients receiving methotrexate or corticosteroids, and in pediatric patients with acute lymphoblastic leukemia on maintenance treatment (weekly methotrexate plus daily 6-mercaptopurine) (53,54). The results we have so far suggest that live vaccines may be safe in some patients receiving long-term immunosuppressive therapies.…”

Section: Discussionmentioning

confidence: 78%

Vaccination With Live Attenuated Vaccines in Four Children With Chronic Myeloid Leukemia While on Imatinib Treatment

et al. 2020

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Chronic myeloid leukemia (CML) in childhood and adolescence is a rare malignancy that can successfully be treated with the tyrosine kinase inhibitor (TKI) imatinib. According to the current experience, treatment is necessary for years and, in the majority of cases, a lifelong approach is required to control the malignant disease. To what extent imatinib causes immunosuppression in different age cohorts is a controversial discussion. According to general medical recommendations, live vaccines are contraindicated in individuals treated with imatinib. However, a recent increase in the number of globally reported cases of measles has been observed and continues to rise. Due to the high contagiousness of the virus, near-perfect vaccination coverage (herd immunity of 93 to 95%) is required to effectively protect against measles resurgence-a scenario that is not realistic in many countries. When four teenagers with CML (median age 13 years, range 12-15) who were enrolled into pediatric trial CML-paed II while on imatinib treatment (median treatment duration 36 months, range 11-84) were identified without protective measles and/or varicella titers, we carefully balanced the risks of a live vaccination under immunosuppressive TKI medication against the benefit of being protected. The patients underwent live vaccination with the live attenuated vaccines MM -RVAX Pro R and Varivax R simultaneously (Patient #1), Priorix R and Varilix R consecutively (Patient #2), and Priorix R (Patients #3 and #4). While the first three patients were vaccinated while receiving TKI therapy, treatment with imatinib was interrupted in patient #4 for 1 week prior and 2 weeks after vaccination. Patients #1 and #3 reacted with stable long-term seroconversion. In Patient #2, serum titer conversion against measles and varicella could not be demonstrated and thus revaccination with Priorix R and Varilix R was performed 3 years later. However, protective titers did not develop or were lost again. Patient #4 also lost protective titers against measles when assessed 10 months after vaccination, but revaccination resulted in stable seroprotective titers over 12 months after the last vaccination during ongoing imatinib treatment. We conclude that in all patients, the safety of live vaccines could be documented, as

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Managing varicella zoster virus contact and infection in patients on anti-rheumatic therapy

Cited by 13 publications

References 71 publications

S2k guidelines for the treatment of psoriasis in children and adolescents – Short version part 2

S2k guidelines for the treatment of psoriasis in children and adolescents – Short version part 2

S2k‐Leitlinie zur Therapie der Psoriasis bei Kindern und Jugendlichen – Kurzfassung Teil 2

Vaccination With Live Attenuated Vaccines in Four Children With Chronic Myeloid Leukemia While on Imatinib Treatment

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