Vaccination completeness in children with rheumatic diseases: A longitudinal, observational multicenter cohort study in Switzerland

Abstract

IntroductionChildren with pediatric inflammatory rheumatic diseases (PRD) have an increased infection risk. Vaccinations are effective to avoid vaccine-preventable diseases. This study aimed to assess the vaccination completeness in Swiss PRD patients stratified by immunosuppressive treatment (IST).Materials and methodsThis multicenter observational cohort study of PRD patients was performed in Basel, Geneva, Lucerne, Lausanne, and Zurich in PRD patients aged < 18 years included in the Juvenile Inflammatory Rheumatism Cohort. Completeness was assessed for i) the overall vaccination status (Swiss national immunization program (NIP) and specific additional PRD-recommended vaccinations), ii) for all and each vaccination of the NIP at PRD diagnosis and reference date (RefD) and iii) all and each specific additional PRD-recommended vaccination at RefD. Completeness was assessed over the disease course and stratified by IST.ResultsOf 616 eligible patients, 234 children were analyzed. Of these, 147 (63%) were girls. Median age at PRD diagnosis was 6.5 years (IQR 2.9–10.3) and 10.9 years at RefD (6.9–14.3). The median follow-up since PRD diagnosis was 3 years (1.1–5.5). 120/234 children received IST. At RefD, overall vaccination completeness was 3.8% (9/234 children), completeness for the NIP vaccinations was 70.1% (164/234 children; IST 65%, no IST: 75.4%) and for all specific additional PRD-recommended vaccinations was 3.8% (9/234 children; IST 2.5%; no IST 5.3%). Vaccination completeness against pneumococcal disease, hepatitis B virus, and human papilloma virus (HPV) was 50.4, 20, 37.9%, respectively. In 25/35 children with negative varicella zoster virus history vaccination status was complete (IST: 94.4%, no IST: 47%). Annual non-live influenza vaccination was complete in 24.2% of children during IST; adherence decreased over the disease course.DiscussionThis study identified a low overall vaccination completeness in children with PRD. Particularly, the completeness of specific additional PRD-recommended vaccinations was low. If not performed early after PRD diagnosis, vaccination status remained frequently incomplete. Close collaboration between pediatrician and rheumatologist to improve vaccination completeness is essential. Exchange of vaccination records, standardized assessment of specific PRD-recommended vaccinations and those of the NIP, and annual reminder for influenza vaccination are crucial to improve vaccination completeness in this vulnerable pediatric population.

Vaccination coverage in children with juvenile idiopathic arthritis, inflammatory bowel diseases, and healthy peers: Cross-sectional electronic survey data

“…Incomplete vaccination in JIA and pediatric rheumatic disease patients were reported in several previous studies[ 18 , 19 , 30 , 31 , 32 ]. From the medical point of view, the main predictors of incomplete vaccination were polyarticular and systemic JIA categories and immunosuppressive medications[ 30 , 31 , 33 ]. In our previous study, the younger JIA onset age was associated with a higher proportion of omitted vaccines similar to the study of Minden et al [ 18 ], but some authors reported that preschool children had a similar rate of vaccine coverage as healthy peers[ 30 , 32 , 33 ].…”

“…Usually, decreased vaccine coverage correlated with patients’ age and teens had more omitted vaccines than preschools[ 18 , 30 , 32 , 33 ]. In our study, the proportion of patients, who received vaccination against pneumococcus was the highest in the IBD subgroup.…”

“…There are no contraindications for the administration of inactive or live vaccines in patients who are not receiving immunosuppressive treatment[ 15 , 16 ]. Despite the higher risk of live vaccines in immune-mediated diseases patients there was no strong correlation between the type of omitted vaccines (live or non-live) and disease activity[ 30 , 33 ]. Sometimes patients with pediatric rheumatic diseases might have omitted non-live vaccines[ 30 , 33 ].…”

“…Despite the higher risk of live vaccines in immune-mediated diseases patients there was no strong correlation between the type of omitted vaccines (live or non-live) and disease activity[ 30 , 33 ]. Sometimes patients with pediatric rheumatic diseases might have omitted non-live vaccines[ 30 , 33 ]. Contemporary EULAR recommendations for children (2021) and adults (2019) with rheumatic diseases allow using live-attenuated vaccines, especially booster doses of MMR and varicella zoster virus in patients with low-grade immune suppression[ 5 , 15 ].…”

“…2013, patients with IBD who got influenza are more likely to be hospitalized and develop viral pneumonia, although this disease can be prevented by vaccination[ 46 ]. Vaccine coverage against pneumococcus was 5% in the Australian pediatric IBD cohort, 18.6% in 430 pediatric IBD patients, from a multicentre study, and 50.3% in JIA patients from Switzerland without differences irrespective of immune-suppressive therapy[ 33 , 47 , 48 ]. In the study of pneumococcal and anti-Hib vaccination of non-systemic and systemic JIA patients was shown the decreasing number of episodes of acute respiratory infections different etiology[ 49 ].…”