Vacinação em pacientes imunossuprimidos e com doenças reumatológicas auto-imunes

Luz, Karine Rodrigues da; Souza, Deborah Colucci Cavalcante de; Ciconelli, Rozana Mesquita

doi:10.1590/s0482-50042007000200005

Cited by 11 publications

(8 citation statements)

References 24 publications

(28 reference statements)

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“…As vacinas feitas de vírus e bactérias mortos ou de proteínas ou açúcares desses patógenos mostraram-se seguras nesse grupo de pacientes. No entanto, as vacinas contendo bactérias ou vírus vivos atenuados, como as vacinas contra febre amarela, são contra indicadas porque têm o potencial de causar infecção incontrolável 14 .…”

Section: Discussionunclassified

Vacinação contra febre amarela em pacientes com diagnósticos de doenças reumáticas, em uso de imunossupressores

Mota

Oliveira

Lima

et al. 2009

Rev. Soc. Bras. Med. Trop.

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A febre amarela é uma doença viral, infecciosa não-contagiosa, endêmica em regiões da África e da América do Sul. É transmitida pela picada de insetos hematófagos da família Culicidae, em especial dos gêneros Aedes e Haemagogus 22 . Vacinação contra febre amarela em pacientes com diagnósticos de doenças reumáticas, em uso de imunossupressores ABSTRACTYellow fever is endemic in some countries. The anti-yellow fever vaccine is the only effective means of protection but is contraindicated for immunocompromised patients. The aim of this paper was to report on a case series of rheumatological patients who were using immunosuppressors and were vaccinated against this disease. This was a retrospective study by means of a questionnaire applied to these patients, who were vaccinated 60 days before the investigation. Seventy patients of mean age 46 years were evaluated. Most of them were female (90%). There were cases of rheumatoid arthritis (54), systemic lupus erythematosus (11), spondyloarthropathy (5) and systemic sclerosis (2). The therapeutic schemes included methotrexate (42), corticosteroids (22), sulfasalazine (26), leflunomide (18), cyclophosphamide (3) and immunobiological agents (9). Sixteen patients (22.5%) reported some minor adverse effect. Among the eight patients using immunobiological agents, only one presented a mild adverse effect. Among these patients using immunosuppressors, adverse reactions were no more frequent than among immunocompetent individuals. This is the first study on this topic. A suscetibilidade é geral e irrestrita, não havendo distinção de raça, idade ou gênero. As manifestações clínicas variam desde um quadro febril leve à infecção grave, acarretando falência renal e hepática, dano cardíaco, hemorragia e choque 23 . Estima-se que apenas 10% sejam formas graves, associadas à elevada letalidade, variando de 20-50% dos casos 1 22 . Não há tratamento específico para a doença. Key

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Section: Discussionunclassified

Vacinação contra febre amarela em pacientes com diagnósticos de doenças reumáticas, em uso de imunossupressores

Mota

Oliveira

Lima

et al. 2009

Rev. Soc. Bras. Med. Trop.

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“…16 Lymphopenia, esophageal dysfunction, ventilatory insufficiency, interstitial lung disease, and calcinosis cutis are considered predictive parameters for infection in inflammatory myopathies. 16 Some drugs commonly used for treatment of rheumatic diseases, such as CT, MTX, azathioprine, cyclosporine A, cyclophosphamide, and tumor necrosis factor inhibitors (anti-TNF) are potentially immunosuppressive 17,18 and were associated with high risk of infection by experts in this study. As expected, the use of NSAIDs and antimalarial drugs was considered low risk.…”

Section: Discussionmentioning

confidence: 85%

Prática de vacinação em crianças com doenças reumáticas

Silva¹,

Terreri²,

Aikawa³

et al. 2010

Rev. Bras. Reumatol.

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Introduction/Objectives: Evaluate clinical practice through assessment of vaccination card and recommendation of specific vaccines in pediatric patients with rheumatic diseases in use of different drugs and reveal the possible association between vaccination frequency and time of the clinical practice of pediatric rheumatologists in the state of São Paulo. Material and Methods: A questionnaire was sent to pediatric rheumatologists of the Departamento de Reumatologia da Sociedade de Pediatria de São Paulo. This instrument included questions about practice time on Pediatric Rheumatology, vaccination of patients with juvenile systemic lupus erythematosus (JSLE), juvenile idiopathic arthritis (JIA), juvenile dermatomyositis (JDM), and immunization according to the treatments used. Results: Vaccination card was seen by 100% of the professionals at the first visit and by 36% annually. Vaccines of live agents were not recommended for patients with JSLE, JIA, and JDM in 44%, 64%, and 48%, respectively. The professionals were divided into two groups: Group A (≤ 15 years of practice, n = 12) and B (≥ 16 years, n = 13). No statistical difference was observed in the use of live agent vaccine and vaccines with inactivated agents or protein components in the two treatment groups (P > 0.05). Moreover, the groups had similar opinion regarding severity of immunosuppression in patients with JSLE, JIA, and JDM (with or without activity) and treatment used (P > 0.05). Conclusions: The frequency of immunization by pediatric rheumatologists in São Paulo is low, especially after the first visit, and not influenced by time of professional practice.

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“…On the other hand, all prospective studies evaluating the efficacy and safety of vaccines in patients with rheumatologic diseases only evaluated inactive vaccines. In addition, most studies are not controlled and included a limited number of patients 3,4,8 . Consequently, recommendations on the use of vaccines in this group of patients are frequently based on the recommendations for other group of patients with other conditions, such as malignancies, who use higher doses of drugs than those prescribed in rheumatology.…”

Section: General Considerations On Immunization Of Children and Adolementioning

confidence: 99%

“…72 Currently, two rotavirus vaccines have been licensed in Brazil. The monovalent vaccine [GIP (8)], which provides crossed immunity (heterotypical) against other serotypes of rotavirus, is available in the public and private health care system since 2006, and the recently licensed pentavalent vaccine [G1, G2, G3, G4, and P (8)]. Both are live vaccines.…”

Section: Rotavirus Vaccinementioning

confidence: 99%

“…6,7 As a rule, recent publications on immunization of adult patients with rheumatologic diseases follow the recommendations for immunosuppressed patients, which contraindicate the administration of live vaccines in patients with rheumatologic diseases using immunosuppressive drugs. 3,4,7,8 This is also the recommendation of the British Pediatric Rheumatology Group. 6 Twenty-six pediatric rheumatologists members of the Pediatric Rheumatology Department of the Pediatrics Society of São Paulo, (SPSP, from the Portuguese) met to establish to established a consensus on the immunization of patients with rheumatologic diseases of infancy and adolescence.…”

Section: Introductionmentioning

confidence: 96%

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Consenso de imunização para crianças e adolescentes com doenças reumatológicas

Silva¹,

Terreri²,

Barbosa³

et al. 2009

Rev. Bras. Reumatol.

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Incidence of infectious diseases is higher in children and adolescents with rheumatic diseases than in the general population due to disease activity, possible immune deficiency secondary to the disease itself, or the use of immunosuppressive drugs. Vaccination is effective in reducing morbidity and mortality in those patients. The objective of this study was to establish an evidence-based consensus on the efficacy and safety of vaccination in children and adolescents with rheumatic diseases. Passive immunization of patients and guidelines for people who live with immunosuppressed patients were also included. The 32 pediatric rheumatologists of the Rheumatology Department of the Pediatrics Society of São Paulo, (SPSP, from the Portuguese), São Paulo, SP, Brazil, and/or the Commission on Pediatrics Rheumatology of the Brazilian Society of Rheumatology are responsible for this consensus; some of those professionals are involved on research and scientific publications in this field. The words efficacy and/or safety of different vaccines in children and adolescents with rheumatologic diseases were searched in Medline and Scielo data bases from 1966 to March 2009, including reviews, controlled studies, and case reports. The degree of recommendation and the scientific evidence of the studies were classified in four levels for each vaccine. As a rule, inactive and protein components vaccines are safe for patients with rheumatologic diseases, even in the presence of immunosuppressive therapy. However, live attenuated vaccines are, in general, contraindicated for immunosuppressed patients.

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Vacinação em pacientes imunossuprimidos e com doenças reumatológicas auto-imunes

Cited by 11 publications

References 24 publications

Vacinação contra febre amarela em pacientes com diagnósticos de doenças reumáticas, em uso de imunossupressores

Vacinação contra febre amarela em pacientes com diagnósticos de doenças reumáticas, em uso de imunossupressores

Prática de vacinação em crianças com doenças reumáticas

Consenso de imunização para crianças e adolescentes com doenças reumatológicas

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