Pediatric rheumatic disease: Vaccination in pediatric rheumatic disease - Risks and benefits

Department of Pediatrics, Division of Pediatric Rheumatology, The Children's Hospital at Montefiore, 3415 Bainbridge Avenue, Rosenthal 3rd Floor, Bronx, NY 10467, USA.
Nature Reviews Rheumatology (Impact Factor: 9.85). 02/2012; 8(4):188-90. DOI: 10.1038/nrrheum.2012.13
Source: PubMed


In an age in which immunosuppression is the standard of care for many pediatric rheumatic diseases, balancing the risks and benefits of vaccinations is forefront. Three main issues-addressed in new guidelines-surround vaccination practices in these patients: safety, immunogenicity and effects of the vaccine on the underlying rheumatic disease.

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    ABSTRACT: Vaccination is a powerful tool to reduce the burden of infectious diseases in paediatric patients with chronic rheumatic diseases. Live attenuated vaccines are not recommended for profoundly immunosuppressed patients, but nonlive vaccines have adequate safety and efficacy profiles in the few (admittedly underpowered) studies published to date. No severe vaccine-specific or disease-specific adverse events have been observed in patients with juvenile idiopathic arthritis (JIA) or childhood-onset systemic lupus erythematosus (SLE) who have been vaccinated with live or nonlive agents. The immune response to live vaccines is variable in these patients but generally adequate, despite concomitant use of immunosuppressive and biologic agents. The proposal that onset of autoimmune rheumatic diseases could be induced by vaccination is controversial and primarily based on case reports; however, patients with mevalonate kinase deficiency can experience febrile attacks after immunizations. Adequately powered studies of live and nonlive vaccination in patients with paediatric rheumatic diseases are necessary to clarify safety and efficacy issues. This narrative Review discusses vaccination in patients with JIA, childhood-onset SLE, juvenile dermatomyositis, juvenile systemic sclerosis, primary vasculitis and autoinflammatory syndromes. Vaccine safety, short-term and long-term changes in disease parameters, and the immunogenicity and influence of immunosuppressive agents are outlined for each combination of disease and vaccine.
    Nature Reviews Rheumatology 07/2013; 9(9). DOI:10.1038/nrrheum.2013.95 · 9.85 Impact Factor