[Show abstract][Hide abstract] ABSTRACT: Objective:
To elaborate recommendations to the vaccination of patients with rheumatoid arthritis (RA) in Brazil.
Literature review and opinion of expert members of the Brazilian Society of Rheumatology Committee of Rheumatoid Arthritis and of an invited pediatric rheumatologist.
Results and conclusions:
The following 12 recommendations were established: 1) Before starting disease-modifying anti-rheumatic drugs, the vaccine card should be reviewed and updated; 2) Vaccines against seasonal influenza and against H1N1 are indicated annually for patients with RA; 3) The pneumococcal vaccine should be indicated for all patients with RA; 4) The vaccine against varicella should be indicated for patients with RA and a negative or dubious history for that disease; 5) The HPV vaccine should be considered for adolescent and young females with RA; 6) The meningococcal vaccine is indicated for patients with RA only in the presence of asplenia or complement deficiency; 7) Asplenic adults with RA should be immunized against Haemophilus influenzae type B; 8) An additional BCG vaccine is not indicated for patients diagnosed with RA; 9) Hepatitis B vaccine is indicated for patients with RA who are negative for antibodies against HBsAg; the combined hepatitis A and B vaccine should be considered; 10) Patients with RA and at high risk for tetanus, who received rituximab in the preceding 24 weeks, should undergo passive immunization with tetanus immunoglobulin in case of exposure; 11) The YF vaccine is contraindicated to patients with RA on immunosuppressive drugs; 12) The above described recommendations should be reviewed over the course of RA.
Full-text · Article · Feb 2013 · Revista Brasileira de Reumatologia
[Show abstract][Hide abstract] ABSTRACT: Background Vaccinations have long been considered to be possible triggering agents for chronic arthritis, but no sufficiently definitive epidemiological study has been published on this issue. There are case reports of chronic arthropathy presumably induced by rubella, meales and mumps vaccination (MMR), but controlled studies have failed to establish this association
Objectives The aim of the present prospective cohort study was to investigate the association of MMR vaccination and the onset of acute or chronic articular symptom in healthy subjects
Methods In Brazil, two prospective cohorts studies taken place during two National immunization campaign: first in 2008 against rubella to reach subjects aged 20-40 years and another in 2011 against measles to reach children aged 1-7 years. In both the vaccine used was MMR. In our city the target was the coverage of 9,000 people to be vaccinated in these age groups, including both males and females. Among those, near 2,000 subjects were randomly selected. Follow-up telephone calls were conducted 2 weeks post vaccination and subsequently monthly after the vaccination over a 6 month period, in order to inquire about occurrence and duration of articular symptoms. In cases where the subjects circumstances were unclear a medical visit was scheduled. Subjects with a preexisting autoimmune disease were excluded from the study
Results Of the 2,000 selected vaccinated subjects, 972 adults and 827 children have completed the follow up period of 6 months. The vaccine was the first dose for 543 subjects (55%) in the adult group and for 672 children (81%). At the time of the first phone call 17/972 (1.7%) adults subjects and 14/827 (1,7%) childhood age group reported acute articular symptoms: twelve reported arthralgia and five arthritis with all of them being fleeting, lasting no longer than 7 days; eleven were female and six male (p=0.5); twelve had received their first dose of RV and the remaining five following a booster (p=1,0). For the childhood group the rate of acute articular symptoms in the first evaluation was the same 1,7% (14/827), among of them 4 had arthritis and only in two lasting one month; in 13/14 had received their first dose of RV and in only one was a booster (p=0,71). None in the both groups had a chronic outcome.
Conclusions In our study, which comprised a large number of healthy subjects in different age groups, rubella vaccination was safe and was not associated with the development of chronic arthritis. These findings should be spread among public healthcare providers in order to encourage vaccinations in accordance with recommended national vaccination schedules.
Disclosure of Interest None Declared
No preview · Article · Jun 2012 · Annals of the Rheumatic Diseases
[Show abstract][Hide abstract] ABSTRACT: To analyze available evidence on vaccinations in paediatric patients with rheumatic and autoinflammatory diseases. This evidence formed the basis of the recently constructed European League against Rheumatism (EULAR) recommendations for vaccination of these patients.
A systematic literature review in the MEDLINE and EMBASE databases was conducted using various terms for vaccinations, paediatric rheumatic and autoinflammatory diseases and immunosuppressive drugs. Only papers on paediatric patients (<18 years of age) were selected. A panel of 13 experts in the field graded methodological quality and extracted data using predefined criteria.
27 papers were available. No studies were found on autoinflammatory diseases. 14 studies considered live-attenuated vaccines. Evidence so far supports the safety and immunogenicity of non-live composite vaccines, although studies were underpowered to accurately assess safety. Live-attenuated vaccines did not cause disease flares or severe adverse events, not even in patients on methotrexate and low dose glucocorticosteroids. Seven patients on anti-TNFalpha therapy were described receiving the live-attenuated measles, mumps, rubella (n=5) or varicella (n=2) booster without severe adverse events.
Data on safety and efficacy of vaccinations in paediatric patients with rheumatic diseases is reassuring, but too limited to draw definite conclusions. More research is needed on the safety and efficacy of especially live-attenuated vaccines in patients with rheumatic and autoinflammatory diseases using high dose immunosuppressive drugs.
Full-text · Article · Aug 2011 · Autoimmunity reviews
[Show abstract][Hide abstract] ABSTRACT: Evidence-based recommendations for vaccination of paediatric patients with rheumatic diseases (PaedRD) were developed by following the EULAR standardised procedures for guideline development. The EULAR task force consisted of (paediatric) rheumatologists/immunologists, one expert in vaccine evaluation, one expert in public health and infectious disease control, and one epidemiologist. A systematic literature review was conducted in MEDLINE, EMBASE, and abstracts of the EULAR and American College of Rheumatology meetings of 2008/9. The level of evidence and strength of recommendation were based on customary scoring systems. Delphi voting was applied to assess the level of agreement between task force members. 107 papers and eight abstracts were used. The majority of papers considered seasonal influenza (41) or pneumococcal (23) vaccination. 26 studies were performed specifically in paediatric patients, and the majority in adult rheumatoid arthritis and systemic lupus erythematosus patients. Fifteen recommendations were developed with an overall agreement of 91.7%. More research is needed on the safety and immunogenicity of (live-attenuated) vaccination in PaedRD, particularly in those using biologicals, and the effect of vaccination on prevention of infections.
No preview · Article · Aug 2011 · Annals of the rheumatic diseases
[Show abstract][Hide abstract] ABSTRACT: To evaluate the safety and immunogenicity of varicella vaccine (VV) in susceptible patients with juvenile rheumatic diseases receiving methotrexate and corticosteroids.
Twenty-five patients with juvenile rheumatic diseases (ages 2-19 years) and 18 healthy children and adolescents (ages 3-18 years) received a single dose of VV. All 25 patients were receiving methotrexate; 13 were also receiving prednisone and 5 were also receiving other disease-modifying antirheumatic drugs. None of the vaccinated patients or controls had a previous history of varicella. Anti-varicella-zoster virus IgG antibody (anti-VZV-IgG) titers were measured by enzyme-linked immunosorbent assay immediately before, 4-6 weeks after, and 1 year after vaccination. The patients were monitored prospectively for adverse reactions related to the vaccine, exposure, and occurrence of varicella. Disease activity was assessed 3 months before and 3 months after VV.
Twenty patients and all of the controls had negative preimmunization titers of VZV-IgG, and 5 patients had equivocal levels. Positive VZV-IgG titers were detected in 10 (50%) of 20 seronegative patients and 13 (72.2%) of 18 controls 4-6 weeks after VV (P = 0.2). One year after vaccination, 8 of 10 patients maintained positive VZV-IgG titers. No overt varicella episodes and no severe adverse reactions were observed during the followup period. No worsening of clinical parameters and no flares of juvenile rheumatic diseases or changes in doses of medications used were detected after vaccination. In fact, the number of active joints in patients with juvenile idiopathic arthritis was significantly lower after VV (P = 0.009).
VV appears to be safe in patients with juvenile rheumatic diseases receiving methotrexate, as long as continuous prospective vigilance for side effects is performed.
[Show abstract][Hide abstract] ABSTRACT: To describe a patient who had polyarteritis nodosa with central nervous system involvement mimicking infectious meningoencephalitis.
Pediatric intensive care unit of a university hospital. Patient: A 9-yr-old boy with prolonged fever, headache, decreased level of consciousness, neck stiffness, and papilledema.
Cerebrospinal fluid examination showed pleocytosis and a high protein level. After neurologic deterioration resulted from the initial treatment with antibiotic, the combination of clinical and laboratory findings with neuroradiologic features led to suspected systemic vasculitis. The patient was treated subsequently with corticosteroid, which resulted in great improvement. Biopsy of a skin lesion confirmed the diagnosis of polyarteritis nodosa.
Critical care physicians must recognize neurologic manifestation patterns of systemic vasculitides because appropriate diagnosis and therapy result in significantly improved morbidity and mortality.
No preview · Article · Jun 2004 · Pediatric Critical Care Medicine