Booster vaccines found largely safe in
children on immunosuppressive drugs
ing that the vaccination is efficacious
in both the cohorts.”
The researchers also calculated the
cost to prevent one case of influenza,
Dr. Adami advised clinicians to
remember the low NNV for TNF in-
hibitor–treated patients with regard
to influenza vaccination. “A direct dis-
closure of the NNV for these patients
might help adherence to vaccina-
tions,” he said.
Next steps for research should
include extending the real-world ef-
fectiveness analysis to other medica-
tions and other diseases, such as
zoster vaccination in patients treated
with Janus kinase inhibitors, Dr. Ad-
Dr. Adami had no financial conflicts
to disclose. Several coauthors disclosed relationships with companies
including Abiogen Pharma, Amgen,
Grünenthal, Janssen-Cilag, Mundip-harma, and Pfizer.
Continued from // previous page
Administration of live attenu- ated booster of the MMR vac- cine with or without varicella (MMR/V) was not associated
with serious adverse events in children on immunosuppressive therapy
for a rheumatic disease, according to
data presented at the European Congress of Rheumatology.
“The study implies that patients can
receive booster vaccinations regardless of age, diagnosis, or therapy,” reported Dr. Veronica Bergonzo Moshe,
a paediatric rheumatologist at Meir
Medical Center, Kfar Saba, Israel.
In the absence of safety data, the
vaccination of children with rheumatic
diseases taking immunosuppressive
therapies has been controversial. Although these children face communicable and sometimes life-threatening
diseases without vaccination, many
clinicians are not offering this protection because they fear adverse consequences.
Current Paediatric Rheumatology
European Society (PReS) guidelines
have been equivocal, recommending that vaccines be considered on a
“case-by-case basis” in children with
a rheumatic disease if they are taking
high doses of disease-modifying antirheumatic drugs (DMARDs), glucocorticoids, or any dose of biologics.
“The fear is that a state of im-
mune suppression might decrease
response to the vaccine or lead to a
flare of the rheumatologic disease,”
Dr. Moshe said.
In the retrospective study presented by Dr. Moshe, data were collected
on 234 children with rheumatic diseases who received a live attenuated
MMR/V booster. The children were
drawn from 12 paediatric rheumatology centers in 10 countries.
In this relatively large series, 82%
of the children had oligoarticular or
polyarticular juvenile idiopathic arthritis (JIA). A range of other rheumatic
diseases, including juvenile derma-tomyositis, localised scleroderma,
and isolated idiopathic uveitis were
represented among the remaining
patients. All were taking medication,
and 48% were in remission.
When broken down by therapy,
there were three localised reactions
in 110 ( 2.7%) children who received
the booster while on methotrexate.
No other adverse events, including
disease flare, were observed.
Similarly, six of the seven adverse
events observed in 76 (8%) patients
who were taking methotrexate plus
a tumour necrosis factor (TNF)–
inhibitor biologic at the time of vaccination were local reactions. Fever was
reported in one patient. All of these
events were transient.
In the 39 patients taking a TNF in-
hibitor alone, there was a single case
of transient fever. There were no ad-
verse events reported in the three pa-
tients vaccinated while on tocilizumab,
seven patients while on anakinra, or
five patients while on canakinumab.
Following vaccination, there were
no signs of symptoms of the diseases
that the vaccines are designed to pre-
vent. In the minority of patients who
did develop localised reactions or fever
in this series, there was no apparent
relationship with disease activity, age,
or sex when compared to those who
did not develop an adverse event.
These retrospective data are not
definitive, but they are reassuring,
according to Dr. Moshe. A larger
prospective study by the PReS vaccination study group is now planned.
The issue of leaving children unvaccinated is topical because of the recent
outbreaks of measles in the United
“We must have clear guidelines on
how to deal with the administration
of live vaccines in this patient population so that we can provide the saf-est and most effective practice,” Dr.
These data are a first step.
“This large retrospective study
demonstrates that live attenuated
booster vaccine is probably safe in
children with rheumatic diseases,”
said Dr. Moshe, but she deferred to
the PReS guidelines in suggesting
that the decision to vaccinate still
might best be performed on a case-by-case basis.