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A study presented at EULAR 2019, jointly organized with the Society of Pediatric Rheumatology (PReS), showed no vaccine infection or disease outbreak in the 234 rheumatic patients who received attenuated booster vaccination at of taking immunosuppressive therapy.1
It is estimated that more than 75,000 children with rheumatic diseases in Europe.2 Safe and effective vaccination is crucial given their increased risk of infections. However, in patients receiving high doses of immune suppressing therapies, it is currently recommended not to administer live attenuated virus vaccines (although this may be considered on a case-by-case basis). case by case). This is due to a theoretical, but not proven, risk of developing the infection.3
Live attenuated vaccines contain viruses or bacteria that have been weakened, but not destroyed, in a laboratory. They can not cause illness in healthy people, but can still produce a strong immune response.4 Some physicians are already vaccinating their patients with rheumatic fever on immunosuppressive therapies with the help of the attenuated live MMR (measles, mumps, rubella) or MMRR (varicella) revaccination. Indeed, in light of recent measles outbreaks in Europe and the United States, they estimate that the theoretical risk of vaccination is much lower than the risk of disease. This study identified 234 patients of this type from 13 centers in 10 countries. and low rates of adverse events.1
"Patients with rheumatic and musculoskeletal diseases have an increased risk of infection. It is therefore essential to vaccinate as much as possible to save lives."Said Professor Hans Bijlsma, President of EULAR.
"There is a lot of" false news "about vaccination in the media and online and, therefore, we welcome the data presented today that should help dispel some of the public's concerns.. "
In the study, the MMR or live attenuated RROV booster vaccine was administered to 110 cases treated with methotrexate with three benign reactions at the site of injection, 76 cases under methotrexate plus one tumor necrosis factor (anti- TNF) and seven reported; and 39 cases with anti-TNF alone with a reporting fever. Other biological treatments were used in the remaining patients, three under tocilizumab, seven under anakinra and five under canakinumab. The vast majority suffered from juvenile idiopathic arthritis (n = 206), with the activity of the disease being considered low, moderate and high at 38%, 7% and 2% respectively.1
"Positive results from our study suggest that live attenuated MMR booster vaccination and MMRV vaccine is safe in children with rheumatic fever."Said Professor Yosef Uziel, Department of Pediatrics, Meir Medical Center, Sackler School of Medicine, Tel Aviv University and PreS Working Group on Immunization, Israel.
"Current recommendations are cautious due to weak evidence. That's why we are launching a prospective study on the safety and effectiveness of the MMR booster vaccine in pediatric rheumatologic patients treated with immunosuppressive therapy, including biological therapy.. "
The influenza vaccine is not life-attenuated and is recommended in all patients with rheumatoid arthritis regardless of treatment. However, there is evidence that patients are not vaccinated according to the recommendations and are therefore at risk.5
The first real influenza vaccine study in patients with autoimmune rheumatic diseases (AIRD) was presented at EULAR 2019. The study included 14,928 cases of AIR and revealed no badociation between the influenza vaccine and the activity of the disease, the prescription of corticosteroids or vasculitis. In fact, the results demonstrate that the influenza vaccine is badociated with a significant reduction in fatigue within 2-3 months of vaccination and a significant reduction in the number of first-line consultations for joint pain in the three months following vaccination. vaccination.6
"Our findings clearly support the use of influenza vaccine in patients with rheumatic fever and should dispel any fears that people have about reported links with disease activity or vasculitis., "Said Dr. Georgina Nakafero, a rheumatology scholar at the University of Nottingham.
Another reason given for not vaccinating against influenza in patients with rheumatic diseases and taking immunosuppressive therapies is that, because the immune system is weakened, the response to the vaccine may not be sufficient to protect the patient from the disease. 39, subsequent influenza infection.6
A third study, also presented today in the framework of the EULAR 2019, reveals that to prevent a single case of influenza, it is enough to vaccinate 10 people with rheumatoid arthritis on a necrosis factor inhibitor. tumor, while it is necessary to vaccinate 71 people in good health. Indeed, although the immunity developed in response to the vaccine may not be as strong in these patients, their increased risk of infection means that more cases are avoided.7
"Our badysis provides additional data on the effectiveness of influenza vaccination in patients with rheumatoid arthritis receiving treatment with sand tumor necrosis factor inhibitor should provide an incentive to action for all rheumatologists so consider the vaccination of these patients."Said Dr. Giovanni Adami, University of Verona, Rheumatology Unit.
References
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Uziel Y et al. Live attenuated vaccines in pediatric rheumatic diseases are safe: retrospective multicenter data collection. EULAR 2019; Madrid: Summary OP0205.
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Clemente D et al. Transitional care for rheumatic diseases in Europe: current clinical practice and available resources. Pediatr Rheumatol Online J.2017; 15: 49.
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Heijstek MW et al. EULAR recommendations for vaccination of pediatric patients with rheumatic diseases Ann Rheum Dis. 2011; 70: 1704-1712.
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NHS. Ingredients of the vaccine. Available at: https://www.nhs.uk/conditions/vaccinations/vaccine-ingredients/[Last accessed May 2019]
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Loubet P et al. Attitude, knowledge and factors badociated with influenza and pneumococcal vaccine uptake in a large cohort of patients with secondary immunodeficiency. Vaccine. 2015; 33 (31): 3703-8.
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Nakafero G et al. Inactivated influenza vaccination does not badociate with disease outbreaks in autoimmune rheumatic diseases: a self-controlled case study using data from clinical research data linkage. EULAR 2019; Madrid: Summary OP0260
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Adami G et al. Effectiveness of influenza vaccine in patients treated with TNF antagonist EULAR 2019; Madrid: Summary OP0230
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