Background In Brazil, there was a National immunization campaign against measles in 2011, using measles, mumps and rubella (MMR) vaccine in children aged 1-7 years.
Objectives The aim of this study was to document whether MMR vaccination aggravated the course of underlying disease in children with rheumatic diseases (RD) or presented risks in these patients when taking immunosuppressive drugs.
Methods In order to accomplish this, a prospective observational study was performed. All 68 patients in this age groupwho had confirmed diagnosis of a juvenile rheumatic diseaseand have been following at two pediatric rheumatology outpatient clinics in Brazil were eligible. They were invited by phone call or during their regular visits to participate in this study. Signed informed consents were obtained from their parents. The first interview was done 2 weeks post vaccination and subsequently the patients were seen monthlyfor 3 monthsin order to access the occurrence of flare-ups or aggravation of disease activity after vaccination and side effects such as clinically overt measles.
Results Twenty-eight/68 (41%) patients vaccinated with MMR were selected (for two of them the vaccine was their first dose and for 26 it was a booster). Twenty of them were male and the mean age was 4.5 years; 22 had Juvenile Idiopathic Arthritis (JIA), 4 with juvenile dermatomyositis and 2 scleroderma. At the time of vaccination 21/28 met no active disease criteria and 9/21 were in remission without medication. Regardless of disease activity, 19 patients were on medication, all of them using methotrexate (MTX); 5 were also receiving prednisone, and 2 were on anti-TNF agents too.
During the follow-up period of 3 months only one patient with active systemic JIA, for whom the MMR vaccine was the first dose, reported worsening of fever and skin rash 20 days after vaccination; and no worsening of clinical parameters, flare-ups or changes in doses of medications was observed in the patients for whom the MMR was a booster.No overt measles infections and no severe adverse reactions were observed, despite the fact that the patients were receiving immunosuppressive medication or biological agents.
Conclusions Conclusions: Most patients with RD can be vaccinated safely with MMR boosters. However, should be considered postponing the vaccination in patients with active disease, especially when the vaccine is the first dose.
Disclosure of Interest None Declared
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