Background Immunization is the least invasive and most cost-effective approach to reduce the incidence of infections and morbidity and mortality in children. Since patients with juvenile idiopathic arthritis (JIA) are at increased risk of infections, immunisations are important. However, despite a literature about on the safety and immunogenicity of individual vaccines in the JIA patients, parental or physician's reluctance to vaccinate because of fear of inducing flare of the disease or avoidance of vaccination during periods of active disease.
Objectives To evaluate the vaccination antibody titers of patients with JIA followed at our paediatric rheumatology clinic and to determine the immunization status of vaccine-preventable diseases.
Methods During the period from 1 November 2012 to 31 March 2013, consecutive patients with JIA visited at our pediatric rheumatology outpatient clinic were included. Demographic data, disease duration, physical examination findings and medications used for JIA treatment were documented. The antibody titers against measles, mumps, rubella, varicella, hepatitis A and hepatitis B were determined.
Results The study included 72 children, 42 girls (58.3%), with a median age of 11.0±4.1 years and a mean follow-up period of 37.6±31.0 months. Patients were classified according to JIA subgroups as oligoarthritis in 28 (38.9%), rheumatoid factor-negative polyarthritis in 11 (15.3%), rheumatoid factor-positive polyarthritis in 1 (1.4%), systemic arthritis in 12 (16.7%), enthesitis-related arthritis in 18 (25.0%) and psoriatic arthritis in 2 (2.8%) patients. Seropositivity rate was 95.8% for rubella, 86.1% for measles, 83.3% for varicella, 73.6% for mumps and hepatitis B, and only 12.5% for hepatitis A. Median antibody titers were 169.3 IU/mL (range:15.7-1000) for hepatitis B, 87.4 IU/mL (range: 8.8-440) for rubella, 6.5 IU/mL (range: 1.2-13.7) for varicella, 4.2 IU/mL for measles (range: 1.2-12.7 IU/mL) and 2.7 IU/mL (range: 1.2-7.9) for mumps. None of the patients had protective antibodies against all tested pathogens. Only 25 (34.7%) patients showed protective antibodies against tested pathogens excluding hepatitis A. The lowest individual vaccination rate was for hepatitis A (12.5%).
Conclusions Monitoring for immunization status should be a part of primary care of children with JIA. According to EULAR recommendation, JIA patients can be vaccinated safely. Our results showed the demand for continuous surveillance of specific antibody titers against vaccine-preventable diseases in children with JIA.
Disclosure of Interest None declared