Article Text

EULAR recommendations for vaccination in paediatric patients with rheumatic diseases
  1. M W Heijstek1,
  2. L M Ott de Bruin1,
  3. M Bijl2,
  4. R Borrow3,4,
  5. F van der Klis5,
  6. I Koné-Paut6,
  7. A Fasth7,
  8. K Minden8,
  9. A Ravelli9,
  10. M Abinun10,
  11. G S Pileggi11,
  12. M Borte12,
  13. N M Wulffraat1
  1. 1Department of Paediatric Immunology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands
  2. 2Department of Rheumatology and Clinical Immunology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
  3. 3Vaccine Evaluation Unit, Health Protection Agency North West, Manchester Royal Infirmary, Manchester, UK
  4. 4Inflammation Sciences Research Group, School of Translational Medicine, University of Manchester, Manchester, UK
  5. 5Centre for Infectious Disease Control Netherlands, National Institute of Public Health and the Environment (RIVM), Bilthoven, The Netherlands
  6. 6Department of Paediatrics, Paediatric Rheumatology, CeReMAI, CHU de Bicêtre, University of Paris SUD, Le Kremlin Bicêtre, France
  7. 7Department of Paediatrics, University of Gothenburg, Göteborg, Sweden
  8. 8German Rheumatism Research Centre Berlin, Epidemiology Unit, Children's University Hospital Charité Berlin, Berlin, Germany
  9. 9Department of Paediatrics, Pediatria II-Reumatologia, Istituto G Gaslini, University of Genova, Genova, Italy
  10. 10Department of Paediatric Immunology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
  11. 11Department of Paediatrics, Immunology and Rheumatology Unit, School of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
  12. 12Department of Paediatrics, Municipal Hospital St Georg Leipzig, Academic Teaching Hospital of the University of Leipzig, Leipzig, Germany
  1. Correspondence to Dr M W Heijstek, Department of Paediatric Immunology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Room KC 03.063.0, PO Box 85090, 3508 AB Utrecht, The Netherlands; m.w.heijstek{at}


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.

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  • Funding This study was funded by EULAR.

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.