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EULAR recommendations for vaccination in adult patients with autoimmune inflammatory rheumatic diseases
  1. S van Assen1,
  2. N Agmon-Levin2,
  3. O Elkayam3,4,
  4. R Cervera5,
  5. M F Doran6,
  6. M Dougados7,
  7. P Emery8,9,
  8. P Geborek10,
  9. J P A Ioannidis11,12,13,14,
  10. D R W Jayne15,
  11. C G M Kallenberg16,
  12. U Müller-Ladner17,
  13. Y Shoenfeld2,4,
  14. L Stojanovich18,
  15. G Valesini19,
  16. N M Wulffraat20,
  17. M Bijl12
  1. 1Department of Internal Medicine, Division of Infectious Diseases, University Medical Centre Groningen, Groningen, The Netherlands
  2. 2The Zabludowicz Centre for Auto-immune Diseases, Sheba Medical Center, Tel Hashomer, Israel
  3. 3Department of Internal Medicine F, Department of Rheumatology, Tel Aviv Medical Center, Tel Aviv, Israel
  4. 4The “Sackler” Faculty of Medicine, Tel Aviv University, Israel
  5. 5Department of Auto-immune Diseases, Hospital Clínic, Barcelona, Spain
  6. 6Department of Rheumatology, St. James's Hospital, Dublin, Ireland
  7. 7Department of Rheumatology, Hospital Cochin, Paris, France
  8. 8Section of Musculoskeletal Disease, Leeds Institute of Molecular Medicine, University of Leeds, Leeds, UK
  9. 9Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust, Leeds, UK
  10. 10Department of Rheumatology, Lund University Hospital, Lund, Sweden
  11. 11Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, USA
  12. 12Department of Hygiene and Epidemiology, School of Medicine, University of Ioannina, Ioannina, Greece
  13. 13Department of Medicine, Tufts University School of Medicine, Boston, USA
  14. 14Harvard School of Public Health, Boston, USA
  15. 15Renal Unit, Addenbrooke's Hospital, Cambridge, UK
  16. 16Department of Rheumatology and Clinical Immunology, University Medical Center Groningen, Groningen, The Netherlands
  17. 17Department of Rheumatology and Clinical Immunology, Justus-Liebig Universität Giessen, Bad Nauheim, Germany
  18. 18Department for Scientific Research, Bezhanijska Kosa University Medical Center, Belgrade, Serbia
  19. 19Department of Medicine, Sapienza Università di Roma, Rome, Italy
  20. 20Department of Pediatric Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
  1. Correspondence to S van Assen, Department of Internal Medicine, Division of Infectious Diseases, University Medical Centre Groningen, AA41 P O Box 30 001, 9700 RB Groningen, The Netherlands; s.van.assen{at}


Objectives To develop evidence-based European League Against Rheumatism (EULAR) recommendations for vaccination in patients with autoimmune inflammatory rheumatic diseases (AIIRD).

Methods A EULAR task force was composed of experts representing 11 European countries, consisting of eight rheumatologists, four clinical immunologists, one rheumatologist/clinical immunologist, one infectious disease physician, one nephrologist, one paediatrician/rheumatologist and one clinical epidemiologist. Key questions were formulated and the eligible spectrum of AIIRD, immunosuppressive drugs and vaccines were defined in order to perform a systematic literature review. A search was made of Medline from 1966 to October 2009 as well as abstracts from the EULAR meetings of 2008 and 2009 and the American College of Rheumatology (ACR) meetings of 2007 and 2008. Evidence was graded in categories I–IV, the strength of recommendations was graded in categories A–D and Delphi voting was applied to determine the level of agreement between the experts of the task force.

Results Eight key questions and 13 recommendations addressing vaccination in patients with AIIRD were formulated. The strength of each recommendation was determined. Delphi voting revealed a very high level of agreement with the recommendations among the experts of the task force. Finally, a research agenda was proposed.

Conclusion Recommendations for vaccination in patients with AIIRD based on the currently available evidence and expert opinion were formulated. More research is needed, particularly regarding the incidence of vaccine-preventable infectious diseases and the safety of vaccination in patients with AIIRD.

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  • Funding EULAR.

  • Competing interests None.

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

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