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Differences in persistence of measles, mumps, rubella, diphtheria and tetanus antibodies between children with rheumatic disease and healthy controls: a retrospective cross-sectional study
  1. Marloes W Heijstek1,
  2. Pieter GM van Gageldonk2,
  3. Guy AM Berbers2,
  4. Nico M Wulffraat1
  1. 1Department of Paediatric Immunology, Wilhelmina Children's Hospital, University Medical Centre, Utrecht, The Netherlands
  2. 2Centre for Infectious Disease Control Netherlands, Laboratory for Infectious Diseases and Screening, National Institute of Public Health and the Environment (RIVM), Utrecht, The Netherlands
  1. Correspondence to Marloes 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}


Objectives To compare the persistence of measles, mumps, rubella, diphtheria and tetanus antibodies between patients with juvenile idiopathic arthritis (JIA) and healthy controls.

Methods Measles, mumps, rubella (MMR) and diphtheria–tetanus toxoid (DT)-specific immunoglobulin G antibody concentrations were compared between 400 patients with JIA and 2176 healthy controls aged 1–19 years. Stored patient samples from the period 1997–2006 were obtained from one Dutch centre for paediatric rheumatology. Healthy control samples had been evaluated previously in a nationwide cohort. Participants had been vaccinated according to the Dutch immunisation programme. Antibody concentrations were measured by ELISA (MMR) or multiplex immunoassay (DT).

Results Corrected for age and the number of vaccinations, lower vaccine-specific geometric mean antibody concentrations (GMC) were found in patients with JIA against mumps, rubella, diphtheria and tetanus (p≤0.001). Measles-specific GMC were higher (p<0.001) compared with healthy controls. The prevalence of protective antibody concentrations was significantly lower in patients for mumps (OR 0.4; 95% CI 0.3 to 0.6), rubella (OR 0.4; 0.3 to 0.7), diphtheria (OR 0.1; 0.06 to 0.2) and tetanus (OR 0.1; 0.05 to 0.3). Seroprotection rates against measles did not differ between patients and healthy controls (OR 1.4; 0.8 to 2.5). Methotrexate and glucocorticosteroid use did not affect pathogen-specific GMC or seroprotection rates.

Conclusions Patients with JIA had lower antibody concentrations and seroprotection rates than healthy controls against mumps, rubella, diphtheria and tetanus, but not measles. In these patients, regular assessment of antibody concentrations and further research on responses to other (booster) vaccines are warranted.

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  • Funding MWH received fees from the Dutch Arthritis Association (project number 07-02-403). Funders were not involved in the study design; in the collection, analysis and interpretation of data; in writing of the report; or in the decision to submit the article for publication.

  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval The protocol for JIA patients was approved by the medical ethics committee of the University Medical Centre Utrecht (protocol number 07-068). The nationwide study in healthy controls was approved by the medical ethics committee of The Netherlands Organisation for Applied Scientific Research (TNO), Leiden, The Netherlands.

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