To update the European League Against Rheumatism (EULAR) recommendations for vaccination in adult patients with autoimmune inflammatory rheumatic diseases (AIIRD) published in 2011. Four systematic literature reviews were performed regarding the incidence/prevalence of vaccine-preventable infections among patients with AIIRD; efficacy, immunogenicity and safety of vaccines; effect of anti-rheumatic drugs on the response to vaccines; effect of vaccination of household of AIIRDs patients. Subsequently, recommendations were formulated based on the evidence and expert opinion. The updated recommendations comprise six overarching principles and nine recommendations. The former address the need for an annual vaccination status assessment, shared decision-making and timing of vaccination, favouring vaccination during quiescent disease, preferably prior to the initiation of immunosuppression. Non-live vaccines can be safely provided to AIIRD patients regardless of underlying therapy, whereas live-attenuated vaccines may be considered with caution. Influenza and pneumococcal vaccination should be strongly considered for the majority of patients with AIIRD. Tetanus toxoid and human papilloma virus vaccination should be provided to AIIRD patients as recommended for the general population. Hepatitis A, hepatitis B and herpes zoster vaccination should be administered to AIIRD patients at risk. Immunocompetent household members of patients with AIIRD should receive vaccines according to national guidelines, except for the oral poliomyelitis vaccine. Live-attenuated vaccines should be avoided during the first 6 months of life in newborns of mothers treated with biologics during the second half of pregnancy. These 2019 EULAR recommendations provide an up-to-date guidance on the management of vaccinations in patients with AIIRD.
- autoimmune diseases
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Handling editor Josef S Smolen
VF and CR contributed equally.
Correction notice This article has been corrected since it published Online First. Author names have been amended, affiliations updated and the equal contribution statement also added.
Contributors All listed authors of the manuscript are the members of the EULAR assigned task force dedicated to the update of recommendations of vaccination in adult patients with AIIRD. All authors contributed to the formulation of the recommendations. In details, the steering committee of the task force that included convenor (OE), co-convenor (ULM), an immunologist (MB), a specialist in infectious disease (SvA) and methodologists (JL and RL) defined the research questions for the systematic literature reviews (SLRs), that were performed by three fellows (VF, CR, MH), under supervision of the experts in rheumatic diseases (MB) and infectious diseases (SvA). The manuscript was drafted by VF and revised by all task members.
Funding This study was funded by European League Against Rheumatism.
Patient consent for publication Not required
Provenance and peer review Not commissioned; externally peer reviewed.
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