Recommendations for vaccination in adult patients with autoimmune inflammatory rheumatic diseases with level of evidence, strength of recommendations and results of Dephi voting per recommendation
| Category of evidence | Strength of recommendation | Mean (SD) level of agreement by Delphi voting (VAS) | |||
|---|---|---|---|---|---|
| Recommendation | Increased incidence of VP infection | Efficacy of vaccination | Harms of vaccination | ||
| The vaccination status should be assessed in the initial investigation of patients with AIIRD | – | D | 9.50 (0.97) | ||
| Vaccination in patients with AIIRD should ideally be administered during stable disease | – | D | 8.88 (1.26) | ||
| Live attenuated vaccines should be avoided whenever possible in immunosuppressed patients with AIIRD | IV | D | 9.25 (1.13) | ||
| Vaccination in patients with AIIRD can be administered during the use of DMARDs and TNFα blocking agents, but should ideally be administered before starting B cell-depleting biological therapy | II | B | 9.13 (1.02) | ||
| Influenza vaccination should be strongly considered for patients with AIIRD | III | Ib | Ib | B–C | 9.00 (1.10) |
| 23-valent polysaccharide pneumococcal vaccination should be strongly considered for patients with AIIRD | III | Ib | Ib | B–C | 8.19 (1.38) |
| Patients with AIIRD should receive tetanus toxoid vaccination in accordance with recommendations for the general population. In case of major and/or contaminated wounds in patients who received rituximab within the last 24 weeks, passive immunisation with tetanus immunoglobulin should be administered | – | II | II | B–D | 9.19 (1.11) |
| Herpes zoster vaccination may be considered in patients with AIIRD | III | – | IV | C–D | 8.00 (1.59) |
| HPV vaccination should be considered in selected patients with AIIRD | III | – | – | C–D | 8.44 (1.41) |
| In hyposplenic/asplenic patients with AIIRD, influenza, pneumococcal, Haemophilus influenzae b and meningococcal C vaccinations are recommended | IV | D | 9.50 (0.82) | ||
| Hepatitis A and/or B vaccination is only recommended in patients with AIIRD at risk | – | II* | III* | D | 9.13 (0.89) |
| Patients with AIIRD who plan to travel are recommended to receive their vaccinations according to general rules, except for live attenuated vaccines which should be avoided whenever possible in immunosuppressed patients with AIIRD | – | D | 9.25 (1.24) | ||
| BCG vaccination is not recommended in patients with AIIRD | III | – | – | D | 9.38 (1.09) |
↵* For hepatitis B only
AIIRD, autoimmune inflammatory disease; BCG, Bacillus Calmette-Guérin; DMARD, disease-modifying antirheumatic drug; HPV, human papillomavirus; TNF, tumour necrosis factor; VAS, visual analogue scale; VP, vaccine-preventable.