Recommendations for vaccination in adult patients with AIIRD with level of evidence for the incidence/prevalence of VPI, efficacy, immunogenicity and safety of vaccines, strength of recommendations (SoR) and level of agreement for each recommendation
| Recommendation | Infection rate | Efficacy | Immuno- genicity | Safety | SoR* | Level of agreement: average/ range (0–10), %≥8 |
| 1. Influenza vaccination should be strongly considered for the majority of patients with AIIRD. | 2b | 2b | 2a | 2b | B | 9.4 7–10 93% |
| 2. Pneumococcal vaccination should be strongly considered for the majority of patients with AIIRD. | 2b | 4 | 2a | 4 | C | 8.7 6–10 93% |
| 3. Patients with AIIRD should receive toxoid tetanus vaccination in accordance with recommendations for the general population. Passive immunisation should be considered for patients treated with B cell depleting therapy. | NA | NA | 2b | 4 | B D | 9.5 8–10 100% |
| 4. Hepatitis A and hepatitis B vaccination should be administrated to patients with AIIRD at risk. In specific situations booster or passive immunisation is indicated. | HAV – NA HBV 2b | NA | 2b | 4 | B C | 9.6 8–10 100% |
| 5. Herpes zoster vaccination may be considered in high-risk patients with AIIRD. | 2b | 2b | 2b | 4 | B | 9.1 7–10 93% |
| 6. Vaccination against yellow fever should be generally avoided in patients with AIIRD. | NA | NA | 2b | 4 | D | 9.2 6–10 85.7% |
| 7. Patients with AIIRD, in particular patients with SLE, should receive vaccinations against HPV in accordance with recommendations for the general population. | 2b | NA | 2b | 4 | C | 9.5 8–10 100% |
| 8. Immunocompetent household members of patients with AIIRD should be encouraged to receive vaccines according to national guidelines with the exception of the oral polio vaccines. | NA | NA | NA | NA | D | 9.1 7–10 93% |
| 9. 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. | NA | NA | NA | NA | D | 9.5 8–10 100% |
*The strength of recommendation was primarily based on the efficacy data. If no efficacy data were available, immunogenicity was used as a major outcome. When immunogenicity outcomes did not directly correlate with protection, the strength of recommendation was downgraded. Few recommendations were primarily based on safety (especially live-attenuated vaccines) and here, the safety outcomes determined the strength of the recommendation.
AIIRD, autoimmune inflammatory rheumatic diseases; HAV, hepatitis A virus; HBV, hepatitis B virus; HPV, human papilloma virus; NA, non-available; SLE, systemic lupus erythematosus.