Vaccination in adults with auto-immune disease and/or drug related immune deficiency: results of the GEVACCIM Delphi survey.
BACKGROUND
There are insufficient data regarding the efficacy and safety of vaccination in patients with auto-immune disease (AID) and/or drug-related immune deficiency (DRID). The objective of this study was to obtain professional agreement on vaccine practices in these patients.


METHODS
A Delphi survey was carried out with physicians recognised for their expertise in vaccinology and/or the caring for adult patients with AID and/or DRID. For each proposed vaccination practice, the experts' opinion and level of agreement were evaluated.


RESULTS
The proposals relating to patients with AID specified: the absence of risk of AID relapse following vaccination; the possibility of administering live virus vaccines (LVV) to patients not receiving immunosuppressants; the pertinence of determining protective antibody titre before vaccination; the absence of need for specific monitoring following the vaccination. The proposals relating to patients with DRID specified that a 3-6 month delay is needed between the end of these treatments and the vaccination with LVV. There is no contraindication to administering LVV in patients receiving systemic corticosteroids prescribed for less than two weeks, regardless of their dose, or at a daily dose not exceeding 10mg of prednisone, if this involves prolonged treatment. Out of 14 proposals, the level of agreement between the experts was "very good" for eleven, and "good" for the remaining three.


CONCLUSIONS
Proposals for vaccine practices in patients with AID and/or DRID should aid with decision-making in daily medical practice and provide better vaccine coverage for these patients.
Duchet-Niedziolka
P
P
Université Paris Descartes, Faculté de Médecine; AP-HP, Groupe Hospitalier Cochin Saint-Vincent de Paul, Pôle de Médecine, CIC de Vaccinologie Cochin-Pasteur; INSERM, CIC BT505, Paris, France.
Launay
O
O
Coutsinos
Z
Z
Ajana
F
F
Arlet
P
P
Barrou
B
B
Beytout
J
J
Bouchaud
O
O
Brouqui
P
P
Buzyn
A
A
Chidiac
C
C
Couderc
L J
LJ
Debord
T
T
Dellamonica
P
P
Dhote
R
R
Duboust
A
A
Durrbach
A
A
Fain
O
O
Fior
R
R
Godeau
B
B
Goujard
C
C
Hachulla
E
E
Marchou
B
B
Mariette
X
X
May
T
T
Meyer
O
O
Milpied
N
N
Morlat
P
P
Pouchot
J
J
Tattevin
P
P
Viard
J P
JP
Lortholary
O
O
Hanslik
T
T
D000305:Adrenal Cortex Hormones / Q000009:adverse effects; D000328:Adult; D000970:Antineoplastic Agents / Q000009:adverse effects; D001327:Autoimmune Diseases / Q000276:immunology* / Q000628:therapy*; D005104:Expert Testimony; D006801:Humans; D007153:Immunologic Deficiency Syndromes / Q000139:chemically induced / Q000276:immunology* / Q000628:therapy*; D007165:Immunosuppression Therapy / Q000009:adverse effects; D007166:Immunosuppressive Agents / Q000009:adverse effects; D011795:Surveys and Questionnaires; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors; D014611:Vaccination / Q000009:adverse effects* / Q000379:methods* / Q000706:statistics & numerical data
D000305:Adrenal Cortex Hormones; D000970:Antineoplastic Agents; D007166:Immunosuppressive Agents; D014409:Tumor Necrosis Factor-alpha