EULAR recommendations for vaccination in adult patients with autoimmune inflammatory rheumatic diseases.
OBJECTIVE
To develop evidence-based European League Against Rheumatism (EULAR) recommendations for vaccination in patients with autoimmune inflammatory rheumatic diseases (AIIRD).


METHODS
A EULAR task force was composed of experts representing 11 European countries, consisting of eight rheumatologists, four clinical immunologists, one rheumatologist/clinical immunologist, one infectious disease physician, one nephrologist, one paediatrician/rheumatologist and one clinical epidemiologist. Key questions were formulated and the eligible spectrum of AIIRD, immunosuppressive drugs and vaccines were defined in order to perform a systematic literature review. A search was made of Medline from 1966 to October 2009 as well as abstracts from the EULAR meetings of 2008 and 2009 and the American College of Rheumatology (ACR) meetings of 2007 and 2008. Evidence was graded in categories I-IV, the strength of recommendations was graded in categories A-D and Delphi voting was applied to determine the level of agreement between the experts of the task force.


RESULTS
Eight key questions and 13 recommendations addressing vaccination in patients with AIIRD were formulated. The strength of each recommendation was determined. Delphi voting revealed a very high level of agreement with the recommendations among the experts of the task force. Finally, a research agenda was proposed.


CONCLUSIONS
Recommendations for vaccination in patients with AIIRD based on the currently available evidence and expert opinion were formulated. More research is needed, particularly regarding the incidence of vaccine-preventable infectious diseases and the safety of vaccination in patients with AIIRD.
Department of Internal Medicine, Division of Infectious Diseases, University Medical Centre Groningen, AA41 P O Box 30 001, 9700 RB Groningen, The Netherlands. s.van.assen@int.umcg.nl
S
S
van Assen
N
N
Agmon-Levin
O
O
Elkayam
R
R
Cervera
M F
MF
Doran
M
M
Dougados
P
P
Emery
P
P
Geborek
J P A
JP
Ioannidis
D R W
DR
Jayne
C G M
CG
Kallenberg
U
U
Müller-Ladner
Y
Y
Shoenfeld
L
L
Stojanovich
G
G
Valesini
N M
NM
Wulffraat
M
M
Bijl
D001327:Autoimmune Diseases / Q000150:complications* / Q000188:drug therapy; D003697:Delphi Technique; D019317:Evidence-Based Medicine / Q000379:methods; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects; D009894:Opportunistic Infections / Q000150:complications* / Q000517:prevention & control*; D012216:Rheumatic Diseases / Q000150:complications* / Q000188:drug therapy; D014611:Vaccination
D007166:Immunosuppressive Agents