title: Vaccination in paediatric patients with auto-immune rheumatic diseases: a systemic literature review for the European League against Rheumatism evidence-based recommendations.
abstract: OBJECTIVE
  To analyze available evidence on vaccinations in paediatric patients with rheumatic and autoinflammatory diseases. This evidence formed the basis of the recently constructed European League against Rheumatism (EULAR) recommendations for vaccination of these patients.
  
  
  METHODS
  A systematic literature review in the MEDLINE and EMBASE databases was conducted using various terms for vaccinations, paediatric rheumatic and autoinflammatory diseases and immunosuppressive drugs. Only papers on paediatric patients (<18 years of age) were selected. A panel of 13 experts in the field graded methodological quality and extracted data using predefined criteria.
  
  
  RESULTS
  27 papers were available. No studies were found on autoinflammatory diseases. 14 studies considered live-attenuated vaccines. Evidence so far supports the safety and immunogenicity of non-live composite vaccines, although studies were underpowered to accurately assess safety. Live-attenuated vaccines did not cause disease flares or severe adverse events, not even in patients on methotrexate and low dose glucocorticosteroids. Seven patients on anti-TNFalpha therapy were described receiving the live-attenuated measles, mumps, rubella (n=5) or varicella (n=2) booster without severe adverse events.
  
  
  CONCLUSIONS
  Data on safety and efficacy of vaccinations in paediatric patients with rheumatic diseases is reassuring, but too limited to draw definite conclusions. More research is needed on the safety and efficacy of especially live-attenuated vaccines in patients with rheumatic and autoinflammatory diseases using high dose immunosuppressive drugs.
authors: Department of Paediatric Immunology, Wilhelmina Children's Hospital, University Medical Center Utrecht, The Netherlands. m.w.heijstek@umcutrecht.nl
authors: M W
authors: MW
authors: Heijstek
authors: L M
authors: LM
authors: Ott de Bruin
authors: R
authors: R
authors: Borrow
authors: F
authors: F
authors: van der Klis
authors: I
authors: I
authors: Koné-Paut
authors: A
authors: A
authors: Fasth
authors: K
authors: K
authors: Minden
authors: A
authors: A
authors: Ravelli
authors: M
authors: M
authors: Abinun
authors: G
authors: G
authors: Pileggi
authors: M
authors: M
authors: Borte
authors: M
authors: M
authors: Bijl
authors: N M
authors: NM
authors: Wulffraat
mesh_terms: D000293:Adolescent; D002644:Chickenpox / Q000276:immunology / Q000517:prevention & control*; D019433:Chickenpox Vaccine / Q000008:administration & dosage / Q000009:adverse effects / Q000276:immunology; D002648:Child; D002675:Child, Preschool; D032921:Consensus; D016206:Databases, Bibliographic; D064420:Drug-Related Side Effects and Adverse Reactions; D019317:Evidence-Based Medicine / Q000592:standards; D005260:Female; D056660:Hereditary Autoinflammatory Diseases / Q000188:drug therapy / Q000276:immunology* / Q000821:virology; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000627:therapeutic use; D007223:Infant; D008297:Male; D008457:Measles / Q000276:immunology / Q000517:prevention & control*; D022542:Measles-Mumps-Rubella Vaccine / Q000008:administration & dosage / Q000009:adverse effects / Q000276:immunology; D009107:Mumps / Q000276:immunology / Q000517:prevention & control*; D017410:Practice Guidelines as Topic; D012216:Rheumatic Diseases / Q000188:drug therapy / Q000276:immunology* / Q000821:virology; D012409:Rubella / Q000276:immunology / Q000517:prevention & control*; D014611:Vaccination / Q000009:adverse effects / Q000592:standards*; D014613:Vaccines, Attenuated / Q000008:administration & dosage / Q000009:adverse effects / Q000276:immunology*
chemical_list: D019433:Chickenpox Vaccine; D007166:Immunosuppressive Agents; D022542:Measles-Mumps-Rubella Vaccine; D014613:Vaccines, Attenuated