title: Differences in persistence of measles, mumps, rubella, diphtheria and tetanus antibodies between children with rheumatic disease and healthy controls: a retrospective cross-sectional study.
abstract: OBJECTIVE
  To compare the persistence of measles, mumps, rubella, diphtheria and tetanus antibodies between patients with juvenile idiopathic arthritis (JIA) and healthy controls.
  
  
  METHODS
  Measles, mumps, rubella (MMR) and diphtheria-tetanus toxoid (DT)-specific immunoglobulin G antibody concentrations were compared between 400 patients with JIA and 2176 healthy controls aged 1-19 years. Stored patient samples from the period 1997-2006 were obtained from one Dutch centre for paediatric rheumatology. Healthy control samples had been evaluated previously in a nationwide cohort. Participants had been vaccinated according to the Dutch immunisation programme. Antibody concentrations were measured by ELISA (MMR) or multiplex immunoassay (DT).
  
  
  RESULTS
  Corrected for age and the number of vaccinations, lower vaccine-specific geometric mean antibody concentrations (GMC) were found in patients with JIA against mumps, rubella, diphtheria and tetanus (p≤0.001). Measles-specific GMC were higher (p<0.001) compared with healthy controls. The prevalence of protective antibody concentrations was significantly lower in patients for mumps (OR 0.4; 95% CI 0.3 to 0.6), rubella (OR 0.4; 0.3 to 0.7), diphtheria (OR 0.1; 0.06 to 0.2) and tetanus (OR 0.1; 0.05 to 0.3). Seroprotection rates against measles did not differ between patients and healthy controls (OR 1.4; 0.8 to 2.5). Methotrexate and glucocorticosteroid use did not affect pathogen-specific GMC or seroprotection rates.
  
  
  CONCLUSIONS
  Patients with JIA had lower antibody concentrations and seroprotection rates than healthy controls against mumps, rubella, diphtheria and tetanus, but not measles. In these patients, regular assessment of antibody concentrations and further research on responses to other (booster) vaccines are warranted.
authors.affiliation: Department of Paediatric Immunology, Wilhelmina Children’s Hospital, University Medical Centre, Utrecht, The Netherlands. m.w.heijstek@umcutrecht.nl
authors.forename: Marloes W
authors.initials: MW
authors.lastname: Heijstek
authors.forename: Pieter G M
authors.initials: PG
authors.lastname: van Gageldonk
authors.forename: Guy A M
authors.initials: GA
authors.lastname: Berbers
authors.forename: Nico M
authors.initials: NM
authors.lastname: Wulffraat
mesh_terms: D000293:Adolescent; D000914:Antibodies, Viral / Q000097:blood / Q000276:immunology*; D001171:Arthritis, Juvenile / Q000188:drug therapy / Q000453:epidemiology* / Q000276:immunology*; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D004165:Diphtheria / Q000517:prevention & control; D015721:Diphtheria-Tetanus-Pertussis Vaccine / Q000276:immunology*; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007223:Infant; D008297:Male; D008457:Measles / Q000517:prevention & control; D022542:Measles-Mumps-Rubella Vaccine / Q000276:immunology*; D008727:Methotrexate / Q000627:therapeutic use; D009107:Mumps / Q000517:prevention & control; D009426:Netherlands / Q000453:epidemiology; D012189:Retrospective Studies; D012409:Rubella / Q000517:prevention & control; D016036:Seroepidemiologic Studies; D013742:Tetanus / Q000517:prevention & control; D055815:Young Adult
chemical_list: D000914:Antibodies, Viral; D015721:Diphtheria-Tetanus-Pertussis Vaccine; D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D022542:Measles-Mumps-Rubella Vaccine; D008727:Methotrexate