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Cunninghame J, Wen S, Dufficy M, Ullman A, Takashima M, Cann M, Doyle R. Immunogenicity and safety of vaccination in children with paediatric rheumatic diseases: a scoping review. Ther Adv Vaccines Immunother 2023; 11:25151355231167116. [PMID: 37124959 PMCID: PMC10131534 DOI: 10.1177/25151355231167116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 03/01/2023] [Indexed: 05/02/2023] Open
Abstract
Children with paediatric rheumatic diseases (PRDs) are at increased risk of vaccine-preventable disease. Safe and effective vaccination is central to preventive care in PRD patients; however, uncertainty surrounding immunogenicity and safety has contributed to suboptimal vaccination. The aim of this study was to evaluate treatment effect on immunogenicity to vaccination in PRD patients and assess vaccine safety, specifically adverse events following immunisation (AEFI) and disease flare. Scoping review. In this scoping review, a systematic search of PubMed, CINAHL and Embase databases was conducted from 2014 to 23 August 2022 to identify observational studies evaluating the immunogenicity and safety of commonly used vaccinations in PRD patients. The primary outcome was immunogenicity (defined as seroprotection and protective antibody concentrations), with secondary outcomes describing AEFI and disease flare also extracted. Due to extensive heterogeneity related to diagnostic and vaccination variability, narrative synthesis was used to describe the findings of each study. Study quality was assessed via the Mixed Methods Appraisal Tool. The review was prospectively registered with PROSPERO (CRD42022307212). The search yielded 19 studies evaluating immunogenicity to vaccination and incidence of AEFI and disease flares in this population, which were of acceptable quality. Corticosteroids did not have deleterious effects on vaccine response. Treatment with conventional disease-modifying antirheumatic drugs (DMARDs) and biologic DMARDs generally had no effect immunogenicity in PRD patients. While patients exhibited adequate seroprotection, protective antibody levels were lower in patients on some immunosuppressant agents. Varicella infections were recorded post vaccination in several patients with low protective antibody levels undergoing treatment with DMARDs and corticosteroids. Most vaccines appear safe and effective in PRD patients, despite immunosuppressant treatment. Booster vaccinations should be considered with some studies highlighting inadequate seroprotection following primary course of vaccinations with acceleration of antibody decline over time. There was limited evidence to support avoiding live vaccines in PRD patients.
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Affiliation(s)
| | - Sophie Wen
- Centre for Children’s Health Research,
Children’s Health Queensland Hospital and Health Service, South Brisbane,
QLD, Australia
- Centre for Clinical Research, The University of
Queensland, Brisbane, QLD, Australia
| | - Mitchell Dufficy
- School of Nursing, Midwifery and Social Work,
The University of Queensland, Brisbane, QLD, Australia
| | - Amanda Ullman
- School of Nursing, Midwifery and Social Work,
The University of Queensland, Brisbane, QLD, Australia
- Centre for Children’s Health Research,
Children’s Health Queensland Hospital and Health Service, South Brisbane,
QLD, Australia
| | - Mari Takashima
- School of Nursing, Midwifery and Social Work,
The University of Queensland, Brisbane, QLD, Australia
- Centre for Children’s Health Research,
Children’s Health Queensland Hospital and Health Service, South Brisbane,
QLD, Australia
| | - Megan Cann
- Centre for Children’s Health Research,
Children’s Health Queensland Hospital and Health Service, South Brisbane,
QLD, Australia
| | - Rebecca Doyle
- School of Nursing, Midwifery and Social Work,
The University of Queensland, Brisbane, QLD, Australia
- Centre for Children’s Health Research,
Children’s Health Queensland Hospital and Health Service, South Brisbane,
QLD, Australia
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Vaccinations Do Not Increase Arthritis Flares in Juvenile Idiopathic Arthritis: A Study of the Relationship between Routine Childhood Vaccinations on the Australian Immunisation Schedule and Arthritis Activity in Children with Juvenile Idiopathic Arthritis. Int J Rheumatol 2020; 2020:1078914. [PMID: 32831849 PMCID: PMC7424527 DOI: 10.1155/2020/1078914] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 06/30/2020] [Indexed: 12/26/2022] Open
Abstract
Background Juvenile idiopathic arthritis (JIA) is a collective term for a group of inflammatory conditions of uncertain origin, which causes chronic arthritis in one or more joints. The clinical course of JIA is characterised by episodes of increased activity, termed flares. Vaccinations have previously been proposed as a “trigger” for some flares, although evidence supporting this is scant. Objective To explore whether routine childhood vaccinations are associated with an increased risk of flares of arthritis activity in children with JIA. Methods Patients aged below 6 years with a diagnosis of JIA were recruited from the Rheumatology Clinical Database at the Royal Children's Hospital, Melbourne, Australia, from 1 January 2010 to 30 April 2016. Patient immunisation status was cross-checked with the Australian Childhood Immunisation Register (ACIR). The self-controlled case series methodology (Rowhani-Rahbar et al., 2012) was applied to determine whether the risk of arthritis flares in the three months following immunisation was greater than the baseline risk for each patient. Results 138 patients were included in the study. 32 arthritis flares occurred in the 90 days following immunisation. The risk of arthritis flares during the 90 days following immunisation was reduced compared with patients' baseline risk (RR 0.59 (95% CI 0.39-0.89, p = 0.012)). Conclusion Routine childhood immunisations were not associated with arthritis flare onset in patients with JIA. The risk of arthritis flares in the 90 days following vaccination was lower than the baseline risk. In the context of COVID19, vaccination will not increase interaction with the healthcare system beyond the immunisation encounter.
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Marino A, Giani T, Cimaz R. Risks associated with use of TNF inhibitors in children with rheumatic diseases. Expert Rev Clin Immunol 2018; 15:189-198. [PMID: 30451548 DOI: 10.1080/1744666x.2019.1550359] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Introduction: Tumor necrosis factor alpha (TNF-α) is a pro-inflammatory cytokine involved in the pathogenesis of many inflammatory diseases. Several drugs blocking TNF-α are employed in clinical practice in pediatrics. Given their action on the immune system, TNF-α inhibitors have raised concerns on their safety profile since their introduction. A broad spectrum of side effects related to TNF inhibition has been reported: immunogenicity, infectious diseases, malignancies, and others. Areas covered: In order to assess the risk related to the use of anti-TNF-α agents in children with rheumatic diseases we analyzed data obtained from retrospective and prospective safety studies, case reports and case series, and controlled trials. Expert commentary: Anti-TNF-α agents have shown a remarkably good safety profile in the pediatric population so far. However, there are lots of questions to be answered and maintaining active surveillance on these drugs is necessary in order to not overlook any possible unexpected adverse effects.
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Affiliation(s)
- Achille Marino
- a Department of Pediatrics, Desio Hospital , ASST Monza , Desio (MB) , Italy.,b PhD student in Biomedical Sciences , University of Florence , Florence , Italy
| | - Teresa Giani
- c Department of Medical Biotechnology , University of Siena , Siena , Italy.,d Rheumatology Unit, Meyer Children's Hospital , University of Florence , Florence , Italy
| | - Rolando Cimaz
- e Department of Neurosciences, Psychology, Drug Research and Child Health, Rheumatology Unit, Meyer Children's Hospital , University of Florence , Florence , Italy
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Huang Y, Wang H, Tam WWS. Is rheumatoid arthritis associated with reduced immunogenicity of the influenza vaccination? A systematic review and meta-analysis. Curr Med Res Opin 2017; 33:1901-1908. [PMID: 28489423 DOI: 10.1080/03007995.2017.1329140] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To determine whether immunogenicity and safety of the influenza vaccination in rheumatoid arthritis (RA) patients are significantly different from those in a healthy population. METHODS PubMed, MEDLINE, Embase, Cochrane Library and Web of Science were searched on 31 August 2016. Studies were included when they met the inclusion criteria. Two reviewers independently extracted data on study characteristics, methodological quality and outcomes. The primary outcome was seroprotection (SP) rate after immunization. RESULTS Thirteen studies were included. The SP rates did not significantly differ between the RA patients and healthy controls for the H3N2 (RR = 0.96, 95% CI, 0.82 to 1.13, p = .64) and B strain (RR = 0.95, 95% CI 0.84 to 1. 08, p = .44). Nevertheless, RA was associated with a significant decrease in SP rate for the H1N1 strain (RR = 0.72, 95% CI 0.60 to 0.86, p < .001). RA patients receiving immunosuppressive chemotherapy, TNF blockers, rituximab and other biologics responded to the H1N1 strain significantly less than healthy controls in SP rate, whereas those receiving steroids did not. Non-adjuvanted vaccination had a significantly lower SP rate than in healthy controls, whereas adjuvanted vaccination did not. RA was associated with an increase in adverse events (RR = 1.77, 95% CI 1.02 to 3.08, p = .04). CONCLUSIONS Immunogenicity was significantly different between RA patients and healthy controls for the H1N1 strain, but not for the H3N2 or B strains. Adverse event rates were higher in RA patients. Adjuvant and special kinds of immunosuppressive biologics may play an important role in immunogenicity of inactivated influenza vaccines for RA patients.
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Affiliation(s)
- Yafang Huang
- a School of General Practice and Continuing Education, Capital Medical University , Beijing , China
| | - Huili Wang
- a School of General Practice and Continuing Education, Capital Medical University , Beijing , China
| | - Wilson W S Tam
- b Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore , Singapore
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Camacho-Lovillo MS, Bulnes-Ramos A, Goycochea-Valdivia W, Fernández-Silveira L, Núñez-Cuadros E, Neth O, Pérez-Romero P. Immunogenicity and safety of influenza vaccination in patients with juvenile idiopathic arthritis on biological therapy using the microneutralization assay. Pediatr Rheumatol Online J 2017; 15:62. [PMID: 28784185 PMCID: PMC5547451 DOI: 10.1186/s12969-017-0190-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 08/01/2017] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Seasonal influenza virus vaccination should be considered in all pediatric patients with rheumatic diseases. Few studies have addressed influenza vaccination safety and efficacy in this group. We aim to prospectively evaluate immunogenicity and safety of the trivalent inactivated influenza vaccine including A/H1N1, A/H3N2 and B strains in children with juvenile idiopathic arthritis (JIA) receiving biological therapy. METHODS Thirty-five children diagnosed with JIA and 6 healthy siblings were included. Serum samples were collected prior to, 4-8 weeks and one year after vaccination. Microneutralization assays were used to determine neutralizing antibody titers. The type and duration of therapy were analyzed to determine its effect on vaccine response. Clinical data of the participants were collected throughout the study including severe adverse events (SAE) and adverse events following immunization (AEFI). RESULTS Twenty-five patients (74.3%) received biological treatment for JIA; anti TNF-α was prescribed in 15, anti IL-1 receptor in 4 and anti IL-6 receptor therapy in 6 children. The seroprotection rate 4-8 weeks after vaccination in the JIA group was 96% for influenza A/(H1N1)pdm and influenza A/H3N2, and 88% for influenza B. No differences were found in GMT, seroprotection and seroconversion rates for the three influenza strains between the control group and patients receiving biological therapy. Furthermore, long-term seroprotection at 12 months after vaccination was similar in patients receiving either biological or non-biological treatments. No SAEs were observed. CONCLUSIONS In this study, influenza vaccination was safe and immunogenic in children with JIA receiving biological therapy.
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Affiliation(s)
- M. S. Camacho-Lovillo
- Unidad de Enfermedades Infecciosas e Inmunopatologías Pediátrica, Hospital Universitario Virgen del Rocío/Instituto de Biomedicina de Sevilla (IBIS), Sevilla, Spain
| | - A. Bulnes-Ramos
- 0000 0000 9542 1158grid.411109.cInstituto de Biomedicina de Sevilla (IBIS), University Hospital Virgen del Rocío/CSIC/University of Sevilla, Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Sevilla, Spain
| | - W. Goycochea-Valdivia
- Unidad de Enfermedades Infecciosas e Inmunopatologías Pediátrica, Hospital Universitario Virgen del Rocío/Instituto de Biomedicina de Sevilla (IBIS), Sevilla, Spain
| | - L. Fernández-Silveira
- Unidad de Enfermedades Infecciosas e Inmunopatologías Pediátrica, Hospital Universitario Virgen del Rocío/Instituto de Biomedicina de Sevilla (IBIS), Sevilla, Spain
| | - E. Núñez-Cuadros
- grid.411457.2Unidad de Reumatología Pediátrica, Hospital Materno Infantil, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - O. Neth
- Unidad de Enfermedades Infecciosas e Inmunopatologías Pediátrica, Hospital Universitario Virgen del Rocío/Instituto de Biomedicina de Sevilla (IBIS), Sevilla, Spain
| | - P. Pérez-Romero
- 0000 0000 9542 1158grid.411109.cInstituto de Biomedicina de Sevilla (IBIS), University Hospital Virgen del Rocío/CSIC/University of Sevilla, Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Sevilla, Spain
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Tanrıöver MD, Akar S, Türkçapar N, Karadağ Ö, Ertenli İ, Kiraz S. Vaccination recommendations for adult patients with rheumatic diseases. Eur J Rheumatol 2015; 3:29-35. [PMID: 27708966 DOI: 10.5152/eurjrheum.2016.16100] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 01/12/2016] [Indexed: 11/22/2022] Open
Abstract
Infectious diseases in any age group can be successfully prevented through immunization. Protection provided through immunization in childhood decreases over the years. Immunization in adulthood is important because of the growing elderly population, chronic diseases, and globalization. Recommendations on this subject are being constantly updated through scientific guidelines. Immunization in adulthood is also important in rheumatology. There is an increased risk not only of infection in rheumatic diseases but also of infections being more severe. Most infections, and their frequently observed complications, are among those diseases that can be prevented through immunization. The type of immunization, immunosuppressive/immunomodulatory therapy received by the patient, disease activity, and presence of chronic diseases affect the immunization process in patients with rheumatic diseases. This review will consider the immunization process followed in rheumatic diseases and also refer to its application.
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Affiliation(s)
- Mine Durusu Tanrıöver
- Department of Internal Medicine, Hacettepe University School of Medicine, Ankara, Turkey
| | - Servet Akar
- Department of Internal Medicine, Division of Rheumatology, İzmir Katip Çelebi University School of Medicine, İzmir, Turkey
| | - Nuran Türkçapar
- Department of Internal Medicine, Division of Rheumatology, Acıbadem Hospital, İstanbul, Turkey
| | - Ömer Karadağ
- Department of Internal Medicine, Division of Rheumatology, Hacettepe University School of Medicine, Ankara, Turkey
| | - İhsan Ertenli
- Department of Internal Medicine, Division of Rheumatology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Sedat Kiraz
- Department of Internal Medicine, Division of Rheumatology, Hacettepe University School of Medicine, Ankara, Turkey
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