Live Attenuated Booster Vaccines Are Safe for Children With Rheumatic Disease on Immunosuppressive Therapy

Live attenuated booster vaccines are safe for children with rheumatic diseases who receive immunosuppressive therapies, according to study results published in Vaccine.¹

Current guidelines suggest withholding live attenuated booster vaccines in patients with rheumatic diseases who are on high doses of immunosuppressive therapy; however, patients with rheumatic diseases are more susceptible to infections and may benefit greatly from vaccines.² In May 2017, the European League Against Rheumatism-Pediatric Rheumatology European Society Task Force for Vaccination updated the recommendation for live vaccines in children with rheumatic diseases on immunosuppressive therapies to suggest that administration of live attenuated vaccines should be considered on a case-by-case basis for this patient population.

The objective of this study was to obtain more evidence to support the 2017 recommendation on administering vaccinations for children with rheumatic diseases on immunosuppressive therapies.

In this retrospective study, researchers sent a questionnaire to pediatric rheumatology centers to determine whether patients had received live attenuated booster vaccines while being treated with immunosuppressive drugs such as methotrexate or adalimumab. Demographic data and information on disease subtypes were collected for 234 patients (157 girls); data were also obtained for disease activity at the time of vaccination, outcomes, and adverse events after vaccinations. Patients who received vaccinations were followed up for 6 months after their vaccinations.

Researchers indicated that 13 patients reported a local skin reaction or a mild adverse event in response to vaccination with the measles-mumps-rubella-varicella (MMR/V) booster. Among 124 patients who received the MMR/V booster while on methotrexate, 3 reported mild adverse events of pain and a local skin reaction. Among 62 patients who received the MMR/V booster while on methotrexate and biologics and 9 who received a combination of 2 disease-modifying antirheumatic drugs, 9 reported mild adverse events of flu-like symptoms and a local skin reaction. Among 39 patients who received the MMR/V booster while on biologics alone, 1 patient reported fever the day after vaccination. 

Among patients in the total study cohort, 111 were in remission on medication, with 86 classified with low disease activity, 19 with moderate disease activity, and 18 with high disease activity. Average score was 1.76 among patients who reported Juvenile Arthritis Disease Activity Score activity. There were no vaccine-related infections or cases of disease flare reported in any patients, including those with high disease activity.

The main limitation was the retrospective nature of the study, with some adverse events potentially being missed.

Researchers concluded that live-attenuated MMR/V booster vaccines are safe for children with rheumatic diseases on immunosuppressive therapies, which strengthens the current recommendation that vaccination with live attenuated vaccines should be considered on a case-by-case basis for this patient population while weighing the benefits of vaccination vs infection risk.

References

1. Uziel Y, Moshe V, Onozo B, et al. Live attenuated MMR/V booster vaccines in children with rheumatic diseases on immunosuppressive therapy are safe: multicenter, retrospective data collection [published online January 24, 2020]. Vaccine. doi:10.1016/j.vaccine.2020.01.037

2. Heijstek MW, Ott de Bruin LM, Bijl M, et al. EULAR recommendations for vaccination in paediatric patients with rheumatic diseases. Ann Rheum Dis. 2011;70:1704-1712.