Abstract
Children with autoimmune disorders are especially at risk of vaccine-preventable diseases due to their underlying disease and the immunosuppressive treatment often required for a long period. In addition, vaccine coverage remains too low in this vulnerable population. This can be explained by a fear of possible adverse effects of vaccines under immunosuppression, but also a lack of data and clear recommendations, particularly with regard to vaccination with live vaccines. In this review, the latest literature and recommendations on vaccination in immunosuppressed children are discussed in detail, with the aim to provide a set of practical guidelines on vaccination for specialists caring for children suffering from different autoimmune disorders and treated with various immunosuppressive regimens.
Highlights
Autoimmune disorders include children with systemic autoimmune diseases and those with autoimmune diseases specific to a single organ, such as the digestive tract, eyes, skin or the central nervous system
A study assessing the risk of infection every 2 months for one year in juvenile idiopathic arthritis-children treated with Biological DMARDs (bDMARDs) reported that 57% (n = 175) of patients developed an infection
Even if larger studies are necessary, it appears that booster vaccinations with live-attenuated vaccines can be considered in patients with autoimmune disorders treated with various csDMARDs at low dose or GCs, or even some bDMARDs (54) more data are needed for these new treatments as they are more specific and, they could impact on a similar pathway needed for vaccine responses
Summary
Autoimmune disorders include children with systemic autoimmune diseases and those with autoimmune diseases specific to a single organ, such as the digestive tract (inflammatory bowel diseases), eyes (uveitis), skin (psoriasis) or the central nervous system (multiple sclerosis). The number of active joints in JIA patients significantly decreased at month 3 after vaccination (43) In another prospective controlled study, 54 children with SLE treated with various csDMARDs and immune for varicella were randomly assigned to receive a single booster dose of VZV vaccine or placebo. Even if larger studies are necessary, it appears that booster vaccinations with live-attenuated vaccines can be considered in patients with autoimmune disorders treated with various csDMARDs at low dose or GCs, or even some bDMARDs (54) more data are needed for these new treatments as they are more specific and, they could impact on a similar pathway needed for vaccine responses. Schedule according to national plan three doses at 0, 2–4 weeks, and 612 months, booster every 10 years
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