Yosef Uziel1, Veronica Moshe2, Beata Onozo3, Andrea Kulcsár4, Diána Tróbert-Sipos5, Jonathan D Akikusa6, Gecilmara Salviato Pileggi7, Despoina Maritsi8, Ozgur Kasapcopur9, Mariana Rodrigues10, Roubini Smerla11, Donato Rigante12, Balahan Makay13, Erato Atsali14, Nico Wulffraat15, Nataša Toplak16. 1. Pediatric Rheumatology Unit, Department of Pediatrics, Meir Medical Center, Kfar Saba, Israel, Sackler Faculty of Medicine, Tel Aviv University, Israel. Electronic address: uziely@zahav.net.il. 2. Pediatric Rheumatology Unit, Department of Pediatrics, Meir Medical Center, Kfar Saba, Israel, Sackler Faculty of Medicine, Tel Aviv University, Israel. 3. Department of Pediatrics, Borsod-Abauj-Zemplen County Central Hospital, Miskolc, Hungary. 4. Department of Special Immunization Services, South-Pest Central Hospital National Institute of Hematology and Infectious Diseases, Budapest, Hungary. 5. Department of Pediatrics, South-Pest Central Hospital National Institute of Hematology and Infectious Diseases, Budapest, Hungary. 6. Department of Paediatrics, The Royal Children's Hospital, Melbourne, Australia. 7. Clinical Research Unit, University Hospital Center, School of Medicine Ribeirão Preto, Sao Paulo University, Sao Paulo, Brazil. 8. Second Department of Pediatrics, Athens Medical School, National and Kapodistrian University of Athens, Athens, Greece. 9. Department of Pediatric Rheumatology, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey. 10. Paediatric Rheumatology Unit, São João University Hospital, Porto Faculty of Medicine, Porto, Portugal. 11. Department of Paediatrics, University of Athens, Athens, Greece. 12. Institute of Pediatrics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy, Università Cattolica Sacro Cuore, Rome, Italy. 13. Department of Pediatric Rheumatology, Izmir Behcet Uz Children's Hospital, Izmir, Turkey. 14. Pediatric Rheumatology Unit, 3rd Department of Pediatrics, Athens Medical School, National and Kapodistrian University of Athens, Athens, Greece. 15. Divisie Kinderen, Wilhelmina Kinderziekenhuis, Utrecht, Netherlands. 16. Department of Allergology, Rheumatology and Clinical Immunology, University Children's Hospital, University Medical Centre Ljubljana, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
Abstract
PURPOSE: To collect retrospective data of patients with Juvenile Idiopathic Arthritis (JIA) and other rheumatic diseases who received live attenuated booster measles-mumps-rubella (MMR) or measles-mumps-rubella-varicella (MMR/V) during treatment with immunosuppressive therapy. RESULTS: Data from 13 pediatric rheumatology centers in 10 countries, including 234 patients, were collected. Mean age at diagnosis was 5 ± 2.7 years, 67% were girls. Among them, 211 (90.2%) had JIA and 110 (47%) were in remission on medication. Disease activity was low in 37%, high in 8%, and moderate in 8%. One hundred-twenty-four received MMR/V booster while on methotrexate (MTX); 3 reported local mild adverse events (AE). Among 62 on MTX + biologics and 9 patients who received a combination of 2 disease modifying antirheumatic drugs (DMARDs), 9 reported mild AE. Among 39 on biologics, 1 reported fever one day after booster vaccination. No vaccine-related infection of measles, rubella, mumps or varicella was reported, none of the patients developed disease flare, including those with high disease activity. CONCLUSIONS: In this retrospective study, live-attenuated MMR/V booster vaccines were safe for children with rheumatic diseases, on immunosuppressive therapies. This strengthens the Paediatric Rheumatology European Society (PReS) recommendation that vaccination with live attenuated vaccines in patients on immunosuppressive therapies can be considered individually, weighing the benefit of vaccination against the risk of inducing infection through vaccination. These data provide the basis for a prospective data collection study, planned by the PReS vaccination study group.
PURPOSE: To collect retrospective data of patients with Juvenile Idiopathic Arthritis (JIA) and other rheumatic diseases who received live attenuated booster measles-mumps-rubella (MMR) or measles-mumps-rubella-varicella (MMR/V) during treatment with immunosuppressive therapy. RESULTS: Data from 13 pediatric rheumatology centers in 10 countries, including 234 patients, were collected. Mean age at diagnosis was 5 ± 2.7 years, 67% were girls. Among them, 211 (90.2%) had JIA and 110 (47%) were in remission on medication. Disease activity was low in 37%, high in 8%, and moderate in 8%. One hundred-twenty-four received MMR/V booster while on methotrexate (MTX); 3 reported local mild adverse events (AE). Among 62 on MTX + biologics and 9 patients who received a combination of 2 disease modifying antirheumatic drugs (DMARDs), 9 reported mild AE. Among 39 on biologics, 1 reported fever one day after booster vaccination. No vaccine-related infection of measles, rubella, mumps or varicella was reported, none of the patients developed disease flare, including those with high disease activity. CONCLUSIONS: In this retrospective study, live-attenuated MMR/V booster vaccines were safe for children with rheumatic diseases, on immunosuppressive therapies. This strengthens the Paediatric Rheumatology European Society (PReS) recommendation that vaccination with live attenuated vaccines in patients on immunosuppressive therapies can be considered individually, weighing the benefit of vaccination against the risk of inducing infection through vaccination. These data provide the basis for a prospective data collection study, planned by the PReS vaccination study group.
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