Consenso de imunização para crianças e adolescentes com doenças reumatológicas

Abstract

Incidence of infectious diseases is higher in children and adolescents with rheumatic diseases than in the general population due to disease activity, possible immune deficiency secondary to the disease itself, or the use of immunosuppressive drugs. Vaccination is effective in reducing morbidity and mortality in those patients. The objective of this study was to establish an evidence-based consensus on the efficacy and safety of vaccination in children and adolescents with rheumatic diseases. Passive immunization of patients and guidelines for people who live with immunosuppressed patients were also included. The 32 pediatric rheumatologists of the Rheumatology Department of the Pediatrics Society of São Paulo, (SPSP, from the Portuguese), São Paulo, SP, Brazil, and/or the Commission on Pediatrics Rheumatology of the Brazilian Society of Rheumatology are responsible for this consensus; some of those professionals are involved on research and scientific publications in this field. The words efficacy and/or safety of different vaccines in children and adolescents with rheumatologic diseases were searched in Medline and Scielo data bases from 1966 to March 2009, including reviews, controlled studies, and case reports. The degree of recommendation and the scientific evidence of the studies were classified in four levels for each vaccine. As a rule, inactive and protein components vaccines are safe for patients with rheumatologic diseases, even in the presence of immunosuppressive therapy. However, live attenuated vaccines are, in general, contraindicated for immunosuppressed patients.

Evaluation of Reference Centers for Special Immunobiologicals implementation

“…Several publications discuss indications of special immunobiologicals or describe the care to specific groups in the CRIE 3 , 5 , 6 , 21 , 24 , 26 , but we did not find studies that evaluate the implementation of CRIE in national perspective.…”

Prática de vacinação em crianças com doenças reumáticas

“…According to this consensus, it was concluded that there are few studies on efficacy and safety of using vaccines for these diseases in pediatric patients. 8 According to the American Academy of Pediatrics, immunization with live vaccine component is contraindicated when prednisone is used in doses equal to or greater than 2 mg/kg or higher than 20 mg/day, for longer than a week. 14 The Committee of Immunization Practices of the CDC instructs that live agents vaccines can be used in patients on MTX at doses ≤ 0.4 mg/kg/week or 28 mg/week in an individual with 70 kg, azathioprine ≤ 3 mg/kg/day, or 6-mercaptopurine ≤ 1.5 mg/kg/day.…”

“…Recently, our concern with these issues was highlighted in a systematic review of medical literature on efficacy and safety of vaccines in children and adolescents with rheumatic diseases based on levels of scientific evidence. 8 This consensus demonstrated the safety and efficacy of inactivated vaccines and protein components against virus, such as hepatitis A and B, influenza, pneumococcus, meningococcus, Haemophilus, Salk, and tetanus, in patients with rheumatic diseases, despite the use of immunosuppressive drugs. Furthermore, this review suggested that vaccination with live agents against yellow fever, BCG, rotavirus, varicella, polio, and MMR are contraindicated in immunosuppressed patients.…”

Situação vacinal de crianças e adolescentes acompanhados em serviço de referência de reumatologia pediátrica

“…Chaves et al (2008) As piores taxas de cobertura, a exemplo do que foi observado no presente estudo, foram para hepatite B, varicela e vacina pneumocócica (CHAVES et al, 2008). (BOSCH et al, 2006;WALLACE;HAHN, 2007) e/ou uso de imunossupressores, no caso de vacinas de componentes vivos atenuados (GLUCK et al, 2005;SILVA et al, 2009). Os pacientes com LES apresentaram a maior porcentagem de atraso vacinal secundário à contraindicação médica (40%), o que seria esperado, já que esses pacientes freqüentemente usam medicamentos imunossupressores.…”

“…Schneeweiss et al (2007) MAILLEFERT et al, 1999;POPE et al, 1998;TOUSSIROT et al, 2000). BSR, 2002;HARPER et al, 2005;SILVA et al, 2009;SMITH et al, 2006).…”