Immune response to influenza vaccination in children treated with methotrexate or/and tumor necrosis factor-α inhibitors

Woerner, Andreas; Sauvain, M J; Aebi, Christoph; Otth, Margrit; Bolt, Isabel

doi:10.4161/hv.7.12.17981

Cited by 18 publications

(27 citation statements)

References 20 publications

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“…Like in other studies in children with RD, no SAEs were reported and vaccination using an inactivated influenza vaccine was shown to be safe with mild systemic and local reactions as most reported AEFI [ 26 , 27 ]. Our patients remained clinically stable (JADAS-71:1 (0-5)) during the study period with only two patients receiving systemic corticoids at the time of vaccination.…”

Section: Discussionmentioning

confidence: 65%

Immunogenicity and safety of influenza vaccination in patients with juvenile idiopathic arthritis on biological therapy using the microneutralization assay

et al. 2017

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BackgroundSeasonal 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.MethodsThirty-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).ResultsTwenty-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.ConclusionsIn this study, influenza vaccination was safe and immunogenic in children with JIA receiving biological therapy.Electronic supplementary materialThe online version of this article (doi:10.1186/s12969-017-0190-0) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 65%

Immunogenicity and safety of influenza vaccination in patients with juvenile idiopathic arthritis on biological therapy using the microneutralization assay

et al. 2017

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“…No increase in disease activity. Woerner et al [ 35 ] 10 anti-TNFα 8 MTX + anti-TNFα 18 MTX 7 GC <0.5 mg/kg combined with MTX or anti-TNFα Versus 16 HC Influenza 3 No significant difference in seroconversion, seroprotection or GMT between treatment groups. Analysis of the effect of biologicals on relative difference between pre- and post vaccination GMT in multivariate analysis showed a trend towards a lower relative change.…”

Section: Vaccine Immunogenicity In Paediatric Patients With Rheumaticmentioning

confidence: 99%

“…2 patients (1 JIA, 1 Takayasu arteritis) experienced a flare of disease within 2 weeks after vaccination. Woerner et al [ 35 ] 25 JIA 3 uveitis 2 IBD 2 RMO 1 vasculitis 1 JSLE 1 MCTD 16 HC 18 MTX 10 anti-TNFα 8 MTX + anti-TNFα 2B Seroprotection and seroconversion were similar in patients and controls. The GMT in patients was lower than in HC.…”

Section: Vaccine Immunogenicity In Paediatric Patients With Rheumaticmentioning

confidence: 99%

“…Fifteen articles described the immunogenicity of seasonal influenza and H1N1 vaccines in pedRD (Table 2 ). They included 899 pedRD patients [ 23 , 24 , 27 – 29 , 31 , 32 , 35 , 36 , 41 – 43 , 56 , 58 ]. One study group described a similar study population in three articles [ 31 , 36 , 58 ].…”

Section: Vaccine Immunogenicity In Paediatric Patients With Rheumaticmentioning

confidence: 99%

“…RCTs, in which patients with rheumatic diseases are vaccinated with adjuvanted versus unadjuvanted vaccines are lacking. In this review, we found 12 reports including 614 patients that studied an adjuvanted non-live vaccine [ 15 , 16 , 21 , 26 , 30 , 35 , 39 , 41 , 52 – 54 , 59 ]. Seven reports including 499 patients studied a non-adjuvanted non-live vaccine [ 24 , 25 , 31 , 32 , 36 , 56 , 58 ].…”

Section: Adjuvant Safety In Paediatric Patients With Rheumatic Diseasmentioning

confidence: 99%

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Vaccinations in Paediatric Rheumatology: an Update on Current Developments

2015

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In 2011, the European League Against Rheumatism (EULAR) published recommendations regarding the vaccination of children with rheumatic diseases. These recommendations were based on a systematic literature review published in that same year. Since then, the evidence body on this topic has grown substantially. This review provides an update of the systematic literature study of 2011, summarizing all the available evidence on the safety and immunogenicity of vaccination in paediatric patients with rheumatic diseases. The current search yielded 21 articles, in addition to the 27 articles described in the 2011 review. In general, vaccines are immunogenic and safe in this patient population. The effect of immunosuppressive drugs on the immunogenicity of vaccines was not detrimental for glucocorticosteroids and methotrexate. Biologicals could accelerate a waning of antibody levels over time, although most patients were initially protected adequately. Overall, persistence of immunological memory may be reduced in children with rheumatic diseases, which shows the need for (booster) vaccination. This update of the 2011 systematic literature review strengthens the evidence base for the EULAR recommendations, and it must be concluded that vaccinations in patients with rheumatic diseases should be advocated.

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Immunogenicity and safety of routine vaccines in children and adolescents with rheumatic diseases on immunosuppressive treatment — a systematic review

2021

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The immunogenicity of vaccines in children with juvenile autoimmune rheumatic diseases (JARDs) can be reduced, there are additional safety concerns around vaccination, and there is a potential for worsening in disease activity. In this systematic review, we summarise studies that investigated the immunogenicity and safety of routine vaccines in children and adolescents with JARD on immunosuppressive treatment. We identified 37 studies investigating 2571 children and adolescents with JARD on immunosuppressive treatment and 4895 control children. Of the 56 geometric mean antibody titres measured, 19 (34%) were lower, six (11%) higher, and 31 (55%) similar; of the 39 seroprotection rates measured, 10 (26%) were lower, two (5%) higher, and 27 (69%) similar; and of the 27 seroconversion rates measured, nine (33%) were lower, two (8%) higher, and 16 (59%) similar in children with JARD on immunosuppressive treatment compared with control children. However, many of the studies were underpowered, and not designed to show non-inferiority between children with JARD and controls. Subgroup analysis for different types of immunosuppressive treatments was not feasible, as most studies did not report results by treatment. Severe adverse events were reported in 38 children (33 with juvenile idiopathic arthritis, four with systemic lupus erythematosus, and one in a healthy child); most of them were likely not related to the vaccination (e.g. elective hospitalisation or surgery). A worsening in disease activity was reported in 44 (2%) children with JARD; again, many of them were likely not related to the vaccination. There were no safety concerns with live attenuated vaccines; however, only few studies reported results for this.Conclusion: Vaccination in children with JARD on immunosuppressive treatment is safe and should be promoted, especially since these children are at increased risk for infection. The importance for the completion of vaccination schedules should be stressed. Strategies to compensate for the lower vaccine responses, which are found in approximately one-third of these children, include measuring antibody levels to determine the optimal timing for the administration of additional booster doses. What is Known: • Children with juvenile autoimmune rheumatic diseases (JARDs) are at higher risk for infections, due to their underlying disease and their immunosuppressive treatment. • In children with JARD, the immunogenicity of vaccines might be reduced, and concerns about safety or the potential for worsening in disease activity after vaccination exist. What is New: • Our systematic review shows that vaccines in children with JARDs on immunosuppressive treatment are safe and immunogenic. • There are several limitations of the currently published studies, including random timing of measuring vaccine responses and age differences between children with JARD and control groups. Many of the studies were underpowered, and not designed to show non-inferiority between children with JARD and controls.

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Immune response to influenza vaccination in children treated with methotrexate or/and tumor necrosis factor-α inhibitors

Cited by 18 publications

References 20 publications

Immunogenicity and safety of influenza vaccination in patients with juvenile idiopathic arthritis on biological therapy using the microneutralization assay

Immunogenicity and safety of influenza vaccination in patients with juvenile idiopathic arthritis on biological therapy using the microneutralization assay

Vaccinations in Paediatric Rheumatology: an Update on Current Developments

Immunogenicity and safety of routine vaccines in children and adolescents with rheumatic diseases on immunosuppressive treatment — a systematic review

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