Safety and immunogenicity of varicella vaccine in patients with juvenile rheumatic diseases receiving methotrexate and corticosteroids

Abstract

Objective. To evaluate the safety and immunogenicity of varicella vaccine (VV) in susceptible patients with juvenile rheumatic diseases receiving methotrexate and corticosteroids. Methods. Twenty-five patients with juvenile rheumatic diseases (ages 2-19 years) and 18 healthy children and adolescents (ages 3-18 years) received a single dose of VV. All 25 patients were receiving methotrexate; 13 were also receiving prednisone and 5 were also receiving other disease-modifying antirheumatic drugs. None of the vaccinated patients or controls had a previous history of varicella. Anti-varicella-zoster virus IgG antibody (anti-VZV-IgG) titers were measured by enzyme-linked immunosorbent assay immediately before, 4 -6 weeks after, and 1 year after vaccination. The patients were monitored prospectively for adverse reactions related to the vaccine, exposure, and occurrence of varicella. Disease activity was assessed 3 months before and 3 months after VV. Conclusion. VV appears to be safe in patients with juvenile rheumatic diseases receiving methotrexate, as long as continuous prospective vigilance for side effects is performed. Results. Twenty patients and all of the controls had negative preimmunization titers of VZV-IgG

Prática de vacinação em crianças com doenças reumáticas

“…Moreover, no worsening in the activity of rheumatic diseases has been verified. 24 Another Brazilian study reported the practice of vaccination against yellow fever in seventy adult patients with rheumatic diseases, with mild adverse events observed in 22% of patients. 25 In conclusion, the practice of immunization surveillance by pediatric rheumatologists is low, especially after the first visit, possibly due to lack of efficacy and safety of vaccines in children and adolescents with rheumatic diseases.…”

In vitro Cytokine Synthesis by Lymphocytes in Children in Juvenile Idiopathic Arthritis Remission Against the Background of Genetically Engineered Biologic Drug Therapy

“…The studies [14,15] have shown that vaccination of patients with rheumatoid arthritis against influenza, diphtheria, tetanus, and meningococcal infection has not resulted in the clinical setting deterioration. However, simultaneous use of supporting immunosuppressive therapy at average age doses was found not to inhibit the production of protective antibodies when vaccinated against diphtheria [15,16], whooping cough [15,17], hepatitis В [15,18], influenza [15,19].…”

Current information about vaccination practice in pediatric rheumatic diseases and recommendations for future applications

“…89 Nevertheless, varicella vaccination is contraindicated in patients receiving glucocorticoids at prednisone equivalent doses of 2 mg/kg/day or 20 mg/ day for >14 days. 90 Pileggi et al 83 evaluated the immunogenicity and tolerance of the VZV vaccine in one study of 25 sensitive children with RD and 18 healthy controls. All patients were receiving MTX, 13 were also receiving prednisone and five others were using DMARDs.…”