The European League Against Rheumatism (EULAR) provided a 2019 update to their recommendations for vaccinating adults with autoimmune inflammatory rheumatic diseases (AIIRD).
The updated recommendations, originally published in 2011, appeared in Annals of the Rheumatic Diseases.
A task force comprising 21 experts including patients, rheumatologists, immunologists, and an infectious disease specialist from eight countries performed systematic literature reviews pertaining to the following: the incidence/prevalence of vaccine-preventable infections among patients with AIIRD, efficacy, immunogenicity and safety of vaccines, effect of anti-rheumatic drugs on the response to vaccines, effect of vaccination of household of AIIRDs patients.
Subsequently, the team developed a list of six overarching principles and nine recommendations. They read as follows:
Overarching Principles
A. The vaccination status and indications for further vaccination in patients with AIIRD should be assessed yearly by the rheumatology team.
B. The individualized vaccination program should be explained to the patient by the rheumatology team, providing a basis for shared decision-making, and be jointly implemented by the primary care physician, the rheumatology team and the patient.
C. Vaccination in patients with AIIRD should preferably be administered during quiescent disease.
D. Vaccines should be preferably administered prior to planned immunosuppression, B-cell depleting therapy.
E. Non-live vaccines can be administered to patients with AIIRD during the use of glucocorticoids and disease-modifying antirheumatic drugs (DMARDs).
F. Live-attenuated vaccines may be considered with caution in patients with AIIRD.
Recommendations
A. Influenza vaccination should be strongly considered for most patients with AIIRD.
B. Pneumococcal vaccination should be strongly considered for most patients with AIIRD.
C. Patients with AIIRD should receive tetanus toxoid vaccination in accordance to recommendations for the general population. Passive immunization should be considered for patients treated with B cell depleting therapy.
D. Hepatitis A and hepatitis B vaccines should be administered to AIIRD patients at risk — in specific situations, booster or passive immunization is indicated.
E. Herpes zoster vaccination may be considered in high-risk patients with AIIRD.
F. Vaccination against yellow fever should be generally avoided in patients with AIIRD.
G. Patients with AIIRD, particularly patients with SLE, should receive vaccinations against HPV in accordance with recommendations for the general population.
H. Immunocompetent household members of patients with AIIRD should be encouraged to receive vaccines according to national guidelines except for the oral polio vaccine.
I. Live-attenuated vaccines should be avoided during the first 6 months of life in newborns of mothers treated with biologics during the second half of pregnancy.
Update of the @eular_org #recommendations for #vaccination in adult patients with #autoimmune #inflammatory #rheumatic diseases just published. See the overarching priniciples at first glance attached!
FULTTEXT: https://t.co/BxNO6JfOws pic.twitter.com/m3yowT4zVm— Annals of the Rheumatic Diseases (@ARD_BMJ) August 16, 2019
In conclusion, the authors of the new guidelines wrote that: “The evidence concerning safety, immunogenicity and efficacy of vaccination among patients with AIIRD has markedly grown during the last years allowing to adjust and upgrade the recommendations and guide physicians in the use of vaccinations in AIIRD.”
A must read!!. The long expected update of the @eular_org recommendations for #vaccination in adults with #autoimmune diseases are published in @ARD_BMJ.
The #1 overarching principle is for the rheum team to assess vaccination status yearly. @EMEUNET #foamed #meded @DrJuanOvalles https://t.co/dBe3k40w0u— Sebastian C Rodriguez-García (@sdlcrodriguez) August 16, 2019
📍Extremely important: #vaccinations in #rheumatic diseases 💉🦠 @eular_org https://t.co/qWub7Au6jB
— Laura Andreoli (@lauraandreoli80) August 16, 2019
© 2025 Mashup Media, LLC, a Formedics Property. All Rights Reserved.