Varicella vaccine safety and immunogenicity in patients with juvenile rheumatic diseases receiving methotrexate and corticosteroids

[Vaccination prior to travelling for patients with rheumatic diseases]

Rheumatologists increasingly face patient questions about the need, the safety and the effectiveness of travel-related vaccinations. Currently, there are no guidelines on travel vaccinations for patients with inflammatory rheumatic diseases. The use of live attenuated vaccines remains contraindicated in patients receiving relevant immunosuppressive therapy despite some encouraging results from initial pilot studies. However, many inactivated travel vaccines can safely be used for patients with rheumatic diseases. Furthermore, rheumatologists should be vigilant in identifying and closing gaps in the routine vaccinations for patients.

Vaccination of children and adolescents with rheumatic diseases

Children with rheumatic diseases (RDs) are at greater risk of infection because of their aberrant immunity and frequent use of immunosuppressive drugs. However, the use of vaccinations in such children is debated by many experts who think that the patients' immune response is insufficient to assure protection; some of them are also afraid that vaccines could trigger a persistent autoimmune response and lead to severe clinical problems including a relapse of the RD. This review describes the available data regarding the risks of vaccine administration, and the immunogenicity, efficacy and tolerability of the vaccines usually recommended for children with RDs. The data not only show that the schedule suggested for otherwise healthy children should be followed, but also that pneumococcal and influenza vaccinations should be strongly recommended because of the known risk of severe infections in patients with RD. However, there are areas in which further research is urgently required.