Pediatric Rheumatology Association of Japan recommendation for vaccination in pediatric rheumatic diseases

Abstract

Pediatric Rheumatology Association of Japan has developed evidence-based guideline of vaccination in pediatric rheumatic diseases (PRDs) as a part of Guideline of Vaccination for Pediatric Immunocompromised Hosts. Available articles on vaccination in both adult rheumatic diseases and PRDs were analyzed. Non-live vaccines are generally safe and effective in patients with PRDs on corticosteroid, immunosuppressant, and/or biologics, although efficacy may be attenuated under high dose of the drugs. On the other hand, efficacy and safety of live-attenuated vaccine for the patients on such medication have not been established. Thus, live-attenuated vaccines should be withheld and, if indicated, may be considered as a clinical trial under the approval by Institutional Review Board. All patients with PRDs anticipating treatment with immunosuppressants or biologics should be screened for infection of hepatitis B and C and tuberculosis before the commencement of medication. Varicella vaccine should be considered in sensitive patients ideally 3 weeks or longer before the commencement of immunosuppressants, corticosteroids, or biologics. Bacille Calmette-Guérin should be withheld at least for 6 months after birth, if their mothers have received anti-tumor necrosis factor-α antibodies during the second or third trimester of pregnancy.

Keywords:

• Immunosuppression
• Pediatric
• Rheumatic disease
• Vaccine

Acknowledgments

The Japanese version of this work is available in the homepage of Pediatric Rheumatology Association of Japan (http://www.kufm.kagoshima-u.ac.jp/∼ped/praj/) and is published as a part of “Guideline of Vaccination for Pediatric Immunocompromised Hosts”. A commentary on this work is published in the Journal of the Japanese Pediatric Society.

Conflict of interest

M. Mori has received lecture fees from Kitasato Daiichi Sankyo Vaccine Co., Ltd, Abbvie GK, MSD Japan, Astellas Pharma Inc, Sanofi-Pasteur Japan, Mitsubishi-Tanabe Pharma, Pfizer Japan, and Glaxo-Smith-Klein Japan.

K. Okada has received lecture fees from Kaketsuken, MSD Japan, The Research Foundation for Microbial Diseases of Osaka University, Kitasato Daiichi Sankyo Vaccine Co., Ltd, Takeda Pharmaceutical Co Ltd, Sanofi-Pasteur Japan, Pfizer Japan, Glaxo-Smith-Klein Japan, and Japan BCG Laboratory.