LAUSR

Background: O ver the years, awareness of vaccine-preventable infection in rheumatic diseases has increased. At the same time, the safety of vaccines is still a hot topic in the public arena. Large-scale registries with data on juvenile idiopathic arthritis or RA taking the combination of methotrexate and biologics have demonstrated an increased incidence of infections. EULAR recommendations for both vaccination in pediatric patients and adults with rheumatic diseases, provide evidence-based guidance based on data from published studies on safety and efficacy of vaccinations in adults and children with rheumatic conditions. Especially in children, few data exist on safety and efficacy of live-attenuated vaccines such as MMR. This is relevant given the decreasing vaccination coverage and occurrence of measles outbreakes Objectives: To provide an overview of vaccines used in patients groups with rheumatic conditions under medication such as MTX and or biologicals. Also we seek for evidence on adverse events, protection rates and persistence of protective antibody titers over time. From these studies general guidelines are proposed. Methods: Literature review of vaccination studies performed in adults and children. In addition the clinical practice of boostering of MMR in JIA patients under immunosuppressive therapy was investigated in several large academic pediatric centers across Europe. Thus 234 JIA patients were identified that received a MMR booster under MTX and or biologicals. Results: EULAR recommendations are updated for children and adults. For most vaccines it is adivised to follow the national vaccination guidelines. Non-live vaccines can be safely provided to AIIRD patients under immunomodulating treatments, whereas the administration of live attenuated vaccines should be avoided under immunomodulating treatment, with the possible exceptions of herpes zoster and MMR. In 234 children with JIA who received the MMR booster while using MTX and or a Biological only 7 of adverse events were reported. Adverse events reported were mild (skin reaction, mild fever, urinary tract infection. There was no relation between disease activity, disease type or duration, sex, age and outcome of vaccinations. Vaccination status of patients with rheumatic conditions should be assessed annually. 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. Conclusion: The EULAR recommendations of 2011 are currently updated and will provide an up-to-date guidance on the management of vaccinations in patients with inflammatory rheumatic conditions. There is still a scartity of data on safety and efficay of live attenuated vaccines under biologicals. The next challenge is the implementation into the clinical practice of health professionals across Europe. Disclosure of Interests: None declared