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Vaccinations in autoimmune inflammatory rheumatic diseases

Leszek Szenborn

Data publikacji online: 2016/12/30
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Pediatric patients with rheumatic diseases are at increased risk of infection due to the effect of immunosuppressive therapy and the disease itself. Current treatment strategies are based on the early use of immunosuppressive and biological drugs, which increases susceptibility to disease. Vaccination is a valuable method of preventing illness – from infectious diseases to autoimmune inflammatory rheumatic diseases (AIRD). However, the efficacy of vaccination in patients with AIRD can be reduced. The hypothetical risk of exacerbation of AIRD after vaccination was the cause of decades of under-performing vaccination in this group of patients. The issues related to the needs and safety of vaccination were discussed with Professor Lidia Rutkowska-Sak from the Clinic and Policlinic of Rheumatology of Developmental Age at the National Institute of Geriatrics, Rheumatology and Rehabilitation in Warsaw. Experts such as rheumatologists and vaccinologists participated in the discussion that took place during the conference of the Polish Society of Vaccinology entitled “Vaccinations in gastroenterology and rheumatology”, held on March 19, 2016 in Warsaw.
For many years, thanks to the spectacular results of widespread immunization, it was possible to eliminate or reduce the incidence of most diseases that could be prevented by this method. Immunization has also been used for indirect protection of patients with AIRD, i.e. herd immunity and herd protection. In the last five years a fundamental change has been observed in the approach to the problem of the needs and safety of vaccination in patients with AIRDs. Recommendations of the European League Against Rheumatism (EULAR) published in 2011 [1] and disseminated from the outset in Polish language by the journal Medycyna Praktyczna [2] are the primary source of information in Europe.
The most current source of information (2015), not bringing any amendments to the EULAR recommendations, but significantly broadening the base of publications on which these recommendations are based, is the practical elaboration by Groot et al. [3]. The original guidelines were based on the analysis of 131 items of literature and the experience of the authors (experts), voting using of Delphi method, and the overall compatibility of the working group members with regard to the recommendations was 91.7%.
In the overall assessment, in a population of patients with AIRD, vaccines are safe and immunogenic....

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