Because diseases like arthritis and rheumatism are caused when a patient is attacked by their own immune system, some rheumatology patients are prescribed anti-immune drugs, which can pose special problems when the patient receives a vaccine, such as those for COVID-19, pneumonia, or other diseases.
“It’s much better to prevent infectious diseases than to treat them,” said Kathryn Edwards, MD, Professor Emerita of Pediatrics at Vanderbilt University School of Medicine, who will speak on the safety and immunogenicity of pediatric vaccines during the session Vaccinations in Pediatric Rheumatic Diseases: ACR Guidelines and More on Monday, Nov. 13, from 11 a.m.– 12 p.m. PT in Room 8 of the San Diego Convention Center. The session will be available for on-demand viewing within 24 hours of the live presentation for registered ACR Convergence 2023 participants.
“Other than clean water, vaccines have had probably the biggest impact on public health for the prevention of diseases,” Dr. Edwards noted.
Special considerations for vaccination in individuals living with rheumatic diseases have been the subject of several guidelines from medical societies in recent years, such as the ACR’s 2022 Guideline for Vaccinations in Patients With Rheumatic and Musculoskeletal Diseases, as well as the guideline issued by EULAR and the recommendations of the Infectious Diseases Society of America.
“One of the problems is that when vaccines for infectious disease are initially studied in the population for which they’ll be used, those are patients who have intact immune responses. There needs to be subsequent studies in immunocompromised populations, and those studies often lag a little bit behind,” Dr. Edwards said. “Also, we sometimes have data in adults, but not in children.”
She will review which vaccines are recommended and which should be avoided for specific patient populations.
“In general, patients on immunosuppression should not receive live vaccines, like the measles vaccine,” Dr. Edwards said. “In these patients, the live vaccine can cause an infection.”
She also will discuss the routine use of yearly influenza vaccines, the use of COVID-19 vaccine boosters, and vaccines that are on the horizon.
Lisa Imundo, MD, Director of Adolescent Rheumatology at Columbia University, will outline pediatric vaccine recommendations in the guideline.
“These guidelines represent a paradigm shift. As rheumatologists, we haven’t previously considered vaccinations to be in our purview. We have actually deferred these to primary care,” she said. “With many new advanced therapies and immunomodulators and biologics available, we’ve become able to achieve better outcomes. Now it’s our responsibility to prevent adverse events and infections. The importance of these guidelines is that, because we’re modulating the immune system, we need to own it by making clear recommendations to utilize available vaccinations,” said Dr. Imundo, a co-author of the ACR’s 2022 guideline.
“These guidelines very much take the position that vaccinations should be given whenever possible,” she continued. “There are very few reasons to ever hold off, but there are exceptions.”
When pregnant patients receive certain medications, for example, it can affect the vaccination schedule for their infants because of the transmission of medication across the placenta.
“It’s important for rheumatologists to give the patients and pediatrician guidance, such as an actual timetable for administering live vaccinations,” Dr. Imundo said, noting that many rheumatic diseases predominantly affect young women, including rheumatoid arthritis and lupus.