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Pediatr Rheumatol Online J. 2018 Mar 21;16(1):19. doi: 10.1186/s12969-018-0235-z.

The safety of live-attenuated vaccines in patients using IL-1 or IL-6 blockade: an international survey.

Author information

1
Department of General Pediatrics, University Medical Center Utrecht, Room KE 04 133 1, PO-Box 85090, 3508, AB Utrecht, The Netherlands.
2
Laboratory for Translational Immunology, University Medical Center Utrecht, Utrecht, the Netherlands.
3
University College Medical School, National Amyloidosis Center, Royal Free Campus, London, UK.
4
Department of Pediatric Rheumatology, Cerrahpasa Medical School-Istanbul University, Istanbul, Turkey.
5
Inflammatory Disease section, National Human Genome Research Institute, Bethesda, MA, USA.
6
Institute of Pediatrics, Università Cattolica Sacro Cuore, Rome, Italy.
7
Division of Immunology, Boston Children's Hospital, Boston, MA, USA.
8
Department of Pediatric Rheumatology, University Medical Center Utrecht, Utrecht, the Netherlands.
9
Department of General Pediatrics, University Medical Center Utrecht, Room KE 04 133 1, PO-Box 85090, 3508, AB Utrecht, The Netherlands. J.Frenkel@umcutrecht.nl.

Abstract

BACKGROUND:

Withholding live-attenuated vaccines in patients using interleukin (IL)-1 or IL-6 blocking agents is recommended by guidelines for both pediatric and adult rheumatic diseases, since there is a risk of infection in an immune suppressed host. However, this has never been studied. This retrospective, multicenter survey aimed to evaluate the safety of live-attenuated vaccines in patients using IL-1 or IL-6 blockade.

METHODS:

We contacted physicians involved in the treatment of autoinflammatory diseases to investigate potential cases. Patients were included if a live-attenuated vaccine had been administered while they were on IL-1 or IL-6 blockade.

RESULTS:

Seventeen patients were included in this survey (7 systemic juvenile idiopathic arthritis (sJIA), 5 cryopyrin associated periodic syndrome (CAPS), 4 mevalonate kinase deficiency (MKD) and 1 familial Mediterranean fever (FMF). Three patients experienced an adverse event, of which two were serious adverse events (a varicella zoster infection after varicella zoster booster vaccination, and a pneumonia after MMR booster). One additional patient had diarrhea after oral polio vaccine. Further, seven patients experienced a flare of their disease, which were generally mild. Eight patients did not experience an adverse event or a flare.

CONCLUSION:

We have described a case series of seventeen patients who received a live-attenuated vaccine while using IL-1 or IL-6 blocking medication. The findings of this survey are not a reason to adapt the existing guidelines. Prospective trials are needed in order to acquire more evidence about the safety and efficacy before considering adaptation of guidelines.

KEYWORDS:

Autoinflammatory diseases; Biologicals; IL-1 blockade; IL-6 blockade; Live-attenuated vaccines

PMID:
29562920
PMCID:
PMC5863478
DOI:
10.1186/s12969-018-0235-z
[Indexed for MEDLINE]
Free PMC Article

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