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Clin Exp Rheumatol. 2019 Aug 27. [Epub ahead of print]

Italian recommendations for influenza and pneumococcal vaccination in adult patients with autoimmune rheumatic diseases.

Author information

1
Department of Medical Sciences, Section of Rheumatology, University of Ferrara, Italy.
2
Infectious Disease Unit, Department of Biomedical and Clinical Sciences L. Sacco, University of Milano, Italy.
3
Rheumatology Unit, Department of Biotechnological and Applied Clinical Science, School of Medicine, University of L'Aquila, Italy.
4
Rheumatology Unit, Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Italy.
5
Division of Infectious Diseases, Azienda Ospedaliero Universitaria Ospedali Riuniti, Ancona, Italy.
6
Unità di Malattie Infettive, Ospedale Civile Spirito Santo, Pescara, Italy.
7
Rheumatology and Clinical Immunology Unit, Spedali Civili of Brescia, Italy.
8
Department of Internal Medicine and Medical Therapy, Section of Rheumatology, University of Messina, Italy.
9
Department of Experimental and Clinical Medicine, University of Florence, and Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy.
10
Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Italy.
11
Infectious Diseases Unit, Galliera Hospital, Genoa, Italy.
12
Clinic of Infectious Diseases, Vita-Salute San Raffaele University, Milano, Italy.
13
University Department of Infectious and Tropical Diseases, University of Brescia and Spedali Civili General Hospital, Brescia, Italy.
14
Division of Infectious and Tropical Diseases, Azienda Ospedaliera and University of Padova, Italy.
15
Rheumatology Unit, Department of Medical and Surgical Science, University of Modena, Azienda Policlinico of Modena, Italy.
16
Infectious Diseases Unit, Teaching Hospital S. Orsola-Malpighi, Alma Mater Studiorum University of Bologna, Italy.
17
Department of Medical Science, University of Turin, Infectious Diseases Amedeo di Savoia Hospital, Turin, Italy.
18
Rheumatology Section, Department of Medicine, University of Verona, Italy.
19
Academic Department of Rheumatology, King's College London, UK.
20
ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy.
21
Division of Infectious Diseases, ASST Papa Giovanni XIII, Bergamo, Italy.
22
Clinic of Infectious Diseases, University of Bari, Italy.
23
First Division of Infectious Diseases, Cotugno Hospital, Azienda Ospedaliera dei Colli, Napoli, Italy.
24
Infectious Diseases Unit, Sapienza University, S.M. Goretti Hospital, Latina, Italy.
25
Division of Infectious and Tropical Diseases, Hospital of Lodi, Italy.
26
Rheumatology Clinic, Department of Medical and Biological Sciences, University Hospital Santa Maria della Misericordia, Udine, Italy.
27
Rheumatology Unit, L. Sacco University Hospital, Milan, Italy.
28
Infectious Disease Unit, Department of Biomedical and Clinical Sciences L. Sacco, University of Milano, Italy. massimo.galli@unimi.it.

Abstract

OBJECTIVES:

To provide evidence-based recommendations for vaccination against influenza virus and S. pneumoniae in patients with autoimmune rheumatic diseases (ARDs).

METHODS:

A Consensus Committee including physicians with expertise in rheumatic and infectious diseases was established by two Italian scientific societies, Società Italiana di Reumatologia (SIR) and Società Italiana di Malattie Infettive e Tropicali (SIMIT). The experts were invited to develop evidence-based recommendations concerning vaccinations in ARDs patients, based on their clinical status before and after undergoing immunosuppressive treatments. Key clinical questions were formulated for the systematic literature reviews, based on the clinical pathway. A search was made in Medline (via PubMed) according to the original MeSH strategy from October 2009 and a keyword strategy from January 2016 up to December 2017, updating existing EULAR recommendations. Specific recommendations were separately voted and scored from 0 (no agreement with) to 100 (maximal agreement) and supporting evidence graded. The mean and standard deviation of the scores were calculated to determine the level of agreement among the experts' panel for each recommendation. Total cumulative agreement ≥70 defined consensus for each statement.

RESULTS:

Nine recommendations, based on 6 key clinical questions addressed by the expert committee, were proposed. The aim of this work is to integrate the 2011 EULAR recommendations on vaccination against influenza and S. pneumoniae in ARDs patients. An implementation plan was proposed to improve the vaccination status of these patients and their safety during immunosuppressive treatments.

CONCLUSIONS:

Influenza and pneumococcus vaccinations are effective and safe in patients with ARDs. More efforts should be made to translate the accumulated evidence into practice.

PMID:
31498077

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