Vaccination in Children with Rheumatic Disease

Children and adolescents with rheumatic disease have an increased risk of infections because of immunosuppression caused by rheumatic disease itself or immunosuppressants such as glucocorticoids, disease modifying antirheumatic drugs or TNF a inhibitors. Therefore safe vaccination and sufficient immune response are extremely important for pediatric patients with rheumatic disease. Immunosuppression may cause weaker immune response to vaccine than in health population, there is increased risk for vaccine-induced infection as well. Therefore some vaccines are not recommended for patients with acquired immunodeficiency. Assessment of possible benefits and harms is very important before every vaccination in children with rheumatic disease. Vaccines can be live attenuated when they consist of attenuated live bacteriae or viruses and vaccines can be killed when they have inactivated or modified bacteriae, viruses, toxins, polisacharides or proteins-polysaccharides conjugates. Live attenuated vaccines are not recommended for patients with rheumatic disease when they use high dose immunosuppressive drugs longer than 2 weeks. If immunosuppressants are used for shorter period of time the patients can be vaccinated. Killed vaccines are safe for pediatric patients with rheumatic disease, because they do not cause exacerbations of the disease or serious side effects. Observation by experienced specialists is highly recommended for pediatric patients with rheumatic disease.