Inactivated and live attenuated vaccines usually produce sufficient immune responses and can be safely used in children with autoimmune diseases received all treated except the most effective immunosuppressants, according to a review of a study.
A team of researchers from the University of Manchester and the NHS Foundation Trust at the University of Manchester reviewed 37 original articles: 25 studied the inactivated vaccine influenza; hepatitis A virus; hepatitis B virus; and human papillomavirus. Twelve studied live attenuated vaccines against varicella zoster virus; measles, mumps and rubella.
The study concluded that low doses of steroids and biological agents had no significant adverse effects on the immune response of the vaccine.
Dr. Peter Arkwright, a senior lecturer at the University of Manchester and pediatric immunology consultant at the Royal Manchester Children’s Hospital, said the evaluation should give patients and clinicians the confidence to ensure that these children will receive the intended vaccination.
The team, including Professor Ray Borrow, a professor of vaccine preventable diseases at the University of Manchester, did find evidence that live vaccines were less effective in patients treated with high doses of steroids and chemotherapy cyclophosphamide.
“Children with autoimmune diseases such as Crohn’s disease, lupus and juvenile arthritis often need to be treated with immunosuppressants,” Dr. Arkwright said. “Although preventing infection is essential for these patients, clinicians have long been concerned about the efficacy and safety of vaccination, especially live attenuated vaccines. There is evidence that both live and inactive vaccines are safe and effective, so it is hoped that this study will solve these problems. Children receiving immunosuppressive drugs for autoimmune diseases should be vaccinated to protect them from vaccination-preventable diseases. However, we do believe that patients taking high doses of steroids and pulsed cyclophosphamide should avoid using live viral vaccines. “
Patients taking immunosuppressants may have lower antibody concentrations, although the vaccine provides adequate protection. As a result, the team believes that patients using these drugs may need to add enhanced vaccines in the future to ensure protection is maintained.