1 - Serviço de Pediatria, Hospital Vila Franca de Xira, Vila Franca de Xira
2 - Serviço de Pediatria, Centro Hospitalar do Médio Ave, Famalicão
3 - Unidade de Reumatologia Pediátrica, Centro Hospitalar de São João, Porto
4 - Serviço de Reumatologia, Hospital de Santa Maria, Centro Hospitalar de Lisboa Norte, Lisboa
5 - Unidade de Reumatologia Pediátrica, Área da Mulher, Criança e Adolescente, Hospital Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, Lisboa
6 - Serviço de Reumatologia, Hospital Garcia de Orta, Almada
7 - Serviço de Pediatria, Hospital Prof. Dr. Fernando Fonseca, Amadora
8 - Serviço de Pediatria, Centro Materno-Infantil do Norte, Porto
- 25th European Paediatric Rheumatology Congress, Lisboa, 5 a 8 de setembro de 2018, poster
Resumo:
Introduction: Children with rheumatic diseases (RD) are at increased risk of infections, due to the immunosuppressive effect of the disease or its treatment. Effective and safe vaccination is key in reducing the burden of infections in this population. However, data on vaccination status in Portuguese children with RD remains scarce.
Objectives: Evaluate the vaccination status of Portuguese children with RD receiving immunosuppressive treatment (IT).
Methods: Multicentre study of consecutive patients with RD undergoing IT observed at a Pediatric Rheumatology Clinic, from January to March of 2018. Patients were evaluated regarding vaccination status and reasons for potential dropout. Demographic data and information about the disease, drug treatments and vaccinations were collected. Chi-squared test was used to study categorical variables. The Portuguese National Vaccination Program (PNV) includes Hep B, IPV, DTaP, Hib, MenC, MMR, HPV for girls and PCV13 for children born after 2015. HPV for boys, varicella, other meningococcal and flu vaccines are not included. In 2015, children receiving IT became eligible for free pneumoccocal vaccines (PCV13 and PPV23).
Results: We studied 120 patients (66% female), mean age 8±5 years, from seven Portuguese Pediatric Rheumatology Units, with a diagnosis of JIA (n=82), uveitis (n=10), jSLE (n=10), other connective tissue diseases (n=7), vasculitis (n=5) and autoinflammatory diseases (n=2). Most patients had been on high dose IT (82%), including biologics (34%). Before initiating IT 98% had an updated PNV and 73% had received one dose of PCV13. At least one dose of Flu and MenB vaccines was given in 12 and 5% of the patients, respectively.Time elapsed between diagnosis and IT (> or < 3 months) was not associated with the prescription of extra-PNV vaccines before treatment, namely varicella. During IT, immunizations were in accordance to the PNV in 91% of the patients. Also, 28 patients were eligible for MMR vaccination (eg, low dose methotrexate), but 11 did not receive it. MMR was administered in six patients under high dose IT (including three with biologics), but no complications were reported. Adequate pneumococcal vaccination was performed in 30%; 74% of patients received flu vaccine before or during IT. No boys received HPV. Patients on high-dose IT did not receive more extra-PNV vaccines than patients with low-dose IT. Six cases of varicella in unvaccinated patients were reported during treatment, and three required hospitalization.
Conclusion: Vaccination rates in Portuguese children with RD are sub-optimal. The low prevalence of extra-PNV safe recommended vaccines (such as other meningococcal) can be partially explained by their high cost. Despite the small sample, MMR vaccination during high-dose IT patients was not associated with complications. Large controlled studies are required to evaluate the safety of live attenuated vaccines, especially with high IT and/or during outbreaks. Since primary health care services in Portugal are overall responsible for vaccinations, optimal communication with tertiary services is indispensable to ensure that the best care is provided. It is essential to promote compliance with recommendations about vaccination of children with RD and provide free recommended vaccines to this group of patients.
Palavras Chave: Immunization, Immunosuppressive Therapy, Paediatric Rheumatology