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Lubimova et al. | Journal of Clinical and Translational Research 2023; 9(6): 392-397 395
immune response and an increase in the risk of infectious as demonstrated by crude OR of 0.30 (P = 0.017) and OR: 0.52
diseases [13,22]. (P = 0.004), respectively [33].
Intercurrent infections not only lead to flares of JIA but Recently, the European League Against Rheumatism
also require treatment discontinuation, which negatively published updated recommendations on the vaccination of
affects the achievement or maintenance of the inactive status children with rheumatic diseases. This update takes into
of the disease and significantly increases the financial costs account new studies on the safety of live attenuated vaccines
associated with treatment [2]. The disrupted vaccination and the immunogenicity of vaccines in patients receiving new
schedule in patients with rheumatological diseases is typical anti-rheumatic drugs. This update addresses three important
even for developed countries, the share of missed vaccines aspects of vaccine safety: no serious side effects, no flare of the
from the national calendar, for example, in Slovenia is 35%, underlying disease, and no triggering of infections in the case of
and in Canada 39% [23,24]. It was found that the proportion of live attenuated vaccines [10].
missed vaccines is proportional to age, as well as the severity According to these recommendations, non-live vaccines can
of arthritis (polyarthritis, systemic arthritis), and depends on the be prescribed to children receiving glucocorticosteroids, disease-
type of vaccines. In the above-described studies, revaccinations modifying anti-rheumatic drugs. Patients with rheumatic diseases
against measles, hepatitis B, diphtheria, rubella, and mumps may have lower antibody titers compared to healthy peers, but
were most often missed [23-25]. in general, vaccination is effective and safe [31,34-37]. Several
According to research, the fear of parents and physicians was studies confirmed the safety of vaccines in pediatric rheumatic
often the reason for the refusal of subsequent vaccinations in diseases [35,38,39].
children with rheumatic diseases [23,26-29]. Many physicians No increased frequency of JIA flares after vaccination against
postpone vaccination until the inactive stage of the disease is chickenpox, PCP, diphtheria, or poliovirus (inactivated) was
reached or long-term remission of JIA, which affects the presence observed [35,38,39].
of a protective antibody titer [23,26]. The group of patients who need to monitor antibodies against
vaccines includes patients who also receive any biological drugs,
4.1. Is vaccination against diphtheria safe and effective?
as well as those who have an incomplete set of vaccines [40].
There is little international experience in the safety and efficacy Personalized vaccination is recommended for patients suffering from
of vaccination of children with rheumatic diseases against rheumatic diseases based on the presence of risk factors, as well as
diphtheria. In a cohort of 29 patients previously vaccinated determining the level of the protective titer of antibodies [10].
against diphtheria and tetanus, aged 2 – 5 years, with polyarticular Educational work with physicians and health-care providers
JIA, who received subcutaneous abatacept, the protective level of reduces fears of vaccination and encourages vaccination in
antibodies against diphtheria was detected in 26 (89.7%) children. children with immunocompromised conditions [41,42].
Methotrexate and low doses of corticosteroids did not affect the Our study is not without the limitations. JIA is a rare disease and
level of antibodies [30]. a small sample size, specific selection of the patients, and different
In our study, the protective level of antibodies against diphtheria times between and after vaccination could affect the study results.
was detected in 51.8% of patients with JIA. However, it should be
borne in mind that in the study by Brunner et al., children at the 5. Conclusion
time of inclusion were younger or preschool age [30]. It should be Treatment with methotrexate and biological drugs is a predictor
noted that the more time passes since the last vaccination, the more of refusal of subsequent vaccination against diphtheria after the
likely it is to have a low level of antibody. According to the study onset of JIA. Vaccination against diphtheria in children with JIA
of Heijstek et al., patients with different JIA categories had equal is a safe and effective tool for controlling incidence in this group
levels of antibodies against diphtheria similar to the results of of patients. It is necessary to increase the level of confidence of
the previous study [30,31]. In this study, incomplete vaccination, doctors in the vaccination of children with rheumatic diseases.
methotrexate treatment duration, and biologics affected the level
of antibodies against diphtheria, which is also observed in our Acknowledgment
study [31]. Methotrexate disturbed the production of antibodies We would like to give our thanks to the patients and their
against diphtheria in a prospective multicenter study by Bühler parents, who participated in this study.
et al. There were no flares of rheumatic disease after vaccination.
These data also coincide with our results [32]. In a multicenter Funding
study on the duration of antibody persistence after vaccination
against diphtheria/tetanus in patients with rheumatic diseases None.
undergoing immunosuppressive therapy after vaccination, Conflicts of Interest
median concentrations of antibodies against diphtheria were
lower in patients with rheumatic diseases than in the control group The authors declare that the research was conducted in the
(0.05 vs. 0.22; P = 0.002). Patients with rheumatic diseases had absence of any commercial or financial relationships that could be
lower proportions of short-term tetanus and diphtheria protection construed as a potential conflict of interest.
DOI: http://dx.doi.org/10.18053/jctres.09.202306.23-00103