August 04, 2022
2 min read
Infants who have been exposed to tumor necrosis factor inhibitors in utero should receive the rotavirus vaccine in the first 6 months of life, according to new recommendations from the American College of Rheumatology.
The new recommendation is one of several updates in the ACR’s 2022 “Guideline for Vaccinations in Patients with Rheumatic and Musculoskeletal Diseases.” The full manuscript has been submitted for peer review and is expected to be published in early 2023, according to an ACR press release.
“Patients worry about the safety of vaccines and the potential for inducing a disease flare,” Anne R. Bass, MD, professor of clinical medicine at the Hospital for Special Surgery and Weill Cornell Medicine in New York, said in the release. “Providers are concerned whether rheumatic diseases and the medications used to treat them could blunt the effectiveness of vaccines.”
Bass added, “They also want to know whether certain vaccines should be given to protect rheumatology patients who are outside the age range for which they are typically recommended. This guideline was designed to address these issues.”
The new guidelines were drafted through the standard ACR development and policy management process. A leadership team consisting of adult and pediatric rheumatologists determined a set of clinical population, intervention, comparator and outcomes questions.
Following the finalization of the questions, a team conducted a literature review. The review consisted of evidence grading and the production of an evidence report, according to the ACR’s summary of the updated recommendations.
The guidelines were finalized and voted on by a panel of experts including rheumatologists, infectious disease specialists and patients. To be adopted, each guideline required 70% or more agreement in direction and strength. Overall, the guidelines are conditional and the quality of supporting evidence is “low,” read the summary.
Some of the new vaccination guidelines of note include:
- All patients with rheumatic and musculoskeletal diseases undergoing immunosuppressive therapy should be vaccinated for pneumococcus.
- Seasonal influenza vaccinations should be administered to patients with RMDs, even in the presence of disease activity or if they are taking high-dose glucocorticoids or rituximab (Rituxan, Genentech).
- If able to, methotrexate should be held for 2 weeks following the administration of an influenza vaccince.
- For patients with rheumatic and musculoskeletal diseases receiving rituximab (Rituxan, Genentech), all vaccines aside from influenza should be held for 6 months following the most recent dose.
- Children exposed to TNF inhibitors in the second or third trimester should receive the rotavirus vaccine in the first 6 months of life.
- Patients aged 65 and younger should receive adjuvanted influenza vaccinations.
The guidelines also include expanded indications for specific vaccinations in patients with rheumatic and musculoskeletal diseases who are undergoing immunosuppressive therapy, as well as how many vaccinations should be given in a single day to these patients and whether patients on glucocorticoids should receive non-live attenuated vaccinations.
“This new guideline recognizes that some patients, particularly very young children with autoinflammatory conditions, simply cannot stay off their medications for very long without having a severe flare of their disease,” Bass said in the release. “However, those patients still need to get vaccinated.”