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Oxford University Hospitals NHS Foundation Trust
OxPARC

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Vaccination advice

Vaccinations and medication

Patients with JIA or other rheumatology conditions receiving steroids, DMARDs or biologics should receive all routine non-live vaccinations, although potentially these may not be quite as effective. Special consideration should be given for live vaccines. Specific advice for patients on Rituximab can be found below.

National guidelines indicate that if an immune modulating drug is being taken live vaccines should not be given. However, following recent systematic reviews and new European guidelines, here in Oxford the rheumatology team advises on a case by case basis. Please contact us for advice.

Flu vaccine

It is a national recommendation that children with a long term illness or who are taking drugs that may cause immunosuppression receive the inactivated IM flu vaccine each year. Current advice is not to give the live nasal spray to these patients.

Chicken-pox vaccine

Prior to commencing immune modifying drugs, children should have their chicken-pox (VZV IgG) status and vaccination history checked. If time allows and the patient is not immune to chicken-pox, the chicken-pox vaccine is recommended. This is usually given at the GP surgery and then a booster repeated 4 weeks later.

VZV IgG should be checked again at least three weeks after the 2nd vaccine to check vaccine up-take.

If children are not immune to chicken pox and are not able to receive a chicken-pox vaccine, please consider giving the vaccine to non-immune family members or discuss with the paediatric rheumatology team.

Please contact us for advice if a child on immune modifying drugs has been in contact with or contracts chicken-pox.

MMR

Prior to commencing immunomodulating drugs, the child's vaccination history will be checked. If children have not received the MMR or the pre-school booster of the MMR, this can be given early from 2 years of age. Alternatively titres can be checked to determine immunity status.

Rituximab

Patients on Rituximab should not be given live vaccines. Should non-live vaccinations be required, these should be completed at least 4 weeks prior to commencing the next course of Rituximab. Annual flu vaccines are recommended.

It is not known whether patients may need re-immunisation of previous non-live vaccines following rituximab. Once immunoglobulins are back to normal, check specific antibodies (Tetanus, Hib, Polio etc.) from previous immunisations and if low, re-immunise and recheck levels.

If a patient has a contaminated wound (and has received rituximab within the last 6 months) and there is any doubt about the patient’s tetanus status, then a tetanus immunoglobulin should be administered.

Reference list

Heijstek, M et al (2011) EULAR recommendations for vaccination in paediatric patients with rheumatic diseases. BMJ (online) Available at http://ard.bmj.com/ (Access 5 August 2011)