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Vaccination in Children with Arthritis

by Dr. Mita Pawar

Children with arthritis and other arthropathies need special attention for their vaccinations. The traditional apprehension about vaccines for children with arthritis is based on the science behind vaccines. For vaccines to be successful the recipient must have a healthy immune system. Vaccines work by exposing a person to a small dose of a virus or bacteria so their immune system will learn to recognize it and be ready to fight it off, if exposed to it later. While less than 10 percent of children may typically have adverse effects from any vaccine (e.g., fever, rash, aches, etc.), the potential for a more serious problems exist if the child's immune system is suppressed by their arthritis and/or medications. Whether caused by arthritis or its treatment, if your child's immune system is altered it may not mount the proper response to a vaccine. That could cause vaccines to fail and not prevent disease if he is ever exposed; or it could result in him possibly developing the disease the vaccine was designed to prevent. It may even cause an arthritis flare.
Corticosteroids, disease-modifying antirheumatic drugs (DMARDs) such as methotrexate and biologic response modifiers (biologics) are examples of medications that can alter the immune system's response to an immunization.
Vaccines, for the most part, can be broken up into two main categories - 1. Live attenuated and 2. Inactivated. In the case of live attenuated vaccines, the vaccine recipient is injected with a live but weakened strain of a disease, virus or bacteria while inactivated vaccines contain the killed strain of the organism.
Children receiving oral corticosteroids in high doses (prednisolone > 2 mg/kg/day or for those weighing more than 10 kg, 20 mg/day or its equivalent) for > 2 weeks should not receive live virus vaccines until the steroids have been discontinued for at least one month. E.g. chicken pox (varicella); measles, mumps, rubella (MMR); and rotavirus.
Inactivated vaccines are safe but may be less efficacious. These vaccines make up the bulk of required vaccines and are safe and effective for all children, including those with arthritis or who are on various medications. They are important for your child to receive because they will help protect her and those around her.E.g. Pneumococcal, Tetanus, Diphtheria, Pertussis, Injection Polio, Typhoid Children on lesser dose of steroids or those on inhaled or topical therapy may be safely and effectively given their age appropriate vaccines.
Children on immunosuppressive therapy other than corticosteroids should avoid live vaccines during therapy unless benefits outweigh risks.
Safe vaccines
These vaccines are safe and recommended for all patients with RA regardless of the medication that they are taking.
Pneumococcal, Tetanus, Diphtheria, Pertussis, Injection Polio, Typhoid
Safe with Precautions
The following are "LIVE" vaccines that are typically prescribed to RA patients who are not on immunosuppressive medications. These vaccines are best given at the time of diagnosis.
Chicken Pox, Shingles Measles, Mumps, Rubella (MMR), Oral Polio
Special Circumstances
The following vaccines are prescribed to RA patients with special circumstances. Your doctor will help decide if these are right for you.
Hepatitis A, Hepatitis B, Human Papillomavirus (HPV)