PDF(Pubmed)
Abstract：
Children with paediatric rheumatic diseases (PRDs) are at increased risk of vaccine-preventable disease. Safe and effective vaccination is central to preventive care in PRD patients; however, uncertainty surrounding immunogenicity and safety has contributed to suboptimal vaccination. The aim of this study was to evaluate treatment effect on immunogenicity to vaccination in PRD patients and assess vaccine safety, specifically adverse events following immunisation (AEFI) and disease flare. Scoping review. In this scoping review, a systematic search of PubMed, CINAHL and Embase databases was conducted from 2014 to 23 August 2022 to identify observational studies evaluating the immunogenicity and safety of commonly used vaccinations in PRD patients. The primary outcome was immunogenicity (defined as seroprotection and protective antibody concentrations), with secondary outcomes describing AEFI and disease flare also extracted. Due to extensive heterogeneity related to diagnostic and vaccination variability, narrative synthesis was used to describe the findings of each study. Study quality was assessed via the Mixed Methods Appraisal Tool. The review was prospectively registered with PROSPERO (CRD42022307212). The search yielded 19 studies evaluating immunogenicity to vaccination and incidence of AEFI and disease flares in this population, which were of acceptable quality. Corticosteroids did not have deleterious effects on vaccine response. Treatment with conventional disease-modifying antirheumatic drugs (DMARDs) and biologic DMARDs generally had no effect immunogenicity in PRD patients. While patients exhibited adequate seroprotection, protective antibody levels were lower in patients on some immunosuppressant agents. Varicella infections were recorded post vaccination in several patients with low protective antibody levels undergoing treatment with DMARDs and corticosteroids. Most vaccines appear safe and effective in PRD patients, despite immunosuppressant treatment. Booster vaccinations should be considered with some studies highlighting inadequate seroprotection following primary course of vaccinations with acceleration of antibody decline over time. There was limited evidence to support avoiding live vaccines in PRD patients.
摘要：
患有小儿风湿性疾病（PRDs）的儿童患疫苗可预防疾病的风险增加。安全有效的疫苗接种对于珠三角患者的预防护理至关重要；然而，围绕免疫原性和安全性的不确定性导致疫苗接种欠佳。这项研究的目的是评估对PRD患者接种疫苗的免疫原性的治疗效果，并评估疫苗的安全性。免疫接种（AEFI）和疾病发作后的特定不良事件。范围审查。在这次范围审查中，系统搜索PubMed,CINAHL和Embase数据库于2014年至2022年8月23日进行，以确定评估PRD患者常用疫苗的免疫原性和安全性的观察性研究。主要结果是免疫原性（定义为血清保护和保护性抗体浓度），还提取了描述AEFI和疾病发作的次要结局。由于与诊断和疫苗接种变异性相关的广泛异质性，使用叙述性综合来描述每一项研究的结果.研究质量通过混合方法评估工具进行评估。该审查在PROSPERO（CRD42022307212）进行了前瞻性注册。该搜索产生了19项研究，评估了该人群中疫苗接种的免疫原性以及AEFI和疾病耀斑的发生率。质量可以接受。皮质类固醇对疫苗反应没有有害影响。在PRD患者中，使用常规疾病缓解抗风湿药（DMARDs）和生物DMARDs的治疗通常没有影响免疫原性。虽然患者表现出足够的血清保护，使用某些免疫抑制剂的患者的保护性抗体水平较低。在接种疫苗后，在接受DMARDs和皮质类固醇治疗的保护性抗体水平低的几名患者中记录了水痘感染。大多数疫苗对PRD患者安全有效，尽管有免疫抑制剂治疗.应考虑加强疫苗接种，一些研究强调主要疫苗接种后血清保护不足，抗体随时间加速下降。支持PRD患者避免活疫苗的证据有限。
