University of Manchester, Royal Manchester Children's Hospital , Manchester, UK.
Vaccine Evaluation Unit, Public Health England, Manchester Royal Infirmary , Manchester, UK.
Expert Rev Vaccines. 2020 Dec;19(12):1115-1127. doi: 10.1080/14760584.2021.1875825. Epub 2021 Jan 28.
: Children with autoimmune diseases often require treatment with systemic immunosuppressives. Efficacy and safety of vaccination, particularly live-attenuated viral vaccines in these patients remain a concern. : To evaluate the immunogenicity and safety of viral vaccines in children and young people treated with systemic immunosuppressive drugs for autoimmune diseases. A systemic literature review was performed using Pubmed including English papers in subjects less than 21 years old. Viral vaccines were generally immunogenic and safe in children receiving immunosuppressive drugs, including biologics. Use of low-dose prednisolone or disease-modifying antirheumatic drugs did not significantly impact on vaccine immunogenicity, although there was anecdotal evidence of reduced immunogenicity in patients receiving high-dose prednisolone/methylprednisolone and pulse cyclophosphamide. Patients on biologics mounted adequate seroprotective responses, but antibody titers tended to be lower. Both live-attenuated and inactivated vaccines were well tolerated with no serious adverse events. Autoimmune disease activity was not adversely affected by vaccination. : Current evidence indicates that administration of viral vaccines to children with autoimmune diseases receiving most systemic immunosuppressive drugs is immunogenic and safe. MMR can safely be given to most patients receiving biologics, but patients on high-dose prednisolone and pulse cyclophosphamide should avoid MMR and other live viral vaccines.
: 患有自身免疫性疾病的儿童通常需要接受全身性免疫抑制剂治疗。疫苗接种的疗效和安全性，特别是在这些患者中使用减毒活病毒疫苗，仍然令人关注。 : 评估接受全身性免疫抑制药物治疗的自身免疫性疾病的儿童和青少年使用病毒疫苗的免疫原性和安全性。使用 Pubmed 进行了系统的文献综述，包括小于 21 岁的主题的英文论文。在接受免疫抑制剂治疗的儿童中，病毒疫苗通常具有免疫原性和安全性，包括生物制剂。低剂量泼尼松龙或疾病修饰抗风湿药物的使用并未显著影响疫苗的免疫原性，尽管有证据表明接受高剂量泼尼松龙/甲泼尼龙和脉冲环磷酰胺治疗的患者免疫原性降低。接受生物制剂治疗的患者产生了足够的血清保护性反应，但抗体滴度往往较低。减毒活疫苗和灭活疫苗均耐受良好，无严重不良事件。疫苗接种并未对自身免疫性疾病活动产生不利影响。 : 目前的证据表明，大多数接受全身性免疫抑制药物治疗的自身免疫性疾病儿童使用病毒疫苗具有免疫原性和安全性。大多数接受生物制剂治疗的患者可以安全接种 MMR，但接受高剂量泼尼松龙和脉冲环磷酰胺治疗的患者应避免接种 MMR 和其他减毒活病毒疫苗。
