Abstract Background/Aims Children receivingdisease-modifying antirheumatic drugs (DMARDs) for autoimmune andautoinflammatory rheumatic diseases (AIIRD) are at an increased risk ofinfection due to both immune dysregulation and immunosuppressive therapy.Historically, live-attenuated vaccines such as measles-mumps-rubella (MMR) andvaricella-zoster virus (VZV) were contraindicated in this cohort. Updated UKguidance in 2017 from Public Health England and Green Book now supports theiradministration on methotrexate, plus on a case-by-case basis followingmultidisciplinary team (MDT) assessment. To align with these recommendations, the Royal Manchester Children’s Hospital (RMCH) established a vaccine MDT toevaluate live vaccine eligibility in immunocompromised children receiving DMARDtherapy. Aim: To evaluate the eligibility of paediatric patients onDMARDs followed at RMCH for MMR and varicella vaccine according with updatedguidelines. Subsequently, to determine whether eligible patients received therecommended vaccination. Secondary aim included reviewing the incidence andmanagement of active varicella infection among unvaccinated patients. Methods Retrospective audit was conducted of immunocompromised paediatric patients (18 years) managed within the RMCH rheumatology service between February 2024 and March 2025. Electronic medical records were reviewed to collect demographic data, measles and varicella serology, patient treatment, MDT outcomes, vaccination delivery, varicella active infection and its treatment therapy. Results 61 children under the care of the paediatric rheumatology, ophthalmology, gastroenterology and general paediatric team were discussed at vaccine MDT between February 2014 and March 2025 and included in this audit. 72% were female and the mean age at time of review was 6.5 years old (IQ range 3-11). The diagnoses were juvenile idiopathic arthritis 53%, followed by idiopathic uveitis 14.7%, juvenile systemic lupus erythematosus 7.3%, other connective tissue disorders 7.4%, inflammatory bowel diseases 5.9%, autoinflammatory diseases 5.9%, juvenile dermatomyositis 3% and other vasculitides 3%. A total of 81 vaccinations (38 VZV and 43 MMR) were recommended by the MDT. 34/81(42%) vaccines have been administered (20/38 VZV and 14/43 MMR).During the same time frame, 4 patients VZV negative followed up by the rheumatology team developed varicella infection, of these 2 were treated with oral acyclovir at home, 2 required hospital admission and of these latter, one developed acute kidney injury resolved with medical support. 7 patients have been treated with prophylactic acyclovir. Conclusion This audit identifies a substantial gap between MDT recommendations and vaccine delivery, underscoring the need for improved coordination between tertiary and primary care services. Strengthening follow-up pathways, standardising communication and reinforcing primary care engagement are key to optimising vaccination uptake and infection prevention in children receiving immunosuppressive therapy. Disclosure C. Buamah: None. S. Hughes: None. G.C. Varnier: None.
Buamah et al. (Wed,) studied this question.
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