AN INTERNATIONAL SURVEY ON APPROACHES TOWARDS IMMUNISATION IN CHILDREN WITH RHEUMATIC DISEASES: A REPORT OF THE PRES VACCINATIONS WORKING GROUP

Background: Data on immunisation practices in Paediatric Rheumatology are scarce. EULAR recommendations for vaccination in paediatric patients with rheumatic disease (RD) were published in 2011. In some countries national recommendations for vaccination of immunocompromised patients are available. Objectives: To ascertain the opinion and current practices of paediatric rheumatologists with regards to immunisation of children with rheumatic diseases (RD), and to establish their confidence to immunise the patients with RD on immunosuppressive medication with live vaccines in light of the evidence available. Methods: An online survey of practices and opinions towards immunisations with a focus on immunisation of the immunocompromised child with RD was distributed to paediatric rheumatologists across the globe. Responses were collected via SurveyMonkey and descriptive analysis was performed. Responses were anonymous with the exception of identification of the country and length of practice. Results: 289 responses were received from 53 countries in Europe, North and South America, Australia and Asia. 35% of the respondents had over 15 years of practice in Paediatric Rheumatology, while 42% had 5 -15 years. 57% responded that all immunisations or at least part of them are given in their paediatric rheumatology unit, and 60% that the vaccinations are mandatory in their country. 93% of respondents support the immunisation of paediatric patients with RD, 6.9% responded that they are either not supportive/not sure/support only vaccinations with inactivated vaccines. 53% reported that national recommendations for immunisations of immunosuppresed child are available but not specific to Paediatric Rheumatology. 41% of respondents inform their practice on immunisation of patients with RD based exclusively on the EULAR recommendations, 37.5% based on national guidelines, 8.5% on local guidelines and 10% on combinations of the above. 48% of clinicians would postpone vaccinations in all cases if disease is active. In terms of immunisations with live vaccines of patients with JIA on immunosuppresive treatment, 41% of respondents would recommend the first dose of MMR or Varicella vaccines to patients with stable disease on Prednisolone < 1 mg/kg/day (maximum 20 mg) for less than 1 month or higher dose up to 2 mg/kg/day for less than 14 days, 14% would also recommend these vaccines if the above steroid dose was given in combination with Methotrexate (MTX) < 15mg/kg/week, 30% would recommend these vaccines if the patient was on MTX monotherapy. Comparable percentages reported confidence to also recommend booster doses of the two vaccines for the above drug combinations (45%, 15.7%, 37%, respectively), whilst up 10% of respondents would recommend them to patients on anti-TNF agent alone, and up to 7% for other biologics. For patients with SLE and quiescent disease on similar medications as above, 41%, 15%, 31%, respectively, of clinicians reported confidence to recommend MMR or Varicella booster doses. 48% of the respondents identified the reluctance of other health professionals involved in the process of immunisations as the main reason hampering the vaccination of paediatric patients with RD, whilst 22% indicated parental refusal or hesitancy. Conclusion: There is variation in practice and opinions worldwide with regards to immunisations in paediatric patients with RD, and this likely reflects the discrepancies between national guidelines for immunisation of immunosuppressed child and also national policies. More studies are required, but there is an increasing vote of confidence towards immunisation of patients on lower grade immunosuppression with MMR or varicella vaccines Disclosure of Interests: None declared DOI: 10.1136/annrheumdis-2019-eular.8063Citation: Ann Rheum Dis, volume 78, supplement 2, year 2019, page A1343Session: Paediatric rheumatology (Scientific Abstracts)