Abstract
Vaccination is a current strategy used to prevent infections in patients with immune-mediated rheumatic diseases. However, the use of live-attenuated vaccines prepared from living microorganisms in these patients should be avoided due to the risk of acquiring infections. The present study aimed to investigate the effect of the yellow fever (YF) vaccine (a live-attenuated vaccine) in 12 patients with rheumatoid arthritis (RA). The sample comprised 12 patients (9 females and 3 males; mean age 52.2 ± 6.5 years) with RA, who inadvertently received fractionated 17D yellow fever vaccination during an outbreak of this disease. In this cohort, 10 were administered leflunomide; 7 were administered methotrexate; 6 were administered prednisone (median dose of 5.0 mg/day); 6 took biologic drugs; and 1 took tofacitinib. All but one patient (used rituximab, prednisone, and methotrexate) seroconverted. None of them developed clinical signs of infection after the procedure. The fractionated dose of the YF vaccine is effective and safe in the observed sample.
Key Points • Patients with autoimmune inflammatory rheumatic diseases (AIIRD) are at a high risk of acquiring infections • The fractionated dose of the YF vaccine is effective and safe in the observed sample • Vaccination against YF should be avoided in patients with AIIRD under immunosuppression owing to the risks of inducing YF infection |
References
Ribeiro AF, Guedes BF, Sulleiman JMAH, de Oliveira FTM, de Souza IOM, Nogueira JS et al (2021) Neurologic disease after yellow fever vaccination, São Paulo, Brazil, 2017–2018. Emerg Infect Dis 27(6):1577–1587. https://doi.org/10.3201/eid2706.204170
Monath TP, Vasconcelos PFC (2015) Yellow fever. J Clin Virol 64:160–73. https://doi.org/10.1016/j.jcv.2014.08.030
Possas C, Lourenço-de-Oliveira R, Tauil PL, Pinheiro FP, Pissinatti A, Cunha RVD et al (2018) Yellow fever outbreak in Brazil: the puzzle of rapid viral spread and challenges for immunization. Mem Inst Oswaldo Cruz 113(10):e180278. https://doi.org/10.1590/0074-02760180278
Camacho LAB, Freire MS, Leal ML, Aguiar SG, Nascimento JP, Iguchi T, Collaborative Group for the Study of Yellow Fever Vaccines et al (2004) Immunogenicity of WHO-17D and Brazilian 17DD yellow fever vaccines: a randomized trial. Rev Saude Publica 38:671–8. https://doi.org/10.1590/S0034-89102004000500009
Furer V, Rondaan C, Heijstek M, van Assen S, Bijl M, Agmon-Levin N et al (2019) Incidence and prevalence of vaccine preventable infections in adult patients with autoimmune inflammatory rheumatic diseases (AIIRD): a systemic literature review informing the 2019 update of the EULAR recommendations for vaccination in adult patients with AIIRD. RMD Open 5(2):e001041. https://doi.org/10.1136/rmdopen-2019-001041 (eCollection 2019)
Falagas ME, Manta KG, Betsi GI, Pappas G (2007) Infection-related morbidity and mortality in patients with connective tissue diseases: a systematic review. Clin Rheumatol 26:663–670. https://doi.org/10.1007/s10067-006-0441-9
Fernandez-Martinez S, Cortes X, Borrás-Blasco J, Gracia-Pérez A, Casterá ME (2016) Effectiveness of a systematic vaccination program in patients with autoimmune inflammatory disease treated with anti-TNF alpha drugs. Expert Opin Biol Ther 16(11):1317–1322. https://doi.org/10.1080/14712598.2016.1218844
Furer V, Rondaan C, Heijstek MW, Agmon-Levin N, van Assen S, Bijl M et al (2020) 2019 update of EULAR recommendations for vaccination in adult patients with autoimmune inflammatory rheumatic diseases. Ann Rheum Dis 79(1):39–52. https://doi.org/10.1136/annrheumdis-2019-215882
Pileggi GS, Da Mota LMH, Kakehasi AM, De Souza AW, Rocha A, de Melo AKG et al (2019) Brazilian recommendations on the safety and effectiveness of the yellow fever vaccination in patients with chronic immune-mediated inflammatory diseases. Adv Rheumatol 59:17. https://doi.org/10.1186/s42358-019-0056-x
Valim V, Machado KLLL, Miyamoto ST, Pinto AD, Rocha PCM, Serrano EV et al (2020) Planned yellow fever primary vaccination is safe and immunogenic in patients with autoimmune diseases: a prospective non-interventional study. Front Immunol 11:1382. https://doi.org/10.3389/fimmu.2020.01382 (eCollection 2020)
Scheinberg M, Guedes-Barbosa LS, Mangueira C, Rosseto EA, Mota L, Oliveira AC et al (2010) Yellow fever revaccination during infliximab therapy. Arthritis Care Res (Hoboken) 62(6):896–898. https://doi.org/10.1002/acr.20045
Oliveira ACV, Mota LMH, Santos-Neto LL, Simões M, Martins-Filho OA, Tauil PL (2015) Seroconversion in patients with rheumatic diseases treated with immunomodulators or immunosuppressants, who were inadvertently revaccinated against yellow fever. Arthritis Rheumatol 67(2):582–583. https://doi.org/10.1002/art.38960
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Ethics approval
This study was approved by the Committee of Ethics in Research 4.221.307 from Mackenzie Evangelic School of Medicine, PR, Brazil.
Disclosures
None.
Additional information
Publisher's note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
dos Reis, B.S., Staub, F.C., Koishi, A. et al. Seroconversion of rheumatoid arthritis patients after yellow fever vaccination. Clin Rheumatol 41, 705–708 (2022). https://doi.org/10.1007/s10067-021-05962-7
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10067-021-05962-7