Conclusions and Future Perspectives

Abstract

Vaccination of immunocompromised children is safe and immunogenic and should be a priority and a concern of every physician in charge of these patients. As soon as a dysimmune disorder is suspected, vaccine status should be verified and all missing vaccines administered if time is sufficient. During immunosuppression, immune responses may be decreased, especially in children treated with high-dose csDMARDs or bDMARDs. In addition, antibody titres decrease more rapidly in the long term in this population than in healthy children. Therefore, the vaccine response should be assessed not only at 1 month post-immunization when possible, but also on a regular basis in order to administer booster doses when necessary. Of note, it is important to determine who has the responsibility for these assessments among the health care providers of these children. Specialists are often the primary care providers of these complex patients and they should be more pro-active in verifying the vaccine status of their patients and making recommendations as to when to administer particular vaccines. In summary, even if larger studies are needed, live vaccines appear to be safe under low-dose immunosuppression or after temporarily interrupting immunosuppressive treatment. Thus, clear guidelines are needed to define in which situations live vaccines can be used.