How do the characteristics of juvenile idiopathic arthritis affect the continuation or refusal of vaccination against diphtheria? A cross-sectional study data

Natalia A. Lubimova¹, Olga V. Goleva², Susanna M. Kharit^2,3, Mikhail M. Kostik^{3 *}

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¹ Almazov National Medical Research Centre, Saint Petersburg, Russia

² Pediatric Research and Clinical Center for Infection Diseases, Saint Petersburg, Russia

³ Saint Petersburg State Pediatric Medical University, Saint Petersburg, Russia

JCTR 2023, 9(6), 392–397; https://doi.org/10.18053/jctres.09.202306.23-00103

Submitted: 19 August 2023 | Revised: 16 September 2023 | Accepted: 18 September 2023 | Published: 18 November 2023

© 2023 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution -Noncommercial 4.0 International License (CC-by the license) ( https://creativecommons.org/licenses/by-nc/4.0/ )

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Abstract

Introduction: Patients with juvenile idiopathic arthritis (JIA) often stop being vaccinated after the onset of the disease due to fear of disease flare, although the effectiveness and safety of vaccination in immunocompromised patients have been demonstrated.

Aim: To evaluate the JIA characteristics associated with the refusal to continue to be vaccinated against diphtheria.

Methods: in a cross-sectional study, we included data about patients who continued (n=25) or refused (n=51) vaccination against diphtheria after the development of JIA. In all patients, the levels of anti-diphtheria vaccine antibodies (IgG) were determined with the ELISA. The data are presented with a median and 25%-75%.

Results: The age of disease onset, JIA duration, and JIA categories were similar between groups. Patients who declined the following vaccination often received methotrexate and biologics and switched at least one biologic. Methotrexate (OR=9.5 [95%CI: 1,004; 90.3]) and biologics (OR=4.4 [95%CI: 1.6; 12.1]) were predictors of refusal of revaccination against diphtheria. Vaccination against diphtheria was effective, as evidenced by the almost two-fold prevalence of patients with a protective antibody titer compared to those who refused revaccination. Serious adverse events, as well as JIA flares in three months after vaccination were not observed.

Conclusion: The continuation of vaccination against diphtheria in children with JIA was effective and safe. The treatment with methotrexate and biologics was a predictor of refusal of revaccination against diphtheria. Further studies are needed to confirm the safety and efficacy of vaccination against diphtheria in children with JIA and can increase the level of confidence of physicians in the vaccination of children with rheumatic diseases.

Relevance for patients: Patients with JIA should know the necessity, efficacy, and safety of vaccination against diphtheria. There are no contraindications from the disease side to vaccination against diphtheria. Healthcare providers should discuss and encourage any vaccination in immune-mediated children.

Keywords

Diphtheria vaccination

Juvenile idiopathic arthritis

Immunocompromised children

Vaccine

Conflict of interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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