From the Guidelines
Vaccines generally do not trigger autoimmune diseases in children, though in extremely rare cases, they might contribute to autoimmune reactions in genetically predisposed individuals. The relationship between vaccines and autoimmunity is complex and not fully understood. In susceptible children, the immune stimulation from vaccines could theoretically activate self-reactive immune cells through molecular mimicry, where the immune system mistakes self-proteins for foreign antigens due to structural similarities. Adjuvants in vaccines, designed to enhance immune response, might also potentially contribute to this process in rare instances. However, it's essential to understand that natural infections pose a much greater risk of triggering autoimmune conditions than vaccines do.
According to the most recent and highest quality study, the EULAR recommendations for vaccination of pediatric patients with autoimmune inflammatory rheumatic diseases suggest that non-live vaccines can be safely given to immunosuppressed patients 1. The study emphasizes the importance of following National Immunisation Programmes and assessing them yearly by the treating specialist. It also recommends that vaccinations should be administered prior to immunosuppressive drugs, if possible, but necessary treatment should never be postponed.
Key points to consider:
- Live-attenuated vaccines should be avoided in immunosuppressed patients, except for the measles-mumps-rubella booster and varicella zoster virus vaccine under specific conditions 1.
- The non-live seasonal influenza vaccination should be strongly considered for immunosuppressed pediatric patients with autoimmune inflammatory rheumatic diseases 1.
- Other studies support the safety and effectiveness of inactivated vaccines, such as the influenza vaccine, in immunocompromised patients 2, 3.
- The benefits of vaccination in preventing serious infectious diseases far outweigh the extremely small theoretical risk of autoimmune reactions.
Parents concerned about their child's specific risk factors should consult with healthcare providers who can provide personalized guidance based on the child's medical history and family background of autoimmune conditions.
From the Research
Vaccine-Triggered Autoimmune Disease Development
- There is no conclusive evidence to support the hypothesis that vaccines cause systemic autoimmune diseases in predisposed children 4.
- However, certain vaccines have been associated with rare autoimmune conditions, such as the flu vaccine and Guillain-Barré syndrome, and the measles-mumps-rubella (MMR) vaccine and thrombocytopenia 4.
- The risk of vaccine-preventable infections is elevated in individuals with autoimmune diseases, making vaccination crucial for this population 5.
Vaccine Safety and Efficacy in Autoimmune Diseases
- Inactivated vaccines are generally safe for individuals with autoimmune diseases, but their immunogenicity may be reduced under immunosuppressive therapy 5.
- Live vaccines are contraindicated under immunosuppressive therapy due to safety concerns, with some exceptions 5.
- The use of viral live attenuated vaccines is being debated in patients with autoimmune conditions, such as type 1 diabetes, due to concerns about triggering or exacerbating the disease 6.
Vaccination Recommendations for Autoimmune Diseases
- Children with autoimmune diseases should receive recommended vaccinations, including inactivated vaccines, to prevent vaccine-preventable infections 7, 8.
- Live vaccines, such as MMR, can be safely administered to most patients receiving biologics, but patients on high-dose prednisolone and pulse cyclophosphamide should avoid live viral vaccines 7.
- Specific vaccination schedules and recommendations may vary depending on the autoimmune disease and immunosuppressive therapy used 8, 5.