2019 update of EULAR recommendations for vaccination in adult patients with autoimmune inflammatory rheumatic diseases

Victoria Furer, Christien Rondaan, Marloes W Heijstek, Nancy Agmon-Levin, Sander van Assen, Marc Bijl, Ferry C Breedveld, Raffaele D'Amelio, Maxime Dougados, Meliha Crnkic Kapetanovic, Jacob M van Laar, A de Thurah, Robert Bm Landewé, Anna Molto, Ulf Müller-Ladner, Karen Schreiber, Leo Smolar, Jim Walker, Klaus Warnatz, Nico M WulffraatOri Elkayam

518 Citations (Scopus)


To update the European League Against Rheumatism (EULAR) recommendations for vaccination in adult patients with autoimmune inflammatory rheumatic diseases (AIIRD) published in 2011. Four systematic literature reviews were performed regarding the incidence/prevalence of vaccine-preventable infections among patients with AIIRD; efficacy, immunogenicity and safety of vaccines; effect of anti-rheumatic drugs on the response to vaccines; effect of vaccination of household of AIIRDs patients. Subsequently, recommendations were formulated based on the evidence and expert opinion. The updated recommendations comprise six overarching principles and nine recommendations. The former address the need for an annual vaccination status assessment, shared decision-making and timing of vaccination, favouring vaccination during quiescent disease, preferably prior to the initiation of immunosuppression. Non-live vaccines can be safely provided to AIIRD patients regardless of underlying therapy, whereas live-attenuated vaccines may be considered with caution. Influenza and pneumococcal vaccination should be strongly considered for the majority of patients with AIIRD. Tetanus toxoid and human papilloma virus vaccination should be provided to AIIRD patients as recommended for the general population. Hepatitis A, hepatitis B and herpes zoster vaccination should be administered to AIIRD patients at risk. Immunocompetent household members of patients with AIIRD should receive vaccines according to national guidelines, except for the oral poliomyelitis vaccine. Live-attenuated vaccines should be avoided during the first 6 months of life in newborns of mothers treated with biologics during the second half of pregnancy. These 2019 EULAR recommendations provide an up-to-date guidance on the management of vaccinations in patients with AIIRD.

Original languageEnglish
JournalAnnals of the Rheumatic Diseases
Issue number1
Pages (from-to)39-52
Number of pages14
Publication statusPublished - Jan 2020


  • Antirheumatic Agents/therapeutic use
  • Autoimmune Diseases/drug therapy
  • Bacterial Infections/prevention & control
  • Family Characteristics
  • Hepatitis A/prevention & control
  • Hepatitis A Vaccines/therapeutic use
  • Hepatitis B/prevention & control
  • Hepatitis B Vaccines/therapeutic use
  • Herpes Zoster/prevention & control
  • Herpes Zoster Vaccine/therapeutic use
  • Humans
  • Influenza Vaccines/therapeutic use
  • Influenza, Human/prevention & control
  • Papillomavirus Infections/prevention & control
  • Papillomavirus Vaccines/therapeutic use
  • Pneumococcal Infections/prevention & control
  • Pneumococcal Vaccines/therapeutic use
  • Rheumatic Diseases/drug therapy
  • Tetanus/prevention & control
  • Tetanus Toxoid/therapeutic use
  • Vaccines/therapeutic use
  • Vaccines, Attenuated/therapeutic use
  • Virus Diseases/prevention & control
  • infections
  • autoimmune diseases
  • vaccination


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