Natalia A. Lubimova, Olga V. Goleva, Susanna M. Kharit, Mikhail M. Kostik*

Lubimova et al. J Clin Transl Res 2023; 9(6):23-00103

Published online: November 18, 2023


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.


Author affiliation

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

*Corresponding author
Mikhail M. Kostik
Saint-Petersburg State Pediatric Medical University, Lytovskaya 2, Saint-Petersburg 194100, Russia.
Tel (fax): +7-812-4165298

Handling editor:
Michal Heger
Department of Pharmaceutics, Utrecht University, the Netherlands
Department of Chemistry, Utrecht University, Utrecht, the Netherlands
Department of Pathology, Erasmus Medical Center, the Netherlands
Department of Pharmaceutics, Jiaxing University Medical College, Zhejiang, China


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