“The most important thing you can do to keep your child healthy is vaccinate!”
This advice from Dr. Grant Schulert, a pediatric rheumatologist and assistant professor of pediatrics at Cincinnati Children’s Hospital, is crucial for all children, but it is especially critical in children with juvenile idiopathic arthritis.
“Being up to date on vaccines is incredibly important for children with JIA,” says Schulert.
Juvenile idiopathic arthritis is an umbrella term for several different types of chronic, inflammatory, rheumatic diseases that arise spontaneously, or have an unknown cause — thus the designation as “idiopathic” — in children 16 years of age or younger. The JIA designation replaces the antiquated term juvenile rheumatoid arthritis.
[See: How to Practice Yoga When You Have Arthritis or Another Chronic Condition.]
The arthritic diseases included under the term JIA are all autoimmune disorders, meaning that they occur when the body’s immune system mistakenly attacks its own healthy tissue. No one really understands why this happens, although genetic and environmental triggers may play a part in some cases of JIA.
The modern drug regimen used to treat children with JIA includes disease-modifying anti-rheumatic drugs, biologic response modifiers and corticosteroids. These drugs, given alone or in combination, have powerful immunosuppressive effects, meaning that they work by suppressing the immune system.
According to Schulert, these medications are very effective in treating arthritis, but they “do have an increased risk of infection.” This risk, he says, is one of the chief concerns of families of children with JIA.
The Centers for Disease Control and Prevention credits childhood immunizations against formerly common childhood diseases — including measles, mumps, rubella, pertussis (whooping cough), diphtheria, smallpox and others — for having saved millions of lives.
The majority of vaccines are composed of killed, or inactivated, viruses and bacteria.
“There is abundant evidence that killed or inactivated vaccines, which are most childhood vaccines, are safe for children with JIA, even [those] being treated with biologic medications,” Schulert says.
However, some vaccines, including vaccines for measles, mumps, rubella, varicella (chickenpox), influenza (flu) and rotavirus, contain a weakened — attenuated — form of the live virus, enough to cause the body to create an immunity to the virus, but not enough to cause the illness.
“In general, we recommend that children taking immunosuppressive medications, such as biologics for JIA, avoid live or attenuated vaccines,” Schulert explains. “There is a small study showing that vaccines like measles, mumps and rubella can be given safely if immunosuppressive medications are held for a few weeks, which is one option,” he adds.
Dr. Anne M. Stevens, associate professor of pediatric rheumatology at the University of Washington School of Medicine and Seattle Children’s Hospital, agrees. “Live vaccines are delayed until the child is on little or no immunosuppression,” she says. “Then we try to catch them up.”
“While I am not aware of any cases of severe infection after [giving] a live attenuated vaccine in a child with JIA, there is a theoretical risk, so we err on the side of being cautious,” Schulert says. “In the case of influenza vaccine, we can just substitute the inactivated vaccine, but for others, such as MMR [measles, mumps and rubella] and varicella, that, unfortunately, isn’t an option,” Schulert explains.
According to Stevens, evidence is mounting that vaccines containing live, attenuated organisms may not increase the risk of infection in immunosuppressed children.
“There are several small studies suggesting that they are probably safe,” Stevens says.
But more research is needed.
“Additional evidence may convince us that live vaccinations could be safe,” she says. “Then we could help to protect our patients from infections that other children are protected from through vaccinations.”
[See: 12 ‘Unhealthy’ Foods With Health Benefits.]
Children with JIA may have a special risk when it comes to vaccinations.
“The biggest problem is that about half of the patients immunized while on immunosuppression do not respond to the vaccines,” Stevens explains.
This means that children with JIA must rely to a great extent on the concept of “herd immunity” to prevent them from getting childhood diseases and infections.
“If most children in the community are vaccinated, it greatly reduces the chances of an outbreak of vaccine-preventable diseases like measles,” Schulert explains. “This concept, called herd immunity, explains why, when vaccine rates drop in a population, we can see epidemics as we have recently in the U. S. and Europe.”
In recent years, a growing number of healthy children have not been adequately vaccinated against childhood illnesses because their parents have believed erroneous media reports that childhood vaccines are responsible for autism and other disorders. This is a dangerous practice for all children, but it presents a special problem for children who are immunosuppressed, like those with JIA.
Because children with JIA either cannot have, or must delay, vaccines made from live, attenuated viruses, “[they] really depend on other healthy children being up to date with their vaccines,” Schulert emphasizes.
In contrast to some parents of healthy children, the majority of parents of children with JIA believe that it’s important to vaccinate their children.
“In general, we’ve found that most of our parents are very supportive of vaccination in their children with JIA,” Schulert says. “Probably the biggest concern parents have with the treatments for JIA is that they will increase the risk for infection. Vaccination is an easy and effective thing that they can do to reduce that risk.”
Stevens agrees.
“Parents do not want their children [with JIA] to get infections, especially if they are on immunosuppressive medications,” she says, “so, most of our families fully vaccinate their children.”
According to Schulert, the CDC recommends additional vaccinations for children taking immunosuppressive medications, including vaccines for pneumonia and meningitis, but “many children with JIA are not necessarily getting these vaccines,” Schulert says.
“Often the family doctor is unaware of these recommendations, or assumes that the rheumatologist will address this, while we specialists just assume that vaccines are handled in the general pediatrician’s office,” he explains.
This means that parents of children with JIA should be especially vigilant in ensuring that their children are up to date with all recommended immunizations, making sure they discuss vaccines with both their pediatrician and their pediatric rheumatologist.
[See: 7 Surprising Things That Age You.]
Schulert has one last piece of advice for families who have children with JIA.
“Probably the most important thing that both children with JIA and family members can do is get their yearly flu shots! While for most people influenza is relatively mild, children with chronic health problems like JIA represent a large number of the patients who are hospitalized every year with influenza,” he says.
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Vaccinations Are Crucial in Children With Juvenile Arthritic Diseases originally appeared on usnews.com
