Immunizations play an important role in the prevention of infections in patients with rheumatic diseases. These patients are at increased risk of infections due to medications and to the suppressed immune response from the disease.

The Centers for Disease Control and Prevention (CDC) has provided guidelines for which children should be considered immunocompromised by their medications. In general, patients receiving high-dose corticosteroids (≥2 mg/kg/day or ≥20 mg/day of prednisone or equivalent) lasting two or more weeks are considered immunosuppressed (MMWR. 2006 Dec.1;55[No. RR-15]:1-48).

Therapy with low-doses of methotrexate (≤0.4 mg/kg/week), azathioprine (≤3 mg/kg/day) or 6-mercaptopurine (≤1.5 mg/kg/day) are not considered sufficiently immunosuppressive to make live virus vaccines contraindicated. However, in many of the diseases for which these medications are used (e.g., systemic lupus erythematosus), there is a state of immunosuppression related to lymphopenia, functional asplenia and low complement levels, among other factors.

Patients taking the newer biologic medications...

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