Thanks to an innovative checklist developed by German rheumatologists, the decision to immunize against potentially fatal viruses could be a little easier.
Caregivers of children with juvenile rheumatic diseases sometimes have complex, difficult decisions to make. Will the child be healthy enough to go to school this year? Is participating in sports worth the pain? Thanks to an innovative checklist developed by German rheumatologists, the decision to immunize against potentially fatal viruses could be a little easier.
Vaccination is a complex issue for people with rheumatic disease
Inflammatory arthritis affects the immune system, making people more susceptible to viruses and infections. Further compounding the problem, some medications prescribed to treat the disease can further compromise the immune system. As a result, children and adults who suffer from autoimmune or inflammatory rheumatic diseases are more frequently at risk of developing serious—potentially life-threatening—infections that may slow healing for, but be much less likely to kill, healthy individuals.
Immunizing people with rheumatic disease against common diseases (e.g., the flu, chickenpox, etc.) has been considered risky in the past. Vaccinating against the varicella-zoster virus (i.e., chickenpox) saves lives; however, the vaccines may pose more significant risks to individuals with certain autoimmune disorders. For this reason, vaccinating people with inflammatory or autoimmune diseases is still fairly uncommon. Some institutions and specialists won’t allow it, as they are concerned it might trigger a significant autoimmune response. Others insist that, with appropriate precautions, immunizing against common illnesses is not only safe, but also responsible.
A group of German physicians conducted a study testing a new pre-screening tool—a checklist—that identifies children for whom the varicella vaccine could be effective and safe, even for those with juvenile arthritis receiving immunosuppressive treatment. Results of this study were presented last month at the European League Against Rheumatism Annual Congress (EULAR 2015).
According to investigator Dr. Fabian Speth, of the German Center for Pediatric and Adolescent Rheumatology,
Although chickenpox is a common and often mild childhood illness, it can be life-threatening in children with a suppressed immune system, such as those being treated for rheumatic disease. While a vaccine is available, its safety in children receiving immunosuppression has long been debated.
The study involved pre-screening 21 children with rheumatic disease between the ages of 2 and 18 who were deemed susceptible to the varicella zoster virus. The children were receiving immunosuppression therapy to dampen their immune responses. Before vaccination, participants were screened with the immunologic checklist.
Children that met the safety criteria received a dose of the varicella vaccine without stopping their immunosuppression treatment. Participants did not develop complications or experience vaccine-induced chickenpox. Dr. Speth notes:
By pre-screening children using easy-to-obtain immunological criteria, we were able to safely and effectively vaccinate a major group of immunocompromised children, without having to stop their treatment. This is a significant development in preventing a persisting, and sometimes fatal, virus.
Even if vaccination in the immunosuppressed patient is deemed unsafe, there are steps family members can take to protect their loved ones from contracting potentially deadly viruses. Healthy, immunocompetent family members should take care to keep their own vaccinations up-to-date.
How is a checklist innovative?
Health professionals solve complicated problems. In his bestselling book The Checklist Manifesto, Dr. Atul Gawande argues that
the volume and complexity of what we know has exceeded our individual ability to deliver its benefits correctly, safely, or reliably.
There’s got to be some way of double-checking a physician’s work—of ensuring that all possible outcomes have been considered—of doing what’s best for each specific patient. Speth’s pre-screening tool (i.e., a checklist) reduces the uncertainty associated with administering live vaccines to patients receiving immunosuppressive treatment. With only 21 participants in this first study, the pre-screening tool will require much wider testing before it can be adopted as a standard. But it’s a good step.
Juvenile arthritis is one of the most common childhood diseases in the United States. An unpredictable autoimmune disease that can make children feel tired all day, it causes pain and swelling of joints, difficulty walking, and periodic fevers, among other symptoms. Juvenile arthritis is estimated to affect approximately 294,000 children in the US, 15,000 children in the UK, 7,900 children in Australia, and 24,000 children in Canada.
The nuviun blog is intended to contribute to discussion and stimulate debate on important issues in global digital health. The views are solely those of the author.