Key messages
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Children with JIA have decreased protective levels of antibodies against vaccines.
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Vaccine coverage in JIA children is lower than in healthy peers.
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Incomplete vaccination, biologics, JIA category, and long-term methotrexate treatment are the main factors of non-protective levels of antibodies against vaccines.
Introduction
Patients and methods
Study design and patient selection
National vaccine schedule
Assessment of the levels of antibodies against vaccines
Statistical analysis
Ethics
Results
Demographics and vaccine coverage
Parameter | Results (n = 170) |
---|---|
Girls, n (%) | 115 (67.7) |
Onset age, years | 6.0 (3.7; 9.0) |
Study inclusion age, years, (min-max) | 2; 17 |
Median (25%; 75%) | 11.4 (7.6; 14.8) |
JIA duration, years | 3.8 (1.9; 6.5) |
JIA categories, n (%): | |
Oligoarthritis | 73 (42.9) |
Polyarthritis | 61 (35.9) |
Systemic 5arthritis | 16 (9.4) |
Enthesitis-related arthritis | 20 (11.8) |
Treatment, n (%) | |
Corticosteroids, n (%) | 43 (25.3) |
Methotrexate, n (%) | 154 (90.6) |
Methotrexate duration, years. | 2.5 (1.1; 5.3) |
Biologics, n (%) | 82 (48.2) |
Biologic duration, years | 1.3 (0.1; 4.2) |
Incomplete vaccination
Parameters | MMR vaccination for age | p* | ||
Whole group (n = 170) | Incomplete (n = 50) | Complete (n = 120) | ||
Anti-measels IgG, IU/ml | 0.2 (0.04; 0.53) | 0.2 (0.0; 0.5) | 0.2 (0.09; 0.6) | 0.181 |
Patients with anti-measles protective IgG level, n (%) | 98 (57.7) | 25 (50) | 73 (60.8) | 0.193 |
Anti-mumps IgG, IU/ml | 2.7 (1.2; 5.3) | 1.9 (0.0; 5.1) | 2.9 (1.3; 5.3) | 0.101 |
Patients with anti-mumps protective IgG level | 136 (80,0) | 35 (70.0) | 101 (84.2) | 0.035 |
Anti-rubella IgG, IU/ml | 79.1 (43.0; 185.1) | 69.9 (36.9; 119.6) | 87.3 (45.3; 198.3) | 0.173 |
Patients with anti-rubella protective IgG level, n (%) | 168 (98.2) | 49 (98.0) | 119 (99.2) | 0.520 |
Time since the last MMR vaccination, years | 7.3 (5.0; 10.3) | 5.5 (4.0; 7.5) | 7.6 (4.9; 10.6) | 0.156 |
Diphtheria vaccination | p* | |||
Whole group (n = 170) | Incomplete (n = 85) | Complete (n = 85) | ||
Anti-diphtheria IgG, IU/ml | 0.12 (0.04; 0.31) | 0.07 (0.03; 0.22) | 0.2 (0.06; 0.4) | 0.001 |
Patients with anti-diphtheria protective IgG level, n (%) | 88 (51,8) | 34 (40.0) | 54 (63.5) | 0.002 |
Time since last diphtheria vaccination, years | 6.0 (4.1; 9.6) | 5.4 (4.1; 9.0) | 6.1 (4.8; 9.3) | 0.468 |
Risk factors of non-protective levels of antibodies against vaccines
Parameters | Measles | Mumps | Rubella | Diphtheria | Hepatitis B | |||||
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HR (95%CI) | р | HR (95%CI) | р | HR (95%CI) | р | HR (95%CI) | р | HR (95%CI) | р | |
soJIA, yes | 1.84 (0.84; 4.03) | 0.128 | 1.43 (0.53; 3.95) | 0.492 | 0.99 (0.05; 18.6) | 0.995 | 2.04 (0.91;4.59) | 0.08 | 2.52 (1.27; 5.0) | 0.008 |
GCS, yes | 1.54 (0.91; 2.61) | 0.104 | 0.31 (0.45;1.84) | 0.799 | 0.736 (0.11; 4.88) | 0.736 | 1.89 (1.1; 3.24) | 0.02 | 1.34 (0.77; 2.32) | 0.295 |
МТХ, yes | 0.86 (0.39; 1.88) | 0.703 | 1.55 (0.49; 4.88) | 0.453 | 1.53 (0.08; 28.64) | 0.776 | 2.02 (0.71; 5.76) | 0.187 | 0.6 (0.31; 1.15) | 0.122 |
Biologics, yes | 2.02 (1.22; 3.32) | 0.006 | 1.76 (0.98; 3.15) | 0.057 | 2.26 (0.5; 9.87) | 0.293 | 1.67 (0.99; 2.8) | 0.053 | 1.2 (0.75; 1.92) | 0.453 |
> 1 biologics, consequent, yes | 1.57 (1.13; 2.2) | 0.007 | 1.4 (0.93; 2.09) | 0.104 | 1.82 (0.71; 4.7) | 0.213 | 1.4 (0.98; 2.0) | 0.062 | 1.11 (0.78; 1.58) | 0.572 |
Incomplete vaccination, yes | 2.02 (1.02; 4.0) | 0.042 | 6.25 (2.13; 17.9) | 0.00008 | na* | na* | 2.39 (1.18; 4.85) | 0.016 | na* | na* |