Italian recommendations for influenza and pneumococcal vaccination in adult patients with autoimmune rheumatic diseases

Giulio Guerrini, Fabio Franzetti, Roberto Giacomelli, Luca Meroni, Agostino Riva, Carlo Alberto Scirè, Rossana Scrivo, Marcello Tavio, Adriana Agostinone, Paolo Airò, Fabiola Atzeni, Filippo Bartalesi, Laura Bazzichi, Onorina Berardicurti, Giovanni Cassola, Antonella Castagna, Francesco Castelli, Annamaria Cattelan, Giorgia Citriniti, Francesco CristiniFrancesco De Rosa, Elena Fracassi, James Galloway, Giuliana Maria Concetta La Paglia, Maria Cristina Moioli, Diego Ripamonti, Annalisa Saracino, Chiara Tani, Carlo Tascini, Tiziana Tieghi, Marco Tinelli, Alen Zabotti, Piercarlo Sarzi-Puttini, Massimo Galli

Research output: Contribution to journalArticlepeer-review


OBJECTIVES: To provide evidence-based recommendations for vaccination against influenza virus and S. pneumoniae in patients with autoimmune rheumatic diseases (ARDs). METHODS: A Consensus Committee including physicians with expertise in rheumatic and infectious diseases was established by two Italian scientific societies, Società Italiana di Reumatologia (SIR) and Società Italiana di Malattie Infettive e Tropicali (SIMIT). The experts were invited to develop evidence-based recommendations concerning vaccinations in ARDs patients, based on their clinical status before and after undergoing immunosuppressive treatments. Key clinical questions were formulated for the systematic literature reviews, based on the clinical pathway. A search was made in Medline (via PubMed) according to the original MeSH strategy from October 2009 and a keyword strategy from January 2016 up to December 2017, updating existing EULAR recommendations. Specific recommendations were separately voted and scored from 0 (no agreement with) to 100 (maximal agreement) and supporting evidence graded. The mean and standard deviation of the scores were calculated to determine the level of agreement among the experts' panel for each recommendation. Total cumulative agreement ≥70 defined consensus for each statement. RESULTS: Nine recommendations, based on 6 key clinical questions addressed by the expert committee, were proposed. The aim of this work is to integrate the 2011 EULAR recommendations on vaccination against influenza and S. pneumoniae in ARDs patients. An implementation plan was proposed to improve the vaccination status of these patients and their safety during immunosuppressive treatments. CONCLUSIONS: Influenza and pneumococcus vaccinations are effective and safe in patients with ARDs. More efforts should be made to translate the accumulated evidence into practice.

Original languageEnglish
Pages (from-to)245-256
Number of pages12
JournalClinical and Experimental Rheumatology
Issue number2
Publication statusPublished - Mar 1 2020

ASJC Scopus subject areas

  • Rheumatology
  • Immunology and Allergy
  • Immunology


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