The following should be taken into consideration with regard to vaccinations for 0-18 yos with rheumatic or musculoskeletal disorders on immunosuppression (view list of medications).
Follow CDC pediatric vaccination schedule unless otherwise outlined below.
Recommended
- Primary PCV13/PCV20 series for all children <2 yo and PPSV23 vaccination to children ≥2 yo
Not recommended
Recommended
- Age ≥6 mo
- If on methotrexate, recommend holding for 2 weeks after vaccination
Recommended
- Age ≥11 yo
Recommended
- Pfizer-BioNTech:
- 6 mo-4 yo: 3 doses of vaccine including at least 1 updated COVID-19 dose
- ≥5 yo: at least 1 updated dose
- Moderna:
- 6 mo-5 yo: 2 doses including at least 1 updated dose
Includes: Intranasal influenza, MMR, rotavirus, typhoid, varicella, yellow fever, zoster
- HOLD immunosuppressive medication (view list of medications) prior to and after vaccination at discretion of a rheumatologist
- Recommended if indicated based on patient age and/or history
- Rotavirus:
- GIVE within first 6 months of life if antenatal 2nd or 3rd trimester TNFi exposure
- HOLD until >6 months of age if antenatal rituximab exposure
Special Considerations
- Other than influenza vaccination, defer vaccinations until next rituximab dose due and delay rituximab dose for 2 weeks after vaccine administration, if disease activity allows
- For patients taking the equivalent of prednisone ≥20 mg/d, defer vaccinations (except influenza) until tapered <20 mg/d
- No contraindications to giving multiple vaccinations to patients on same day