EULAR recommendations for infection prevention and vaccination administration in adult patients with AIIRD

Figure 1. 2022 EULAR recommendations: Overarching principles* 

AIIRD, autoimmune inflammatory rheumatic diseases; bDMARD, biological disease-modifying antirheumatic drug; csDMARD, conventional synthetic disease-modifying antirheumatic drug; DMARD, disease modifying antirheumatic drug; EULAR, European Alliance of Associations for Rheumatology; tsDMARD, targeted synthetic disease-modifying antirheumatic drug.

*Adapted from Fragoulis, et al.¹

Figure 2. 2022 EULAR recommendations for prevention of opportunistic and chronic infections in adults with AIIRD* 

AIIRD, autoimmune inflammatory rheumatic diseases; bDMARDs, biological disease-modifying antirheumatic drugs; csDMARDs, conventional synthetic disease-modifying antirheumatic drugs; EULAR, European Alliance of Associations for Rheumatology; GoR, grade of recommendation; HBV, hepatitis B virus; LoA, level of agreement; LoE, level of evidence; PCP, pneumocystis pneumonia; tsDMARDs, targeted synthetic disease-modifying antirheumatic drugs; VZV, varicella zoster virus.
*Adapted from Fragoulis, et al.^1
†Based on the Oxford Evidence Based Medicine categorization, as per EULAR guidance.
^‡Denotes separate LoE and GoR, where this is different from the rest of the statement.

Figure 3. Recommended screening schedule for HBV* 

anti-HBs; hepatitis B surface antibody; DNA, deoxyribonucleic acid; HBsAg, hepatitis B surface antigen; HBV, hepatitis B virus; LFT, liver function test.
*Adapted from Fragoulis, et al.^1
†Positive anti-HBs without positive HBsAg or anti-HBcore is consistent with prior vaccination. If all three (HBsAg, anti-HBcore, anti-HBs) are negative, means no previous exposure to HBV.
^‡Consider referral for antiviral prophylaxis for those commencing rituximab, having also low titers of anti-HBs. Risk is assessed on an individual basis.
^§HBV-reactivation: rise or appearance of HBV-DNA, or conversion from HBsAg-negative to HBsAg-positive.
^‖Periodic: there are no data to specify the exact time at which re-screening for HBV-reactivation should be performed. However, every 3–6 months is the standard for many national guidelines. Risk factors and cost should also be considered.
^¶Referral to hepatologists is also recommended.

Figure 4. EULAR 2019 vaccination recommendations: Overarching principles* 

AIIRD, autoimmune inflammatory rheumatic diseases; DMARD, disease-modifying antirheumatic drug; EULAR, European Alliance of Associations for Rheumatology.
*Adapted from Furer, et al.²

Figure 5. EULAR 2019 vaccination recommendations* 

AIIRD, autoimmune inflammatory rheumatic diseases; EULAR, European Alliance of Associations for Rheumatology; HAV, hepatitis A virus; HBV, hepatitis B virus; HPV, human papilloma virus; LoA, level of agreement; NA, non-available; SLE, systemic lupus erythematosus; SoR, strength of recommendation.
*Adapted from Furer, et al.^2
†Determined following the standards of the Oxford Centre for Evidence Based Medicine. The strength of recommendation was primarily based on the efficacy data. If no efficacy data were available, immunogenicity was used as a major outcome. When immunogenicity outcomes did not directly correlate with protection, the strength of recommendation was downgraded. Few recommendations were primarily based on safety (especially live-attenuated vaccines) and here, the safety outcomes determined the strength of the recommendation.