Experience of Vaccination of a Patient with Systemic Juvenile Idiopathic Arthritis (sJIA) with a 13-Valent Pneumococcal Conjugate Vaccine, prior to the Appointment of Therapy with Tocilizumab, an Anti-IL-6-Receptor Monoclonal Antibody
Daria D. Vankova, 
Ekaterina I. Alekseeva,
Margarita А. Soloshenko,
Tatiana М. Dvoriakovskaia,
Ksenia B. Isaeva,
Rina V. Denisova,
Anna V. Mamutova,
Mariya G. Rudnitskaya,
Nikolay A. Mayansky,
Natal’ya Е. Tkachenko
Ekaterina I. Alekseeva,
Margarita А. Soloshenko,
Tatiana М. Dvoriakovskaia,
Ksenia B. Isaeva,
Rina V. Denisova,
Anna V. Mamutova,
Mariya G. Rudnitskaya,
Nikolay A. Mayansky,
Natal’ya Е. Tkachenko https://doi.org/10.15690/vsp.v17i4.1926
Abstract
Background. Infections are the main cause of death for patients with autoimmune rheumatic diseases. In adult patients with rheumatoid arthritis (RA), mortality caused by respiratory infections is 2–5 times higher than in the population. One of the frequent infectious complications in the course of treatment with tocilizumab, the first-choice drug for treating systemic juvenile idiopathic arthritis (sJIA), is pneumonia characterized by a poor clinical picture, normal values of laboratory indices of the disease activity (ESR, C-reactive protein) with pronounced changes in the lungs revealed by computed tomography. In case of acute respiratory infection in children with systemic JIA, immunosuppressants and genetically engineered biological preparations (GEBP) are discontinued. This often leads to an exacerbation of the underlying disease and the progression of a pathological process. At present, vaccination against pneumococcal infection in Russia is not included in the standard for managing patients with rheumatic diseases. Studies of the safety and efficacy of vaccination with 13-valent pneumococcal conjugate vaccine (PCV) in patients with sJIA receiving genetically engineered biological preparations were not conducted. Clinical Case Description. The article shares the experience of vaccination of a girl aged 9 years with a 13-valent PCV that was conducted in the course of a scientific investigation, which studied the efficacy and safety of vaccination of children with systemic JIA prior to prescription of GEBP tocilizumab. Vaccination did not cause a deterioration in the course of the main disease (1 month), led to a reduction in the incidence of acute respiratory infections (from 4 to 1 time within 6 months before and after vaccination), and discontinuation of antibacterial drugs within 6 months after vaccination. Conclusion. The safety of a 13-valent PCV in a child with sJIA and a decrease of the incidence of respiratory diseases after vaccination, their complications, and the use of antibacterial drugs have been shown.
Keywords
children,
pneumococcal infection,
vaccination,
13-valent pneumococcal conjugate vaccine,
tocilizumab,
systemic juvenile idiopathic arthritis,
clinical case
Supporting agencies: Not specified
About the Authors
Daria D. Vankova
National Medical Research Center of Children’s Health
Russian Federation
Moscow
Disclosure of interest:
Russian Federation
Moscow
Disclosure of interest:
Not declared
Ekaterina I. Alekseeva
National Medical Research Center of Children’s Health;
Sechenov First Moscow State Medical University (Sechenov University)
Russian Federation
Moscow
Disclosure of interest: Receiving research funding from pharmaceutical companies Roche, Abbott, Pfizer, Novartis
Russian Federation
Moscow
Disclosure of interest: Receiving research funding from pharmaceutical companies Roche, Abbott, Pfizer, Novartis
Margarita А. Soloshenko
National Medical Research Center of Children’s Health
Russian Federation
Moscow
Disclosure of interest:
Russian Federation
Moscow
Disclosure of interest:
Not declared
Tatiana М. Dvoriakovskaia
National Medical Research Center of Children’s Health;
Sechenov First Moscow State Medical University (Sechenov University)
Russian Federation
Moscow
Disclosure of interest: Receiving research funding from pharmaceutical companies Roche, Pfizer
Russian Federation
Moscow
Disclosure of interest: Receiving research funding from pharmaceutical companies Roche, Pfizer
Ksenia B. Isaeva
National Medical Research Center of Children’s Health
Russian Federation
Moscow
Disclosure of interest: Receiving research funding from pharmaceutical companies Roche, Novartis
Russian Federation
Moscow
Disclosure of interest: Receiving research funding from pharmaceutical companies Roche, Novartis
Rina V. Denisova
National Medical Research Center of Children’s Health
Russian Federation
Moscow
Disclosure of interest:
Russian Federation
Moscow
Disclosure of interest:
Not declared
Anna V. Mamutova
National Medical Research Center of Children’s Health
Russian Federation
Moscow
Disclosure of interest:
Russian Federation
Moscow
Disclosure of interest:
Not declared
Mariya G. Rudnitskaya
National Medical Research Center of Children’s Health
Russian Federation
Moscow
Disclosure of interest:
Russian Federation
Moscow
Disclosure of interest:
Not declared
Nikolay A. Mayansky
National Medical Research Center of Children’s Health
Russian Federation
Moscow
Disclosure of interest: Receiving research funding and fees for being a speaker from pharmaceutical companies Pfizer and GlaxoSmithKline
Russian Federation
Moscow
Disclosure of interest: Receiving research funding and fees for being a speaker from pharmaceutical companies Pfizer and GlaxoSmithKline
Natal’ya Е. Tkachenko
National Medical Research Center of Children’s Health
Russian Federation
Moscow
Disclosure of interest:
Russian Federation
Moscow
Disclosure of interest:
Not declared
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29.
Review
For citations:
Vankova D.D., Alekseeva E.I., Soloshenko M.А., Dvoriakovskaia T.М., Isaeva K.B., Denisova R.V., Mamutova A.V., Rudnitskaya M.G., Mayansky N.A., Tkachenko N.Е. Experience of Vaccination of a Patient with Systemic Juvenile Idiopathic Arthritis (sJIA) with a 13-Valent Pneumococcal Conjugate Vaccine, prior to the Appointment of Therapy with Tocilizumab, an Anti-IL-6-Receptor Monoclonal Antibody. Current Pediatrics. 2018;17(4):322-327. (In Russ.) https://doi.org/10.15690/vsp.v17i4.1926
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