Idiopathic Juvenile Arthritis: Effects of MMR Booster Vaccination

Marloes Heijstek MD  University Medical Center, Wilhelmina Children's Hospital Department of Pediatric Immunology and Rheumatology Room number KC 03.063.0 P.O. Box 85090 Lundlaan 6 3508 AB Interview with:
Marloes Heijstek MD

University Medical Center, Wilhelmina Children’s Hospital
Department of Pediatric Immunology and Rheumatology
Room number KC 03.063.0
P.O. Box 85090 Lundlaan 6
3508 AB Utrecht What are the main findings of the study?

Dr. Heijstek: The main findings of our study are that MMR booster vaccination does not affect JIA disease, does not cause flares of arthritis and induces high rates of protective immunity. Were any of the findings unexpected?

Dr. Heijstek: The safety of MMR vaccination has been questioned particularly in patients with JIA because the rubella component has been linked to the induction of arthritis in small uncontrolled studies. Moreover, JIA disease flares have been described after MMR vaccination. Our trial shows that MMR booster vaccination has no effect on JIA disease activity. What should clinicians and patients take away from your report?

Dr. Heijstek: For clinicians and patients it is important to know that the booster MMR vaccination does not affect JIA disease activity and does induce high rates of protective immune responses. This even seems to apply to patients using the immunosuppressive drug methotrexate. Hence, MMR booster vaccination should be advocated rather than feared in patients with JIA. Our data should lead to improved vaccination coverage in pediatric patients with JIA, and subsequently in improved protection against MMR infections in these vulnerable patients. What recommendations do you have for future research as a result of this study?

Dr. Heijstek: The most important unanswered questions about vaccinations and JIA, are the safety and immunogenicity of live-attenuated vaccines (for example varicella vaccination and MMR vaccination) in patients using biologicals, because more and more JIA patients are nowadays treated with highly immunosuppressive biologicals. The number of patients using biologics in our study was too small to draw firm conclusions.


Heijstek MW, Kamphuis S, Armbrust W, et al. Effects of the Live Attenuated Measles-Mumps-Rubella Booster Vaccination on Disease Activity in Patients With Juvenile Idiopathic Arthritis: A Randomized Trial. JAMA. 2013;309(23):2449-2456. doi:10.1001/jama.2013.6768.


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