Vaccination recommendations for adults with autoimmune inflammatory rheumatic diseases: EULAR update

European League Against Rheumatism (EULAR) has updated its recommendations for vaccination in adult patients with autoimmune inflammatory rheumatic diseases (AIIRD) published in 2011. The updated recommendations comprise six overarching principles and nine recommendations. They address the need for an annual vaccination status assessment, shared decision-making and timing of vaccination, favoring vaccination during quiescent disease, preferably prior to the initiation of immunosuppression. Non-live vaccines can be safely provided to AIIRD patients regardless of underlying therapy, whereas live-attenuated vaccines may be considered with caution. Influenza and pneumococcal vaccination should be strongly considered for the majority of patients with AIIRD. Tetanus toxoid and human papillomavirus vaccination should be provided to AIIRD patients as recommended for the general population. Hepatitis A, hepatitis B, and herpes zoster vaccination should be administered to AIIRD patients at risk. Immunocompetent household members of patients with AIIRD should receive vaccines according to national guidelines, except for the oral poliomyelitis vaccine. Live-attenuated vaccines should be avoided during the first 6 months of life in newborns of mothers treated with biologics during the second half of pregnancy. These 2019 EULAR recommendations provide up-to-date guidance on the management of vaccinations in patients with AIIRD.