Produção Nacional
Brazilian recommendations on the safety and effectiveness of the yellow fever vaccination in patients with chronic immune-mediated inflammatory diseases
2019; BioMed Central; Volume: 59; Issue: 1 Linguagem: Inglês
10.1186/s42358-019-0056-x
ISSN2523-3106
AutoresGecilmara Salviato Pileggi, Lícia Maria Henrique da Mota, Adriana María Kakehasi, Alexandre Wagner Silva de Souza, Aline Pereira da Rocha, Ana Karla Guedes de Melo, C.A.M. da Fonte, Cecilia Bortoletto, Claiton Viegas Brenol, Cláudia Diniz Lopes Marques, Cyrla Zaltman, Eduardo Ferreira Borba, Enio Ribeiro Reis, Eutília Andrade Medeiros Freire, Evandro Mendes Klumb, Georges Basile Christopoulos, Iêda Maria Magalhães Laurindo, Isabella Ballalai, Izaías Pereira da Costa, Lessandra Michelin, Lilian David de Azevêdo Valadares, Liliana Andrade Chebli, Marcus Lacerda, Maria Amazile Toscano, Michel Alexandre Yazbek, Rejane Maria Rodrigues de Abreu Vieira, Renata Ferreira Magalhães, Renato de Ávila Kfouri, Rosana Richtmann, Selma Merenlender, Valéria Valim, Marcos Renato de Assis, Sérgio Cândido Kowalski, Virgínia Fernandes Moça Trevisani,
Tópico(s)Autoimmune and Inflammatory Disorders Research
ResumoIn Brazil, we are facing an alarming epidemic scenario of Yellow fever (YF), which is reaching the most populous areas of the country in unvaccinated people. Vaccination is the only effective tool to prevent YF. In special situations, such as patients with chronic immune-mediated inflammatory diseases (CIMID), undergoing immunosuppressive therapy, as a higher risk of severe adverse events may occur, assessment of the risk-benefit ratio of the yellow fever vaccine (YFV) should be performed on an individual level. Faced with the scarcity of specific orientation on YFV for this special group of patients, the Brazilian Rheumatology Society (BRS) endorsed a project aiming the development of individualized YFV recommendations for patients with CIMID, guided by questions addressed by both medical professionals and patients, followed an internationally validated methodology (GIN-McMaster Guideline Development). Firstly, a systematic review was carried out and an expert panel formed to take part of the decision process, comprising BRS clinical practitioners, as well as individuals from the Brazilian Dermatology Society (BDS), Brazilian Inflammatory Bowel Diseases Study Group (GEDIIB), and specialists on infectious diseases and vaccination (from Tropical Medicine, Infectious Diseases and Immunizations National Societies); in addition, two representatives of patient groups were included as members of the panel. When the quality of the evidence was low or there was a lack of evidence to determine the recommendations, the decisions were based on the expert opinion panel and a Delphi approach was performed. A recommendation was accepted upon achieving ≥80% agreement among the panel, including the patient representatives. As a result, eight recommendations were developed regarding the safety of YFV in patients with CIMID, considering the immunosuppression degree conferred by the treatment used. It was not possible to establish recommendations on the effectiveness of YFV in these patients as there is no consistent evidence to support these recommendations. This paper approaches a real need, assessed by clinicians and patient care groups, to address specific questions on the management of YFV in patients with CIMID living or traveling to YF endemic areas, involving specialists from many areas together with patients, and might have global applicability, contributing to and supporting vaccination practices. We recommended a shared decision-making approach on taking or not the YFV.
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