The safety of live-attenuated vaccines in patients using IL-1 or IL-6 blockade: an international survey

Pediatr Rheumatol Online J. 2018 Mar 21;16(1):19. doi: 10.1186/s12969-018-0235-z.


Background: Withholding live-attenuated vaccines in patients using interleukin (IL)-1 or IL-6 blocking agents is recommended by guidelines for both pediatric and adult rheumatic diseases, since there is a risk of infection in an immune suppressed host. However, this has never been studied. This retrospective, multicenter survey aimed to evaluate the safety of live-attenuated vaccines in patients using IL-1 or IL-6 blockade.

Methods: We contacted physicians involved in the treatment of autoinflammatory diseases to investigate potential cases. Patients were included if a live-attenuated vaccine had been administered while they were on IL-1 or IL-6 blockade.

Results: Seventeen patients were included in this survey (7 systemic juvenile idiopathic arthritis (sJIA), 5 cryopyrin associated periodic syndrome (CAPS), 4 mevalonate kinase deficiency (MKD) and 1 familial Mediterranean fever (FMF). Three patients experienced an adverse event, of which two were serious adverse events (a varicella zoster infection after varicella zoster booster vaccination, and a pneumonia after MMR booster). One additional patient had diarrhea after oral polio vaccine. Further, seven patients experienced a flare of their disease, which were generally mild. Eight patients did not experience an adverse event or a flare.

Conclusion: We have described a case series of seventeen patients who received a live-attenuated vaccine while using IL-1 or IL-6 blocking medication. The findings of this survey are not a reason to adapt the existing guidelines. Prospective trials are needed in order to acquire more evidence about the safety and efficacy before considering adaptation of guidelines.

Keywords: Autoinflammatory diseases; Biologicals; IL-1 blockade; IL-6 blockade; Live-attenuated vaccines.

Publication types

  • Multicenter Study

MeSH terms

  • Adolescent
  • Adult
  • Child
  • Child, Preschool
  • Female
  • Hereditary Autoinflammatory Diseases / drug therapy
  • Hereditary Autoinflammatory Diseases / immunology*
  • Humans
  • Immunosuppressive Agents / adverse effects*
  • Immunosuppressive Agents / therapeutic use
  • Infant
  • Interleukin-1 / antagonists & inhibitors*
  • Interleukin-6 / antagonists & inhibitors*
  • Male
  • Middle Aged
  • Retrospective Studies
  • Surveys and Questionnaires
  • Vaccines, Attenuated / administration & dosage
  • Vaccines, Attenuated / adverse effects*
  • Young Adult


  • Immunosuppressive Agents
  • Interleukin-1
  • Interleukin-6
  • Vaccines, Attenuated