FRI0141 Vaccination decisions and incidence of neonatal infections in mothers exposed to biologicals during pregnancy
Authors: S.J. Bond, L. Young, K. Poulsen, H.L. Barrett, A.L. Taylor, C. Barrett
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> Rheumatologic diseases commonly affect women of childbearing age(.<sup><sup>1, 2</sup></sup> There is currently limited data available regarding the safety of vaccinations in infants after in utero exposure to biologics. <h3>Objectives</h3> To determine the vaccination decisions of mothers with rheumatologic diseases exposed to biologics during pregnancy and the incidence of serious neonatal infections after third trimester exposure. <h3>Methods</h3> All Australian women with inflammatory arthritis, exposed to biologics during the preconception, antenatal and/or postpartum periods, were invited to participate in the Pregnancy Exposed to Biological (PEB) study from May 2009 – . Jan 2018 Recruitment was via direct invitation from patients treating rheumatologists, community groups, and via social media. Following self-referral to the study, retrospective data was collected, including biological exposure, vaccination history and the incidence of serious neonatal infections, defined as infection requiring hospitalisation. <h3>Results</h3> Preliminary data is available regarding 35 offspring from 28 mothers. 34 of 35 offspring were vaccinated. 29 received vaccinations in accordance with the Australian National Immunisation Program Schedule. 1 mother declined to immunise her infant due to personal preference. 13 infants were exposed to a tumour necrosis factor inhibitor (TNFi) during the third trimester. Of these, 4 had Rotavirus vaccine delayed from 2 to 4 months and 1 infant until 6 months. 1 infant did not receive the Rotavirus vaccine at 2 months due to exposure to a TNFi while breastfeeding. There were no incidences of serious neonatal infections. <h3>Conclusions</h3> Current guidelines recommend deferring live vaccines, such as rotavirus, until after 6 months if exposed to a biologic in the third trimesterr.(<sup><sup>2–5</sup></sup> Compliance with these recommendations was only observed in one infant in our study. One infant received delayed Rotavirus vaccination due to concern about TNFi exposure during breastfeeding; this is not in keeping with current guidelines. Of the 12 infants exposed to a biologic during the third trimester who did not delay live vaccination until after 6 months, there were no incidents of serious neonatal infections, in keeping with the findings of current published case series. <h3>References</h3> [1] Brouwer J, Hazes JM, Laven JS, Dolhain RJ. Fertility in women with rheumatoid arthritis: influence of disease activity and medication. Ann Rheum Dis. 2015;74(10):1836–41. [2] Gotestam Skorpen C, Hoeltzenbein M, Tincani A, Fischer-Betz R, Elefant E, Chambers C, et al. The EULAR points to consider for use of antirheumatic drugs before pregnancy, and during pregnancy and lactation. Ann Rheum Dis. 2016;75(5):795–810. [3] Flint J, Panchal S, Hurrell A, van de Venne M, Gayed M, Schreiber K, et al. BSR and BHPR guideline on prescribing drugs in pregnancy and breastfeeding-Part I: standard and biologic disease modifying anti-rheumatic drugs and corticosteroids. Rheumatology (Oxford). 2016;55(9):1693–7. [4] Health AGDo. 3.3 Groups with special vaccination requirements2017. [5] Ostensen M. The use of biologics in pregnant patients with rheumatic disease. Expert Rev Clin Pharmacol2017;10(6):661–9. <h3>Disclosure of Interest</h3> None declared