Título:	Brazilian recommendations on the safety and effectiveness of the yellow fever vaccination in patients with chronic immune-mediated inflammatory diseases
Autor(es):	Pileggi, Gecilmara Salviato Mota, Licia Maria Henrique da Kakehasi, Adriana Maria Souza, Alexandre Wagner de Rocha, Aline Melo, Ana Karla Guedes de Fonte, Caroline Araujo M. da Bortoletto, Cecilia Brenol, Claiton Viegas Marques, Claudia Diniz Lopes Zaltman, Cyrla Borba, Eduardo Ferreira Reis, Enio Ribeiro Freire, Eutilia Andrade Medeiros Klumb, Evandro Mendes Christopoulos, Georges Basile Laurindo, Ieda Maria M. Ballalai, Isabella Costa, Izaias Pereira da Michelin, Lessandra Valadares, Lilian David de Azevêdo Chebli, Liliana Andrade Lacerda, Marcus Toscano, Maria Amazile Ferreira Yazbek, Michel Alexandre Vieira, Rejane Maria R. de Abreu Magalhães, Renata Kfouri, Renato Richtmann, Rosana Merenlender, Selma da Costa Silva Valim, Valeria Assis, Marcos Renato de Kowalski, Sergio Candido Trevisani, Virginia Fernandes Moça
ORCID:	http://orcid.org/0000-0003-0054-7754
Data de publicação:	2019
Editora:	Sociedade Brasileira de Reumatologia
Referência:	PILEGGI, Gecilmara Salviato et al. Brazilian recommendations on the safety and effectiveness of the yellow fever vaccination in patients with chronic immune-mediated inflammatory diseases. Advances in Rheumatology, v. 59,17, 2019. DOI: https://doi.org/10.1186/s42358-019-0056-x. Disponível em: http://scielo.br/scielo.php?script=sci_arttext&pid=S2523-31062019000100302. Acesso em: 23 jan. 2020.
Abstract:	Background: In 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. Main body of the abstract: 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. Conclusion: 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.
Unidade Acadêmica:	Faculdade de Medicina (FMD)
Licença:	© The Author(s). 2019 Open Access - This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
DOI:	https://doi.org/10.1186/s42358-019-0056-x
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