Child with Juvenile idiopathic arthritis on etanercept, and given accidentaly polio vaccine. How to treat this child if he is in need for oral polio vaccine?
First it is necessary to know if the polio vaccine given is OPV (weakened live Oral polio vaccine) or IPV (injectable inactivated polio vaccine). OPV has not been used in the USA since 2000.
If the vaccine is live, one must stop etanercept of course to avoid the risk of polio disease.
In case of IPV there is no risk of polio. The question remains as to what extent he can build an immune response to the vaccine in the presence of etanercept.
So in both cases, etanercept must be stopped.
Other modalities of treatment of his arthritis can be sought: combination of salazopyrine and hydroxychloroquine and NSAID.
Dear Dr.
Try to read the following:
http://www.rheumatology.org.uk/includes/documents/cm_docs/2009/v/vaccinations_in_the_immunocompromised_person.pdf
If the patient take etanercept few days before the vaccine which is always almost oral in Iraq, or shortly after the vaccine, there is a risk of the viral infection.
Since there is no antidote to etanercept, so I prefer to use a trial of some medications like celecoxib that can increase the level of TNF to counteract the effect of etanercept.
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