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When is the appropriate time to administer vaccines to an infant whose mother received anti-tumour necrosis factor (anti-TNF) alpha immunosuppressants during pregnancy?
  1. Bryan Padraig Finn1,
  2. John Fitzsimons1,2
  1. 1 General Paediatrics, CHI at Temple Street, Dublin, Dublin, Ireland
  2. 2 Emergency Department, Temple Street Children's University Hospital, Dublin, Ireland
  1. Correspondence to Dr Bryan Padraig Finn, Paediatrics, University Hopsital Limerick, Limerick D01YC67, Ireland; 112305976{at}

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A mother being treated for rheumatoid arthritis has been advised by her rheumatologist not to give any vaccines to her child until he is over 6 months of age but now seeks a second opinion. She reports that this advice was given because she was receiving etanercept before conception but was switched to certolizumab prior to the second trimester which was continued until delivery. She breast fed for a few days following delivery.

Structured clinical question

In infants born to mothers receiving anti-tumour necrosis factor (anti-TNF) alpha, immunosuppressants during pregnancy (population), is the administration of live and non-live vaccines prior to 6 months of age (intervention) associated with an increased risk of vaccine-related adverse events and/or reduced efficacy (outcome) when compared with infants whose mothers did not receive anti-TNF therapy (control)?


Primary sources: PubMed from inception to 04 January 2020 using (vaccin* OR immunization) AND (immunosuppress* OR TNF alpha blockers OR TNF OR etanerecept OR certolizumab OR infliximab) AND (infant OR neonat* OR mother OR parent). A total of 5377 results returned. Of these studies, only 43 papers were initially returned which were relevant including further studies obtained from the references of papers found in the original search. Seven papers were analysed in detail as per the attached table.

Secondary sources: Cochrane from inception to 30 March 2020 using vaccin*—141 results returned, no studies relevant. (vaccin* OR immunization) AND (immunosuppress* OR TNF alpha blockers OR TNF OR etanerecept OR certolizumab OR infliximab OR biologics) AND (infant OR neonat* OR mother OR parent)—10 Cochrane reviews returned—no results relevant. Seven hundred twenty-one trials returned—two trials relevant—of these, only one had been carried out which the PubMed search had found, the second remained an uncompleted methodology but no results or paper available.


An increasing number of infants are born to mothers receiving anti-TNF agents as part …

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  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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