Abstract
This study provides practical recommendations on infection screening in pediatric patients with immune-mediated rheumatic
diseases and immunosuppressive therapies. For this reason, a qualitative approach was applied. A narrative literature review
was performed via Medline. Primary searches were conducted using Mesh and free texts to identify articles that analyzed
data on infections and vaccinations in pediatric patients with immune-mediated rheumatic diseases and immunosuppressive
therapies. The results were presented and discussed in a nominal group meeting, comprising a committee of 12 pediatric
rheumatologists from the infections prevention and treatment working group of the Spanish Society of Pediatric Rheuma tology. Several recommendations were generated. A consensus procedure was implemented via a Delphi process that was
extended to members of the Spanish Society of Pediatric Rheumatology and Vaccine Advisory Committee of the Spanish
Association of Pediatrics. Participants to the process produced a score ranging from 0=totally disagree to 10=totally agree.
Agreement was considered if at least 70% of participants voted≥7. The literature review included more than 400 articles.
Overall, 63 recommendations were generated (21 on infection screening) voted by 59 pediatric rheumatologists and other
pediatric specialists, all of them achieving the pre-established agreement level. The recommendations on screening cover all
the procedures (serology, assessment of risk factors, and other clinical activities) connected with the screening for infections
including tuberculosis; hepatitis A, B, and C viruses; measles; mumps; rubella; diphtheria; and other infections.
Conclusion: Screening for infections is an essential part of risk management in pediatric patients with immune-mediated
rheumatic diseases and immunosuppressive therapies.