***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: Recent findings demonstrated a reduced immunogenicity of the influenza A H1N1/2009 vaccine in juvenile rheumatic diseases . However , a point of concern is whether the vaccine could induce disease flares . The aim of this study was to assess the disease safety of and the possible influence of disease parameters and therapy on  nonadjuvant influenza A H1N1 vaccine response of juvenile systemic lupus erythematosus ( SLE ) patients OBJECTIVES The aim of the present paper is to assess the influence of demographic , muscle enzymes , JDM scores and treatment on non-adjuvanted influenza A H1N1/2009 vaccine immunogenicity in juvenile dermatomyositis ( JDM ) patients . METHODS Thirty JDM patients and 81 healthy age-matched controls were vaccinated . All participants were evaluated pre- and 21 days post-vaccination and serology for anti-H1N1 was performed by haemagglutination inhibition assay . Muscle enzymes , JDM scores and treatment were evaluated before and after vaccination . Adverse events were reported . RESULTS After immunisation , seroconversion rates were significantly lower in JDM patients compared to age-matched controls ( 86.7 vs. 97.5 % , p=0.044 ) , whereas seroprotection ( p=0.121 ) , geometric mean titres ( GMT ) ( p=0.992 ) and factor increase ( FI ) in GMT ( p=0.827 ) were similar in both groups . Clinical and laboratorial evaluations revealed that JDM scores and muscle enzymes remained stable throughout the study ( p>0.05 ) . A higher frequency of chronic course was observed in non-seroconverted compared to seroconverted ( 100 % vs. 27 % , p=0.012 ) . Regarding treatment , a lower rate of seroconversion was observed in patients under prednisone>20mg/day ( 50 % vs. 4 % , p=0.039 ) , and in those treated with a combination of prednisone , methotrexate and cyclosporine ( 50 % vs. 4 % , p=0.039 ) . Local and systemic vaccine adverse events were mild and similar in patients and controls ( p>0.05 ) . CONCLUSIONS This study identified that chronic course and immunosuppressive therapy are the major factors hampering seroconversion in JDM , suggesting that a specific protocol may be required for this subgroup of patients . In spite of that , a single dose of non-adjuvanted influenza A/H1N1 2009 vaccine was generally seroprotective in this disease with no evident deleterious effect in disease itself ( Clinical Trials.gov , no. NCT01151644 ) OBJECTIVES To evaluate the influence of low-dose MTX and etanercept treatment on efficacy of measles , mumps and rubella ( MMR ) revaccination in children with juvenile idiopathic arthritis . METHODS A prospect i ve nested case-control study was performed to investigate markers of MMR revaccination induced humoral and cell-mediated immunity in 15 patients with juvenile idiopathic arthritis ( ages 6 - 17 yrs ) , treated with either low-dose MTX therapy alone or in combination with etanercept . The control group consisted of 22 healthy children .  Production of IFN-gamma by T memory cells upon in vitro stimulation with measles , mumps and rubella antigens and seroprevalence of virus-specific IgG antibodies were assessed . Medication use , disease activity and patients ' comments on side-effects were observed during the period of 6 months before and after revaccination . RESULTS Low-dose MTX therapy following MMR vaccination proved not to hamper T-cell mediated immunity in vitro . Neither low-dose MTX nor etanercept treatment , given simultaneously with revaccination , markedly interfered with generation of long-lived virus-restricted T cells and protective levels of virus-specific IgG antibodies . No increase in disease activity or medication use was seen within 6 months after MMR revaccination , including JIA patients using etanercept . No overt measles , mumps , rubella or secondary severe infections were noted . CONCLUSIONS Low-dose MTX and etanercept treatment do not seem to interfere with intended outcome of MMR revaccination in children with JIA OBJECTIVES In this study , we examined the antibody responses after recombinant hepatitis B vaccine in juvenile SLE patients and whether antibody levels were affected by immunosuppressive therapy . METHODS This study consisted of 64 juvenile SLE patients and 24 healthy controls . We evaluated HBsAg , Anti-HBs and Anti-HbcIgG titers in SLE patients . 24 patients ( 37 % ) were non-immunised , 39 patients were immunised ( 61 % ) and 1 patient ( 1.5 % ) was chronic hepatitis B carrier . Of the 24 non-immunised patients , 3 had active disease ( SLEDAI>10 ) and 1 was being treated for tuberculosis infection so they were not included in the vaccination program . Twenty non-immunised SLE patients were given 3 dose recombinant hepatitis B vaccine doses at 0,1,6 months .  AntiHBs antibody titer > 10 IU/ml one month after the last dose of vaccine was accepted as seroconversion . RESULTS After 3 doses of vaccination , 16 ( 80 % ) of SLE patients and all of the healthy controls had seroconversion . Since two patients had SLEDAI score > 10 after the first 2 doses of vaccine and one patient had SLEDAI score > 10 after the first dose , these patients were given only two doses of hepatitis B vaccine . These patients had already seroconverted . One patient had exacerbation of the disease one month after the third dose of the vaccine . Protective antibody responses were statistically insignificant between the two groups ( p=0.49 ) . Geometric mean antibody titers of SLE patients were lower than those of the healthy controls . Adequate antibody response was not affected by immunosuppressive treatment as prednisone , azathioprine , and hydroxychloroquine . CONCLUSIONS Juvenile SLE patients could reach an adequate antibody response after recombinant hepatitis B vaccination and this response is not affected by immunosuppressive treatment Objectives To compare the immunogenicity and safety of the bivalent human papillomavirus (HPV)16/18 vaccine between female patients with juvenile idiopathic arthritis ( JIA ) and healthy female adolescents . Methods 68 patients and 55 healthy girls aged 12–18 years were included in a prospect i ve controlled observational cohort and were vaccinated at 0 , 1 and 6 months . Primary outcomes were immunogenicity expressed as seropositivity rate after three vaccine doses at 7 and 12 months and HPV-specific geometric mean antibody concentrations . Secondary outcomes were HPV16/18-specific memory B cell responses in a subset of participants and safety , defined as adverse events and the effect of vaccination on JIA disease activity . Results All participants were seropositive for HPV16 and HPV18 at 7 months . One patient turned seronegative at 12 months for HPV16/18 . No significant differences were found between patients and controls in HPV-specific antibody concentrations ; however , antibody concentrations were consistently lower in patients . No effect of methotrexate on HPV16 antibodies ( p=0.79 ) or HPV18 antibodies ( p=0.37 ) was detected . All patients on anti-TNFα treatment were seropositive after vaccination . The kinetics of HPV16/18 memory B cell responses was comparable between patients and controls , but the magnitude of B cell responses at 7 and 12 months appeared lower in patients . No relevant differences in adverse events were found . HPV vaccination did not aggravate JIA disease . Conclusions The bivalent HPV16/18 vaccine is immunogenic and well tolerated in JIA patients . However , HPV-specific antibodies and B cell responses tended to be lower in patients compared with healthy controls . Clinical trial listing OBJECTIVE Influenza immunization is recommended for children with chronic conditions and children receiving chronic acetylsalicylic acid therapy . Our study assessed the safety and immunogenicity of this vaccination in children with chronic arthritis . METHODS The frequency of possible adverse reactions following influenza vaccination , and virus specific HI antibody levels prior to and 4 weeks after vaccination with an inactivated split virus vaccine prepared for the 1991/92 season , were assessed in a prospect i ve open study of children with chronic arthritis . Thirty-four patients were assessed clinical ly at vaccination and one month later . Local symptoms at the injection site and systemic symptoms were assessed by diary in 26 patients and 13 immunized healthy control children . RESULTS Tenderness and /or redness at the injection site , and fever occurred equally in patients and controls . Malaise/nausea occurred in 12 patients and 3 controls ( p = 0.3 ) , but patients had more symptomatic days than controls ( p = 0.01 ) . No child with inactive arthritis developed a swollen joint following immunization . There were no significant differences between the 2 visits for a.m. stiffness , pain ( VAS ) , global assessment , joint count or erythrocyte sedimentation rate ( ESR ) . More patients improved than deteriorated by each measure . Three patients deteriorated by global assessment , 7 patients had an increased joint count . At least 95 % of patients developed presumably protective levels of antibodies ( HI titers > or = 40 ) to each virus . Preimmunization titers , seroresponse rates ( 4 x rise or rise from < 20 to > or = 40 ) and final titers were the same between patients ( whether or not they were taking prednisone or a second line antirheumatic drug ) and controls . CONCLUSION There was no convincing evidence that influenza vaccination is associated with significant adverse reactions or arthritis flares in children with chronic arthritis . Children with chronic arthritis appeared to respond adequately to influenza vaccination OBJECTIVE To determine whether vaccinations aggravate the course of autoimmune diseases such as juvenile idiopathic arthritis ( JIA ) and whether the immune response to vaccinations may be hampered by immunosuppressive therapy for the underlying disease . METHODS In this multicenter cohort study , 234 patients with JIA ( ages 1 - 19 years ) were vaccinated with meningococcal serogroup C ( MenC ) conjugate to protect against serogroup C disease ( caused by Neisseria meningitidis ) . Patients were followed up for disease activity for 1 year , from 6 months before until 6 months after vaccination . IgG antibody titers against MenC polysaccharide and the tetanus carrier protein were determined by enzyme-linked immunosorbent assay and toxin binding inhibition assay , respectively . A serum bactericidal assay was performed to determine the function of the anti-MenC antibodies . RESULTS No change in values for any of the 6 components of the core set criteria for juvenile arthritis disease activity was seen after MenC vaccination . Moreover , no increase in the frequency of disease relapse was detected . Mean anti-MenC IgG concentrations in JIA patients rose significantly within 6 - 12 weeks after vaccination . Of 157 patients tested , 153 were able to mount anti-MenC IgG serum levels > 2 micro g/ml , including patients receiving highly immunosuppressive medication . The 4 patients with a lower anti-MenC antibody response displayed sufficient bactericidal activity despite receiving highly immunosuppressive medication . CONCLUSION The MenC conjugate vaccine does not aggravate JIA disease activity or increase relapse frequency and results in adequate antibody levels , even in patients receiving highly immunosuppressive medication . Therefore , patients with JIA can be vaccinated safely and effectively with the MenC conjugate OBJECTIVES Hepatitis B is a vaccine preventable disease with intermediate endemicity in Greece . Patients with juvenile idiopathic arthritis ( JIA ) on immunomodulating therapy  are prone to infection or reactivation of hepatitis B virus ( HBV ) . The aim of this study is to define the immune status against HBV in children newly-diagnosed with JIA . METHODS Case-control prospect i ve study including 89 JIA patients and 89 controls matched for age and gender . Eighty-nine JIA patients were included in the study ( 22 males ) , with a mean age of 6.8 years . Sera were tested for hepatitis B surface antigen , hepatitis B core antibody , and anti-HBs . Patients with anti-HBs titers ≥10 IU/L were considered immune . Data were analysed with SPSS 18.0 version . RESULTS In the JIA group 55 % were HBV immune ( anti-HBs level ≥10 IU/L ) while in the control group 92 % were immune against HBV ( p<0.001 ) . Antibody levels in the patient group were significantly lower compared to the control group . The mean concentration of anti-HBs levels in JIA patients was 18.3 IU/L versus 82.6 IU/L in the control group ( p<0.001 ) . 
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Children with SIRDs generally achieved seroprotection and seroconversion ; nevertheless , the antibody levels were often lower when compared with healthy children .
Glucocorticoids and conventional disease-modifying anti-rheumatic drugs do not seem to significantly hamper the immune responses , whereas TNF inhibitors may reduce antibody production , particularly in response to pneumococcal conjugate , influenza , meningococcal C and hepatitis A vaccine .
There were no serious adverse events , nor evidence of a relevant worsening of the underlying rheumatic disease .
Concerning live attenuated vaccines , the evidence is scarce , but no episodes of overt disease were reported , even in patients under biological therapy .
Existing literature demonstrates that vaccines are generally well tolerated and effective in stable SIRD patients , yet antibody titers are frequently lower than in healthy controls .
There is some evidence that biological therapy could hamper the immune response .