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Table 2 Questions used to formulate the recommendations

From: Brazilian recommendations on the safety and effectiveness of the yellow fever vaccination in patients with chronic immune-mediated inflammatory diseases

1. Are there specific restrictions on the indication of YFV in patients with CIMID baseline disease, activity, or medication use facing a yellow fever outbreak?

2. Is the risk of SAE following primary or booster YFV vaccination higher in patients with CIMID? Is this related to disease type or activity?

3. Is the risk of SAE following primary and booster YFV vaccination higher in patients using corticosteroid or CsDMARD, TsDMARD or JAK inhibitors?

4. Is the risk of SAE after primary or booster YFV vaccination higher in patients with CIMID using immunosuppressive drugs (azathioprine, cyclophosphamide, cyclosporine, mycophenolate mofetil/acid) or bDMARD?

5. Should an interval be recommended between YFV application (primary or booster) and initiation or restart of medications for CIMID treatment?

6. Should a minimum interval be recommended between discontinuation of medications for CIMID treatment and YFV application (primary or booster)?

7. Does the concomitant application of other vaccines interfere in the YFV response in patients receiving or not CIMID treatment?

8. Is there any contraindication of YFV in close contacts or people living with CIMID patients?

9. Does the use of immunomodulatory and/or immunosuppressive agents in patients with CIMID interfere in the YFV response or long-term efficacy?

  1. YFV: yellow fever vaccine; CIMID: chronic immune-mediated inflammatory diseases; DMARD: disease modifying anti-rheumatic drugs; csDMARD conventional synthetic DMARD – methotrexate, leflunomide, sulfasalazine and antimalarials (hydroxychloroquine and chloroquine); tsDMARD: synthetic target-specific DMARD – tofacitinib; bDMARD: biological DMARD – tumor necrosis factor inhibitors/TNFi (adalimumab, certolizumab, etanercept, golimumab, infliximab), T-lymphocyte costimulation modulator (abatacept), anti-CD20 (rituximab), and IL-6 receptor blocker (tocilizumab)