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| Recommendation | Median agreement by DELPHI voting on a scale of 0–9 (IQR) |
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| General vaccination guidelines |
| 1 | Vaccination status (including varicella and HBsAb) should be assessed in the initial investigation of patients with inflammatory rheumatic disease | 9 (1) |
| 2 | Vaccination should be administered 2–4 weeks before starting immunosuppressive therapy in patients with inflammatory rheumatic disease and ideally only during stable disease | 9 (0) |
| 3 | Vaccination of patients with inflammatory rheumatic disease should be carried out by the treating rheumatologist or in collaboration with public health physicians | 9 (2) |
| 4 | Live attenuated vaccines should be avoided in immunosuppressed patients with inflammatory rheumatic disease and those receiving biologic therapy and targeted synthetic DMARDs | 9 (1) |
| 5 | Nonlive attenuated vaccines can be administered alongside conventional synthetic DMARDs and TNFα-blocking agents in patients with inflammatory rheumatic disease, but they should ideally be administered prior to starting biologics or targeted synthetic DMARDs where possible, especially for B cell-depleting therapies | 9 (1) |
| 6 | The household members of immunocompromised patients can safely receive inactivated vaccines. Household members should be up to date and vaccinated on their recommended vaccines, especially influenza, varicella, and MMR. Inactivated polio vaccine (IPV) should be used instead of the oral live vaccine. Rotavirus vaccines should be avoided in household members of IRD patients receiving biologic therapy | 9 (1) |
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| Specific pathogen recommendations |
| 7 | Nonlive influenza vaccination should be strongly considered for patients with inflammatory rheumatic disease. The updated influenza vaccine should be given annually in all patients with autoimmune inflammatory disease | 9 (1) |
| 8 | Pneumococcal vaccination should be strongly considered for all patients with inflammatory rheumatic diseases | 9 (0) |
| 9 | Patients with inflammatory rheumatic disease should receive tetanus toxoid vaccination in accordance with Kuwaiti MOH recommendations for the general population. In case of major and/or contaminated wounds in patients who received rituximab within the last 24 weeks, passive immunisation with tetanus immunoglobulin should be administered | 9 (1) |
| 10 | Hepatitis B is endemic in Kuwait. It is recommended that all patients with inflammatory rheumatic diseases be screened for hepatitis B and vaccinated as required | 9 (1) |
| 11 | Varicella and zoster vaccines can be considered in patients with inflammatory rheumatic disease. Administration should be 2–4 weeks prior to initiation of conventional synthetic DMARDs, high-dose (>20 mg) steroids or biologic therapies, and targeted synthetic DMARDs | 9 (2) |
| 12 | BCG vaccination is not recommended in patients with inflammatory rheumatic disease | 8 (2) |
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| For specific patient subgroups |
| 13 | Pap smear test screening should be mandated for sexually active females; if indicated, HPV vaccination can be given in both male and female patients with inflammatory rheumatic diseases | 9 (1) |
| 14 | In hyposplenic or asplenic patients with inflammatory rheumatic disease, nonlive influenza, Haemophilus influenzae b, conjugate pneumococcal, and conjugate meningococcal ACWY vaccinations are recommended | 9 (0) |
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| For patients who wish to travel |
| 15 | Patients with inflammatory rheumatic diseases who plan to travel are recommended to receive their nonlive attenuated vaccines according to general Kuwaiti MOH and CDC rules. Live attenuated vaccines should be avoided in IRD patients on immunosuppression therapy | 9 (0) |
| 16 | Patients with inflammatory rheumatic disease who wish to undertake Hajj should receive meningococcal ACWY and pneumococcal vaccines within 10 days to 3 years prior to undertaking Hajj and seasonal nonlive influenza vaccine within 1 year | 9 (0) |
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