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Beer E, Chowdhury H, Carroll B, Luintel A, van Tulleken C, Longley N. Advising the immunocompromised traveller: a review of immunocompromise at The London Hospital for Tropical Diseases Travel Clinic between 1st April 2019 and 30th April 2020. Trop Dis Travel Med Vaccines 2024; 10:8. [PMID: 38616263 PMCID: PMC11017494 DOI: 10.1186/s40794-024-00217-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 01/09/2024] [Indexed: 04/16/2024] Open
Abstract
BACKGROUND Immunocompromised travellers (ICTs) face greater infectious and non-infectious travel-associated risks than their immunocompetent counterparts. Increasing travel and emergence of novel immunosuppressants poses great challenges for travel medicine practitioners to confidently provide up-to-date evidence-based risk management advice and pre-travel care for ICTs. METHODS We reviewed the records of ICTs attending the London Hospital for Tropical Diseases (HTD) Travel Clinic between 1st April 2019 and 30th April 2020 with the aim to describe demographic and travel characteristics, type, and severity of immunocompromise, the degree of risk associated with intended travel and evaluate travel advice. RESULTS Of the 193 ICTs identified, immunocompromise was due to physiological reasons (42%), chronic infection (17.1%) and immunosuppressive therapy (16.6%). Median age was 38 (range 9 months to 84 years) and male to female ratio 0.75 (83:110). Travel was intended to 80 countries for a median of 16 days (range 2 to 3167), predominantly for leisure (53%), non-medical work (17%) and visiting friends and relatives (12%). Live vaccine safety dominated discussion in the pre-travel consultation. Existing guidelines arguably fell short in dealing with travel risks associated with hyper-specific conditions, targeted immunosuppressants and non-vaccine preventable infections. CONCLUSIONS Our cohort represents a wide spectrum of immunocompromise, for whom we arguably need more measurable ways to approach travel-associated risks. We propose prospective qualitative participatory research to inform our unit of the priorities of ICTs in the pre-travel consultation. We further recommend the formation of a repository of specialists and formulary of complex cases to direct subsequent informative systematic review and prospective risk studies.
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Affiliation(s)
- Ellen Beer
- University College London Hospital, London, NW1 2BU, UK.
| | | | | | - Akish Luintel
- University College London Hospital, London, NW1 2BU, UK
| | | | - Nicky Longley
- Hospital for Tropical Diseases, University College London Hospital, London, NW1 2BU, UK
- London School of Hygiene & Tropical Medicine, Keppel St, London, WC1E 7HT, UK
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2
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Shan DM, Chandy RJ, Fultz A, Sanders JW, Feldman SR. Live vaccinations in dermatology for immunosuppressed patients: a narrative review. Arch Dermatol Res 2024; 316:96. [PMID: 38430244 DOI: 10.1007/s00403-024-02827-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 09/06/2023] [Accepted: 01/25/2024] [Indexed: 03/03/2024]
Abstract
Given the higher susceptibility to infectious disease in patients receiving immunosuppressive therapies for inflammatory dermatologic conditions, immunization is important in this population. While live vaccines protect against life-threatening diseases, they can be harmful in immunosuppressed patients given the risk of replication of the attenuated pathogen and adverse reactions. The utilization of live vaccines in immunosuppressed patients depends on multiple factors such as the vaccine and therapy regimen. To provide an overview of evidence-based recommendations for the use of live vaccines in patients receiving immunosuppressive therapies for dermatological conditions. A literature search of the PubMed database was performed using keywords live vaccine, live-attenuated vaccine, dermatology, immunosuppressed, and immunocompromised, and specific immunosuppressive therapies: corticosteroids, glucocorticoids, methotrexate, azathioprine, cyclosporine, mycophenolate mofetil, biologics. Relevant articles written in English were included. Using these keywords, 125 articles were reviewed, of which 28 were ultimately selected. Recommendations for live vaccines can be determined on a case-by-case basis. Measles, mumps, rubella, varicella (MMRV) vaccines may be safely administered to patients on low-dose immunosuppressive agents while the yellow fever vaccine is typically contraindicated. It may be safe to administer live MMRV boosters to children on immunosuppressive therapies and the live herpes zoster vaccine to patients on biologics. Given poor adherence to immunization guidelines in immunosuppressed patients, dermatologists have a critical role in educating patients and general practitioners regarding live vaccines. By reviewing a patient's vaccination history and following immunization guidelines prior to initiating immunosuppressive therapies, physicians can mitigate morbidity and mortality from vaccine-preventable diseases.
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Affiliation(s)
- Divya M Shan
- Center for Dermatology Research, Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
| | - Rithi J Chandy
- Center for Dermatology Research, Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Andrew Fultz
- Center for Dermatology Research, Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - John W Sanders
- Department of Infectious Diseases, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Steven R Feldman
- Center for Dermatology Research, Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- Department of Pathology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- Department of Dermatology, University of Southern Denmark, Odense, Denmark
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3
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Amai M, Nojima M, Yuki Y, Kiyono H, Nagamura F. A review of criteria strictness in "Toxicity Grading Scale for Healthy Adult and Adolescent Volunteers Enrolled in Preventive Vaccine Clinical Trials". Vaccine 2023; 41:5622-5629. [PMID: 37532612 DOI: 10.1016/j.vaccine.2023.07.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 07/25/2023] [Accepted: 07/29/2023] [Indexed: 08/04/2023]
Abstract
To assess safety in vaccine development, stricter grading scales, such as the "Toxicity Grading Scale for Healthy Adult and Adolescent Volunteers Enrolled in Preventive Vaccine Clinical Trials" issued by the U.S. Food and Drug Administration (FDA grading scale), are required. However, concern exists that their strictness may lead to an overestimation of some adverse events (AEs). We analyzed the details of AEs in a phase I clinical trial of a preventive vaccine for infectious diseases. In this trial, we observed the high occurrence of Grade 1 or greater AEs in hemoglobin changes from baseline value, and hypernatremia, and hypokalemia by FDA grading scale. The range considered as non-AE according to the FDA grading scale shifted or became narrower when compared to reference intervals, especially for a Japanese cohort. For sodium grading, the criterion for hypernatremia was around 2 to mEq/L lower than the upper limit of most standards in several countries. Also, the criterion for hypokalemia was around 0.2 mEq/L higher than the lower limit of most standards. Regarding a decrease in hemoglobin from baseline, the criterion of "any decrease" used for a Grade 1 AE was too strict and we suggest this be omitted. Upper and lower limits of AE criteria for sodium and potassium should be equal to, or 10-20% above, the reference interval consistent with other toxicities determined by laboratory tests. Consideration should be given to the issues surrounding the criteria that determine AEs before conducting clinical trials.
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Affiliation(s)
- Motoki Amai
- Center for Translational Research, IMSUT Hospital, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Masanori Nojima
- Center for Translational Research, IMSUT Hospital, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan; Division of Advanced Medicine Promotion, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan.
| | - Yoshikazu Yuki
- Department of Human Mucosal Vaccinology, Chiba University Hospital, Chiba, Japan; HanaVax Inc., Chiba, Japan
| | - Hiroshi Kiyono
- HanaVax Inc., Chiba, Japan; Chiba University Synergy Institute for Futuristic Mucosal Vaccine Research and Development (cSIMVa), Future Medicine Education and Research Organization, Chiba University, Chiba, Japan; CU-UCSD Center for Mucosal Immunology, Allergy, and Vaccine (cMAV), Departments of Medicine and Pathology, University of California, San Diego, CA, USA
| | - Fumitaka Nagamura
- Center for Translational Research, IMSUT Hospital, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan; Division of Advanced Medicine Promotion, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
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4
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Kling K, Domingo C, Bogdan C, Duffy S, Harder T, Howick J, Kleijnen J, McDermott K, Wichmann O, Wilder-Smith A, Wolff R. Duration of Protection After Vaccination Against Yellow Fever: A Systematic Review and Meta-Analysis. Clin Infect Dis 2022; 75:2266-2274. [PMID: 35856638 PMCID: PMC9761887 DOI: 10.1093/cid/ciac580] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 06/30/2022] [Accepted: 07/13/2022] [Indexed: 01/19/2023] Open
Abstract
The duration of protection after a single dose of yellow fever vaccine is a matter of debate. To summarize the current knowledge, we performed a systematic literature review and meta-analysis. Studies on the duration of protection after 1 and ≥2 vaccine doses were reviewed. Data were stratified by time since vaccination. In our meta-analysis, we used random-effects models. We identified 36 studies from 20 countries, comprising more than 17 000 participants aged 6 months to 85 years. Among healthy adults and children, pooled seroprotection rates after single vaccination dose were close to 100% by 3 months and remained high in adults for 5 to 10 years. In children vaccinated before age 2 years, the seroprotection rate was 52% within 5 years after primary vaccination. For immunodeficient persons, data indicate relevant waning. The extent of waning of seroprotection after yellow fever vaccination depends on age and immune status at primary vaccination.
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Affiliation(s)
- Kerstin Kling
- Immunization Unit, Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Cristina Domingo
- Center for International Health Protection, Robert Koch Institute, Berlin, Germany
| | - Christian Bogdan
- Mikrobiologisches Institut - Klinische Mikrobiologie, Immunologie und Hygiene, Friedrich Alexander Universität (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Steven Duffy
- Kleijnen Systematic Reviews Ltd, York, United Kingdom
| | - Thomas Harder
- Immunization Unit, Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Jeremy Howick
- Kleijnen Systematic Reviews Ltd, York, United Kingdom
| | - Jos Kleijnen
- Kleijnen Systematic Reviews Ltd, York, United Kingdom
| | | | - Ole Wichmann
- Immunization Unit, Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Annelies Wilder-Smith
- Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany.,Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Robert Wolff
- Kleijnen Systematic Reviews Ltd, York, United Kingdom
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5
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Wigg de Araújo Lagos L, de Jesus Lopes de Abreu A, Caetano R, Braga JU. Yellow fever vaccine safety in immunocompromised individuals: a systematic review and meta-analysis. J Travel Med 2022; 30:6659960. [PMID: 35947986 DOI: 10.1093/jtm/taac095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 07/21/2022] [Accepted: 08/02/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND Yellow fever is an arbovirus with variable severity, including severe forms with high mortality. The vaccination is the most effective measure to protect against the disease. Nonserious and serious adverse events have been described in immunocompromised individuals, but previous studies have failed to demonstrate this association. This systematic review assessed the risk of adverse events after yellow fever vaccination in immunocompromised individuals compared to its use in non-immunocompromised individuals. METHODS A search was conducted in the MEDLINE, LILACS, EMBASE, SCOPUS, DARE, Toxiline, Web of Science and grey literature databases for publications until February 2021. Randomized and quasi-randomized clinical trials and observational studies that included immunocompromised participants (individuals with HIV infection, organ transplants, with cancer, who used immunosuppressive drugs for rheumatologic diseases and those on immunosuppressive therapy for other diseases) were selected. The methodological quality of observational or non-randomized studies was assessed by the ROBINS-I tool. Two meta-analyses were performed, proportion and risk factor analyses, to identify the summary measure of relative risk (RR) in the studies that had variables suitable for combination. RESULTS Twenty-five studies were included, most with risk of bias classified as critical. Thirteen studies had enough data to carry out the proposed meta-analyses. Seven studies without a comparator group had their results aggregated in the proportion meta-analysis, identifying an 8.5% (95% CI 0.07-21.8) risk of immunocompromised individuals presenting adverse events after vaccination. Six cohort studies were combined, with an RR of 1.00 (95% CI 0.78-1.29). Subgroup analysis was performed according to the aetiology of immunosuppression and was also unable to identify an increased risk of adverse events following vaccination. CONCLUSIONS It is not possible to affirm that immunocompromised individuals, regardless of aetiology, have a higher risk of adverse events after receiving the yellow fever vaccine.
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Affiliation(s)
- Letícia Wigg de Araújo Lagos
- Núcleo de Avaliação de Tecnologias em Saúde (NATS), Instituto Nacional de Cardiologia, Rio de Janeiro, RJ, Brazil
| | | | - Rosângela Caetano
- Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, RJ, Brazil
| | - José Ueleres Braga
- Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, RJ, Brazil
- Escola Nacional de Saúde Pública Sérgio Arouca, Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, RJ, Brazil
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6
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Jansen MH, Rondaan C, Legger G, Minden K, Uziel Y, Toplak N, Maritsi D, van den Berg M, Berbers G, Bruijning P, Egert Y, Normand C, Bijl M, Foster H, Kone-Paut I, Wouters C, Ravelli A, Elkayam O, Wulffraat NM, Heijstek MW. Efficacy, Immunogenicity and Safety of Vaccination in Pediatric Patients With Autoimmune Inflammatory Rheumatic Diseases (pedAIIRD): A Systematic Literature Review for the 2021 Update of the EULAR/PRES Recommendations. Front Pediatr 2022; 10:910026. [PMID: 35874582 PMCID: PMC9298835 DOI: 10.3389/fped.2022.910026] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 05/25/2022] [Indexed: 11/13/2022] Open
Abstract
Background In 2011, the first European League Against Rheumatism (EULAR) vaccination recommendations for pediatric patients with autoimmune inflammatory rheumatic diseases (pedAIIRD) were published. The past decade numerous new studies were performed to assess the safety, efficacy and immunogenicity of vaccinations in pedAIIRD. A systematic literature review (SLR) was therefore performed to serve as the basis for the updated 2021 EULAR/PRES recommendations. Methods An SLR was performed according to the standard operating procedures for EULAR-endorsed recommendations. Primary outcomes were efficacy, immunogenicity and safety of vaccination in pedAIIRD. The search was performed in Medline, Embase and the Cochrane Library and included studies published from November 2010 until July 2020. Results The SLR yielded 57 studies which were included for critical appraisal and data extraction. Only 8 studies described the occurrence of vaccine-preventable infections after vaccination (efficacy), none of these studies were powered to assess efficacy. The majority of studies assessed (humoral) immune responses as surrogate endpoint for vaccine efficacy. Studies on non-live vaccines showed that these were safe and in general immunogenic. Biologic disease-modifying antirheumatic drugs (bDMARDs) in general did not significantly reduce seroprotection rates, except for B-cell depleting therapies which severely hampered humoral responses. Four new studies on human papilloma virus vaccination showed that this vaccine was safe and immunogenic in pedAIIRD. Regarding live-attenuated vaccinations, level 1 evidence of the measles mumps rubella (MMR) booster vaccination became available which showed the safety of this booster for patients treated with methotrexate. In addition, level 3 evidence became available that suggested that the MMR and varicella zoster virus (VZV) vaccination for patients on low dose glucocorticosteroids and bDMARDs might be safe as well. Conclusions The past decade, knowledge on the safety and immunogenicity of (live-attenuated) vaccines in pedAIIRD significantly increased. Data on efficacy (infection prevention) remains scarce. The results from this SLR are the basis for the updated EULAR/PRES vaccination recommendations in pedAIIRD.
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Affiliation(s)
- Marc H. Jansen
- Department of Paediatric Immunology & Rheumatology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, Netherlands
- RITA, European Reference Networks, Brussels, Belgium
| | - Christien Rondaan
- Department of Medical Microbiology and Infection Prevention, University Medical Centre Groningen, University of Groningen, Groningen, Netherlands
| | - Geertje Legger
- RITA, European Reference Networks, Brussels, Belgium
- Department of Paediatric Rheumatology, Beatrix Children's Hospital, University Medical Centre Groningen, University of Groningen, Groningen, Netherlands
| | - Kirsten Minden
- Department of Paediatric Respiratory Medicine, Immunology and Critical Care Medicine, Deutsches Rheuma-Forschungszentrum Berlin, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Berlin, Germany
- Epidemiology Unit, German Rheumatism Research Centre, Berlin, Germany
| | - Yosef Uziel
- Paediatric Rheumatology Unit, Department of Paediatrics, Meir Medical Centre, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Nataša Toplak
- RITA, European Reference Networks, Brussels, Belgium
- Department of Allergology, Rheumatology and Clinical Immunology, University Children's Hospital Ljubljana, Ljubljana, Slovenia
| | - Despoina Maritsi
- Infectious Diseases, Immunology and Rheumatology Unit, Second Department of Paediatrics, Medical School, P. & A. Kyriakou Children's Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Guy Berbers
- Centre for Infectious Disease Control, Laboratory for Infectious Diseases and Screening, National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
| | - Patricia Bruijning
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
| | - Yona Egert
- European Network for Children With Arthritis (ENCA), MCI Secretariat, Geneva, Switzerland
| | - Christophe Normand
- RITA, European Reference Networks, Brussels, Belgium
- European Network for Children With Arthritis (ENCA), MCI Secretariat, Geneva, Switzerland
| | - Marc Bijl
- Department of Rheumatology and Clinical Immunology, Martini Hospital Groningen, Groningen, Netherlands
| | - Helen Foster
- Population and Health Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Isabelle Kone-Paut
- RITA, European Reference Networks, Brussels, Belgium
- Department of Paediatric Rheumatology and CEREMAIA, Bicêtre University Hospital, Université Paris Saclay, Paris, France
| | - Carine Wouters
- Division of Paediatric Rheumatology University Hospitals Leuven, Leuven, Belgium
| | - Angelo Ravelli
- RITA, European Reference Networks, Brussels, Belgium
- Direzione Scientifica, IRCCS Istituto Giannina Gaslini, Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili (DINOGMI), Università degli Studi di Genova, Genoa, Italy
| | - Ori Elkayam
- Department of Rheumatology, Sackler Faculty of Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Nicolaas M. Wulffraat
- Department of Paediatric Immunology & Rheumatology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, Netherlands
- RITA, European Reference Networks, Brussels, Belgium
| | - Marloes W. Heijstek
- RITA, European Reference Networks, Brussels, Belgium
- Department of Rheumatology & Clinical Immunology, University Medical Centre Utrecht, Utrecht, Netherlands
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A New Consideration for Corticosteroid Injections: Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2/COVID-19) Vaccination. J Hand Surg Am 2022; 47:79-83. [PMID: 34561136 PMCID: PMC8282473 DOI: 10.1016/j.jhsa.2021.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 06/07/2021] [Accepted: 07/02/2021] [Indexed: 02/07/2023]
Abstract
Corticosteroid injection (CSI) is a commonly used tool in hand surgery that is often given little consideration as a potential detriment to vaccination efficacy. The authors reviewed guidelines issued by relevant societies for the timing of CSI around the severe acute respiratory syndrome coronavirus 2 vaccination period and the evidence used to support them. Ultimately, providers and patients should be adequately educated on the theoretical risks and benefits before proceeding with CSI immediately before, during, or immediately after coronavirus disease 2019 vaccination.
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8
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Friedman MA, Curtis JR, Winthrop KL. Impact of disease-modifying antirheumatic drugs on vaccine immunogenicity in patients with inflammatory rheumatic and musculoskeletal diseases. Ann Rheum Dis 2021; 80:1255-1265. [PMID: 34493491 DOI: 10.1136/annrheumdis-2021-221244] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 08/25/2021] [Indexed: 12/14/2022]
Abstract
Patients with rheumatic diseases are at increased risk of infectious complications; vaccinations are a critical component of their care. Disease-modifying antirheumatic drugs may reduce the immunogenicity of common vaccines. We will review here available data regarding the effect of these medications on influenza, pneumococcal, herpes zoster, SARS-CoV-2, hepatitis B, human papilloma virus and yellow fever vaccines. Rituximab has the most substantial impact on vaccine immunogenicity, which is most profound when vaccinations are given at shorter intervals after rituximab dosing. Methotrexate has less substantial effect but appears to adversely impact most vaccine immunogenicity. Abatacept likely decrease vaccine immunogenicity, although these studies are limited by the lack of adequate control groups. Janus kinase and tumour necrosis factor inhibitors decrease absolute antibody titres for many vaccines, but do not seem to significantly impact the proportions of patients achieving seroprotection. Other biologics (interleukin-6R (IL-6R), IL-12/IL-23 and IL-17 inhibitors) have little observed impact on vaccine immunogenicity. Data regarding the effect of these medications on the SARS-CoV-2 vaccine immunogenicity are just now emerging, and early glimpses appear similar to our experience with other vaccines. In this review, we summarise the most recent data regarding vaccine response and efficacy in this setting, particularly in light of current vaccination recommendations for immunocompromised patients.
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Affiliation(s)
| | - Jeffrey R Curtis
- Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham Department of Medicine, Birmingham, Alabama, USA
| | - Kevin L Winthrop
- Medicine, Oregon Health & Science University, Portland, Oregon, USA.,School of Public Health, Oregon Health & Science University, Portland, Oregon, USA
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9
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Lara AN, Miyaji KT, Ibrahim KY, Lopes MH, Sartori AMC. Adverse events following yellow fever vaccination in immunocompromised persons. Rev Inst Med Trop Sao Paulo 2021; 63:e13. [PMID: 33656136 PMCID: PMC7924977 DOI: 10.1590/s1678-9946202163013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 10/15/2020] [Indexed: 12/15/2022] Open
Abstract
This observational retrospective study conducted during an yellow fever (YF)
outbreak in Sao Paulo, Brazil, in 2017-2018, describes adverse events (AE)
following YF vaccination of immunocompromised persons. Risks and benefits of
vaccination were individually evaluated by physicians. AE were assessed by phone
call or electronic mail, 14 to 90 days after vaccination. Three hundred and
eighty one immunocompromised persons received a full-dose of YF vaccine. Their
age ranged from 1.4 to 89.3 years (median 50.8 years); 53% were women; 178
(46.7%) had chronic kidney disease, 78 (20.5%) had immune-mediated inflammatory
diseases; 94 (24.7%) were using or had recently used immunosuppressive/
immunomodulatory drugs. All of them denied previous YF vaccination. We were able
to contact 341 (89.5%) vaccinees: 233 (68.3%) of them received the YF vaccine
from BioManguinhos and 108 (31.7%) received the vaccine from Sanofi-Pasteur; 130
(38.1%) vaccinees received other vaccines (up to 4) simultaneously with the the
YF vaccine, mostly hepatitis B (59 vaccinees), pneumococcal polysaccharide
23-valent (46), influenza (43) and diphtheria-tetanus (dT, 41). One hundred and
eleven vaccinees (32.6%) reported at least one AE: 79 (23.2%) presented systemic
AE, 44 (12.9%) had local AE and 12 had both, local and systemic AE. The most
common AE was pain at the injection site (41 persons, 12%), myalgia (34; 10%),
fever (25; 7.3%) and headache (16; 4.7%). There was no statistically significant
difference on the AE frequency according to the vaccine producer. There were
four severe AE: one hospitalization and three deaths, considered not related to
the YF vaccine.
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Affiliation(s)
- Amanda Nazareth Lara
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Centro de Referência para Imunobiológicos Especiais, São Paulo, São Paulo, Brazil
| | - Karina Takesaki Miyaji
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Centro de Referência para Imunobiológicos Especiais, São Paulo, São Paulo, Brazil
| | - Karim Yaqub Ibrahim
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Centro de Referência para Imunobiológicos Especiais, São Paulo, São Paulo, Brazil
| | - Marta Heloisa Lopes
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Centro de Referência para Imunobiológicos Especiais, São Paulo, São Paulo, Brazil
| | - Ana Marli Christovam Sartori
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Centro de Referência para Imunobiológicos Especiais, São Paulo, São Paulo, Brazil
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10
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Gresham LM, Marzario B, Dutz J, Kirchhof MG. An evidence-based guide to SARS-CoV-2 vaccination of patients on immunotherapies in dermatology. J Am Acad Dermatol 2021; 84:1652-1666. [PMID: 33482251 PMCID: PMC7816618 DOI: 10.1016/j.jaad.2021.01.047] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 01/08/2021] [Accepted: 01/15/2021] [Indexed: 12/15/2022]
Abstract
Immune-mediated diseases and immunotherapeutics can negatively affect normal immune functioning and, consequently, vaccine safety and response. The COVID-19 pandemic has incited research aimed at developing a novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine. As SARS-CoV-2 vaccines are developed and made available, the assessment of anticipated safety and efficacy in patients with immune-mediated dermatologic diseases and requiring immunosuppressive and/or immunomodulatory therapy is particularly important. A review of the literature was conducted by a multidisciplinary committee to provide guidance on the safety and efficacy of SARS-CoV-2 vaccination for dermatologists and other clinicians when prescribing immunotherapeutics. The vaccine platforms being used to develop SARS-CoV-2 vaccines are expected to be safe and potentially effective for dermatology patients on immunotherapeutics. Current guidelines for the vaccination of an immunocompromised host remain appropriate when considering future administration of SARS-CoV-2 vaccines.
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Affiliation(s)
- Louise M Gresham
- Division of Dermatology, Department of Medicine, University of Ottawa and The Ottawa Hospital, Ottawa, Canada
| | - Barbara Marzario
- Division of Dermatology, Department of Medicine, University of Ottawa and The Ottawa Hospital, Ottawa, Canada
| | - Jan Dutz
- Department of Dermatology and Skin Sciences, University of British Columbia, Vancouver, Canada
| | - Mark G Kirchhof
- Division of Dermatology, Department of Medicine, University of Ottawa and The Ottawa Hospital, Ottawa, Canada.
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11
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Valim V, Machado KLLL, Miyamoto ST, Pinto AD, Rocha PCM, Serrano EV, Dinis VG, Gouvêa SA, Dias JGF, Campi-Azevedo AC, Teixeira-Carvalho A, Peruhype-Magalhães V, da Costa-Rocha IA, de Lima SMB, Miranda EH, Trindade GF, Maia MDLDS, Gavi MBRDO, da Silva LB, Duque RH, Gianordoli APE, Casagrande TZ, Oliveira KG, Moura BCDM, Nicole-Batista F, Rodrigues LC, Clemente TB, Magalhães ES, Bissoli MDF, Gouvea MDPG, Pinto-Neto LFDS, Costa CZ, Giovelli RA, Brandão LR, Polito ETL, Koehlert IDO, Borjaille BP, Pereira DB, Dias LH, Merlo DL, Genelhu LFF, Pretti FZ, Giacomin MDS, Burian APN, Fantinato FFST, Pileggi GS, da Mota LMH, Martins-Filho OA. Planned Yellow Fever Primary Vaccination Is Safe and Immunogenic in Patients With Autoimmune Diseases: A Prospective Non-interventional Study. Front Immunol 2020; 11:1382. [PMID: 32765496 PMCID: PMC7379374 DOI: 10.3389/fimmu.2020.01382] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Accepted: 05/29/2020] [Indexed: 12/16/2022] Open
Abstract
Yellow Fever (YF) vaccination is suggested to induce a large number of adverse events (AE) and suboptimal responses in patients with autoimmune diseases (AID); however, there have been no studies on 17DD-YF primary vaccination performance in patients with AID. This prospective non-interventional study conducted between March and July, 2017 assessed the safety and immunogenicity of planned 17DD-YF primary vaccination in patients with AID. Adult patients with AID (both sexes) were enrolled, along with healthy controls, at a single hospital (Vitória, Brazil). Included patients were referred for planned vaccination by a rheumatologist; in remission, or with low disease activity; and had low level immunosuppression or the attending physician advised interruption of immunosuppression for safety reasons. The occurrence of AE, neutralizing antibody kinetics, seropositivity rates, and 17DD-YF viremia were evaluated at various time points (day 0 (D0), D3, D4, D5, D6, D14, and D28). Individuals evaluated (n = 278), including patients with rheumatoid arthritis (RA; 79), spondyloarthritis (SpA; 59), systemic sclerosis (8), systemic lupus erythematosus (SLE; 27), primary Sjögren's syndrome (SS; 54), and healthy controls (HC; 51). Only mild AE were reported. The frequency of local and systemic AE in patients with AID and HC did not differ significantly (8 vs. 10% and 21 vs. 32%; p = 1.00 and 0.18, respectively). Patients with AID presented late seroconversion profiles according to kinetic timelines of the plaque reduction neutralization test (PRNT). PRNT-determined virus titers (copies/mL) [181 (95% confidence interval (CI), 144–228) vs. 440 (95% CI, 291–665), p = 0.004] and seropositivity rate (78 vs. 96%, p = 0.01) were lower in patients with AID after 28 days, particularly those with SpA (73%) and SLE (73%), relative to HC. The YF viremia peak (RNAnemia) was 5–6 days after vaccination in all groups. In conclusion, consistent seroconversion rates were observed in patients with AID and our findings support that planned 17DD-YF primary vaccination is safe and immunogenic in patients with AID.
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Affiliation(s)
- Valéria Valim
- Divisão de Reumatologia do Hospital Universitário Cassiano Antônio de Moraes, Universidade Federal do Espírito Santo (UFES), Vitória, Brazil
| | - Ketty Lysie Libardi Lira Machado
- Divisão de Reumatologia do Hospital Universitário Cassiano Antônio de Moraes, Universidade Federal do Espírito Santo (UFES), Vitória, Brazil
| | - Samira Tatiyama Miyamoto
- Divisão de Reumatologia do Hospital Universitário Cassiano Antônio de Moraes, Universidade Federal do Espírito Santo (UFES), Vitória, Brazil
| | - Arthur Dalmaso Pinto
- Divisão de Reumatologia do Hospital Universitário Cassiano Antônio de Moraes, Universidade Federal do Espírito Santo (UFES), Vitória, Brazil
| | - Priscila Costa Martins Rocha
- Divisão de Reumatologia do Hospital Universitário Cassiano Antônio de Moraes, Universidade Federal do Espírito Santo (UFES), Vitória, Brazil
| | - Erica Vieira Serrano
- Divisão de Reumatologia do Hospital Universitário Cassiano Antônio de Moraes, Universidade Federal do Espírito Santo (UFES), Vitória, Brazil
| | - Valquiria Garcia Dinis
- Divisão de Reumatologia do Hospital Universitário Cassiano Antônio de Moraes, Universidade Federal do Espírito Santo (UFES), Vitória, Brazil.,Escola de Ciências da Saúde da Santa Casa de Misericórdia, Vitória, Brazil
| | - Sônia Alves Gouvêa
- Divisão de Reumatologia do Hospital Universitário Cassiano Antônio de Moraes, Universidade Federal do Espírito Santo (UFES), Vitória, Brazil
| | - João Gabriel Fragoso Dias
- Divisão de Reumatologia do Hospital Universitário Cassiano Antônio de Moraes, Universidade Federal do Espírito Santo (UFES), Vitória, Brazil
| | | | | | | | | | - Sheila Maria Barbosa de Lima
- Instituto de Tecnologia em Imunobiológicos (Bio-Manguinhos), Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil
| | - Emily Hime Miranda
- Instituto de Tecnologia em Imunobiológicos (Bio-Manguinhos), Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil
| | - Gisela Freitas Trindade
- Instituto de Tecnologia em Imunobiológicos (Bio-Manguinhos), Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil
| | | | | | - Lidia Balarini da Silva
- Divisão de Reumatologia do Hospital Universitário Cassiano Antônio de Moraes, Universidade Federal do Espírito Santo (UFES), Vitória, Brazil
| | - Ruben Horst Duque
- Divisão de Reumatologia do Hospital Universitário Cassiano Antônio de Moraes, Universidade Federal do Espírito Santo (UFES), Vitória, Brazil
| | - Ana Paula Espíndula Gianordoli
- Divisão de Reumatologia do Hospital Universitário Cassiano Antônio de Moraes, Universidade Federal do Espírito Santo (UFES), Vitória, Brazil
| | - Thays Zanon Casagrande
- Divisão de Reumatologia do Hospital Universitário Cassiano Antônio de Moraes, Universidade Federal do Espírito Santo (UFES), Vitória, Brazil
| | - Karine Gadioli Oliveira
- Divisão de Reumatologia do Hospital Universitário Cassiano Antônio de Moraes, Universidade Federal do Espírito Santo (UFES), Vitória, Brazil
| | - Bruna Costa da Mata Moura
- Divisão de Reumatologia do Hospital Universitário Cassiano Antônio de Moraes, Universidade Federal do Espírito Santo (UFES), Vitória, Brazil
| | - Fernanda Nicole-Batista
- Divisão de Reumatologia do Hospital Universitário Cassiano Antônio de Moraes, Universidade Federal do Espírito Santo (UFES), Vitória, Brazil
| | - Luiza Correa Rodrigues
- Divisão de Reumatologia do Hospital Universitário Cassiano Antônio de Moraes, Universidade Federal do Espírito Santo (UFES), Vitória, Brazil
| | - Thalles Brandão Clemente
- Divisão de Reumatologia do Hospital Universitário Cassiano Antônio de Moraes, Universidade Federal do Espírito Santo (UFES), Vitória, Brazil
| | - Enan Sales Magalhães
- Divisão de Reumatologia do Hospital Universitário Cassiano Antônio de Moraes, Universidade Federal do Espírito Santo (UFES), Vitória, Brazil
| | - Maria de Fatima Bissoli
- Divisão de Reumatologia do Hospital Universitário Cassiano Antônio de Moraes, Universidade Federal do Espírito Santo (UFES), Vitória, Brazil
| | - Maria da Penha Gomes Gouvea
- Divisão de Reumatologia do Hospital Universitário Cassiano Antônio de Moraes, Universidade Federal do Espírito Santo (UFES), Vitória, Brazil
| | | | | | | | | | | | | | | | | | - Laiza Hombre Dias
- Sociedade de Reumatologia do Espírito Santo (SORES), Vitória, Brazil
| | | | | | - Flavia Zon Pretti
- Sociedade de Reumatologia do Espírito Santo (SORES), Vitória, Brazil
| | | | - Ana Paula Neves Burian
- Centro de Referências para Imunobiológicos Especiais (CRIE) da Secretaria de Saúde do Estado do Espírito Santo, Vitória, Brazil
| | | | | | - Lícia Maria Henrique da Mota
- Divisão de Reumatologia do Hospital Universitário de Brasília, Faculdade de Medicina, Universidade de Brasília, Brasília, Brazil
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12
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Rondaan C, Furer V, Heijstek MW, Agmon-Levin N, Bijl M, Breedveld FC, D'Amelio R, Dougados M, Kapetanovic MC, van Laar JM, Ladefoged de Thurah A, Landewé R, Molto A, Müller-Ladner U, Schreiber K, Smolar L, Walker J, Warnatz K, Wulffraat NM, van Assen S, Elkayam O. Efficacy, immunogenicity and safety of vaccination in adult patients with autoimmune inflammatory rheumatic diseases: a systematic literature review for the 2019 update of EULAR recommendations. RMD Open 2019; 5:e001035. [PMID: 31565247 PMCID: PMC6744079 DOI: 10.1136/rmdopen-2019-001035] [Citation(s) in RCA: 86] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 08/01/2019] [Accepted: 08/06/2019] [Indexed: 12/18/2022] Open
Abstract
Aim To present a systematic literature review (SLR) on efficacy, immunogenicity and safety of vaccination in adult patients with autoimmune inflammatory rheumatic diseases (AIIRD), aiming to provide a basis for updating the EULAR evidence-based recommendations. Methods An SLR was performed according to the standard operating procedures for EULAR-endorsed recommendations. Outcome was determined by efficacy, immunogenicity and safety of vaccination in adult patients with AIIRD, including those receiving immunomodulating therapy. Furthermore, a search was performed on the effect of vaccinating household members of patients with AIIRD on the occurrence of vaccine-preventable infections in patients and their household members (including newborns). The literature search was performed using Medline, Embase and the Cochrane Library (October 2009 to August 2018). Results While most investigated vaccines were efficacious and/or immunogenic in patients with AIIRD, some were less efficacious than in healthy control subjects, and/or in patients receiving immunosuppressive agents. Adverse events of vaccination were generally mild and the rates were comparable to those in healthy persons. Vaccination did not seem to lead to an increase in activity of the underlying AIIRD, but insufficient power of most studies precluded arriving at definite conclusions. The number of studies investigating clinical efficacy of vaccination is still limited. No studies on the effect of vaccinating household members of patients with AIIRD were retrieved. Conclusion Evidence on efficacy, immunogenicity and safety of vaccination in patients with AIIRD was systematically reviewed to provide a basis for updated recommendations.
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Affiliation(s)
- Christien Rondaan
- Medical microbiology and infection prevention, UMCG, Groningen, The Netherlands.,Rheumatology and Clinical Immunology, UMCG, Groningen, The Netherlands
| | - Victoria Furer
- Rheumatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Faculty of Medicine, Tel Aviv University Sackler, Tel Aviv, Israel
| | - Marloes W Heijstek
- Internal Medicine and Allergology, Rheumatology and Clinical Immunology, UMC Utrecht, Utrecht, The Netherlands
| | - Nancy Agmon-Levin
- Faculty of Medicine, Tel Aviv University Sackler, Tel Aviv, Israel.,Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, Israel
| | - Marc Bijl
- Internal Medicine, Martini Hospital, Groningen, The Netherlands
| | - Ferdinand C Breedveld
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Raffaele D'Amelio
- Dipartimento di Medicina Clinica e Molecolare, Sapienza University of Rome, Roma, Italy
| | - Maxime Dougados
- Hopital Cochin, Rheumatology, Université Paris Descartes, Paris, France.,Clinical epidemiology and biostatistics, PRES Sorbonne Paris- Cité, Paris, France
| | - Meliha C Kapetanovic
- Department of Clinical Sciences, Section for Rheumatology, Lund University, Lund and Skåne University Hospital, Lund, Sweden
| | - Jacob M van Laar
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Robert Landewé
- Clinical Immunology & Rheumatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.,Rheumatology, Zuyderland Medical Centre, Sittard-Geleen - Heerlen, The Netherlands
| | - Anna Molto
- Hopital Cochin, Rheumatology, Université Paris Descartes, Paris, France
| | - Ulf Müller-Ladner
- Rheumatology and Clinical Immunology, Giessen University, Giessen, Germany
| | - Karen Schreiber
- Department of Thrombosis and Haemophilia, Guy's and Saint Thomas' Hospitals NHS Trust, London, UK.,Rheumatology, King Christian X's Hospital for Rheumatic Diseases in Gråsten, Graasten, Denmark
| | - Leo Smolar
- Patient Research Partner, Tel Aviv, Israel
| | - Jim Walker
- Patient Research Partner, Elgin, Scotland
| | - Klaus Warnatz
- Centre for Chronic Immunodeficiency, University Medical Centre Freiburg, Freiburg, Germany
| | - Nico M Wulffraat
- Pediatric Rheumatology, Wilhelmina Kinderziekenhuis, Utrecht, The Netherlands
| | - Sander van Assen
- Internal medicine (infectious diseases), Treant Care Group, Hoogeveen, The Netherlands
| | - Ori Elkayam
- Rheumatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Faculty of Medicine, Tel Aviv University Sackler, Tel Aviv, Israel
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13
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Furer V, Rondaan C, Heijstek MW, Agmon-Levin N, van Assen S, Bijl M, Breedveld FC, D'Amelio R, Dougados M, Kapetanovic MC, van Laar JM, de Thurah A, Landewé RBM, Molto A, Müller-Ladner U, Schreiber K, Smolar L, Walker J, Warnatz K, Wulffraat NM, Elkayam O. 2019 update of EULAR recommendations for vaccination in adult patients with autoimmune inflammatory rheumatic diseases. Ann Rheum Dis 2019; 79:39-52. [DOI: 10.1136/annrheumdis-2019-215882] [Citation(s) in RCA: 357] [Impact Index Per Article: 71.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 07/19/2019] [Accepted: 07/22/2019] [Indexed: 12/16/2022]
Abstract
To update the European League Against Rheumatism (EULAR) recommendations for vaccination in adult patients with autoimmune inflammatory rheumatic diseases (AIIRD) published in 2011. Four systematic literature reviews were performed regarding the incidence/prevalence of vaccine-preventable infections among patients with AIIRD; efficacy, immunogenicity and safety of vaccines; effect of anti-rheumatic drugs on the response to vaccines; effect of vaccination of household of AIIRDs patients. Subsequently, recommendations were formulated based on the evidence and expert opinion. The updated recommendations comprise six overarching principles and nine recommendations. The former address the need for an annual vaccination status assessment, shared decision-making and timing of vaccination, favouring vaccination during quiescent disease, preferably prior to the initiation of immunosuppression. Non-live vaccines can be safely provided to AIIRD patients regardless of underlying therapy, whereas live-attenuated vaccines may be considered with caution. Influenza and pneumococcal vaccination should be strongly considered for the majority of patients with AIIRD. Tetanus toxoid and human papilloma virus vaccination should be provided to AIIRD patients as recommended for the general population. Hepatitis A, hepatitis B and herpes zoster vaccination should be administered to AIIRD patients at risk. Immunocompetent household members of patients with AIIRD should receive vaccines according to national guidelines, except for the oral poliomyelitis vaccine. Live-attenuated vaccines should be avoided during the first 6 months of life in newborns of mothers treated with biologics during the second half of pregnancy. These 2019 EULAR recommendations provide an up-to-date guidance on the management of vaccinations in patients with AIIRD.
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14
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Pileggi GS, Da Mota LMH, Kakehasi AM, De Souza AW, Rocha A, de Melo AKG, da Fonte CAM, Bortoletto C, Brenol CV, Marques CDL, Zaltman C, Borba EF, Reis ER, Freire EAM, Klumb EM, Christopoulos GB, Laurindo IMM, Ballalai I, Da Costa IP, Michelin L, de Azevêdo Valadares LD, Chebli LA, Lacerda M, Toscano MAF, Yazbek MA, De Abreu Vieira RMR, Magalhães R, Kfouri R, Richtmann R, Merenlender SDCS, Valim V, De Assis MR, Kowalski SC, Trevisani VFM. Brazilian recommendations on the safety and effectiveness of the yellow fever vaccination in patients with chronic immune-mediated inflammatory diseases. Adv Rheumatol 2019; 59:17. [PMID: 31036077 DOI: 10.1186/s42358-019-0056-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 03/06/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In Brazil, we are facing an alarming epidemic scenario of Yellow fever (YF), which is reaching the most populous areas of the country in unvaccinated people. Vaccination is the only effective tool to prevent YF. In special situations, such as patients with chronic immune-mediated inflammatory diseases (CIMID), undergoing immunosuppressive therapy, as a higher risk of severe adverse events may occur, assessment of the risk-benefit ratio of the yellow fever vaccine (YFV) should be performed on an individual level. Faced with the scarcity of specific orientation on YFV for this special group of patients, the Brazilian Rheumatology Society (BRS) endorsed a project aiming the development of individualized YFV recommendations for patients with CIMID, guided by questions addressed by both medical professionals and patients, followed an internationally validated methodology (GIN-McMaster Guideline Development). Firstly, a systematic review was carried out and an expert panel formed to take part of the decision process, comprising BRS clinical practitioners, as well as individuals from the Brazilian Dermatology Society (BDS), Brazilian Inflammatory Bowel Diseases Study Group (GEDIIB), and specialists on infectious diseases and vaccination (from Tropical Medicine, Infectious Diseases and Immunizations National Societies); in addition, two representatives of patient groups were included as members of the panel. When the quality of the evidence was low or there was a lack of evidence to determine the recommendations, the decisions were based on the expert opinion panel and a Delphi approach was performed. A recommendation was accepted upon achieving ≥80% agreement among the panel, including the patient representatives. As a result, eight recommendations were developed regarding the safety of YFV in patients with CIMID, considering the immunosuppression degree conferred by the treatment used. It was not possible to establish recommendations on the effectiveness of YFV in these patients as there is no consistent evidence to support these recommendations. CONCLUSION This paper approaches a real need, assessed by clinicians and patient care groups, to address specific questions on the management of YFV in patients with CIMID living or traveling to YF endemic areas, involving specialists from many areas together with patients, and might have global applicability, contributing to and supporting vaccination practices. We recommended a shared decision-making approach on taking or not the YFV.
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Affiliation(s)
- Gecilmara Salviato Pileggi
- SBR. Faculdade de Ciências da Saúde de Barretos - FACISB, Barretos, São Paulo, Brazil. .,School of Medical Science Barretos- FACISB, Avenue Masonic Lodge Renovadora 68, No. 100 - Airport Neighborhood, Barretos/SP, 14785-002, Brazil.
| | | | - Adriana Maria Kakehasi
- SBR. Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | - Aline Rocha
- Pós graduanda do programa de Medicina Baseada em Evidências, Universidade Federal do Estado de São Paulo (UNIFESP), São Paulo, Brazil
| | - Ana Karla Guedes de Melo
- SBR. Hospital Universitário Lauro Wanderley, Universidade Federal da Paraíba (UFPB), João Pessoa, Brazil
| | | | | | - Claiton Viegas Brenol
- SBR. Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | | | - Cyrla Zaltman
- GEDIIB. Presidente do GEDIIB 2017-2019, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Eduardo Ferreira Borba
- SBR. Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Enio Ribeiro Reis
- SBR. Diretor médico do Centro de infusão do Hospital Humanitas, Varginha, Brazil
| | | | - Evandro Mendes Klumb
- SBR. Unidade Docente Assistencial de Reumatologia, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | | | | | - Isabella Ballalai
- SBIm. Vice-Presidente da Sociedade Brasileira de Imunizações (SBIm), SBiM, Rio de Janeiro, Brazil
| | - Izaias Pereira Da Costa
- SBR. Professor da Faculdade de Medicina da Universidade Federal do Mato Grosso do Sul, Cuiabá, Brazil
| | - Lessandra Michelin
- SBI. Professora na faculdade de Medicina, Universidade de Caxias do Sul, Caxias do Sul, Brazil
| | | | - Liliana Andrade Chebli
- GEDIIB, Faculdade de Medicina da Universidade Federal de Juiz de Fora, Juiz de Fora, Brazil
| | - Marcus Lacerda
- SMBT. Instituto Leônidas e Maria Deane (Fiocruz - Amazônia), Fundação de Medicina Tropical Dr. Heitor Vieira Dourado (FMT-HVD), Maceio-AL, Brazil
| | | | | | | | - Renata Magalhães
- SBD. Faculdade de Medicina da Universidade Estadual de Campinas, Campinas, Brazil
| | - Renato Kfouri
- SBIm. Presidente do Departamento de Imunizações da Sociedade Brasileira de Pediatria (SBP), Maceio-AL, Brazil
| | | | | | - Valeria Valim
- SBR. Faculdade de Medicina, Universidade Federal do Espírito Santo, Vitória, Brazil
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15
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Papp KA, Haraoui B, Kumar D, Marshall JK, Bissonnette R, Bitton A, Bressler B, Gooderham M, Ho V, Jamal S, Pope JE, Steinhart AH, Vinh DC, Wade J. Vaccination Guidelines for Patients With Immune-Mediated Disorders on Immunosuppressive Therapies. J Cutan Med Surg 2018; 23:50-74. [PMID: 30463418 PMCID: PMC6330697 DOI: 10.1177/1203475418811335] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND: Patients with immune-mediated diseases on immunosuppressive therapies have more infectious episodes than healthy individuals, yet vaccination practices by physicians for this patient population remain suboptimal. OBJECTIVES: To evaluate the safety and efficacy of vaccines in individuals exposed to immunosuppressive therapies and provide evidence-based clinical practice recommendations. METHODS: A literature search for vaccination safety and efficacy in patients on immunosuppressive therapies (2009-2017) was conducted. Results were assessed using the Grading of Recommendation, Assessment, Development, and Evaluation system. RESULTS: Several immunosuppressive therapies attenuate vaccine response. Thus, vaccines should be administered before treatment whenever feasible. Inactivated vaccines can be administered without treatment discontinuation. Similarly, evidence suggests that the live zoster vaccine is safe and effective while on select immunosuppressive therapy, although use of the subunit vaccine is preferred. Caution regarding other live vaccines is warranted. Drug pharmacokinetics, duration of vaccine-induced viremia, and immune response kinetics should be considered to determine appropriate timing of vaccination and treatment (re)initiation. Infants exposed to immunosuppressive therapies through breastmilk can usually be immunized according to local guidelines. Intrauterine exposure to immunosuppressive agents is not a contraindication for inactivated vaccines. Live attenuated vaccines scheduled for infants and children ⩾12 months of age, including measles, mumps, rubella, and varicella, can be safely administered as sufficient time has elapsed for drug clearance. CONCLUSIONS: Immunosuppressive agents may attenuate vaccine responses, but protective benefit is generally maintained. While these recommendations are evidence based, they do not replace clinical judgment, and decisions regarding vaccination must carefully assess the risks, benefits, and circumstances of individual patients.
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Affiliation(s)
- Kim A Papp
- 1 K Papp Clinical Research, Waterloo, ON, Canada.,2 Probity Medical Research, Waterloo, ON, Canada
| | - Boulos Haraoui
- 3 Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Deepali Kumar
- 4 University Health Network, Toronto, ON, Canada.,5 Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - John K Marshall
- 6 Department of Medicine and Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, ON, Canada
| | | | - Alain Bitton
- 8 McGill University Health Centre, Montreal, QC, Canada
| | - Brian Bressler
- 9 Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.,10 St Paul's Hospital, Vancouver, BC, Canada
| | - Melinda Gooderham
- 2 Probity Medical Research, Waterloo, ON, Canada.,11 Faculty of Medicine, Queen's University, Kingston, ON, Canada
| | - Vincent Ho
- 9 Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Shahin Jamal
- 12 Vancouver Coastal Health, Vancouver, BC, Canada
| | - Janet E Pope
- 13 Faculty of Medicine, University of Western Ontario, London, ON, Canada.,14 St Joseph's Health Care, London, ON, Canada
| | - A Hillary Steinhart
- 5 Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,15 Mount Sinai Hospital, Toronto, ON, Canada
| | - Donald C Vinh
- 8 McGill University Health Centre, Montreal, QC, Canada.,16 Research Institute, McGill University Health Centre, Montreal, QC, Canada
| | - John Wade
- 9 Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.,17 Vancouver General Hospital, Vancouver, BC, Canada
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16
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Porudominsky R, Gotuzzo EH. Yellow fever vaccine and risk of developing serious adverse events: a systematic review. Rev Panam Salud Publica 2018; 42:e75. [PMID: 31093103 PMCID: PMC6386100 DOI: 10.26633/rpsp.2018.75] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 08/11/2017] [Indexed: 11/24/2022] Open
Abstract
Objective To evaluate contraindications and precautions for the yellow fever vaccine (YFV) in risk populations. Methods A literature review was conducted by searching PubMed for “yellow fever vaccine” and “adverse events” (AEs); 207 studies were found, and 43 of them met the inclusion criteria and were included in a systematic review. Results The results for first dose of YFV in elderly patients were conflicting—some showed AEs while some showed benefits. Therefore, precaution and case-by-case decisionmaking for YFV in this population are advised. The same precautions are warranted for YFV in infants 6-8 months, with the vaccine contraindicated in those < 6 months old and safe after 9 months of age. YFV seems safe in the first trimester of pregnancy, and probably throughout gestation, as it was not associated with increased malformations. During breastfeeding, YFV continues to be controversial. The vaccine seems safe in people being treated with immunomodulatory or immunosuppressive therapy, people with immunosuppressive diseases, and solid organ and hematopoietic stem cell transplant patients; in stem cell transplants, however, a booster dose should only be applied once immunity is recovered. HlV-infected patients with a CD4+ count > 200 cells/mm3 do not have increased risk of AEs from YFV. Egg allergy vaccination protocols seem to provide a safe way to immunize these patients. Conclusions YFV safety has been confirmed based on data from many vaccination campaigns and multiple studies. AEs seem more frequent after a first-time dose, mainly in risk groups, but this review evaluated YFV in several of the same risk groups and the vaccine was found to be safe in most of them.
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17
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Huber F, Ehrensperger B, Hatz C, Chappuis F, Bühler S, Eperon G. Safety of live vaccines on immunosuppressive or immunomodulatory therapy-a retrospective study in three Swiss Travel Clinics. J Travel Med 2018; 25:4763691. [PMID: 29394383 DOI: 10.1093/jtm/tax082] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 11/14/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND Patients increasingly benefit from immunosuppressive/immunomodulatory medications for a range of conditions allowing them a lifestyle similar to healthy individuals, including travel. However, the administration of live vaccines to immunodeficient patients bears the risk of replication of the attenuated vaccine microorganism. Therefore, live vaccines are generally contraindicated on immunosuppression. Data on live vaccinations on immunosuppressive/immunomodulatory medication are scarce. We identified all travellers seeking pre-travel advice in three Swiss travel clinics with a live vaccine during immunosuppressive/immunomodulatory therapy to ascertain experienced side effects. A retrospective and multi-centre study design was chosen to increase the sample size. METHODS This study was conducted in the travel clinics of the University of Zurich; the Swiss TPH, Basel; and Geneva University Hospitals. Travellers on immunosuppressive/immunomodulatory therapy who received live vaccines [yellow fever vaccination (YFV), measles/mumps/rubella (MMR), varicella and/ or oral typhoid vaccination (OTV)] between 2008 and 2015 were identified and interviewed. A total of 60 age- and sex-matched controls (matched to Basel/Zurich travel clinics travellers) were included. RESULTS Overall, 197 patients were identified. And 116 patients (59%) and 60 controls were interviewed. YFV was administered 92 times, MMR 21 times, varicella 4 times and OTV 6 times to patients on immunosuppressive/immunomodulatory therapy. Most common medications were corticosteroids (n = 45), mesalazine (n = 28) and methotrexate (n = 19). Live vaccines were also administered on biological treatment, e.g. TNF-alpha inhibitors (n = 8). Systemic reactions were observed in 12.2% of the immunosuppressed vs 13.3% of controls; local reactions in 7.8% of the immunosuppressed vs 11.7% of controls. In controls, all reactions were mild/moderate. In the immunosuppressed, 2/21 severe reactions occurred: severe local pain on interferon-beta and severe muscle/joint pain on sulfasalazine. CONCLUSION Safety of live vaccines given to immunosuppressed patients cannot be concluded. However, it is re-assuring that in the examined patient groups no serious side effects or infections by the attenuated vaccine strain occurred.
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Affiliation(s)
- Fabienne Huber
- Epidemiology, Biostatistics and Prevention Institute, Department of Public Health, Division of Infectious Diseases/Travel Clinic, University of Zurich, Hirschengraben 84, 8001 Zurich, Switzerland
| | - Benoît Ehrensperger
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 6, 1205 Geneva, Switzerland
| | - Christoph Hatz
- Epidemiology, Biostatistics and Prevention Institute, Department of Public Health, Division of Infectious Diseases/Travel Clinic, University of Zurich, Hirschengraben 84, 8001 Zurich, Switzerland.,Department of Medicine and Diagnostics, Swiss Tropical and Public Health Institute, Socinstrasse 57, 4051 Basel, Switzerland
| | - François Chappuis
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 6, 1205 Geneva, Switzerland
| | - Silja Bühler
- Epidemiology, Biostatistics and Prevention Institute, Department of Public Health, Division of Infectious Diseases/Travel Clinic, University of Zurich, Hirschengraben 84, 8001 Zurich, Switzerland
| | - Gilles Eperon
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 6, 1205 Geneva, Switzerland
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18
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Croce E, Hatz C, Jonker EF, Visser L, Jaeger VK, Bühler S. Safety of live vaccinations on immunosuppressive therapy in patients with immune-mediated inflammatory diseases, solid organ transplantation or after bone-marrow transplantation – A systematic review of randomized trials, observational studies and case reports. Vaccine 2017; 35:1216-1226. [DOI: 10.1016/j.vaccine.2017.01.048] [Citation(s) in RCA: 114] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 01/10/2017] [Accepted: 01/20/2017] [Indexed: 11/29/2022]
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19
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Friedman MA, Winthrop KL. Vaccines and Disease-Modifying Antirheumatic Drugs. Rheum Dis Clin North Am 2017; 43:1-13. [DOI: 10.1016/j.rdc.2016.09.003] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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20
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Prevention and management of glucocorticoid-induced side effects: A comprehensive review. J Am Acad Dermatol 2017; 76:191-198. [DOI: 10.1016/j.jaad.2016.02.1240] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 02/01/2016] [Indexed: 01/04/2023]
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Abstract
PURPOSE OF REVIEW Rheumatoid arthritis (RA) patients experience increased infectious disease-related morbidity and mortality, and vaccinations represent an important element in their care. However, vaccine immunogenicity can be affected by disease-modifying antirheumatic drug (DMARD) therapy, such that vaccine choice and timing can be clinically challenging. We review the indications, safety, and immunogenicity of vaccines in the setting of RA. RECENT FINDINGS Recent recommendations highlight the use of influenza, pneumococcal, and shingles vaccines in RA patients. Studies suggest influenza and pneumococcal vaccines are underutilized, but well tolerated in RA patients and generally immunogenic during DMARD use with the exception of rituximab. Though data for other nonlive vaccines are more limited, hepatitis B virus and human papilloma virus vaccines also appear well tolerated and immunogenic in this population. Live vaccines for shingles and yellow fever remain contraindicated in some RA patients; however, limited data suggest they might be well tolerated in certain individuals. SUMMARY The review updates rheumatologists on the optimal use and timing of routine vaccinations in the care of RA.
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22
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Mathian A, Arnaud L, Adoue D, Agard C, Bader-Meunier B, Baudouin V, Belizna C, Bonnotte B, Boumedine F, Chaib A, Chauchard M, Chiche L, Daugas E, Ghali A, Gobert P, Gondran G, Guettrot-Imbert G, Hachulla E, Hamidou M, Haroche J, Hervier B, Hummel A, Jourde-Chiche N, Korganow AS, Kwon T, Le Guern V, Le Quellec A, Limal N, Magy-Bertrand N, Marianetti-Guingel P, Martin T, Martin Silva N, Meyer O, Miyara M, Morell-Dubois S, Ninet J, Pennaforte JL, Polomat K, Pourrat J, Queyrel V, Raymond I, Remy P, Sacre K, Sibilia J, Viallard JF, Viau Brabant A, Hanslik T, Amoura Z. Prévention des infections au cours du lupus systémique chez l’adulte et l’adolescent : élaboration de recommandations pour la pratique clinique, à partir d’une analyse de la littérature et de l’avis d’experts. Rev Med Interne 2016; 37:307-20. [DOI: 10.1016/j.revmed.2016.01.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Revised: 01/03/2016] [Accepted: 01/05/2016] [Indexed: 12/21/2022]
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23
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Bonilla FA, Barlan I, Chapel H, Costa-Carvalho BT, Cunningham-Rundles C, de la Morena MT, Espinosa-Rosales FJ, Hammarström L, Nonoyama S, Quinti I, Routes JM, Tang MLK, Warnatz K. International Consensus Document (ICON): Common Variable Immunodeficiency Disorders. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2015; 4:38-59. [PMID: 26563668 DOI: 10.1016/j.jaip.2015.07.025] [Citation(s) in RCA: 515] [Impact Index Per Article: 57.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2015] [Revised: 06/24/2015] [Accepted: 07/24/2015] [Indexed: 02/06/2023]
Affiliation(s)
| | - Isil Barlan
- Marmara University Pendik Education and Research Hospital, Istanbul, Turkey
| | - Helen Chapel
- John Radcliffe Hospital and University of Oxford, Oxford, United Kingdom
| | | | | | - M Teresa de la Morena
- Children's Medical Center and University of Texas Southwestern Medical Center, Dallas, Texas
| | | | | | | | | | - John M Routes
- Children's Hospital of Wisconsin and Medical College of Wisconsin, Milwaukee, Wis
| | - Mimi L K Tang
- Royal Children's Hospital and Murdoch Children's Research Institute, University of Melbourne, Melbourne, Australia
| | - Klaus Warnatz
- University Medical Center Freiburg, Freiburg, Germany
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24
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Diphtheria, tetanus, poliomyelitis, yellow fever and hepatitis B seroprevalence among HIV1-infected migrants. Results from the ANRS VIHVO vaccine sub-study. Vaccine 2015. [PMID: 26209841 DOI: 10.1016/j.vaccine.2015.07.036] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Few data are available on the seroprotection status of HIV1-infected patients with respect to vaccine-preventable diseases. OBJECTIVE To describe, in a population of HIV1-infected migrants on stable, effective ART therapy, the seroprevalence of diphtheria, poliomyelitis, tetanus, yellow fever antibodies and serostatus for hepatitis B, and to identify factors associated with seroprotection. Vaccine responses against diphtheria, tetanus, poliomyelitis and yellow fever were also studied. METHODS Sub-Saharan African patients participating in the ANRS-VIHVO cohort were enrolled prior to travel to their countries of origin. Serologic analyses were performed in a central laboratory before and after the trip. Univariate and multivariate logistic regression was used to identify factors associated with initial seroprotection. RESULTS 250 patients (99 men and 151 women) were included in the seroprevalence study. Median age was 45 years (IQR 39-52), median CD4 cell count was 440/μL (IQR 336-571), and 237 patients (95%) had undetectable HIV1 viral load. The initial seroprevalence rates were 69.0% (95%CI 63.2-74.7) for diphtheria, 70.7% (95%CI 65.0-76.3) for tetanus, and 85.9% (95%CI 81.6-90.2) for yellow fever. Only 64.4% (95%CI 58.5-70.3) of patients had protective antibody titers against all three poliomyelitis vaccine strains before travel. No serological markers of hepatitis B were found in 18.6% of patients (95%CI 13.7-23.3). Patient declaration of prior vaccination was the only factor consistently associated with initial seroprotection. CONCLUSIONS We found a low prevalence of seroprotection against diphtheria, poliomyelitis, tetanus and hepatitis B. HIV infected migrants living in France and traveling to their native countries need to have their vaccine schedule completed.
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Aung AK, Trubiano JA, Spelman DW. Travel risk assessment, advice and vaccinations in immunocompromised travellers (HIV, solid organ transplant and haematopoeitic stem cell transplant recipients): A review. Travel Med Infect Dis 2014; 13:31-47. [PMID: 25593039 DOI: 10.1016/j.tmaid.2014.12.007] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2014] [Revised: 12/17/2014] [Accepted: 12/19/2014] [Indexed: 12/19/2022]
Abstract
International travellers with immunocompromising conditions such as human immunodeficiency virus (HIV) infection, solid organ transplantation (SOT) and haematopoietic stem cell transplantation (HSCT) are at a significant risk of travel-related illnesses from both communicable and non-communicable diseases, depending on the intensity of underlying immune dysfunction, travel destinations and activities. In addition, the choice of travel vaccinations, timing and protective antibody responses are also highly dependent on the underlying conditions and thus pose significant challenges to the health-care providers who are involved in pre-travel risk assessment. This review article provides a framework of understanding and approach to aforementioned groups of immunocompromised travellers regarding pre-travel risk assessment and management; in particular travel vaccinations, infectious and non-infectious disease risks and provision of condition-specific advice; to reduce travel-related mortality and morbidity.
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Affiliation(s)
- A K Aung
- Department of General Medicine, The Alfred Hospital, Melbourne, Victoria, Australia; Department of Infectious Diseases, The Alfred Hospital, Melbourne, Victoria, Australia.
| | - J A Trubiano
- Department of Infectious Diseases, The Alfred Hospital, Melbourne, Victoria, Australia; Department of Microbiology, The Alfred Hospital, Melbourne, Victoria, Australia
| | - D W Spelman
- Department of Infectious Diseases, The Alfred Hospital, Melbourne, Victoria, Australia; Department of Microbiology, The Alfred Hospital, Melbourne, Victoria, Australia; Monash University, Melbourne, Victoria, Australia
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Li Z, Yang H, Yang J, Lin H, Wang W, Liu L, Zhao Y, Liu L, Zeng X, Yu Y, Li Y. Construction and preliminary investigation of a novel dengue serotype 4 chimeric virus using Japanese encephalitis vaccine strain SA14-14-2 as the backbone. Virus Res 2014; 191:10-20. [PMID: 25091563 DOI: 10.1016/j.virusres.2014.07.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Revised: 06/24/2014] [Accepted: 07/16/2014] [Indexed: 11/25/2022]
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27
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The medically immunocompromised adult traveler and pre-travel counseling: Status quo 2014. Travel Med Infect Dis 2014; 12:219-28. [DOI: 10.1016/j.tmaid.2014.04.009] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Revised: 04/16/2014] [Accepted: 04/24/2014] [Indexed: 12/11/2022]
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28
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Launay O. Vaccination of immunocompromised travelers: need for specific recommendations! J Travel Med 2013; 20:275-7. [PMID: 23992568 DOI: 10.1111/jtm.12055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2013] [Revised: 06/06/2013] [Accepted: 06/13/2013] [Indexed: 11/27/2022]
Affiliation(s)
- Odile Launay
- Université Paris Descartes, Sorbonne Paris Cité, Hôpital Cochin, CIC de Vaccinologie Cochin Pasteur, Paris, France
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