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Schwaneck EC, Harasim AS, Tony HP, Gawlik M, Witte T, Joos S, Gernert M, Schmalzing M, Morbach H, Fröhlich M, Krone M. Vaccination status of patients with primary immunodeficiencies in Germany-a multicentric epidemiologic analysis. Z Rheumatol 2024:10.1007/s00393-024-01549-0. [PMID: 39174715 DOI: 10.1007/s00393-024-01549-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2024] [Indexed: 08/24/2024]
Abstract
BACKGROUND Vaccinations represent an easily accessible, safe, and important method for preventing infections. Patients with primary immunodeficiencies (PID) are more susceptible to infections and should receive an extended spectrum of immunizations in many countries. METHODS Between January 2019 and May 2020, vaccination certificates of 70 patients with PID from the regions of Würzburg and Hanover in Germany were evaluated. The patients were additionally surveyed regarding their attitude towards vaccinations and the communication with their physicians. Medical records were analyzed. RESULTS Of the 70 patients, 54 (77%) suffered from common variable immunodeficiency, 30 (43%) were diagnosed with accompanying autoimmunity, 62 (89%) had an increased susceptibility to infections, and 56 (80%) were on immunoglobulin substitution therapy. Seven patients (10%) had neither a vaccination certificate nor were they able to recollect of their last vaccination. Only 55 (79%) and 43 (61%) patients stated that their rheumatologist or immunologist had recommended an influenza and a pneumococcal vaccination, respectively. When asked about their overall trust in vaccinations on a scale of 0 to 10 (0 = very low, 10 = very high), the mean value was 7.8. The most common vaccination was against tetanus in 63 (90%) patients, 49 (70%) had received vaccination against pneumococci, and 39 (56%) had received an influenza vaccination. Interestingly, 26 patients (37%) were vaccinated against measles, even though this is contraindicated in most PID patients. CONCLUSION Our data suggest that vaccination rates in this at-risk population are insufficient. Healthcare providers should emphasize vaccinations routinely when caring for these patients.
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Affiliation(s)
- Eva C Schwaneck
- Division of Rheumatology/Immunology, University Hospital Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany.
- MVZ Rheumatologie und Autoimmunmedizin, Mönckebergstraße 27, 20095, Hamburg, Germany.
| | - Anna S Harasim
- Division of Rheumatology/Immunology, University Hospital Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany
| | - Hans-Peter Tony
- Division of Rheumatology/Immunology, University Hospital Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany
| | - Micha Gawlik
- Department of Psychiatry and Psychotherapy, University of Würzburg, Margarete-Höppel-Platz 1, 97080, Würzburg, Germany
- Helios Fachkliniken Hildburghausen, Hildburghausen, Deutschland
| | - Torsten Witte
- Department of Rheumatology and Clinical Immunology, Hanover Medical School, Carl-Neuberg-Straße 1, 30625, Hanover, Germany
| | - Stefanie Joos
- Institute for General Practice and Interprofessional Healthcare, Eberhardt-Karls-University, Osianderstraße 5, 72076, Tübingen, Germany
| | - Michael Gernert
- Division of Rheumatology/Immunology, University Hospital Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany
| | - Marc Schmalzing
- Division of Rheumatology/Immunology, University Hospital Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany
| | - Henner Morbach
- Pediatric Immunology, Department of Pediatrics, University Hospital Würzburg, Josef-Schneider-Straße 2, 97080, Würzburg, Germany
| | - Matthias Fröhlich
- Division of Rheumatology/Immunology, University Hospital Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany
| | - Manuel Krone
- Institute for Hygiene and Microbiology, University of Würzburg, Josef-Schneider-Straße 2/E1, 97080, Würzburg, Germany
- Infection Control and Antimicrobial Stewardship Unit, University Hospital Würzburg, Josef-Schneider-Straße 2/E1, 97080, Würzburg, Germany
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Miyake H, Minoda Sada R, Manabe A, Tsugihashi Y, Hatta K. Factors and Reasons for Non-vaccination among Patients with Systemic Lupus Erythematosus: A Single-centre, Cross-sectional Study. Intern Med 2023; 62:2483-2491. [PMID: 36575017 PMCID: PMC10518547 DOI: 10.2169/internalmedicine.1067-22] [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: 10/01/2022] [Accepted: 11/20/2022] [Indexed: 12/28/2022] Open
Abstract
Objective This study aimed to clarify the vaccination coverage of vaccine-preventable diseases and the factors and reasons for non-vaccination among patients with systemic lupus erythematosus (SLE). Methods This single-centre, cross-sectional study was conducted from 1 September to 30 November 2020 in a 715-bed regional tertiary-care teaching hospital in Japan. A questionnaire survey was undertaken to investigate the vaccination status of patients with SLE, and the factors and reasons for not receiving the influenza vaccine, 23-valent-pneumococcal-polysaccharide vaccine (PPSV23), 13-valent pneumococcal conjugate vaccine (PCV13), varicella vaccine live (VVL), and recombinant zoster vaccine (RZV). Results The vaccination coverage for the influenza vaccine, PPSV23, PCV13, VVL, and RZV was 61%, 22%, 19%, 3.4%, and 0%, respectively, among 261 patients. The most common reason for vaccine hesitancy was 'efficacy concerns about vaccines' for the influenza vaccine and 'cost' for PPSV23 and PCV13. The factors significantly associated with non-vaccination were prescription of high-dose glucocorticoids and no history of visits to other internal medicine clinics for the influenza vaccine; a younger age and prescription of high-dose glucocorticoids for PPSV23; and a younger age, no medication with hydroxychloroquine, no history of hospitalisation in internal medicine, and extensive clinical experience of the doctor for PCV13. Conclusion These findings, which demonstrated that the factors and reasons for non-vaccination varied by vaccine type, suggest that individualised strategies should be used to promote vaccination in this population.
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Affiliation(s)
- Hirofumi Miyake
- Department of General Internal Medicine, Tenri Hospital, Japan
| | - Ryuichi Minoda Sada
- Department of General Internal Medicine, Tenri Hospital, Japan
- Department of Infection Control, Graduate School of Medicine, Osaka University, Japan
- Department of Transformative Protection to Infectious Disease, Graduate School of Medicine, Osaka University, Japan
| | - Atsushi Manabe
- Department of General Internal Medicine, Tenri Hospital, Japan
- Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University, Japan
| | - Yukio Tsugihashi
- Medical Home Care Centre, Tenri Hospital Shirakawa Branch, Japan
| | - Kazuhiro Hatta
- Department of General Internal Medicine, Tenri Hospital, Japan
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Tay WC, Bewley A, Maul JT, Oon HH. Attitudes towards COVID Vaccine and Vaccine Hesitancy in Dermatology: A Narrative Review. Vaccines (Basel) 2023; 11:1365. [PMID: 37631933 PMCID: PMC10459048 DOI: 10.3390/vaccines11081365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 08/08/2023] [Accepted: 08/09/2023] [Indexed: 08/29/2023] Open
Abstract
Vaccine hesitancy has been a contentious issue even before the pandemic. The COVID-19 crisis has further amplified vaccine hesitancy, with worries about adverse effects, cultural and religious beliefs, and misinformation on social media. In dermatology, patients with pre-existing skin conditions may have specific concerns about the impact of the vaccine on their skin health. Factors such as cutaneous reactions, potential flares of underlying conditions, and fears of psoriasis worsening post-vaccination contribute to vaccine hesitancy. Healthcare professionals, including dermatologists, play a crucial role in addressing vaccine hesitancy by providing accurate information, addressing concerns, and understanding the psychological impact on patients. The concept of vaccine fatigue is also explored, noting the challenges in sustaining vaccine acceptance over time, especially with regards to booster vaccinations. Overcoming vaccine hesitancy requires trust-building, effective communication strategies, and collaboration between healthcare workers and non-healthcare individuals to combat misinformation. By recognizing and addressing psychological factors, dermatologists can increase vaccine acceptance and improve public health efforts.
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Affiliation(s)
- Woo Chiao Tay
- National Skin Centre, 1 Mandalay Road, Singapore 308205, Singapore
| | - Anthony Bewley
- Department of Dermatology, Barts Health NHS Trust, London E11 1NR, UK
- Queen Mary University, London E1 4NS, UK
| | - Julia-Tatjana Maul
- Department of Dermatology and Venereology, University Hospital of Zurich, 8091 Zurich, Switzerland
- Faculty of Medicine, University of Zurich, 8006 Zurich, Switzerland
| | - Hazel H. Oon
- National Skin Centre, Skin Research Institute of Singapore, 1 Mandalay Road, Singapore 308205, Singapore
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Noe MH, Archila M, Barbieri JS, Goldman N, Lopez CG, Mostaghimi A, Scherer AM, Tan AJ, Perez-Chada LM, Asgari MM, Gelfand JM. The patient perspective on vaccine uptake in adults with psoriasis and eczema. Arch Dermatol Res 2023; 315:1583-1592. [PMID: 36749390 PMCID: PMC9904245 DOI: 10.1007/s00403-023-02546-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 01/05/2023] [Accepted: 01/22/2023] [Indexed: 02/08/2023]
Abstract
Having a chronic disease is one of the most consistent factors associated with vaccine uptake for adults in the general population, but vaccination beliefs and behaviors specific to those with chronic skin diseases have not been explored. The objective of this study was to explore factors associated with vaccine uptake and barriers to vaccination in adults with psoriasis and eczema. Virtual, video-based semi-structured interviews were performed with adults who self-reported a diagnosis of psoriasis or eczema. Interviews explored themes around healthcare decision making, perceived risks/benefits to vaccination, barriers, and vaccine knowledge. Thematic analysis was used to analyze the data. Of 34 study participants, 25 participants (74%) were females and 9 (26%) were males, with a mean age of 50.8 years (SD: 16.4, range: 24-71 yrs). Half of participants (n = 17) had psoriasis, and half (n = 17) had eczema. Participants recognized both personal and societal benefits to vaccines. Common vaccination barriers identified were access to appointments, concerns about side effects, and misinformation. Physicians, friends/family, and media, including internet resources, were health information resources identified by patients. These results summarize the unique patient perspective around vaccine uptake in adults with eczema and psoriasis and represent an important first step in a multi-pronged approach to improve vaccination rates in adults with chronic skin diseases.
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Affiliation(s)
- Megan H Noe
- Department of Dermatology, Brigham and Women's Hospital, Boston, MA, USA.
| | - Marjorie Archila
- Department of Dermatology, Brigham and Women's Hospital, Boston, MA, USA
| | - John S Barbieri
- Department of Dermatology, Brigham and Women's Hospital, Boston, MA, USA
| | - Nathaniel Goldman
- Department of Dermatology, Brigham and Women's Hospital, Boston, MA, USA
- School of Medicine, New York Medical College, New York, NY, USA
| | - Christina G Lopez
- Department of Dermatology, Brigham and Women's Hospital, Boston, MA, USA
| | - Arash Mostaghimi
- Department of Dermatology, Brigham and Women's Hospital, Boston, MA, USA
| | - Aaron M Scherer
- Department of Internal Medicine, University of Iowa, Iowa, IA, USA
| | - Alice J Tan
- Department of Dermatology, Brigham and Women's Hospital, Boston, MA, USA
- University of Massachusetts Medical School, Worcester, MA, USA
| | | | - Maryam M Asgari
- Department of Dermatology, Massachusetts General Hospital, Boston, MA, USA
- Department of Population Medicine, Harvard Medical School, Boston, MA, USA
| | - Joel M Gelfand
- Department of Dermatology, University of Pennsylvania, Philadelphia, PA, USA
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA, USA
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Krasselt M, Wagner U, Seifert O. Influenza, Pneumococcal and Herpes Zoster Vaccination Rates in Patients with Autoimmune Inflammatory Rheumatic Diseases. Vaccines (Basel) 2023; 11:vaccines11040760. [PMID: 37112672 PMCID: PMC10146832 DOI: 10.3390/vaccines11040760] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 03/20/2023] [Accepted: 03/28/2023] [Indexed: 04/01/2023] Open
Abstract
Background: Vaccination rates are known to be low in patients with autoimmune inflammatory rheumatic diseases (AIIRD). We therefore aimed to determine current vaccination rates against influenza, Streptococcus pneumoniae and herpes zoster in a cohort of patients with AIIRD in Germany. Methods: Consecutive adult patients with an AIIRD were recruited from our outpatient clinic during their regular consultations. The individual vaccination status regarding influenza, Streptococcus pneumoniae and herpes zoster was obtained by reviewing the vaccination documents. Results: A total of 222 AIIRD patients (mean age 62.9 ± 13.9 years) were included. In total, 68.5% were vaccinated against influenza, 34.7% against Streptococcus pneumoniae and 13.1% against herpes zoster (HZ). The pneumococcal vaccination was outdated in 29.4% of the vaccinated patients. Vaccination rates were significantly higher in patients ≥60 years old (odds ratio (OR) 2.167, 95% confidence interval (CI) 1.213–3.870, p = 0.008 for influenza, OR 4.639, 95% CI 2.555–8.422, p < 0.0001 for pneumococcal and OR 6.059, 95% CI 1.772–20.712, p = 0.001 for HZ vaccination). Ages > 60 years, female sex, glucocorticoid use and influenza vaccination were all independently associated with a pneumococcal vaccination. Regarding influenza vaccination, only a positive pneumococcal vaccination history remained independently associated. In patients with HZ vaccination, glucocorticoid use and a preceding pneumococcal vaccination were independently associated with HZ protection. Conclusions: The frequencies of vaccinations against influenza, Streptococcus pneumoniae and HZ have increased during recent years. While this can be partly explained by continuous efforts in patient education during the outpatient visits, the COVID-19 pandemic might also have contributed. Nevertheless, the persistently high incidence and mortality of these preventable diseases in patients with AIIRDs mandates further efforts to increase vaccination coverage, particularly in SLE patients.
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Affiliation(s)
- Marco Krasselt
- Correspondence: ; Tel.: +49-341-97-24710; Fax: +49-341-97-24709
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Vaccination Coverage against Tetanus, Diphtheria, Pertussis and Poliomyelitis and Validity of Self-Reported Vaccination Status in Patients with Multiple Sclerosis. J Pers Med 2022; 12:jpm12050677. [PMID: 35629100 PMCID: PMC9146089 DOI: 10.3390/jpm12050677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 04/08/2022] [Accepted: 04/15/2022] [Indexed: 02/01/2023] Open
Abstract
Multiple sclerosis (MS) is a chronic immune-mediated disease with a neurodegenerative component of the central nervous system. Immunomodulatory therapy can increase the risk of infection, which is a particular risk for MS patients. Therefore, a complete vaccination status is of utmost importance as protection against vaccine-preventable infectious diseases. Our aim was to investigate the vaccination status, vaccination card knowledge and the vaccination behavior of MS patients with regard to vaccinations against tetanus, diphtheria, pertussis and poliomyelitis. Three hundred twenty-seven patients with MS were evaluated by anamnesis, clinical examination, structured interview and vaccination card control in this two-center study. Based on the recommendations of the Robert Koch Institute, we assessed the completeness of the vaccination status of the examined vaccinations. Furthermore, a comparative analysis of patients with complete/incomplete or correctly/wrongly self-reported vaccination status was performed. In the cohort analyzed, the vaccination coverage was 79.5% for tetanus, 79.2% for diphtheria, 74.8% for pertussis and 84.8% for poliomyelitis. The assumed vaccination status was higher for tetanus (86.5%) and lower for diphtheria (69.4%), pertussis (61.2%) and poliomyelitis (75.9%). Patients who were unvaccinated or only partially vaccinated against tetanus had received vaccination advice from a physician less often in the past year (13.4 vs. 36.9%, p < 0.001) and had no one to check the vaccination card more often (35.8 vs. 12.3%, p < 0.001). High sensitivity (93.7%) and low specificity (30.3%) were determined regarding the validity of self-reported tetanus vaccination status. Patients with a correctly reported tetanus vaccination status were more likely to have their vaccination card checked by a physician than those who overestimated or underestimated their vaccination status (76.7 vs. 63.0/43.8%, p = 0.002). Similar findings were seen with regard to diphtheria, pertussis and poliomyelitis vaccination. Patients without a regular vaccination card control (17.1%) were more likely to be male (44.6 vs. 29.4%, p = 0.037), had fewer siblings on average (1.1 vs. 1.6, p = 0.016), dealt less frequently with the issue of vaccination in the past year (32.1 vs. 69.3%, p < 0.001) and more frequently had the wish to receive vaccination advice (48.2 vs. 34.4%, p = 0.030) than patients in whom the vaccination card was checked regularly by a physician. To minimize the risk of infection in MS patients, treating physicians should provide regular vaccination counseling and perform vaccination card controls, as these factors are associated with a higher vaccination coverage and a higher validity of self-reported vaccination statuses.
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Sim JJL, Lim CC. Influenza Vaccination in Systemic Lupus Erythematosus: Efficacy, Effectiveness, Safety, Utilization, and Barriers. Am J Med 2022; 135:286-296.e9. [PMID: 34563493 DOI: 10.1016/j.amjmed.2021.08.038] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 08/26/2021] [Accepted: 08/27/2021] [Indexed: 12/19/2022]
Abstract
Influenza increases morbidity and mortality in systemic lupus erythematosus (SLE) and lupus nephritis but is preventable through vaccination. This systematic review of PubMed, Embase, CENTRAL, WHO Clinical Trials, and ClinicalTrials.gov publications until August 2021 identified 45 reports (16,596 patients), including 8.5% with renal involvement or lupus nephritis: 9 studies (10,446 patients) on clinical effectiveness, 20 studies (1327 patients) on vaccine efficacy, 22 studies (1116 patients) on vaccine safety, 14 studies (4619 patients) on utilization rates, and 5 studies (3220 patients) on barriers. Pooled seroconversion rates ranged between 46% and 56%, while seroprotection rates ranged from 68% to 73% and were significantly associated with age and disease duration. Influenza infection was lower in vaccinated patients with systemic lupus erythematosus compared with unvaccinated patients. Disease activity scores did not change significantly after vaccination and reported flares were mild to moderate. Pooled current vaccination rate was 40.0% (95% confidence interval [CI]: 33.7%-46.5%) with significant heterogeneity and associated with the gross domestic product (P = .002) and disease duration (P = .001). Barriers to vaccination were the lack of doctor recommendation (57.4%) and concerns over the safety or efficacy of the vaccine (12.7%).
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Affiliation(s)
- Jackie Jia Lin Sim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Cynthia Ciwei Lim
- Department of Renal Medicine, Singapore General Hospital, Singapore.
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COVID-19 Vaccination Coverage in Patients with Rheumatic Diseases in a German Outpatient Clinic: An Observational Study. Vaccines (Basel) 2022; 10:vaccines10020253. [PMID: 35214709 PMCID: PMC8880778 DOI: 10.3390/vaccines10020253] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 01/31/2022] [Accepted: 02/05/2022] [Indexed: 01/27/2023] Open
Abstract
Background: In the second year of the COVID-19 pandemic, highly effective and safe vaccines became available. Since patients with rheumatic diseases show increased susceptibility to infections and typical medications raise the risk of severe COVID-19, high vaccination coverage is of significant importance to these patients. Methods: Consecutive patients with different rheumatic diseases were asked for their vaccination status regarding COVID-19, influenza and Streptococcus pneumoniae during their routine consultations. Any reported vaccination was validated with their personal vaccination card and/or by reviewing the CovPass smartphone app. Reasons for not having a COVID-19 vaccination were documented. Results: A total of 201 patients (mean age 62.3 ± 14.1 years) were included, the majority of them (44.3%) with rheumatoid arthritis, followed by spondyloarthritis (27.4%) and connective tissue diseases (21.4%). Vaccination coverage for SARS-CoV-2 was 80.1%; 85.6% got at least the first vaccination shot. Both valid influenza and pneumococcus coverage were associated with a higher probability of SARS-CoV-2 vaccination (odds ratio (OR) 6.243, 95% confidence interval (CI) 2.637–14.783, p < 0.0001 and OR 6.372, 95% CI 2.105–19.282, p = 0.0003, respectively). The main reason for a missing SARS-CoV-2 vaccination (70%) was being sceptical about the vaccine itself (i.e., the subjective impression that the vaccine was not properly tested and fear of unwanted side effects). Conclusions: Vaccination coverage against SARS-CoV-2 is high in patients with rheumatic diseases. Nevertheless, there are unmet needs regarding vaccination education to further increase vaccination rates.
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Simard JF, Rossides M, Gunnarsson I, Svenungsson E, Arkema EV. Infection hospitalisation in systemic lupus in Sweden. Lupus Sci Med 2021; 8:8/1/e000510. [PMID: 34526357 PMCID: PMC8444249 DOI: 10.1136/lupus-2021-000510] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 08/02/2021] [Indexed: 11/24/2022]
Abstract
Objective Immune dysregulation in SLE and the corresponding immune-modulating and immunosuppressive nature of the treatments may play key roles in infection risk. We compared serious infection rates among individuals with incident SLE with the general population, and examined the role of treatment initiation in SLE. Methods Newly diagnosed patients with SLE (2006–2013) and general population comparators from the Swedish Lupus Linkage cohort were followed for serious infection through 2016. Adjusted Cox and frailty models estimated the relative risk of first and recurrent infections, respectively. Using a new-user design, rates of serious infections were compared between disease-modifying antirheumatic drugs (DMARDs) and hydroxychloroquine (HCQ) initiators. We then evaluated three DMARDs (azathioprine, mycophenolate mofetil and methotrexate) in multivariable-adjusted models. Results Individuals with SLE experienced more infections (22% vs 6%), especially during the first year of follow-up, and recurrent serious infections were also more common (HR=2.22, 95% CI 1.93 to 2.56). DMARDs were associated with a higher rate of serious infection versus HCQ (HR=1.82, 95% CI 1.27 to 2.60), which attenuated after multivariable-adjustment (HR=1.30, 95% CI 0.86 to 1.95). Among DMARDs, azathioprine was associated with infection (HR=2.19, 95% CI 1.14 to 4.21) and mycophenolate mofetil yielded an HR=1.39 (95% CI 0.65 to 2.96) in multivariable-adjusted models compared with methotrexate. Results were comparable across numerous sensitivity analyses. Conclusion Individuals with incident SLE were 2–4 times more likely to be hospitalised for infection and experienced more recurrent infections than the general population. Among DMARD initiators, azathioprine was associated with the highest rate.
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Affiliation(s)
- Julia F Simard
- Department of Epidemiology & Population Health, Stanford University School of Medicine, Stanford, California, USA .,Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Marios Rossides
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Iva Gunnarsson
- Department of Medicine Solna, Rheumatology Unit, Karolinska Institutet, Stockholm, Sweden
| | - Elisabet Svenungsson
- Department of Medicine Solna, Rheumatology Unit, Karolinska Institutet, Stockholm, Sweden
| | - Elizabeth V Arkema
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
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Steffen G, Sperle I, Harder T, Sarma N, Beermann S, Thamm R, Bremer V, Zimmermann R, Dudareva S. Hepatitis B vaccination coverage in Germany: systematic review. BMC Infect Dis 2021; 21:817. [PMID: 34391406 PMCID: PMC8364709 DOI: 10.1186/s12879-021-06400-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 07/02/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Despite being considered as a low prevalence country for hepatitis B (HBV), some populations in Germany are at higher risk of infection. In the context of the World Health Organization's (WHO) viral hepatitis elimination goals, a valid epidemiological data base is needed to plan and monitor the national response. Prevention strategies include general and targeted HBV vaccination programmes. OBJECTIVE The aim of this work was to estimate the HBV vaccination coverage (VC) in the general population (GP) and different population groups in Germany from available evidence and to identify current evidence gaps for future research. METHODS We conducted a systematic review on HBV VC in the general population and populations at high risk of HBV exposure or severe infection in Germany. We included eligible publications (01/01/2017 to 06/06/2020) from databases Embase, Pubmed and Livivo, from a previous scoping review (including data published 01/01/2005-17/03/2017), from the national surveillance system and screened the reference lists of all publications at full text level. Risk of bias was assessed using the Hoy et al. tool. RESULTS We included 68 publications of 67 studies and assigned them to one or more suitable population groups. Twenty-one studies contained data among children/adolescents and three among adults from the GP (VC 65.8-90.5% and 22.9-52.1%, respectively), one among travelers (VC 89.0%), 13 among immunocompromised populations (VC 7.8-89.0%), 16 among populations with occupational risk and 16 with non-occupational risk of HBV exposure (VC 63.6-96.5% and 4.4-84.5%, respectively). CONCLUSION Comprehensive evidence at low risk of bias was identified for children/adolescents. However, 25 years after including HBV in the national immunisation schedule, VC in Germany is still below the 95%-goal defined by WHO. For people at occupational risk of HBV exposure, VC was mostly reported to be over the WHO goal of 80%, but quality of evidence was heterogenous and should be improved. For people at non-occupational risk of HBV exposure, evidence was sparse and of low quality. The low VC highlights the need for future research to plan vaccination programmes targeting these populations.
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Affiliation(s)
- Gyde Steffen
- Department of Infectious Disease Epidemiology, Unit for HIV/AIDS, STI and Blood-borne Infections, Robert Koch Institute, Berlin, Germany.
- Translational Epidemiology of DZIF, Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany.
| | - Ida Sperle
- Department of Infectious Disease Epidemiology, Unit for Gastrointestinal Infections, Zoonoses and Tropical Infections, Robert Koch Institute, Berlin, Germany
| | - Thomas Harder
- Department of Infectious Disease Epidemiology, Immunisation Unit, Robert Koch Institute, Berlin, Germany
| | - Navina Sarma
- Department of Infectious Disease Epidemiology, Unit for Crisis Management, Outbreak Investigations and Training Programmes, Focal Point for the Public Health Service, Robert Koch Institute, Berlin, Germany
| | - Sandra Beermann
- Centre for International Health Protection, Robert Koch Institute, Berlin, Germany
| | - Roma Thamm
- Department of Epidemiology and Health Monitoring, Unit for Physical Health, Robert Koch Institute, Berlin, Germany
| | - Viviane Bremer
- Department of Infectious Disease Epidemiology, Unit for HIV/AIDS, STI and Blood-borne Infections, Robert Koch Institute, Berlin, Germany
| | - Ruth Zimmermann
- Department of Infectious Disease Epidemiology, Unit for HIV/AIDS, STI and Blood-borne Infections, Robert Koch Institute, Berlin, Germany
| | - Sandra Dudareva
- Department of Infectious Disease Epidemiology, Unit for HIV/AIDS, STI and Blood-borne Infections, Robert Koch Institute, Berlin, Germany
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Humoral Immunity to Varicella Zoster Virus in Patients with Systemic Lupus Erythematosus and Rheumatoid Arthritis Compared to Healthy Controls. Vaccines (Basel) 2021; 9:vaccines9040325. [PMID: 33915820 PMCID: PMC8067210 DOI: 10.3390/vaccines9040325] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 03/22/2021] [Accepted: 03/29/2021] [Indexed: 12/30/2022] Open
Abstract
Background: The prevalence of herpes zoster (HZ) is high in patients with rheumatic diseases. Systemic lupus erythematosus (SLE) doubles the risk for developing HZ. However, little is known about natural humoral immunity against varicella zoster virus (VZV) in patients with SLE. Hence, we compared VZV IgG antibody concentrations in a group of SLE patients with healthy controls and patients with rheumatoid arthritis (RA). Methods: n = 56 patients with SLE, n = 54 patients with RA, and n = 56 healthy controls were included in this study. The VZV IgG antibody concentration was measured using an enzyme-linked immunosorbent assay (ELISA). The antibody concentrations were compared between the groups. Results: Overall IgG antibody titers for VZV in SLE patients were comparable to healthy controls but higher when compared to patients with rheumatoid arthritis (p = 0.0012). In consequence, antibody levels in controls were higher than in RA patients (p = 0.0097). Stratification by age revealed highest titers among SLE patients in the fourth life decade (p = 0.03 for controls, p = 0.0008 for RA patients) whereas RA patients in their sixth decade had the lowest antibody concentration (p = 0.03 for controls, p = 0.04 for SLE patients). Regarding the individual HZ history, antibody levels of SLE patients with a positive history exceeded all other groups. Conclusions: Although humoral VZV immunity in SLE patients is comparable to healthy controls it seems to be pronounced in young SLE patients between 30 and 39. The lowest VZV IgG levels were found in RA patients. HZ seems to induce antibody production, particularly in patients with SLE. Immunological processes might contribute to VZV antibody levels in SLE patients, but further investigations are needed to substantiate this hypothesis. Even though the increased HZ prevalence seems to be independent of humoral immunity in SLE patients, reduced humoral immunity might contribute to HZ in RA patients. The available HZ subunit vaccination might be an appropriate way to reduce the HZ risk in patients with rheumatic diseases.
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Krasselt M, Baerwald C, Petros S, Seifert O. Sepsis Mortality Is high in Patients With Connective Tissue Diseases Admitted to the Intensive Care Unit (ICU). J Intensive Care Med 2021; 37:401-407. [PMID: 33631998 PMCID: PMC8772250 DOI: 10.1177/0885066621996257] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Objectives: Patients with connective tissue diseases (CTD) such as systemic lupus erythematosus (SLE) have an increased risk for infections. This study investigated the outcome and characteristics of CTD patients under intensive care unit (ICU) treatment for sepsis. Methods: A single-center retrospective analysis was conducted and reviewed all patients with a CTD diagnosis admitted to the ICU of a university hospital for sepsis between 2006 and 2019. Mortality was computed and multivariate logistic regression was used to detect independent risk factors for sepsis mortality. Furthermore, the positive predictive value of ICU scores such as Sequential Organ Failure Assessment (SOFA) score was evaluated. Results: This study included 44 patients with CTD (mean age 59.8 ± 16.1 years, 68.2% females), most of them with a diagnosed SLE (61.4%) followed by systemic sclerosis (15.9%). 56.8% (n = 25) were treated with immunosuppressives and 81.8% (n = 36) received glucocorticoids. Rituximab was used in 3 patients (6.8%). The hospital mortality of septic CTD patients was high with 40.9%. It was highest among systemic sclerosis (SSc) patients (85.7%). SOFA score and diagnosis of SSc were independently associated with mortality in multivariate logistic regression (P = 0.004 and 0.03, respectively). The Simplified Acute Physiology Score II (SAPS II), SOFA and Acute Physiology and Chronic Health Evaluation II (APACHE II) scores were good predictors of sepsis mortality in the investigated cohort (SAPS II AUC 0.772, P = 0.002; SOFA AUC 0.756, P = 0.004; APACHE II AUC 0.741, P = 0.007). Conclusions: In-hospital sepsis mortality is high in CTD patients. SSc diagnoses and SOFA were independently associated with mortality. Additionally, common ICU scores were good predictors for mortality.
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Affiliation(s)
- Marco Krasselt
- Rheumatology, Medical Department III–Endocrinology, Nephrology and Rheumatology, University Hospital of Leipzig, Leipzig, Germany
- Marco Krasselt, Rheumatology, Medical Department III–Endocrinology, Nephrology and Rheumatology, University Hospital of Leipzig Liebigstr. 20/22, 04103 Leipzig, Germany.
| | - Christoph Baerwald
- Rheumatology, Medical Department III–Endocrinology, Nephrology and Rheumatology, University Hospital of Leipzig, Leipzig, Germany
| | - Sirak Petros
- Medical Intensive Care Unit, University Hospital of Leipzig, Leipzig, Germany
| | - Olga Seifert
- Rheumatology, Medical Department III–Endocrinology, Nephrology and Rheumatology, University Hospital of Leipzig, Leipzig, Germany
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Peracchi OA, Nicácio AAM, Yamada J, Len CA, Moraes-Pinto MID, Terreri MT. Adequate tetanus but poor diphtheria and pertussis response to a Tdap booster in adolescents with juvenile systemic lupus erythematosus. Lupus 2020; 30:299-306. [PMID: 33197362 DOI: 10.1177/0961203320973263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Reports on vaccine responses in immunocompromised patients, such as juvenile systemic lupus erythematosus (jSLE), have shown highly variable results. OBJECTIVE To compare the immune response and safety after a Tdap booster in 26 jSLE patients and 26 matched healthy adolescents.Methodology: Adverse events and disease activity were evaluated. Lymphocyte immunophenotyping was performed by flow cytometry. Tetanus, diphtheria and pertussis toxin antibodies were assessed by ELISA; whole blood was stimulated with whole cell pertussis and supernatants were assessed for cytokines by xMAP. RESULTS Both groups showed a similar frequency of adverse events. There was no evidence of disease reactivation after Tdap booster in the jSLE cohort. Both groups showed a significant increase in antibody titers for all three antigens on D14 and D28 (p < 0.001). jSLE patients had a significantly lower increase in diphtheria titers than the control group (p = 0.007). jSLE patients had a distinct titer increase of tetanus and pertussis antibodies when compared to controls (p = 0.004 and p < 0.001, respectively). There was a lower frequency of pertussis seroconversion in the jSLE group on D14 (p = 0.009), D28 (p = 0.023), D12m (p = 0.015) and D24m (p = 0.004). Cellular immune response to Bordetella pertussis showed significantly lower levels of IFNγ (p < 0.001) and higher levels of IL10, IL12, IL21 and TNFα in jSLE patients than controls. CONCLUSIONS jSLE patients had good response to Tdap booster dose for the tetanus antigen, but not for diphtheria and pertussis. This vaccine was safe in relation to adverse events and absence of disease reactivation.
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Affiliation(s)
- Octávio Ab Peracchi
- Unit of Pediatric Rheumatology, Department of Pediatrics, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Aline Alencar Mf Nicácio
- Unit of Pediatric Rheumatology, Department of Pediatrics, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Juliana Yamada
- Research Laboratory, Division of Pediatric Infectious Diseases, Department of Pediatrics, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Claudio Arnaldo Len
- Unit of Pediatric Rheumatology, Department of Pediatrics, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Maria Isabel de Moraes-Pinto
- Research Laboratory, Division of Pediatric Infectious Diseases, Department of Pediatrics, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Maria Teresa Terreri
- Unit of Pediatric Rheumatology, Department of Pediatrics, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
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Krasselt M, Baerwald C, Petros S, Seifert O. Outcome of Patients With Necrotizing Vasculitis Admitted to the Intensive Care Unit (ICU) for Sepsis: Results of a Single-Centre Retrospective Analysis. J Intensive Care Med 2020; 36:1410-1416. [PMID: 32873111 PMCID: PMC8600591 DOI: 10.1177/0885066620953768] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION/BACKGROUND Vasculitis patients have a high risk for infections that may require intensive care unit (ICU) treatment in case of resulting sepsis. Since data on sepsis mortality in this patient group is limited, the present study investigated the clinical characteristics and outcomes of vasculitis patients admitted to the ICU for sepsis. METHODS The medical records of all necrotizing vasculitis patients admitted to the ICU of a tertiary hospital for sepsis in a 13-year period have been reviewed. Mortality was calculated and multivariate logistic regression was used to determine independent risk factors for sepsis mortality. Moreover, the predictive power of common ICU scores was further evaluated. RESULTS The study included 34 patients with necrotizing vasculitis (mean age 69 ± 9.9 years, 35.3% females). 47.1% (n = 16) were treated with immunosuppressives (mostly cyclophosphamide, n = 35.3%) and 76.5% (n = 26) received glucocorticoids. Rituximab was used in 4 patients (11.8%).The in-hospital mortality of septic vasculitis patients was 41.2%. The Sequential Organ Failure Assessment (SOFA) score (p = 0.003) was independently associated with mortality in multivariate logistic regression. Acute Physiology And Chronic Health Evaluation II (APACHE II), Simplified Acute Physiology Score II (SAPS II) and SOFA scores were good predictors of sepsis mortality in the investigated vasculitis patients (APACHE II AUC 0.73, p = 0.02; SAPS II AUC 0.81, p < 0.01; SOFA AUC 0.898, p < 0.0001). CONCLUSIONS Sepsis mortality was high in vasculitis patients. SOFA was independently associated with mortality in a logistic regression model. SOFA and other well-established ICU scores were good mortality predictors.
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Affiliation(s)
- Marco Krasselt
- Rheumatology, Medical Department III-Endocrinology, Nephrology and Rheumatology, University Hospital of Leipzig, Liebigstr, Leipzig, Germany
| | - Christoph Baerwald
- Rheumatology, Medical Department III-Endocrinology, Nephrology and Rheumatology, University Hospital of Leipzig, Liebigstr, Leipzig, Germany
| | - Sirak Petros
- Medical Intensive Care Unit, University Hospital of Leipzig, Liebigstr, Leipzig, Germany
| | - Olga Seifert
- Rheumatology, Medical Department III-Endocrinology, Nephrology and Rheumatology, University Hospital of Leipzig, Liebigstr, Leipzig, Germany
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Vieira de Rezende RP, Mattos GA, de Mello Leal Augusto R, Machado Gayer CR, Mendes Klumb E. Predictors for seasonal influenza vaccination and reasons for inadequate vaccination coverage against a broad spectrum of vaccine-preventable diseases: a cross-sectional study among a Brazilian cohort of adult patients with systemic lupus erythematosus. Lupus 2019; 28:794-796. [DOI: 10.1177/0961203319846383] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- R P Vieira de Rezende
- Departamento de Medicina Clínica, Universidade Federal Fluminense, Rio de Janeiro, Brazil
| | - G A Mattos
- Departamento de Reumatologia, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - R de Mello Leal Augusto
- Departamento de Reumatologia, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - C R Machado Gayer
- Departamento de Bioquímica, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - E Mendes Klumb
- Departamento de Reumatologia, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
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Krasselt M, Baerwald C, Liebert UG, Seifert O. Humoral immunity to varicella zoster virus is altered in patients with rheumatoid arthritis. Clin Rheumatol 2019; 38:2493-2500. [PMID: 31028550 DOI: 10.1007/s10067-019-04563-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Revised: 04/08/2019] [Accepted: 04/12/2019] [Indexed: 12/26/2022]
Abstract
INTRODUCTION The prevalence of herpes zoster (HZ) is high in patients with rheumatologic diseases. The incidence in patients with rheumatoid arthritis (RA) is at least twice as high as in healthy people. Nevertheless, little is known about humoral immunity against varicella zoster virus (VZV), in particular in patients with RA. We, therefore, aimed to retrospectively compare VZV antibody concentrations in a collective of patients with RA in a German outpatient clinic with age- and sex-matched controls without RA. METHODS We included n = 247 patients with RA from one single university centre as well as n = 250 age- and sex-matched controls from the in-house routine in this retrospective analysis. The concentration of VZV IgG antibody concentration was either available from the records or was measured using an enzyme-linked immunosorbent assay (ELISA). Additionally, avidity for specific IgG was analysed for some of the samples. The antibody concentrations have been compared between the two groups. Moreover, a consecutive subgroup analysis after stratification by age was performed. RESULTS A total of 68.4% (n = 169) of the included patients were treated with conventional synthetic DMARDs, either as monotherapy or in combination. Biological originator DMARDs were used in 45.8% (n = 113) of the patients, with the majority (85%, n = 96) of them being on tumour necrosis factor (TNF)-inhibiting agents. As the main result of this study, antibody titres for VZV were found to be significantly lower in RA patients compared with healthy controls (p < 0.0001). The observed difference was most pronounced for the older patients being in the sixth and seventh decade. Antibody avidity was high in both groups with a significantly higher avidity among the controls (p = 0.0006). CONCLUSIONS A possible explanation for the low VZV antibody concentration in RA patients might be premature immunosenescence, which most likely also effects the B cell compartment and humoral immunity. This thesis is emphasised by the significantly higher antibody avidity among the controls. The data also suggest that the increased HZ risk is a consequence of a poor humoral immunity. The available HZ vaccinations should contribute to decreasing the elevated HZ risk in RA patients. KEY POINTS • Humoral immunity to varicella zoster virus seems to be reduced in patients with RA. • This impaired immunity might contribute to the increased herpes zoster susceptibility in RA patients. • An accelerated immunosenescence in RA could be causative for this finding.
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Affiliation(s)
- Marco Krasselt
- Division of Rheumatology, Medical Department III - Endocrinology, Nephrology and Rheumatology, Department of Internal Medicine, Neurology and Dermatology, University of Leipzig Medical Centre, Liebigstr. 20/22, 04103, Leipzig, Germany.
| | - Christoph Baerwald
- Division of Rheumatology, Medical Department III - Endocrinology, Nephrology and Rheumatology, Department of Internal Medicine, Neurology and Dermatology, University of Leipzig Medical Centre, Liebigstr. 20/22, 04103, Leipzig, Germany
| | - Uwe G Liebert
- Institute for Virology, University of Leipzig, Johannisallee 30, 04103, Leipzig, Germany
| | - Olga Seifert
- Division of Rheumatology, Medical Department III - Endocrinology, Nephrology and Rheumatology, Department of Internal Medicine, Neurology and Dermatology, University of Leipzig Medical Centre, Liebigstr. 20/22, 04103, Leipzig, Germany
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Adawi M, Bragazzi NL, McGonagle D, Watad S, Mahroum N, Damiani G, Conic R, Bridgewood C, Mahagna H, Giacomelli L, Eggenhöffner R, Mahamid M, Pigatto PDM, Amital H, Watad A. Immunogenicity, safety and tolerability of anti-pneumococcal vaccination in systemic lupus erythematosus patients: An evidence-informed and PRISMA compliant systematic review and meta-analysis. Autoimmun Rev 2018; 18:73-92. [PMID: 30408581 DOI: 10.1016/j.autrev.2018.08.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 08/06/2018] [Indexed: 12/16/2022]
Abstract
The immunological perturbations associated with systemic lupus erythematosus (SLE) put many patients at a higher risk of infections, including pneumococcal pneumonia. However, the uptake and utility of anti-pneumococcal vaccines in SLE patient is both controversial and not completely agreed upon. Indeed, several epidemiological studies of anti-pneumococcal vaccine safety and efficacy in SLE have reported short-term immunogenicity with elevated anti-pneumococcal antibody titres but inconsistent long-term findings, with some studies finding poor responses, mainly for long-term immune protection. Moreover, the safety and efficacy of the pneumococcal vaccine in SLE patients remains controversial due to the different types of anti-pneumococcal vaccines, and the heterogeneity of SLE patients. Several reviews addressing anti-pneumococcal vaccination in SLE patients exist, however, to the best of our knowledge, the present is the first systematic review and meta-analysis. To better understand the efficacy and safety of pneumococcal vaccination in SLE, a comprehensive literature search was performed identifying 18 studies, which have been included in the present systematic review and meta-analysis. All studies were designed as longitudinal investigations, 2, in particular, were of high quality, being randomized, double-blind trials (RCTs). Four studies had control groups. Total sample size included 601 participants. Vaccine immunogenicity in terms of subjects with protective antibody titers ranged from 36% to 97.6%. According to our systematic review and metanalysis, high erythrocyte sedimentation rate (ESR), older age, earlier SLE onset, high disease activity, and immunosuppressive therapy were predictors of poor immunogenicity, although belimumab was found to have no significant impact. With regard to safety, no serious adverse events were found, with up to one third of cases reporting mild/low-grade complaints. In conclusion, due to the high risk of pneumococcal infection in SLE patients and given the safety and, at least partial, effectiveness, according to our systematic review and meta-analysis, in such patients, preventive strategies mainly by immunization, are required in all age groups and, in those needing immunosuppressive therapy, immunization should be given prior the initiation of the treatment. PROSPERO registration code CRD42018103605.
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Affiliation(s)
- Mohammad Adawi
- Azrieli Faculty of Medicine, Bar-Ilan University, Zefat, Israel; Padeh and Ziv Medical Centers, Zefat, Israel
| | - Nicola Luigi Bragazzi
- Postgraduate School of Public Health, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy.
| | - Dennis McGonagle
- Section of Musculoskeletal Disease, Leeds Institute of Molecular Medicine, University of Leeds, NIHR Leeds Musculoskeletal Biomedical Research Unit, Chapel Allerton Hospital, Leeds, UK
| | - Samaa Watad
- Department of Statistics and Operations Research, Tel Aviiv University, Tel Aviv, Israel
| | - Naim Mahroum
- Department of Medicine 'B', Sheba Medical Center, Tel-Hashomer, Israel; Zabludowicz center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Hashomer, Israel
| | - Giovanni Damiani
- Young Dermatologists Italian Network (YDIN), GISED, Bergamo, Italy; Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Unità Operativa di Dermatologia, IRCCS Fondazione Ca' Granda, Ospedale maggiore Policlinico, Milano, Italy; Clinical Dermatology, Department of Biomedical, Surgical and Dental Sciences, IRCCS Galeazzi Orthopaedic Institute, University of Milan, 20126 Milan, Italy
| | - Rosalynn Conic
- Department of Dermatology, Case Western Reserve University, Cleveland, OH, USA
| | - Charlie Bridgewood
- Section of Musculoskeletal Disease, Leeds Institute of Molecular Medicine, University of Leeds, NIHR Leeds Musculoskeletal Biomedical Research Unit, Chapel Allerton Hospital, Leeds, UK
| | - Hussein Mahagna
- Department of Medicine 'B', Sheba Medical Center, Tel-Hashomer, Israel; Zabludowicz center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Hashomer, Israel
| | - Luca Giacomelli
- Dipartimento di Scienze chirurgiche e Diagnostiche Integrate (DISC) Università degli Studi di Genova, Genova, Italy
| | - Roberto Eggenhöffner
- Dipartimento di Scienze chirurgiche e Diagnostiche Integrate (DISC) Università degli Studi di Genova, Genova, Italy
| | - Mahmud Mahamid
- Azrieli Faculty of Medicine, Bar-Ilan University, Zefat, Israel; Endoscopy Unit of the Nazareth Hospital EMMS, Nazareth, Israel
| | - Paolo Daniele Maria Pigatto
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Unità Operativa di Dermatologia, IRCCS Fondazione Ca' Granda, Ospedale maggiore Policlinico, Milano, Italy
| | - Howard Amital
- Department of Medicine 'B', Sheba Medical Center, Tel-Hashomer, Israel; Zabludowicz center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Hashomer, Israel
| | - Abdulla Watad
- Section of Musculoskeletal Disease, Leeds Institute of Molecular Medicine, University of Leeds, NIHR Leeds Musculoskeletal Biomedical Research Unit, Chapel Allerton Hospital, Leeds, UK; Department of Medicine 'B', Sheba Medical Center, Tel-Hashomer, Israel; Zabludowicz center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Hashomer, Israel
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Tarasova GM, Belov BS, Bukhanova DV, Cherkasova MV, Solovyev SK, Aseeva EA, Reshetnyak TM, Popkova TV. INVESTIGATION OF IMMUNOGENICITY AND SAFETY OF 23-VALENT POLYSACCHARIDE PNEUMOCOCCAL VACCINE IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS. RHEUMATOLOGY SCIENCE AND PRACTICE 2018. [DOI: 10.14412/1995-4484-2018-433-438] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Objective: to investigate the safety and immunogenicity of 23-valent polysaccharide pneumococcal vaccine (PPV-23) in patients with systemic lupus erythematosus (SLE). Subjects and methods. The investigation enrolled 30 patients with a reliable diagnosis of SLE; of them there were 27 women and 3 men at the age of 19 to 62 years. The disease duration ranged from 9 months to 20 years. At the time of inclusion in the investigation, the disease activity was high in 2 patients, moderate in 3, and low in 20; five patients were in remission. During a year before vaccination, pneumonia was detected in 5 (16.7%) of the 30 patients; there were a total of 18 episodes of various respiratory and ENT infections. The patients were examined at baseline and at 1, 3 and 12 months after vaccination. Standard clinical and laboratory studies and a detailed blood immunological analysis were carried out at visits. The levels of IgG antibodies to capsular polysaccharide pneumococcus were determined during each visit. Twenty-nine patients received glucocorticoids (GCs) at a dose of 5–30 mg/day; 24 – hydroxychloroquine; 14 – cytostatics (CS); 10 – biological agents (BAs) (5 – rituximab, 5 – belimumab). A single dose of 0.5 ml of PPV-23 (Pneumo 23, Aventis) was subcutaneously injected into the upper outer arm. Vaccination was done during the ongoing therapy with GC/CS and belimumab, as well as at least 1 month before the first (next) administration and/or 4.5–5 months after the last rituximab infusion. Results and discussion. 60% of patients were observed to have mild and moderate standard local vaccine reactions; 1 (3.3%) patient had a local hyperergic reaction eliminated within 7 days of the local application of antihistamines and GCs. During the follow-up, there was no SLE exacerbation significantly associated with the vaccination performed. No new autoimmune phenomena were found in any of the cases. A year after vaccination, a significant (2-fold or more) increase in anti-pneumococcal antibody levels remained in 19 (63.3%) patients (respondents); 36.7% of patients were nonrespondents. Among the patients who received a BA, the non-responders were significantly more than among those who did not take the drug (7 (70%) and 4 (20%), respectively) (p = 0.01). When treated with rituximab and belimumab, the number of non-respondents was comparable (4 and 3, respectively). The immunogenicity of PPV-23 was independent of the degree of SLE activity: the vaccine response was absent in 1 out of the 5 patients with high (n = 2) and medium (n = 3) SLE activities, as well as in 10 out of the 25 patients with low disease activity and remission. There was no development of considerable adverse reactions after vaccination in patients with high and medium SLE activity. The overall clinical efficiency of vaccination was 93.3%. Conclusion. Thus, PPV-23 shows a good tolerability and a sufficient immunogenicity in patients with SLE. There is a need for further investigations conducted in large samples of patients during long-term follow-ups in order to more fully evaluate the clinical efficacy, tolerability, and immunogenicity of PPV-23.
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Recommendations and barriers to vaccination in systemic lupus erythematosus. Autoimmun Rev 2018; 17:990-1001. [PMID: 30103044 DOI: 10.1016/j.autrev.2018.04.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 04/12/2018] [Indexed: 01/06/2023]
Abstract
Patients with Systemic Lupus Erythematosus (SLE) pose a unique dilemma pertaining to immunization against common pathogens. SLE patients are usually not immunized with vaccines based on the fear of either precipitating infection in this immunosuppressed patient population (with live vaccines) or aggravating autoimmunity and hence lupus flares (with any vaccines). However, elevated vulnerability to infection makes patients with SLE precisely the population that needs protection from vaccine-preventable diseases. A summary of guidelines from the Centers for Disease Control and Prevention, professional societies, review articles and expert opinions regarding use of individual vaccines applicable to adults with SLE is presented in this review.
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