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D’Amelio R, Asero R, Cassatella MA, Laganà B, Lunardi C, Migliorini P, Nisini R, Parronchi P, Quinti I, Racanelli V, Senna G, Vacca A, Maggi E. Anti-COVID-19 Vaccination in Patients with Autoimmune-Autoinflammatory Disorders and Primary/Secondary Immunodeficiencies: The Position of the Task Force on Behalf of the Italian Immunological Societies. Biomedicines 2021; 9:1163. [PMID: 34572349 PMCID: PMC8465958 DOI: 10.3390/biomedicines9091163] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 08/30/2021] [Accepted: 09/01/2021] [Indexed: 02/06/2023] Open
Abstract
The Coronavirus disease 2019 (COVID-19) pandemic has represented an unprecedented challenge for humankind from health, economic, and social viewpoints. In February 2020, Italy was the first western country to be deeply hit by the pandemic and suffered the highest case/fatality rate among western countries. Brand new anti-COVID-19 vaccines have been developed and made available in <1-year from the viral sequence publication. Patients with compromised immune systems, such as autoimmune-autoinflammatory disorders (AIAIDs), primary (PIDs) and secondary (SIDs) immunodeficiencies, have received careful attention for a long time regarding their capacity to safely respond to traditional vaccines. The Italian Immunological Societies, therefore, have promptly faced the issues of safety, immunogenicity, and efficacy/effectiveness of the innovative COVID-19 vaccines, as well as priority to vaccine access, in patients with AIADs, PIDs, and SIDs, by organizing an ad-hoc Task Force. Patients with AIADs, PIDs, and SIDs: (1) Do not present contraindications to COVID-19 vaccines if a mRNA vaccine is used and administered in a stabilized disease phase without active infection. (2) Should usually not discontinue immunosuppressive therapy, which may be modulated depending on the patient's clinical condition. (3) When eligible, should have a priority access to vaccination. In fact, immunizing these patients may have relevant social/health consequences, since these patients, if infected, may develop chronic infection, which prolongs viral spread and facilitates the emergence of viral variants.
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Affiliation(s)
- Raffaele D’Amelio
- Dipartimento di Medicina Clinica e Molecolare, Sapienza Università di Roma, Via di Grottarossa 1035-1039, 00189 Rome, Italy;
| | - Riccardo Asero
- Ambulatorio di Allergologia, Clinica S. Carlo di Paderno Dugnano, Via Ospedale 21, 20037 Milano, Italy;
| | - Marco Antonio Cassatella
- Sezione di Patologia Generale, Dipartimento di Medicina, Università di Verona, Strada Le Grazie 4, 37134 Verona, Italy;
| | - Bruno Laganà
- UOC Medicina Interna, Dipartimento di Medicina Clinica e Molecolare, AOU S. Andrea, Sapienza Università di Roma, Via di Grottarossa 1035-1039, 00189 Rome, Italy;
| | - Claudio Lunardi
- Responsabile Unità di Malattie Autoimmunitarie, Dipartimento di Medicina, AOU Policlinico G.B. Rossi, Borgo Roma, Università di Verona, Piazzale Ludovico Antonio Scuro 10, 37134 Verona, Italy;
| | - Paola Migliorini
- Direttore Unità Operativa di Immunoallergologia Clinica, Dipartimento di Medicina Clinica e Sperimentale, Azienda Ospedaliero Universitaria Pisana, Università di Pisa, Via Roma 67, 56126 Pisa, Italy;
| | - Roberto Nisini
- Direttore Reparto Immunologia, Dipartimento di Malattie Infettive, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome, Italy;
| | - Paola Parronchi
- Direttore SOD Immunologia e Terapie Cellulari, Dipartimento di Medicina Sperimentale e Clinica, AOU Careggi, Università di Firenze, Largo Brambilla 3, 50134 Firenze, Italy;
| | - Isabella Quinti
- Responsabile UOD Centro di Riferimento Regionale per le Immunodeficienze, Dipartimento di Medicina Molecolare, AOU Policlinico Umberto I, Sapienza Università di Roma, Viale dell’Università 37, 00161 Rome, Italy;
| | - Vito Racanelli
- UOC Medicina Interna “Guido Baccelli”, Dipartimento di Scienze Biomediche ed Oncologia Umana, AOU Policlinico, Università di Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy;
| | - Gianenrico Senna
- Direttore USD Allergologia, Dipartimento di Medicina, AOU Policlinico G.B. Rossi, Borgo Roma, Università di Verona, Piazzale Ludovico Antonio Scuro 10, 37134 Verona, Italy;
| | - Angelo Vacca
- Direttore UOC Medicina Interna “Guido Baccelli”, Dipartimento di Scienze Biomediche ed Oncologia Umana, AOU Policlinico, Università di Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy;
| | - Enrico Maggi
- Unità di Immunità Traslazionale, Dipartimento di Immunologia, Ospedale Pediatrico Bambino Gesù, IRCCS, Viale di S. Paolo 15, 00146 Rome, Italy
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Immunogenicity of Viral Vaccines in the Italian Military. Biomedicines 2021; 9:biomedicines9010087. [PMID: 33477366 PMCID: PMC7829820 DOI: 10.3390/biomedicines9010087] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 01/09/2021] [Accepted: 01/12/2021] [Indexed: 11/17/2022] Open
Abstract
Military personnel of all armed forces receive multiple vaccinations and have been doing so since long ago, but relatively few studies have investigated the possible negative or positive interference of simultaneous vaccinations. As a contribution to fill this gap, we analyzed the response to the live trivalent measles/mumps/rubella (MMR), the inactivated hepatitis A virus (HAV), the inactivated trivalent polio, and the trivalent subunits influenza vaccines in two cohorts of Italian military personnel. The first cohort was represented by 108 students from military schools and the second by 72 soldiers engaged in a nine-month mission abroad. MMR and HAV vaccines had never been administered before, whereas inactivated polio was administered to adults primed at infancy with a live trivalent oral polio vaccine. Accordingly, nearly all subjects had baseline antibodies to polio types 1 and 3, but unexpectedly, anti-measles/-mumps/-rubella antibodies were present in 82%, 82%, and 73.5% of subjects, respectively (43% for all of the antigens). Finally, anti-HAV antibodies were detectable in 14% and anti-influenza (H1/H3/B) in 18% of the study population. At mine months post-vaccination, 92% of subjects had protective antibody levels for all MMR antigens, 96% for HAV, 69% for the three influenza antigens, and 100% for polio types 1 and 3. An inverse relationship between baseline and post-vaccination antibody levels was noticed with all the vaccines. An excellent vaccine immunogenicity, a calculated long antibody persistence, and apparent lack of vaccine interference were observed.
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Rivera-Izquierdo M, Valero-Ubierna MDC, Nieto-Gómez P, Martínez-Bellón MD, Fernández-Martínez NF, Barranco-Quintana JL. Vaccination in patients under monoclonal antibody treatment: an updated comprehensive review. Expert Rev Vaccines 2020; 19:727-744. [PMID: 32702246 DOI: 10.1080/14760584.2020.1800462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Monoclonal antibodies (mAbs) have become an increasing source of biological treatments. Clinicians should make an effort to update their knowledge on mechanisms of action, indications, and adverse events of these novel therapies. Most of them have immunosuppressive effects and, therefore, vaccination is indicated. AREAS COVERED vaccination of patients under mAbs therapies. EXPERT OPINION Recommendations on vaccination are still based on expert recommendations and have not been updated in recent years. Specific recommendations for each mAb have not been addressed in the current literature. The aim of this comprehensive review was to collect all the therapeutic mAbs approved up to 1 January 2020 and, based on previous recommendations and the pharmaceutical characteristics of each drug, to propose an updated guide with recommendations on vaccination. Influenza, sequential pneumococcal and Hepatitis B vaccination in patients with negative serology were the only consistent recommendations. Hepatitis A vaccination was proposed for mAbs with special hepatotoxic characteristics. Other vaccines are reviewed and discussed. Several non-immunosuppressive mAbs were detected and, therefore, vaccinations not recommended. We hope that this review can serve as a starting point for compiling updated vaccination recommendations and collecting all the therapeutic mAbs approved up to 2020.
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Affiliation(s)
- Mario Rivera-Izquierdo
- Service of Preventive Medicine and Public Health, Hospital Universitario Clínico San Cecilio , Granada, Spain.,Unidad de Gestión Clínica de Prevención, Promoción y Vigilancia de la Salud , Granada, Spain.,Department of Preventive Medicine and Public Health, University of Granada , Granada, Spain
| | - Maria Del Carmen Valero-Ubierna
- Service of Preventive Medicine and Public Health, Hospital Universitario Clínico San Cecilio , Granada, Spain.,Unidad de Gestión Clínica de Prevención, Promoción y Vigilancia de la Salud , Granada, Spain
| | - Pelayo Nieto-Gómez
- Service of Hospital Pharmacy, Hospital Universitario Clínico San Cecilio , Granada, Spain
| | - María Dolores Martínez-Bellón
- Service of Preventive Medicine and Public Health, Hospital Universitario Clínico San Cecilio , Granada, Spain.,Unidad de Gestión Clínica de Prevención, Promoción y Vigilancia de la Salud , Granada, Spain
| | - Nicolás Francisco Fernández-Martínez
- Service of Preventive Medicine and Public Health, Hospital Universitario Reina Sofía , Córdoba, Spain.,Maimonides Biomedical Research Institute of Cordoba (IMIBIC) , Córdoba, Spain
| | - José Luis Barranco-Quintana
- Service of Preventive Medicine and Public Health, Hospital Universitario Reina Sofía , Córdoba, Spain.,Maimonides Biomedical Research Institute of Cordoba (IMIBIC) , Córdoba, Spain.,Expert Committee on Andalusian Vaccine Plan, Consejería de Salud y Familias, Junta de Andalucía , Sevilla, Spain
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Shende P, Waghchaure M. Combined vaccines for prophylaxis of infectious conditions. ARTIFICIAL CELLS NANOMEDICINE AND BIOTECHNOLOGY 2019; 47:696-705. [PMID: 30829068 DOI: 10.1080/21691401.2019.1576709] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
In recent years, the application of vaccines shows limitations, including the high number of vaccine administrations and the fear of safety and effectiveness. In this regard, advanced vaccine products have been developed, like the combined vaccines, or are under development, such as nucleic acid vaccines (DNA and RNA), polymer-based vaccines, etc. Moreover, the possible use of traditional, like aluminium hydroxide and aluminium phosphate, or innovative adjuvants, like monophosphoryl lipid A, polysaccharides and nanoparticulate system, may further increase vaccine effectiveness. This review article focuses on the combined vaccines, which, especially when they are associated with adjuvants, reduce the dosing frequency, and prolong the duration of action, thus providing better vaccine coverage. Marketed preparations, like Typhim Vi, Peda typh and Boostrix showed better vaccine coverage for diseases like typhoid, tetanus, diphtheria and acellular pertussis. The future aspect for the development of combined vaccines will protect not only against infectious diseases but likely even against various infectious conditions, like pneumonia, meningococcal infection and respiratory syncytial virus infection.
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Affiliation(s)
- Pravin Shende
- a Shobhaben Pratapbhai Patel School of Pharmacy and Technology Management , SVKM's NMIMS , Mumbai , India
| | - Mansi Waghchaure
- a Shobhaben Pratapbhai Patel School of Pharmacy and Technology Management , SVKM's NMIMS , Mumbai , India
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Reduced IgG titers against pertussis in rheumatoid arthritis: Evidence for a citrulline-biased immune response and medication effects. PLoS One 2019; 14:e0217221. [PMID: 31136605 PMCID: PMC6538243 DOI: 10.1371/journal.pone.0217221] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 05/07/2019] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The antibody response to pertussis vaccination in rheumatoid arthritis is unknown, a concerning omission given the relatively low efficacy of the pertussis vaccine, a rise in pertussis infections, and a general increased susceptibility to infection in rheumatoid arthritis. Additionally, the contributions from an intrinsically dysregulated immune system in rheumatoid arthritis and immune-suppressing medications to the response to pertussis vaccination is poorly defined. This study examines antibody titers against pertussis in vaccinated rheumatoid arthritis patients and controls as well as evaluates potential contributions from demographic factors, immune suppressing medications, and reactivity against citrullinated pertussis. METHODS Serum IgG titers against native and citrullinated pertussis and tetanus were quantified by enzyme-linked immunosorbent assay in rheumatoid arthritis subjects and controls who were vaccinated within 10 years. Titers were compared by t-test and percent immunity by Fisher's exact test. Multivariable logistic regression was used to identify clinical factors that correlate with native pertussis titers. RESULTS Compared to controls, rheumatoid arthritis subjects had lower titers against pertussis, but not tetanus, and reduced immunity to pertussis. These results were even more prominent at 5-10 years post-vaccination, when rheumatoid arthritis patients had 50% lower titers than controls and 2.5x more rheumatoid arthritis subjects were not considered immune to pertussis. Multiple logistic regression demonstrated that female sex and methotrexate use, but not TNF inhibiting medications, correlated with reduced immunity to pertussis. Finally, rheumatoid arthritis patients had higher IgG titers against citrullinated pertussis than native pertussis. CONCLUSIONS Pertussis titers are lower in vaccinated rheumatoid arthritis patients with evidence for contributions from female sex, a citrulline-biased immune response, and methotrexate use.
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