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Kermond RF, Ozimek-Kulik JE, Kim S, Alexander SI, Hahn D, Kesson A, Wood N, McCarthy HJ, Durkan AM. Immunologic response to SARS-CoV-2 mRNA vaccination in pediatric kidney transplant recipients. Pediatr Nephrol 2023; 38:859-866. [PMID: 35833990 PMCID: PMC9281214 DOI: 10.1007/s00467-022-05679-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 06/10/2022] [Accepted: 06/29/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND COVID-19 disease in kidney transplant (KT) recipients is associated with increased morbidity, mortality, and hospitalization rates. Unfortunately, KT recipients also have a reduced response to SARS-CoV-2 immunization. The primary aim of this study was to assess immunologic response to SARS-CoV-2 mRNA vaccines in pediatric kidney transplant recipients 12-18 years of age. Secondary aims were to assess response rates following a third immunization and determine factors that influence immunization response. METHODS Pediatric KT recipients in a single tertiary center received SARS-CoV-2 mRNA vaccination as per local protocol. SARS-CoV-2 immunoglobulin (IgG) was measured following second and/or third vaccination. Demographics including patient factors (age, gender, and underlying disease), transplant factors (time and type of transplant), and immunosuppression (induction, maintenance, and immunomodulatory therapies such as IVIG) were collected from the medical records. RESULTS Of 20 participants, 10 (50%) responded following a two-dose vaccine schedule, which increased to 15 (75%) after three doses. Maintenance immunosuppression affected immunologic response, with azathioprine demonstrating a higher rate of response to vaccine compared to mycophenolate (100% vs. 38%, p = 0.04). Increasing prednisolone dose had a negative impact on immunologic response (0.01 mg/kg/day increase: OR 1.60 95% CI 1.01 to 2.57). Tacrolimus dose and trough levels, age, time post-transplant, underlying disease, and other immunosuppression did not impact immunologic response. CONCLUSIONS Pediatric KT recipients had similar response rates following SARS-CoV-2 immunization as adult KT recipients. Immunologic response improved following a third immunization. Choice of antimetabolite and prednisolone dosing influenced the rate of response. A higher resolution version of the Graphical abstract is available as Supplementary Information.
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Affiliation(s)
- Rachael F Kermond
- Department of Pediatric Nephrology, Children's Hospital Westmead, Westmead, NSW, 2145, Australia.
| | - Justyna E Ozimek-Kulik
- Department of Pediatric Nephrology, Children's Hospital Westmead, Westmead, NSW, 2145, Australia.
- School of Women's and Children's Health, University of New South Wales, Kensington, Australia.
| | - Siah Kim
- Department of Pediatric Nephrology, Children's Hospital Westmead, Westmead, NSW, 2145, Australia
- Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, 2145, Australia
- School of Public Health, Sydney University, Camperdown, NSW, Australia
| | - Stephen I Alexander
- Department of Pediatric Nephrology, Children's Hospital Westmead, Westmead, NSW, 2145, Australia
- Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, 2145, Australia
- School of Pediatrics and Child Health, University of Sydney, Sydney, Australia
| | - Deirdre Hahn
- Department of Pediatric Nephrology, Children's Hospital Westmead, Westmead, NSW, 2145, Australia
| | - Alison Kesson
- School of Pediatrics and Child Health, University of Sydney, Sydney, Australia
- Department of Infectious Disease, Children's Hospital Westmead, Westmead, NSW, 2145, Australia
- Sydney Institute for Infectious Diseases, University of Sydney, Sydney, Australia
| | - Nicholas Wood
- School of Pediatrics and Child Health, University of Sydney, Sydney, Australia
- Department of General Pediatrics, Children's Hospital Westmead, Westmead, NSW, 2145, Australia
- National Centre for Immunisation Research and Surveillance, Sydney Children's Hospitals Network, Sydney, Australia
| | - Hugh J McCarthy
- Department of Pediatric Nephrology, Children's Hospital Westmead, Westmead, NSW, 2145, Australia
- School of Women's and Children's Health, University of New South Wales, Kensington, Australia
- Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, 2145, Australia
| | - Anne M Durkan
- Department of Pediatric Nephrology, Children's Hospital Westmead, Westmead, NSW, 2145, Australia
- School of Pediatrics and Child Health, University of Sydney, Sydney, Australia
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Grupper A, Katchman H. SARS-CoV-2 Vaccines: Safety and Immunogenicity in Solid Organ Transplant Recipients and Strategies for Improving Vaccine Responses. CURRENT TRANSPLANTATION REPORTS 2022; 9:35-47. [PMID: 35096509 PMCID: PMC8783189 DOI: 10.1007/s40472-022-00359-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/27/2021] [Indexed: 12/20/2022]
Abstract
Purpose of Review While solid organ transplant (SOT) recipients are at the highest risk for severe complications and increased mortality from COVID19 disease, their vaccination against SARS-CoV-2 remains challenging due to fear of immune-mediated adverse events and suboptimal immune response. Our current review is aimed to summarize current knowledge about the safety and efficacy of SARS-CoV-2 vaccines, describe factors that are correlated with immune response, and discuss strategies to improve vaccine immunogenicity in SOT recipients. Recent Findings SARS-CoV-2 vaccines are safe in SOT recipients and not related to rejection or other major adverse events. The immune response to two doses of vaccine is suboptimal and correlated to age and magnitude of immunosuppression. Administration of a third vaccine dose brings to significant amplification of immune response. Summary This review strengthens the existing recommendation of vaccination by three doses of vaccine in all SOT recipients and completion of vaccination before transplantation if possible.
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Ducloux D, Colladant M, Chabannes M, Bamoulid J, Courivaud C. Factors associated with humoral response after BNT162b2 mRNA COVID-19 vaccination in kidney transplant patients. Clin Kidney J 2021; 14:2270-2272. [PMID: 34603706 PMCID: PMC8483680 DOI: 10.1093/ckj/sfab125] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 06/21/2021] [Indexed: 01/23/2023] Open
Affiliation(s)
- Didier Ducloux
- CHU Besançon, Department of Nephrology, Dialysis, and Renal Transplantation, Federation Hospitalo-Universitaire INCREASE, Besançon, France
| | - Mathilde Colladant
- CHU Besançon, Department of Nephrology, Dialysis, and Renal Transplantation, Federation Hospitalo-Universitaire INCREASE, Besançon, France
| | - Melchior Chabannes
- CHU Besançon, Department of Nephrology, Dialysis, and Renal Transplantation, Federation Hospitalo-Universitaire INCREASE, Besançon, France
| | - Jamal Bamoulid
- CHU Besançon, Department of Nephrology, Dialysis, and Renal Transplantation, Federation Hospitalo-Universitaire INCREASE, Besançon, France
| | - Cécile Courivaud
- CHU Besançon, Department of Nephrology, Dialysis, and Renal Transplantation, Federation Hospitalo-Universitaire INCREASE, Besançon, France
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Dembiński Ł, Stelmaszczyk-Emmel A, Sznurkowska K, Szlagatys-Sidorkiewicz A, Radzikowski A, Banaszkiewicz A. Immunogenicity of cholera vaccination in children with inflammatory bowel disease. Hum Vaccin Immunother 2021; 17:2586-2592. [PMID: 33794737 PMCID: PMC8475559 DOI: 10.1080/21645515.2021.1884475] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
The cholera vaccine can protect patients with inflammatory bowel disease (IBD) against both cholera and travelers' diarrhea. However, both immunosuppressive treatment and IBD can affect its vaccine immunogenicity. The aim of this study was to assess the immunogenicity and safety of the cholera vaccine in children with IBD. Children older than 6 years with diagnosed IBD were enrolled in this multicenter study. All patients were administered two doses of the oral cholera vaccine (Dukoral®). Anti-cholera toxin B subunit IgA and IgG seroconversion rates were evaluated in a group with immunosuppressive (IS) treatment and a group without IS treatment (NIS). Immunogenicity was assessed in 70 children, 79% of whom received IS treatment. Post-vaccination seroconversion was displayed by 33% of children, for IgA, and 70% of children, for IgG. No statistically significant differences were found in the immune responses between the IS and NIS groups: 35% vs. 27% (p = .90), for IgA, and 68% vs. 80.0% (p = .16), for IgG, respectively. One case of IBD exacerbation after vaccination was reported. The oral cholera vaccine is safe. The immunogenicity of the oral cholera vaccine in children with IBD was lower than previously observed in healthy ones. The treatment type does not seem to affect the vaccine immunogenicity.
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Affiliation(s)
- Łukasz Dembiński
- Department of Pediatric Gastroenterology and Nutrition, The Medical University of Warsaw, Warsaw, Poland
- CONTACT Łukasz Dembiński ; Department of Pediatric Gastroenterology and Nutrition, Medical University of Warsaw, Zwirki I Wigury 63A, Warsaw02-091, Poland
| | - Anna Stelmaszczyk-Emmel
- Department of Laboratory Diagnostics and Clinical Immunology of Developmental Age, Medical University of Warsaw, Warsaw, Poland
| | - Katarzyna Sznurkowska
- Department of Pediatrics, Gastroenterology, Allergology and Nutrition, Faculty of Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - Agnieszka Szlagatys-Sidorkiewicz
- Department of Pediatrics, Gastroenterology, Allergology and Nutrition, Faculty of Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - Andrzej Radzikowski
- Department of Pediatric Gastroenterology and Nutrition, The Medical University of Warsaw, Warsaw, Poland
| | - Aleksandra Banaszkiewicz
- Department of Pediatric Gastroenterology and Nutrition, The Medical University of Warsaw, Warsaw, Poland
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Grupper A, Rabinowich L, Schwartz D, Schwartz IF, Ben-Yehoyada M, Shashar M, Katchman E, Halperin T, Turner D, Goykhman Y, Shibolet O, Levy S, Houri I, Baruch R, Katchman H. Reduced humoral response to mRNA SARS-CoV-2 BNT162b2 vaccine in kidney transplant recipients without prior exposure to the virus. Am J Transplant 2021; 21:2719-2726. [PMID: 33866672 PMCID: PMC8250589 DOI: 10.1111/ajt.16615] [Citation(s) in RCA: 274] [Impact Index Per Article: 91.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 04/14/2021] [Accepted: 04/14/2021] [Indexed: 01/25/2023]
Abstract
COVID-19 is associated with increased morbidity and mortality in transplant recipients. There are no efficacy data available regarding these patients with any of the available SARS-CoV-2 vaccines. We analyzed the humoral response following full vaccination with the BNT162b2 (Pfizer-BioNTech) in 136 kidney transplant recipients, and compared it to 25 controls. In order to exclude prior exposure to the virus, only participants with negative serology to SARS-CoV-2 nucleocapsid protein were included. All controls developed a positive response to spike protein, while only 51 of 136 transplant recipients (37.5%) had positive serology (p < .001). Mean IgG anti-spike level was higher in the controls (31.05 [41.8] vs. 200.5 [65.1] AU/mL, study vs. control, respectively, p < .001). Variables associated with null humoral response were older age (odds ratio 1.66 [95% confidence interval 1.17-2.69]), high-dose corticosteroids in the last 12 months (1.3 [1.09-1.86]), maintenance with triple immunosuppression (1.43 [1.06-2.15]), and regimen that includes mycophenolate (1.47 [1.26-2.27]). There was a similar rate of side effects between controls and recipients, and no correlation was found between the presence of symptoms and seroconversion. Our findings suggest that most kidney transplant recipients remain at high risk for COVID-19 despite vaccination. Further studies regarding possible measures to increase recipient's response to vaccination are required.
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Affiliation(s)
- Ayelet Grupper
- Nephrology Department, Sackler Faculty of Medicine, Tel-Aviv Medical Center, Tel-Aviv University, Tel-Aviv, Israel
- Organ Transplantation Unit, Sackler Faculty of Medicine, Tel-Aviv Medical Center, Tel-Aviv University, Tel-Aviv, Israel
| | - Liane Rabinowich
- Organ Transplantation Unit, Sackler Faculty of Medicine, Tel-Aviv Medical Center, Tel-Aviv University, Tel-Aviv, Israel
- Liver Unit, Sackler Faculty of Medicine, Gastroenterology Institute, Tel Aviv Medical Center, Tel-Aviv University, Tel Aviv, Israel
| | - Doron Schwartz
- Nephrology Department, Sackler Faculty of Medicine, Tel-Aviv Medical Center, Tel-Aviv University, Tel-Aviv, Israel
| | - Idit F. Schwartz
- Nephrology Department, Sackler Faculty of Medicine, Tel-Aviv Medical Center, Tel-Aviv University, Tel-Aviv, Israel
| | - Merav Ben-Yehoyada
- Liver Unit, Sackler Faculty of Medicine, Gastroenterology Institute, Tel Aviv Medical Center, Tel-Aviv University, Tel Aviv, Israel
| | - Moshe Shashar
- Nephrology Section, Laniado Hospital, Netanya, Israel
- Ruth and Bruce Rappoport Faculty of Medicine, Technion, Haifa, Israel
| | - Eugene Katchman
- Department of Infectious Diseases, Sackler Faculty of Medicine, Tel Aviv Medical Center, Tel-Aviv University, Tel Aviv, Israel
| | - Tami Halperin
- Department of Infectious Diseases, Sackler Faculty of Medicine, Tel Aviv Medical Center, Tel-Aviv University, Tel Aviv, Israel
| | - Dan Turner
- Department of Infectious Diseases, Sackler Faculty of Medicine, Tel Aviv Medical Center, Tel-Aviv University, Tel Aviv, Israel
| | - Yaacov Goykhman
- Organ Transplantation Unit, Sackler Faculty of Medicine, Tel-Aviv Medical Center, Tel-Aviv University, Tel-Aviv, Israel
| | - Oren Shibolet
- Organ Transplantation Unit, Sackler Faculty of Medicine, Tel-Aviv Medical Center, Tel-Aviv University, Tel-Aviv, Israel
- Liver Unit, Sackler Faculty of Medicine, Gastroenterology Institute, Tel Aviv Medical Center, Tel-Aviv University, Tel Aviv, Israel
| | - Sharon Levy
- Organ Transplantation Unit, Sackler Faculty of Medicine, Tel-Aviv Medical Center, Tel-Aviv University, Tel-Aviv, Israel
- Liver Unit, Sackler Faculty of Medicine, Gastroenterology Institute, Tel Aviv Medical Center, Tel-Aviv University, Tel Aviv, Israel
| | - Inbal Houri
- Organ Transplantation Unit, Sackler Faculty of Medicine, Tel-Aviv Medical Center, Tel-Aviv University, Tel-Aviv, Israel
- Liver Unit, Sackler Faculty of Medicine, Gastroenterology Institute, Tel Aviv Medical Center, Tel-Aviv University, Tel Aviv, Israel
| | - Roni Baruch
- Nephrology Department, Sackler Faculty of Medicine, Tel-Aviv Medical Center, Tel-Aviv University, Tel-Aviv, Israel
- Organ Transplantation Unit, Sackler Faculty of Medicine, Tel-Aviv Medical Center, Tel-Aviv University, Tel-Aviv, Israel
| | - Helena Katchman
- Organ Transplantation Unit, Sackler Faculty of Medicine, Tel-Aviv Medical Center, Tel-Aviv University, Tel-Aviv, Israel
- Liver Unit, Sackler Faculty of Medicine, Gastroenterology Institute, Tel Aviv Medical Center, Tel-Aviv University, Tel Aviv, Israel
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6
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Babu TM, Kotton CN. Immunizations in Chronic Kidney Disease and Kidney Transplantation. CURRENT TREATMENT OPTIONS IN INFECTIOUS DISEASES 2021; 13:47-65. [PMID: 34025219 PMCID: PMC8126514 DOI: 10.1007/s40506-021-00248-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2021] [Indexed: 12/23/2022]
Abstract
PURPOSE OF REVIEW Infection is a significant cause of morbidity and mortality in both patients with chronic kidney disease (CKD) and in recipients of a kidney transplant (KT). We review the current data in patients with CKD, on dialysis, and in KT recipients to provide further guidance for clinicians regarding vaccine optimization in this patient population. RECENT FINDINGS This patient population remains under-vaccinated and thus more vulnerable to vaccine-preventable illness. Despite diminished responses to immunization in this population, significant protection is generally achieved. SUMMARY Vaccines are an important preventative tool and offer protection against infection. In the setting of suboptimal and waning immunity in this patient population, future studies are indicated to determine optimal vaccination regimens.
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Affiliation(s)
- Tara M. Babu
- Division of Allergy and Infectious Diseases, University of Washington, 908 Jefferson Street, Suite 11NJ-1166, Seattle, WA 98104 USA
- Division of Infectious Diseases, University of Rochester Medical Center, Rochester, NY USA
| | - Camille N. Kotton
- Transplant and Immunocompromised Host Infectious Diseases, Infectious Diseases Division, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Cox 5, Boston, MA 02114 USA
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7
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Wang AX, Quintero Cardona O, Ho DY, Busque S, Lenihan CR. Influence of immunosuppression on seroconversion against SARS-CoV-2 in two kidney transplant recipients. Transpl Infect Dis 2020; 23:e13423. [PMID: 32701196 PMCID: PMC7404350 DOI: 10.1111/tid.13423] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 07/13/2020] [Accepted: 07/14/2020] [Indexed: 12/23/2022]
Abstract
Solid organ transplant recipients are at risk for infectious complications due to chronic immunosuppression. The outbreak of coronavirus disease 2019 (COVID‐19) in the United States has raised growing concerns for the transplant patient population. We seek to add to the current limited literature on COVID‐19 in transplant recipients by describing the clinical course of two kidney transplant recipients with SARS‐CoV‐2 infection monitored by both RT‐PCR and serology. Through careful adjustment of their immunosuppression regimen, both patients had excellent recovery with intact graft function and development of anti‐SARS‐CoV‐2 antibodies.
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Affiliation(s)
- Aileen X Wang
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Orlando Quintero Cardona
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Dora Y Ho
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Stephan Busque
- Division of Abdominal Transplantation, Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Colin R Lenihan
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
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8
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Laws HJ, Baumann U, Bogdan C, Burchard G, Christopeit M, Hecht J, Heininger U, Hilgendorf I, Kern W, Kling K, Kobbe G, Külper W, Lehrnbecher T, Meisel R, Simon A, Ullmann A, de Wit M, Zepp F. Impfen bei Immundefizienz. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2020; 63:588-644. [PMID: 32350583 PMCID: PMC7223132 DOI: 10.1007/s00103-020-03123-w] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Hans-Jürgen Laws
- Klinik für Kinder-Onkologie, -Hämatologie und Klinische Immunologie, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland
| | - Ulrich Baumann
- Klinik für Pädiatrische Pneumologie, Allergologie und Neonatologie, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - Christian Bogdan
- Mikrobiologisches Institut - Klinische Mikrobiologie, Immunologie und Hygiene, Universitätsklinikum Erlangen, Friedrich-Alexander Universität FAU Erlangen-Nürnberg, Erlangen, Deutschland
- Ständige Impfkommission (STIKO), Robert Koch-Institut, Berlin, Deutschland
| | - Gerd Burchard
- Ständige Impfkommission (STIKO), Robert Koch-Institut, Berlin, Deutschland
- Bernhard-Nocht-Institut für Tropenmedizin, Hamburg, Deutschland
| | - Maximilian Christopeit
- Interdisziplinäre Klinik für Stammzelltransplantation, Universitätsklinikum Eppendorf, Hamburg, Deutschland
| | - Jane Hecht
- Abteilung für Infektionsepidemiologie, Fachgebiet Nosokomiale Infektionen, Surveillance von Antibiotikaresistenz und -verbrauch, Robert Koch-Institut, Berlin, Deutschland
| | - Ulrich Heininger
- Ständige Impfkommission (STIKO), Robert Koch-Institut, Berlin, Deutschland
- Universitäts-Kinderspital beider Basel, Basel, Schweiz
| | - Inken Hilgendorf
- Klinik für Innere Medizin II, Abteilung für Hämatologie und Internistische Onkologie, Universitätsklinikum Jena, Jena, Deutschland
| | - Winfried Kern
- Klinik für Innere Medizin II, Abteilung Infektiologie, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - Kerstin Kling
- Abteilung für Infektionsepidemiologie, Fachgebiet Impfprävention, Robert Koch-Institut, Berlin, Deutschland.
| | - Guido Kobbe
- Klinik für Hämatologie, Onkologie und Klinische Immunologie, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland
| | - Wiebe Külper
- Abteilung für Infektionsepidemiologie, Fachgebiet Impfprävention, Robert Koch-Institut, Berlin, Deutschland
| | - Thomas Lehrnbecher
- Klinik für Kinder- und Jugendmedizin, Universitätsklinikum Frankfurt, Frankfurt am Main, Deutschland
| | - Roland Meisel
- Klinik für Kinder-Onkologie, -Hämatologie und Klinische Immunologie, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland
| | - Arne Simon
- Klinik für Pädiatrische Onkologie und Hämatologie, Universitätsklinikum des Saarlandes, Homburg/Saar, Deutschland
| | - Andrew Ullmann
- Medizinische Klinik und Poliklinik II, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | - Maike de Wit
- Klinik für Innere Medizin - Hämatologie, Onkologie und Palliativmedizin, Vivantes Klinikum Neukölln, Berlin, Deutschland
- Klinik für Innere Medizin - Onkologie, Vivantes Auguste-Viktoria-Klinikum, Berlin, Deutschland
| | - Fred Zepp
- Ständige Impfkommission (STIKO), Robert Koch-Institut, Berlin, Deutschland
- Zentrum für Kinder- und Jugendmedizin, Universitätsmedizin Mainz, Mainz, Deutschland
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AMICIZIA D, MICALE R, PENNATI B, ZANGRILLO F, IOVINE M, LECINI E, MARCHINI F, LAI P, PANATTO D. Burden of typhoid fever and cholera: similarities and differences. Prevention strategies for European travelers to endemic/epidemic areas. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2019; 60:E271-E285. [PMID: 31967084 PMCID: PMC6953460 DOI: 10.15167/2421-4248/jpmh2019.60.4.1333] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 09/04/2019] [Indexed: 11/16/2022]
Abstract
The burden of diarrheal diseases is very high, accounting for 1.7 to 5 billion cases per year worldwide. Typhoid fever (TF) and cholera are potentially life-threatening infectious diseases, and are mainly transmitted through the consumption of food, drink or water that have been contaminated by the feces or urine of subjects excreting the pathogen. TF is mainly caused by Salmonella typhi, whereas cholera is caused by intestinal infection by the toxin-producing bacterium Vibrio cholerae. These diseases typically affect low- and middle-income countries where housing is overcrowded and water and sanitation are poor, or where conflicts or natural disasters have led to the collapse of the water, sanitation and healthcare systems. Mortality is higher in children under 5 years of age. Regarding their geographical distribution, TF has a high incidence in sub-Saharan Africa, India and south-east Asia, while cholera has a high incidence in a few African countries, particularly in the Horn of Africa and the Arabian Peninsula. In the fight against these diseases, preventive measures are fundamental. With modern air travel, transmissible diseases can spread across continents and oceans in a few days, constituting a threat to global public health. Nowadays, people travel for many reasons, such as tourism and business. Several surveys have shown that a high proportion of travelers lack adequate information on safety issues, such as timely vaccination and prophylactic medications. The main objective of this overview is to provide information to help European travelers to stay healthy while abroad, and thus also to reduce the potential importation of these diseases and their consequent implications for public health and society. The preventive measures to be implemented in the case of travel to countries where these diseases are still endemic are well known: the adoption of safe practices and vaccinations. It is important to stress that an effective preventive strategy should be based both on vaccinations and on hygiene travel guidelines. Furthermore, the emergence of multidrug-resistant strains is becoming a serious problem in the clinical treatment of these diseases. For this reason, vaccination is the main solution.
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Affiliation(s)
| | | | | | | | | | | | | | | | - D. PANATTO
- Department of Health Sciences, University of Genoa, Italy
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