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Bühler S, Jaeger VK, Eperon G, Furrer H, Fux CA, Jansen S, Neumayr A, Rochat L, Schmid S, Schmidt-Chanasit J, Staehelin C, de Visser AW, Visser LG, Niedrig M, Hatz C. Safety and immunogenicity of a primary yellow fever vaccination under low-dose methotrexate therapy-a prospective multi-centre pilot study1. J Travel Med 2020; 27:5878835. [PMID: 32729905 DOI: 10.1093/jtm/taaa126] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 06/17/2020] [Accepted: 07/24/2020] [Indexed: 11/14/2022]
Abstract
BACKGROUND More people on immunosuppression live in or wish to travel to yellow fever virus (YFV)-endemic areas. Data on the safety and immunogenicity of yellow fever vaccination (YFVV) during immunosuppression are scarce. The aim of this study was to compare the safety and immunogenicity of a primary YFVV between travellers on methotrexate and controls. METHODS We conducted a prospective multi-centre controlled observational study from 2015 to 2017 in six Swiss travel clinics. 15 adults (nine with rheumatic diseases, five with dermatologic conditions and one with a gastroenterological disease) on low-dose methotrexate (≤20 mg/week) requiring a primary YFVV and 15 age and sex-matched controls received a YFVV. Solicited/unsolicited adverse reactions were recorded, YFV-RNA was measured in serum samples on Days 3, 7, 10, 14, 28 and neutralizing antibodies on Days 0, 7, 10, 14, 28. RESULTS Patients´ and controls' median ages were 53 and 52 years; 9 patients and 10 controls were female. 43% of patients and 33% of controls showed local side effects (P = 0.71); 86% of patients and 66% of controls reported systemic reactions (P = 0.39). YFV-RNA was detected in patients and controls on Day 3-10 post-vaccination and was never of clinical significance. Slightly more patients developed YFV-RNAaemia (Day 3: n = 5 vs n = 2, Day 7: n = 9 vs n = 7, Day 10: n = 3 vs n = 2, all P > 0.39). No serious reactions occurred. On Day 10, a minority of vaccinees was seroprotected (patients: n = 2, controls: n = 6). On Day 28, all vaccinees were seroprotected. CONCLUSIONS First-time YFVV was safe and immunogenic in travellers on low-dose methotrexate. Larger studies are needed to confirm these promising results.
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Affiliation(s)
- Silja Bühler
- Department of Public Health and Global Health/Division of Infectious Diseases, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, 8001 Zurich, Switzerland.,Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine, Bernhard-Nocht-Strasse 74, 20359 Hamburg, Germany.,Division of Hygiene and Infectious Diseases, Institute of Hygiene and Environment, Marckmannstrasse 129a, 20539 Hamburg, Germany
| | - Veronika Katharina Jaeger
- Department of Rheumatology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland.,Department of Clinical Epidemiology, Institute of Epidemiology and Social Medicine, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149 Münster, Germany
| | - Gilles Eperon
- Division of Tropical and Humanitarian Medicine, Department of Primary Care, Geneva University Hospitals (HUG), Rue Gabrielle-Perret-Gentil 6, 1205 Geneva, Switzerland
| | - Hansjakob Furrer
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Freiburgstrasse 15, 3010 Bern, Switzerland
| | - Christoph A Fux
- Department of Infectious Diseases and Hospital Hygiene, Kantonsspital Aarau, Tellstrasse 25, 5001 Aarau, Switzerland
| | - Stephanie Jansen
- Department of Arbovirology, Bernhard Nocht Institute for Tropical Medicine, Bernhard-Nocht-Strasse 74, 20359 Hamburg, Germany
| | - Andreas Neumayr
- Department of Medicine, Swiss Tropical and Public Health Institute, Socinstrasse 57, 4051 Basel, Switzerland.,University of Basel, Socinstrasse 57, 4051 Basel, Switzerland
| | - Laurence Rochat
- Travel Clinic, Department of Ambulatory Care and Community Medicine, University Hospital Lausanne, Rue du Bugnon 21, 1011 Lausanne, Switzerland
| | - Sabine Schmid
- Department of Public Health and Global Health/Division of Infectious Diseases, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, 8001 Zurich, Switzerland
| | - Jonas Schmidt-Chanasit
- Department of Arbovirology, Bernhard Nocht Institute for Tropical Medicine, Bernhard-Nocht-Strasse 74, 20359 Hamburg, Germany.,Faculty of Mathematics, Informatics and Natural Sciences, University of Hamburg, Bundesstraße 55, 20146 Hamburg, Germany
| | - Cornelia Staehelin
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Freiburgstrasse 15, 3010 Bern, Switzerland
| | - Adriëtte W de Visser
- Department of Infectious Diseases, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Leonardus G Visser
- Department of Infectious Diseases, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Matthias Niedrig
- Robert Koch Institute (RKI), Seestraße 10, 13353 Berlin, Germany
| | - Christoph Hatz
- Department of Public Health and Global Health/Division of Infectious Diseases, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, 8001 Zurich, Switzerland.,Department of Medicine, Swiss Tropical and Public Health Institute, Socinstrasse 57, 4051 Basel, Switzerland.,University of Basel, Socinstrasse 57, 4051 Basel, Switzerland.,Department of Infectious Diseases and Hospital Hygiene, Cantonal Hospital St. Gallen, Rorschacherstrasse 95, 9007 St. Gallen, Switzerland
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