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Piri-Gharaghie T, Ghajari G, Rezaeizadeh G, Adil M, Mahdi MH. A novel vaccine strategy against Brucellosis using Brucella abortus multi-epitope OMPs vaccine based on Lactococcus lactis live bacterial vectors. Int Immunopharmacol 2024; 134:112204. [PMID: 38703567 DOI: 10.1016/j.intimp.2024.112204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Revised: 04/25/2024] [Accepted: 05/01/2024] [Indexed: 05/06/2024]
Abstract
Brucella infections typically occur in mucosal membranes, emphasizing the need for mucosal vaccinations. This study evaluated the effectiveness of orally administering Lactococcus lactis (L. lactis) for producing the Brucella abortus multi-epitope OMPs peptide. A multi-epitope plasmid was generated through a reverse vaccinology method, and mice were administered the genetically modified L. lactis orally as a vaccine. The plasmid underwent digestion, synthesizing a 39 kDa-sized protein known as OMPs by the target group. The sera of mice that were administered the pNZ8124-OMPs-L. lactis vaccine exhibited a notable presence of IgG1 antibodies specific to outer membrane proteins (OMPs), heightened levels of interferon (IFN-λ) and tumor necrosis factor alpha (TNF-α), and enhanced transcription rates of interleukin 4 (IL-4) and interleukin 10 (IL-10). The spleen sections from the pNZ8124-OMPs-L. lactis and IRIBA group had less morphological damage associated with inflammation, infiltration of lymphocytes, and lesions to the spleen. The findings present a novel approach to utilizing the food-grade, non-pathogenic L. lactis as a protein cell factory to synthesize innovative immunological candidate OMPs. This approach offers a distinctive way to evaluate experimental medicinal items' practicality, safety, affordability, and long-term sustainability.
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Affiliation(s)
- Tohid Piri-Gharaghie
- Biotechnology Research Center, Faculty of Biological Sciences, East Tehran Branch, Islamic Azad University, Tehran, Iran.
| | - Ghazal Ghajari
- Department of Cell and Molecular Biology, Faculty of Biological Sciences, Kharazmi University, Tehran, Iran
| | - Golnoosh Rezaeizadeh
- Department of Microbiology, Falavarjan Branch, Islamic Azad University, Isfahan, Iran
| | - Mohaned Adil
- Pharmacy College, Al-Farahidi University, Baghdad, Iraq
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Zhang Y, Guo Y, Zhang K, Fan L, Ma J, Li Y, Zhou Q, Zhao Q, Hou S, Wang H. Comorbidities among adult patients with psoriasis in Tianjin: a cross-sectional analysis of the Health Database study. BMJ Open 2024; 14:e083683. [PMID: 38772892 PMCID: PMC11110554 DOI: 10.1136/bmjopen-2023-083683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Accepted: 04/11/2024] [Indexed: 05/23/2024] Open
Abstract
OBJECTIVES This study aims to examine the prevalence of comorbidities in adult patients with psoriasis and compare them with those in control subjects without psoriasis in Tianjin, China. DESIGN The study is a cross-sectionalanalysis. PARTICIPANTS The participants were established by identifying all patients (age ≥18 years) who visited hospitals and clinics in Tianjin between 1 January 2016 and 31 October 2019. SETTING The study group consisted of 20 678 adult patients with psoriasis, and a comparison group was created after 1:1 propensity score matching. Logistic regression analyses were conducted to examine the risk of 22 comorbidities for these two groups. RESULTS Patients with psoriasis had a significantly higher prevalence of 11 comorbidities and a lower prevalence of 2 comorbidities within 12 months of follow-up. Our results also showed that the proportion of psoriatic arthritis might account for approximately 2% of all patients with psoriasis. This psoriatic arthritis group had a higher average age and CCI (Charlson Comorbidity Index) index score (2.27 >1.62, p <0.001) than the non-arthritis group. CONCLUSIONS This study showed that psoriasis in Tianjin is associated with various comorbidities. It also emphasises the importance of clinical treatment in improving therapeutic effects and reducing the burden of psoriasis in China.
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Affiliation(s)
- Yiming Zhang
- Department of Dermatovenereology, Tianjin Medical University General Hospital/ Tianjin Institute of Sexually Transmitted Disease, Tianjin, China
| | - Yali Guo
- Department of Dermatovenereology, Tianjin Medical University General Hospital/ Tianjin Institute of Sexually Transmitted Disease, Tianjin, China
- Department of Dermatology, Tianjin Haihe Hospital, Tianjin, China
| | - Kaiyue Zhang
- Department of Dermatovenereology, Tianjin Medical University General Hospital/ Tianjin Institute of Sexually Transmitted Disease, Tianjin, China
| | - Liyun Fan
- Department of Dermatovenereology, Tianjin Medical University General Hospital/ Tianjin Institute of Sexually Transmitted Disease, Tianjin, China
| | - Jingyue Ma
- Department of Dermatovenereology, Tianjin Medical University General Hospital/ Tianjin Institute of Sexually Transmitted Disease, Tianjin, China
| | - Yan Li
- Department of Dermatovenereology, Tianjin Medical University General Hospital/ Tianjin Institute of Sexually Transmitted Disease, Tianjin, China
| | - Quan Zhou
- Department of Dermatovenereology, Tianjin Medical University General Hospital/ Tianjin Institute of Sexually Transmitted Disease, Tianjin, China
| | - Qian Zhao
- Department of Dermatovenereology, Tianjin Medical University General Hospital/ Tianjin Institute of Sexually Transmitted Disease, Tianjin, China
| | - Shuping Hou
- Department of Dermatovenereology, Tianjin Medical University General Hospital/ Tianjin Institute of Sexually Transmitted Disease, Tianjin, China
| | - Huiping Wang
- Department of Dermatovenereology, Tianjin Medical University General Hospital/ Tianjin Institute of Sexually Transmitted Disease, Tianjin, China
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Rutskaya-Moroshan K, Abisheva S, Sarsenova M, Ogay V, Vinnik T, Aubakirova B, Abisheva A. Autoimmune rheumatic diseases and COVID-19 vaccination: a retrospective cross-sectional study from Astana. Reumatologia 2024; 62:26-34. [PMID: 38558898 PMCID: PMC10979372 DOI: 10.5114/reum/184335] [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: 11/25/2023] [Accepted: 02/20/2024] [Indexed: 04/04/2024] Open
Abstract
Introduction The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus has had an unprecedented impact on people around the world, particularly those who were suffering from autoimmune rheumatic diseases (AIRDs). The world community acknowledges the significance of COVID-19 vaccination in patients with autoimmune disorders and emphasizes the priority of this category to receive vaccination over the general population. Although many studies have been published since the first phases of vaccination all over the world, multiple related factors still need to be further investigated. Material and methods We investigated the COVID-19 vaccination status in patients with AIRDs, by performing a cross-sectional, interview-based study filled in by patients attending their clinics in the Astana city, capital of Kazakhstan, from April to July 2023. The survey questionnaire consisted of a set of questions, concerning patient characteristics, treatment details, accepted vaccines and characteristics of COVID-19 infection. The study objectives were to evaluate vaccine hesitancy, adverse effects, breakthrough infections and flare of underlying rheumatic disease in this population subgroup. Results There were 193 participants, with a median age of 50.3 ±12.9 years. Among them, 62 (32.1%) were vaccinated with at least single dose of vaccine, 16 (25.8%) of whom were fully vaccinated. The commonest (89; 68%) reason for vaccine hesitancy was a fear of autoimmune disease worsening. Vaccine-related adverse effects (AEs) were reported by 66.7% of patients. We found that vaccination provoked AIRD exacerbation in 19% of patients with AEs. Eight patients reported flare of pre-existing rheumatic disease after vaccination. The incidence of breakthrough infections was similar in the groups of vaccinated individuals (n = 12), 12.9% of whom were partially and 6.5% fully vaccinated. Conclusions The vaccination was found to be safe in patients with rheumatic diseases. Fear of autoimmune status was the major reason for vaccine reluctance. All reported adverse events were minor. The minority subgroup within the sample had subsequent breakthrough infections or autoimmune disease flare-ups.
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Affiliation(s)
| | - Saule Abisheva
- NJSC Astana Medical University, Department of Family Medicine No. 1, Astana, Kazakhstan
| | - Madina Sarsenova
- Department of Medicine, School of Medicine, Nazarbayev University, Astana, Kazakhstan
| | - Vyacheslav Ogay
- Laboratory of Stem Cells, National Center for Biotechnology, Astana, Kazakhstan
| | - Tatyana Vinnik
- Department of Molecular Biology, Ariel University, Ariel, Israel
| | | | - Anilim Abisheva
- NJSC Astana Medical University, Department of Family Medicine No. 1, Astana, Kazakhstan
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4
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Elmahdi R, Ward D, Ernst MT, Poulsen G, Hallas J, Pottegård A, Jess T. Impact of immunosuppressive therapy on SARS-CoV-2 mRNA vaccine effectiveness in patients with immune-mediated inflammatory diseases: a Danish nationwide cohort study. BMJ Open 2024; 14:e077408. [PMID: 38387988 PMCID: PMC10882296 DOI: 10.1136/bmjopen-2023-077408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 02/06/2024] [Indexed: 02/24/2024] Open
Abstract
OBJECTIVE Patients receiving immunosuppressives have been excluded from trials for SARS-CoV-2 vaccine efficacy. Investigation of immunosuppressants' impact on effectiveness of vaccines, particularly in patients with immune-mediated inflammatory diseases (IMID), is therefore required. DESIGN We performed a nationwide cohort study to assess the risk of COVID-19 infection in vaccinated patients with IMID exposed to immunosuppressives compared with IMID unexposed to immunosuppressives. Exposure to immunosuppressives in the 120 days before receiving the second SARS-CoV-2 mRNA vaccination was assessed. Patients were followed from date of second vaccination and weighted Cox models were used to estimate the risk of infection associated with immunosuppressives. Secondary outcomes included hospitalisation and death associated with a positive SARS-CoV-2 test. Risk of infection by immunosuppressant drug class was also analysed. SETTING This study used population-representative data from Danish national health registries in the period from 1 January to 30 November 2021. RESULTS Overall, 152 440 patients were followed over 19 341 person years. Immunosuppressants were associated with a significantly increased risk of infection across IMID (HR: 1.4, 95% CI 1.2 to 1.5), in inflammatory bowel disease (IBD) (HR: 1.6, 95% CI 1.4 to 1.9) and arthropathy (HR: 1.3, 95% CI 1.1 to 1.4) but not psoriasis (HR: 1.1, 95% CI 0.9 to 1.4). Immunosuppressants were also associated with an increased risk of hospitalisation across IMID (HR: 1.4, 95% CI 1.1 to 2.0), particularly in IBD (HR: 2.1, 95% CI 1.0 to 4.1). No significantly increased risk of death in immunosuppressant exposed patients was identified. Analyses by immunosuppressant drug class showed increased COVID-19 infection and hospitalisation with anti-tumour necrosis factor (TNF), systemic corticosteroid, and rituximab and other immunosuppressants in vaccinated patients with IMID. CONCLUSION Immunosuppressive therapies reduced effectiveness of mRNA SARS-CoV-2 vaccination against infection and hospitalisation in patients with IMID. Anti-TNF, systemic corticosteroids, and rituximab and other immunosuppressants were particularly associated with these risks.
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Affiliation(s)
- Rahma Elmahdi
- Department of Clinical Medicine, Aalborg Universitet, Copenhagen, Denmark
- Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, North Denmark Region, Denmark
| | - Daniel Ward
- Department of Clinical Medicine, Aalborg Universitet, Copenhagen, Denmark
| | - Martin T Ernst
- Clinical Pharmacology and Pharmacy, Department of Public Health, University of Southern Denmark, Odense, Syddanmark, Denmark
| | - Gry Poulsen
- Department of Clinical Medicine, Aalborg Universitet, Copenhagen, Denmark
| | - Jesper Hallas
- Clinical Pharmacology and Pharmacy, Department of Public Health, University of Southern Denmark, Odense, Syddanmark, Denmark
| | - Anton Pottegård
- Clinical Pharmacology and Pharmacy, Department of Public Health, University of Southern Denmark, Odense, Syddanmark, Denmark
| | - Tine Jess
- Department of Clinical Medicine, Aalborg Universitet, Copenhagen, Denmark
- Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, North Denmark Region, Denmark
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5
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Finckh A, Ciurea A, Raptis CE, Rubbert-Roth A. Susceptibility to COVID-19 and Immunologic Response to Vaccination in Patients With Immune-Mediated Inflammatory Diseases. J Infect Dis 2023; 228:S13-S23. [PMID: 37539758 PMCID: PMC10401619 DOI: 10.1093/infdis/jiad148] [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: 03/16/2023] [Accepted: 05/06/2023] [Indexed: 08/05/2023] Open
Abstract
Immune-mediated inflammatory diseases (IMIDs) are a highly heterogeneous group of diseases that share a common etiology of immune dysregulation, such as rheumatoid arthritis, inflammatory bowel disease, and psoriasis, among others. It is estimated that the prevalence of IMIDs ranges between 5% and 7% in developed countries. As current management of IMIDs includes the use of immunomodulatory medications, the resulting weakened immune response can increase the risk of infection, including with SARS-CoV-2 (the causative agent of COVID-19) and reduce response to vaccination, placing these individuals at continued risk of severe outcomes from COVID-19. In this article, we summarize the current literature related to COVID-19 outcomes and the immunogenicity and reactogenicity of COVID-19 mRNA vaccination among patients with rheumatologically dominated IMIDs, as well as the effect of immunomodulatory therapies on these outcomes. We conclude by providing current COVID-19 vaccination recommendations for individuals with IMID.
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Affiliation(s)
- Axel Finckh
- Division of Rheumatology, Geneva University Hospitals, Geneva, Switzerland
- Geneva Centre for Inflammation Research, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Adrian Ciurea
- Department of Rheumatology, Zurich University Hospital, University of Zurich, Zurich, Switzerland
| | | | - Andrea Rubbert-Roth
- Correspondence: A. Rubbert-Roth, MD, Division of Rheumatology, Cantonal Hospital St. Gallen, Rorschacherstr 95, 9007 St. Gallen, Switzerland ()
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6
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van Dam KP, Wieske L, Stalman EW, Kummer LY, Roosen J, van Kempen ZL, Killestein J, Volkers AG, Boekel L, Wolbink GJ, van der Kooi AJ, Raaphorst J, Löwenberg M, Takkenberg RB, D'Haens GR, Spuls PI, Bekkenk MW, Musters AH, Post NF, Bosma AL, Hilhorst ML, Vegting Y, Bemelman FJ, Voskuyl AE, Broens B, Sanchez AP, van Els CA, de Wit J, Rutgers A, de Leeuw K, Horváth B, Verschuuren JJ, Ruiter AM, van Ouwerkerk L, van der Woude D, Allaart RC, Teng YO, van Paassen P, Busch MH, Jallah PB, Brusse E, van Doorn PA, Baars AE, Hijnen DJ, Schreurs CR, van der Pol W, Goedee HS, Steenhuis M, Keijzer S, Keijser JB, Cristianawati O, Rispens T, Brinke AT, Verstegen NJ, Marieke van Ham S, Tas SW, Kuijpers TW, Eftimov F. Disease activity in patients with immune-mediated inflammatory diseases after SARS-CoV-2 vaccinations. J Autoimmun 2023; 135:102984. [PMID: 36621174 PMCID: PMC9805902 DOI: 10.1016/j.jaut.2022.102984] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 12/15/2022] [Indexed: 01/03/2023]
Abstract
For patients with immune-mediated inflammatory diseases (IMIDs), concerns exist about increased disease activity after vaccination. We aimed to assess changes in disease activity after SARS-CoV-2 vaccination in patients with IMIDs, and determine risk factors for increased disease activity. In this substudy of a prospective observational cohort study (Target-to-B!), we included patients with IMIDs who received a SARS-CoV-2 vaccine. Patients reported changes in disease activity on a five-point Likert scale every 60 days for up to twelve months after first vaccination. In case of self-reported increased activity, hospital records were screened whether the treating physician reported increased activity, and for potential intensification of immunosuppressive (ISP) treatment. Mixed models were used to study determinants for self-reported increased disease activity. In total, 2111 patients were included for analysis after primary immunization (mean age 49.7 years [SD 13.7], 1329/2111 (63.0%) female), from which 1266 patients for analysis after first additional vaccination. Increased disease activity at 60 days after start of primary immunization was reported by 223/2111 (10.6%). In 96/223 (43.0%) the increase was confirmed by the treating physician and in 36/223 (16.1%) ISP treatment was intensified. Increased disease activity at seven to 60 days after additional vaccination, was reported by 139/1266 (11.0%). Vaccinations were not temporally associated with self-reported increased disease activity. Conversely, increased disease activity before first vaccination, neuromuscular disease, and multiple sclerosis were associated. Altogether, self-reported increased disease activity after vaccination against SARS-CoV-2 was recorded in a minority of patients and was generally mild. Moreover, multivariate analyses suggest that disease related factors, but not vaccinations are the major determinants for self-reported increased disease activity.
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Affiliation(s)
- Koos P.J. van Dam
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Luuk Wieske
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, the Netherlands,Department of Clinical Neurophysiology, St Antonius Hospital, Nieuwegein, the Netherlands
| | - Eileen W. Stalman
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Laura Y.L. Kummer
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, the Netherlands,Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, Amsterdam, the Netherlands
| | - Jesse Roosen
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Zoé L.E. van Kempen
- Department of Neurology, Amsterdam UMC, VU University Medical Center, Amsterdam, the Netherlands
| | - Joep Killestein
- Department of Neurology, Amsterdam UMC, VU University Medical Center, Amsterdam, the Netherlands
| | - Adriaan G. Volkers
- Department of Gastroenterology and Hepatology, Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Laura Boekel
- Amsterdam Rheumatology and Immunology Center, Location Reade, Department of Rheumatology, Amsterdam, the Netherlands
| | - Gerrit J. Wolbink
- Amsterdam Rheumatology and Immunology Center, Location Reade, Department of Rheumatology, Amsterdam, the Netherlands
| | - Anneke J. van der Kooi
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Joost Raaphorst
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Mark Löwenberg
- Department of Gastroenterology and Hepatology, Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - R. Bart Takkenberg
- Department of Gastroenterology and Hepatology, Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Geert R.A.M. D'Haens
- Department of Gastroenterology and Hepatology, Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Phyllis I. Spuls
- Department of Dermatology, Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Marcel W. Bekkenk
- Department of Dermatology, Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Annelie H. Musters
- Department of Dermatology, Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Nicoline F. Post
- Department of Dermatology, Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Angela L. Bosma
- Department of Dermatology, Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Marc L. Hilhorst
- Department of Internal Medicine, Section of Nephrology, Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Yosta Vegting
- Department of Internal Medicine, Section of Nephrology, Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Frederike J. Bemelman
- Department of Internal Medicine, Section of Nephrology, Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Alexandre E. Voskuyl
- Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and Immunology Center, VU University Medical Center, Amsterdam, the Netherlands
| | - Bo Broens
- Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and Immunology Center, VU University Medical Center, Amsterdam, the Netherlands
| | - Agner Parra Sanchez
- Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and Immunology Center, VU University Medical Center, Amsterdam, the Netherlands,Amsterdam Rheumatology and Immunology Center, Amsterdam UMC, Department of Rheumatology and Clinical Immunology, University of Amsterdam, Amsterdam, the Netherlands
| | - Cécile A.C.M. van Els
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands,Faculty of Veterinary Medicine, Utrecht University, Utrecht, the Netherlands
| | - Jelle de Wit
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Abraham Rutgers
- Department of Rheumatology and Clinical Immunology, University Medical Center Groningen, Groningen, the Netherlands
| | - Karina de Leeuw
- Department of Rheumatology and Clinical Immunology, University Medical Center Groningen, Groningen, the Netherlands
| | - Barbara Horváth
- Department of Dermatology, Center for Blistering Diseases, University Medical Center Groningen, University Groningen, Groningen, the Netherlands
| | | | - Annabel M. Ruiter
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
| | - Lotte van Ouwerkerk
- Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Diane van der Woude
- Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Renée C.F. Allaart
- Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Y.K. Onno Teng
- Centre of Expertise for Lupus, Vasculitis- and Complement-mediated Systemic Diseases, Department of Internal Medicine – Nephrology Section, Leiden University Medical Centre, Leiden, the Netherlands
| | - Pieter van Paassen
- Department of Nephrology and Clinical Immunology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Matthias H. Busch
- Department of Nephrology and Clinical Immunology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Papay B.P. Jallah
- Department of Nephrology and Clinical Immunology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Esther Brusse
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Pieter A. van Doorn
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Adája E. Baars
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Dirk Jan Hijnen
- Department of Dermatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Corine R.G. Schreurs
- Department of Dermatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - W.Ludo van der Pol
- Brain Center UMC Utrecht, Department of Neurology and Neurosurgery, Utrecht, the Netherlands
| | - H. Stephan Goedee
- Brain Center UMC Utrecht, Department of Neurology and Neurosurgery, Utrecht, the Netherlands
| | - Maurice Steenhuis
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, Amsterdam, the Netherlands
| | - Sofie Keijzer
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, Amsterdam, the Netherlands
| | - Jim B.D. Keijser
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, Amsterdam, the Netherlands
| | - Olvi Cristianawati
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, Amsterdam, the Netherlands
| | - Theo Rispens
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, Amsterdam, the Netherlands
| | - Anja ten Brinke
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, Amsterdam, the Netherlands
| | - Niels J.M. Verstegen
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, Amsterdam, the Netherlands
| | - S. Marieke van Ham
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, Amsterdam, the Netherlands,Swammerdam Institute for Life Sciences, University of Amsterdam, the Netherlands
| | - Sander W. Tas
- Amsterdam Rheumatology and Immunology Center, Amsterdam UMC, Department of Rheumatology and Clinical Immunology, University of Amsterdam, Amsterdam, the Netherlands
| | - Taco W. Kuijpers
- Department of Pediatric Immunology, Rheumatology and Infectious Disease, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Filip Eftimov
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, the Netherlands.
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7
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María FP, María BGA, Darío RFO, Paula AP, Vicent LRJ, Inés FP, Lucía FG, Germán FR, Federico FN, Ismael HG. Immunogenicity of the hepatitis B vaccine adjuvanted with AS04C in patients with biological therapies. Vaccine 2023; 41:744-749. [PMID: 36522266 DOI: 10.1016/j.vaccine.2022.12.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 11/20/2022] [Accepted: 12/01/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Hepatitis B vaccination is necessary for patients with biologic therapies because of the immunomodulatory effect of these drugs. Due to the elevated use of these therapies in the latest years, the research for new vaccination regimens and the improvement of the current ones is essential. New adjuvants like AS04C might be a potential strategy to improve immune response. Hepatitis B vaccine adjuvanted with AS04C has not been studied in this population before. We analyzed the immunogenicity of an adjuvanted hepatitis B vaccine in patients with biologic therapies. Variables that might affect vaccine response were also evaluated. METHODS Analytic observational retrospective cohort study performed between January 2016 and September 2018. 301 patients under biological treatment aged from 18 years were included. Patients received 4 doses of hepatitis B adjuvanted vaccine (Fendrix®) in a 0-1-2-6 month immunization schedule. Several sociodemographic, clinical and pharmacological variables were evaluated. The outcome variable was measured as the antibody titers (anti-HBs). The geometric mean of titers (GMT) as a measure for the central tendency was calculated from these values. RESULTS The immunization schedule of the hepatitis B vaccine adjuvanted with AS04C demonstrated high levels of seroconversion with 82.1 % (95 % CI, 77.6-86.6) of vaccinated patients seroconverting after primary vaccination and achieving 89.0 % (95 % IC, 85.3-92.7) after the booster doses for non-responders. The use of corticosteroid therapy and high doses of them, age over 60 years and the main diagnosis were associated with lower seroconversion rates and lower anti-HBs titers. CONCLUSIONS The hepatitis B vaccine adjuvanted with AS04C (Fendrix®) produces an adequate immune response in patients with autoimmune diseases and immunosuppressive and/or immunomodulating therapies. This immunization schedule is proposed as a very suitable and adapted option for the protection of patients with autoimmune diseases under active biological therapies.
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Affiliation(s)
- Fernández-Prada María
- Vaccines Unit, Preventive Medicine and Public Health Department, Hospital Vital Alvarez Buylla, Mieres, Spain.
| | | | | | | | - Latorre-Royán Josep Vicent
- Epidemiological Surveillance Department, Alicante Public Healthcare Center, Conselleria de Sanitat Universal i Salut Pública, Alicante, Spain
| | - Fernández-Peón Inés
- Family and Community Medicine, Hospital Universitario San Agustín, Área Sanitaria III, Avilés, Spain
| | - Fernández-González Lucía
- Family and Community Medicine, Hospital Universitario Central de Asturias, Área Sanitaria IV, Oviedo, Spain
| | | | | | - Huerta-González Ismael
- Epidemiological Surveillance Department, Dirección General de Salud Pública, Asturias, Spain
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8
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Lin Q, Zhu J, Chen J, Jia S, Nie S. Significance of cuproptosis- related genes in the diagnosis and classification of psoriasis. Front Mol Biosci 2023; 10:1115091. [PMID: 37091865 PMCID: PMC10119406 DOI: 10.3389/fmolb.2023.1115091] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 03/28/2023] [Indexed: 04/25/2023] Open
Abstract
Cuproptosis is a novel form of cell death linked to mitochondrial metabolism and is mediated by protein lipoylation. The mechanism of cuproptosis in many diseases, such as psoriasis, remains unclear. In this study, signature diagnostic markers of cuproptosis were screened by differential analysis between psoriatic and non-psoriatic patients. The differentially expressed cuproptosis-related genes (CRGs) for patients with psoriasis were screened using the GSE178197 dataset from the gene expression omnibus database. The biological roles of CRGs were identified by GO and KEGG enrichment analyses, and the candidates of cuproptosis-related regulators were selected from a nomogram model. The consensus clustering approach was used to classify psoriasis into clusters and the principal component analysis algorithms were constructed to calculate the cuproptosis score. Finally, latent diagnostic markers and drug sensitivity were analyzed using the pRRophetic R package. The differential analysis revealed that CRGs (MTF1, ATP7B, and SLC31A1) are significantly expressed in psoriatic patients. GO and KEGG enrichment analyses showed that the biological functions of CRGs were mainly related to acetyl-CoA metabolic processes, the mitochondrial matrix, and acyltransferase activity. Compared to the machine learning method used, the random forest model has higher accuracy in the occurrence of cuproptosis. However, the decision curve of the candidate cuproptosis regulators analysis showed that patients can benefit from the nomogram model. The consensus clustering analysis showed that psoriasis can be grouped into three patterns of cuproptosis (clusterA, clusterB, and clusterC) based on selected important regulators of cuproptosis. In advance, we analyzed the immune characteristics of patients and found that clusterA was associated with T cells, clusterB with neutrophil cells, and clusterC predominantly with B cells. Drug sensitivity analysis showed that three cuproptosis regulators (ATP7B, SLC31A1, and MTF1) were associated with the drug sensitivity. This study provides insight into the specific biological functions and related mechanisms of CRGs in the development of psoriasis and indicates that cuproptosis plays a non-negligible role. These results may help guide future treatment strategies for psoriasis.
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Affiliation(s)
- Qingyuan Lin
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
- Department of Pathology, Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jinchao Zhu
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
- Department of Pathology, Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jun Chen
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
| | - Shouqiang Jia
- Department of Imaging, Jinan People’s Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
- *Correspondence: Shouqiang Jia, ; Shengdong Nie,
| | - Shengdong Nie
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
- *Correspondence: Shouqiang Jia, ; Shengdong Nie,
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9
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Cao Y, Feng J, Duan S, Yang Y, Zhang Y. SARS-CoV-2-inactivated vaccine hesitancy and the safety in inflammatory bowel disease patients: a single-center study. Therap Adv Gastroenterol 2022; 15:17562848221101722. [PMID: 35706827 PMCID: PMC9189530 DOI: 10.1177/17562848221101722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 05/03/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) vaccine is thought to be the most effective preventive method of controlling the coronavirus disease 2019 (COVID-19) epidemic. Some patients with immune-related diseases, including inflammatory bowel disease (IBD) patients, however, may hesitate to be vaccinated for various reasons. Although several guidelines recommend vaccinating all IBD patients with inactivated SARS-CoV-2 vaccines, there is still a lack of real-world data on the safety of inactivated SARS-CoV-2 vaccines and COVID-19 vaccination rate in IBD patients. In this study, we investigated the reasons for hesitancy in COVID-19 vaccination, the COVID-19 vaccination rate, and the safety of SARS-CoV-2-inactivated vaccination in patients with IBD. METHODS This was a retrospective study. A total of 418 participants with IBD were enrolled to calculate the vaccination rates. A total of 232 patients with IBD who did not receive SARS-CoV-2 vaccination were recruited to investigate the reasons for hesitation. A follow-up survey of 151 IBD patients and 188 healthy participants who had received the SARS-CoV-2-inactivated vaccination was conducted to analyze adverse reactions. RESULTS The COVID-19 vaccination rate was 49.3% and almost half of the participants were 'Concerned about the safety of the vaccine (such as adverse reactions) due to IBD'. After SARS-CoV-2 vaccination, adverse reactions were mild or moderate. The adverse reactions in the IBD and non-IBD populations were roughly the same, and IBD medications did not increase the risk of adverse reactions. CONCLUSION SARS-CoV-2-inactivated vaccination rates in IBD patients are still low and a significant proportion of patients are hesitant about the vaccine because of safety concerns. SARS-CoV-2-inactivated vaccination in patients with IBD appears to be safe.
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Affiliation(s)
- Yubin Cao
- Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu, P.R. China,West China School of Medicine, Sichuan University, Chengdu, P.R. China
| | - Jiaming Feng
- West China School of Medicine, Sichuan University, Chengdu, P.R. China
| | - Shihao Duan
- Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu, P.R. China,West China School of Medicine, Sichuan University, Chengdu, P.R. China
| | - Yi Yang
- Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu, P.R. China,West China School of Medicine, Sichuan University, Chengdu, P.R. China
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10
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Wang Q, Lv C, Han X, Shen M, Kuang Y. A Web-Based Survey on Factors for Unvaccination and Adverse Reactions of SARS-CoV-2 Vaccines in Chinese Patients with Psoriasis. J Inflamm Res 2021; 14:6265-6273. [PMID: 34866925 PMCID: PMC8636842 DOI: 10.2147/jir.s341429] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 11/15/2021] [Indexed: 12/13/2022] Open
Abstract
Purpose Vaccination is one of the most important strategy to prevent infections and control epidemics, but it also raises concerns about safety in patients receiving treatments. This study aimed to investigate the rate and factors for unvaccination, as well as adverse reactions and deterioration of disease after SARS-CoV-2 vaccination in psoriatic patients. Methods A web-based questionnaire survey on SARS-CoV-2 vaccination, adverse reactions, and self-reported change of disease condition after vaccination in patients with psoriasis was conducted. Demographic, clinical, and psychological data were collected. Multivariable logistic regression was used in the estimation of associations. Results A total of 788 psoriatic patients were investigated, and 68.9% reported SARS-CoV-2 vaccination. Younger age, use of interleukin-17 inhibitors, and symptoms of anxiety were associated with unvaccination. The incidence of overall adverse reactions after vaccination was 30.8%, and no severe adverse reaction was reported. The most common local and systemic adverse reactions were pain at the injection site and fatigue, respectively. Most patients reported no change in psoriasis after vaccination, while 16.6% and 4.4% reported slight and significant deteriorations of the disease, respectively. Nonadherence to treatment, symptoms of anxiety and depression, and perceived stress were associated with self-reported deterioration of psoriasis after vaccination. Conclusion While a favorable safety profile of SARS-CoV-2 vaccines is observed, receiving biologic treatment is factor for unvaccination in patients with psoriasis. Deterioration of psoriasis reported by a small proportion of patients is partially attributable to mental and behavioral factors.
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Affiliation(s)
- Qiaolin Wang
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China.,National Clinical Research Center for Geriatric Disorders (Xiangya Hospital), Changsha, Hunan, People's Republic of China.,Hunan Engineering Research Center of Skin Health and Disease; Hunan Key Laboratory of Skin Cancer and Psoriasis (Xiangya Hospital), Changsha, Hunan, People's Republic of China
| | - Chengzhi Lv
- Department of Psoriasis, Dalian Dermatosis Hospital, Dalian, Liaoning, People's Republic of China
| | - Xi Han
- ULink College Guangzhou, Guangzhou, Guangdong, People's Republic of China
| | - Minxue Shen
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China.,National Clinical Research Center for Geriatric Disorders (Xiangya Hospital), Changsha, Hunan, People's Republic of China.,Hunan Engineering Research Center of Skin Health and Disease; Hunan Key Laboratory of Skin Cancer and Psoriasis (Xiangya Hospital), Changsha, Hunan, People's Republic of China.,Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, Hunan, People's Republic of China
| | - Yehong Kuang
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China.,National Clinical Research Center for Geriatric Disorders (Xiangya Hospital), Changsha, Hunan, People's Republic of China.,Hunan Engineering Research Center of Skin Health and Disease; Hunan Key Laboratory of Skin Cancer and Psoriasis (Xiangya Hospital), Changsha, Hunan, People's Republic of China
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11
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Macaluso FS, Liguori G, Galli M. Vaccinations in patients with inflammatory bowel disease. Dig Liver Dis 2021; 53:1539-1545. [PMID: 34116972 DOI: 10.1016/j.dld.2021.05.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 05/13/2021] [Accepted: 05/15/2021] [Indexed: 02/07/2023]
Abstract
Treatment of inflammatory bowel disease (IBD) frequently requires administration of immunosuppressive therapies, which increases susceptibility to a number of infectious pathogens. However, many infections can be prevented by correct and appropriate utilization of vaccinations. While several guidelines have been published on vaccination schedules in patients with IBD, vaccination rates remain suboptimal and even lower than those in the general population. This is due to many factors including poor awareness of the importance of vaccines by gastroenterologists and general practitioners as well as potential prejudices of patients regarding the safety and benefits of vaccines. With the aim of increasing awareness about the key role of immunization in the management of patients with IBD, the present review examines the existing literature relating to the main vaccinations and their application in these patients. We also summarize current evidence in order to provide clinicians with an easy source of reference for the principal recommendations for prevention of infectious diseases in patients with IBD. In addition, the recommendations about traveling for IBD patients are briefly explored. Lastly, since it is important for gastroenterologists to be aware of recommendations on vaccination, we recommend implementing educational programs to ensure compliance with current guidelines.
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Affiliation(s)
- Fabio Salvatore Macaluso
- Department of Medicine, ''Villa Sofia-Cervello'' Hospital, Sicilian Network for Inflammatory Bowel Disease (SN-IBD), Palermo, Italy.
| | | | - Massimo Galli
- Department of Biomedical and Clinical Sciences, L Sacco" University of Milan, Via Giovan Battista Grassi 74, Milan 20157, Italy
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12
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Jena A, Mishra S, Deepak P, Kumar-M P, Sharma A, Patel YI, Kennedy NA, Kim AHJ, Sharma V, Sebastian S. Response to SARS-CoV-2 vaccination in immune mediated inflammatory diseases: Systematic review and meta-analysis. Autoimmun Rev 2021; 21:102927. [PMID: 34474172 PMCID: PMC8404391 DOI: 10.1016/j.autrev.2021.102927] [Citation(s) in RCA: 125] [Impact Index Per Article: 41.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 08/23/2021] [Accepted: 08/25/2021] [Indexed: 01/01/2023]
Abstract
Objectives The treatment for COVID-19 often utilizes immune-modulating drugs. These drugs are also used in immune mediated inflammatory diseases (IMIDs). We performed a systematic review about seroconversion after SARS-CoV-2 vaccination in patients with IMIDs and impact of various drugs on seroconversion rates. Methods Electronic databases were searched to identify relevant studies reporting seroconversion rates following SARS-CoV-2 vaccination in IMIDs. We calculated the pooled seroconversion rates after a single or two doses of vaccination, pooled seroconversion rates in patients with specific IMIDs, and rates in patients on various drugs/drug classes. Results Twenty-five studies were included in the systematic review. The pooled seroconversion rates after two doses of mRNA vaccination were higher (83.1, 95%CI: 74.9–89.0, I2 = 90%) as compared to a single dose (69.3, 52.4–82.3, I2 = 95%). The odds of seroconversion were lower in IMIDs as compared to healthy controls (0.05, 0.02–0.13, I2 = 21%). The seroconversion rates in patients with inflammatory bowel disease (95.2, 95%CI: 92.6–96.9, I2 = 0%), spondyloarthropathy (95.6, 95% CI: 83.4–98.9, I2 = 35%), and systemic lupus erythematosus (90.7, 95%CI: 85.4–94.2, I2 = 0%) were higher as compared to rheumatoid arthritis (79.5, 95% CI: 65.1–88.9, I2 = 85%), and vasculitis (70.5, 95% CI: 52.9–83.5, I2 = 51%). The seroconversion rates following double dose of mRNA were excellent (>90%) in those on anti-tumour necrosis factor (TNF), anti-integrin (vedolizumab), anti-IL 17 (secukinumab), anti-IL6 (Tocilizumab) and anti-IL12/23 (Ustekinumab) therapies but attenuated (<70%) in patients on anti-CD20 (Rituximab) or anti-cytotoxic T lymphocyte associated antigen (CTLA-4) therapies (Abatacept). The seroconversion rates were good (70–90%) with steroids, hydroxychloroquine, JAK inhibitors, mycophenolate mofetil and leflunomide. Combination of anti-TNF with immunomodulators (azathioprine, 6-meracptopurine, methotrexate) resulted in an attenuated vaccine response as compared to anti-TNF monotherapy. Conclusion Seroconversion rates after SARS-CoV-2 vaccination are lower in patients with IMIDs. Certain therapies (anti-TNF, anti-integrin, anti-IL 17, anti-IL6, anti-12/23) do not impact seroconversion rates while others (anti-CD20, anti-CTLA-4) result in poorer responses.
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Affiliation(s)
- Anuraag Jena
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Shubhra Mishra
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Parakkal Deepak
- Inflammatory Bowel Diseases Center, Division of Gastroenterology,Washington University in Saint Louis School of Medicine, St. Louis, MO, USA.
| | - Praveen Kumar-M
- Department of Pharmacology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Aman Sharma
- Clinical Immunology and Rheumatology Wing, Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Yusuf I Patel
- Department of Rheumatology, Hull University Teaching Hospitals NHS Trust, Hull, UK.
| | - Nicholas A Kennedy
- Department of Gastroenterology, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK.
| | - Alfred H J Kim
- Division of Rheumatology, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA.
| | - Vishal Sharma
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | - Shaji Sebastian
- IBD Unit - Gastroenterology, Hull University Teaching Hospitals NHS Trust, Hull, UK.
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13
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Influenza Vaccination in Psoriatic Patients-Epidemiology and Patient Perceptions: A German Multicenter Study (Vac-Pso). Vaccines (Basel) 2021; 9:vaccines9080843. [PMID: 34451968 PMCID: PMC8402561 DOI: 10.3390/vaccines9080843] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 07/27/2021] [Accepted: 07/28/2021] [Indexed: 01/10/2023] Open
Abstract
The risk of developing severe complications from an influenza virus infection is increased in patients with chronic inflammatory diseases such as psoriasis (PsO) and atopic dermatitis (AD). However, low influenza vaccination rates have been reported. The aim of this study was to determine vaccination rates in PsO compared to AD patients and explore patient perceptions of vaccination. A multicenter cross-sectional study was performed in 327 and 98 adult patients with PsO and AD, respectively. Data on vaccination, patient and disease characteristics, comorbidity, and patient perceptions was collected with a questionnaire. Medical records and vaccination certificates were reviewed. A total of 49.8% of PsO and 32.7% of AD patients were vaccinated at some point, while in season 2018/2019, 30.9% and 13.3% received an influenza vaccination, respectively. There were 96.6% and 77.6% of PsO and AD patients who had an indication for influenza vaccination due to age, immunosuppressive therapy, comorbidity, occupation, and/or pregnancy. Multivariate regression analysis revealed higher age (p < 0.001) and a history of bronchitis (p = 0.023) as significant predictors of influenza vaccination in PsO patients. Considering that most patients had an indication for influenza vaccination, the rate of vaccinated patients was inadequately low.
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14
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Okay G, Biberci Keskin E, Akkoyunlu Y, Bolukcu S, Betül Uslu A, Meric Koc M. Evaluation of hepatitis B vaccine efficacy and factors affecting vaccine nonresponse in patients receiving anti-tumor necrosis factor agents. Eur J Gastroenterol Hepatol 2021; 33:1091-1096. [PMID: 32675781 DOI: 10.1097/meg.0000000000001849] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES The response rate of patients to hepatitis B virus (HBV) vaccination receiving anti-tumor necrosis factor (TNF) agents is quite low. We aimed to assess the efficiency of HBV vaccination in patients with chronic inflammatory diseases (CIDs) receiving anti-TNF agents as well as in healthy controls. We also evaluated the impact of different factors on the efficacy of HBV vaccination. METHODS Patients with CIDs receiving anti-TNF agents and healthy controls vaccinated for HBV were included in the study during 2018-2019. An adequate immune response and an effective immune response to HBV were defined as >10 IU/L and > 100 IU/L, respectively. RESULTS Among 274 participants, 187 were patients with CID and 87 were healthy controls. The mean age of the patients with CID (43.9 ± 11.7 years) was significantly higher than that of the healthy controls (31.4 ± 7 years) (P = 0.000). Adequate immune response was 60.8 and 94.3% in patients with CID and healthy controls (P = 0.000), respectively, whereas effective immune response was 37.9 and 75.9% (P = 0.000), respectively. In logistic regression analysis, male sex [odds ratio (OR), 0.408; 95% confidence interval (CI), 0.201-0.830; P = 0.013), use of infliximab (OR, 2.694; 95% CI, 1.203-6.035; P = 0.016) and sertoluzimab (OR, 3.307; 95% CI, 1.287-8.498; P = 0.013), vaccination after anti-TNF treatment (OR, 0.224; 95% CI, 0.083-0.602; P = 0.003) were identified as risk factors of nonresponse to HBV vaccine. CONCLUSIONS Infliximab and sertoluzimab usage, male sex, and vaccination after anti-TNF treatment were risk factors of nonresponse. HBV vaccination should be given to patients with CID before initiation of anti-TNF treatment and awareness should be spread on this subject.
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Affiliation(s)
- Gülay Okay
- Department of Gastroenterology, Faculty of Medicine, Istanbul, Bezmialem Vakif University, Turkey
| | | | | | - Sibel Bolukcu
- Department of Infectious Diseases and Clinical Microbiology
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15
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Summa C, Patel P, Kesselman MM, Demory Beckler M. Psoriasis: To Vaccinate or Not to Vaccinate? Cureus 2021; 13:e15860. [PMID: 34327086 PMCID: PMC8301291 DOI: 10.7759/cureus.15860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 06/22/2021] [Indexed: 12/01/2022] Open
Abstract
Psoriasis is a chronic, inflammatory, autoimmune disease characterized by red, dry, itchy, and scaly patches of abnormal skin growth on the elbows, knees, and/or scalp, which can negatively impact a patient's quality of life and activities of daily living. Both genetic predispositions and environmental factors, which can vary in susceptibility and effect, including infection, stress, medications, and cold temperatures, can lead to the onset of psoriasis and progression of the condition. This review aims to highlight recent advances in understanding the pathophysiology of psoriasis and provide insight into the importance of vaccinations and their role in reducing the risk of infection in psoriasis patients. Vaccination has been shown to reduce the risk of infection in psoriasis patients and those with other autoimmune diseases. Still, vaccination remains limited among autoimmune disease patients. Awareness of the benefits of vaccination needs to be raised among healthcare professionals due to the overarching impact on these patients' lives. The focus of this literature review is to examine the existing data to determine whether vaccination is beneficial for psoriasis patients. Herein, we primarily focus on influenza, pneumococcal, and herpes zoster vaccines and whether immunization benefits or adversely affects psoriasis patients. Overall, we found that most psoriasis and vaccine literature support immunization of this patient population, particularly with non-live attenuated vaccines; however, more studies are needed to fully develop a vaccine recommendation schedule for psoriasis patients.
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Affiliation(s)
- Christian Summa
- Osteopathic Medicine, Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Davie, USA
| | - Poonam Patel
- Osteopathic Medicine, Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Davie, USA
| | - Marc M Kesselman
- Rheumatology, Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Davie, USA
| | - Michelle Demory Beckler
- Immunology, Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Davie, USA
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16
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Onsun N, Kaya G, Işık BG, Güneş B. A generalized pustular psoriasis flare after CoronaVac COVID-19 vaccination: Case report. Health Promot Perspect 2021; 11:261-262. [PMID: 34195051 PMCID: PMC8233675 DOI: 10.34172/hpp.2021.32] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 04/22/2021] [Indexed: 12/30/2022] Open
Abstract
CoronoVac is a non-viable vaccine for severe acute respiratory syndrome coronavirus 2 (SARSCoV-2). Nowadays, there has been vaccination program for at-risk groups and older adults in Turkey. We here present 72-year-old male psoriasis patient who developed generalized pustular psoriasis flare after administration of CoronoVac. The COVID-PCR test was negative and investigations for flare etiology were all normal. He was first (to the best of our knowledge) psoriasis patient who developed an erythrodermic flare after the first dose of CoronaVac vaccine.
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Affiliation(s)
- Nahide Onsun
- Department of Dermatology and Venereology, Bezmialem Vakif University, Istanbul, Turkey
| | - Gökhan Kaya
- Department of Dermatology and Venereology, Bezmialem Vakif University, Istanbul, Turkey
| | - Bengisu Güçkan Işık
- Department of Dermatology and Venereology, Bezmialem Vakif University, Istanbul, Turkey
| | - Begüm Güneş
- Department of Dermatology and Venereology, Bezmialem Vakif University, Istanbul, Turkey
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17
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Otero-Romero S, Rodríguez-García J, Vilella A, Ara J, Brieva L, Calles C, Carmona O, Casanova V, Costa-Frossard L, Eichau S, García-Merino J, Garcia-Vidal C, González-Platas M, Llaneza M, Martínez-Ginés M, Meca-Lallana J, Prieto J, Rodríguez-Antigüedad A, Tintoré M, Blanco Y, Moral E. Recommendations for vaccination in patients with multiple sclerosis who are eligible for immunosuppressive therapies: Spanish consensus statement. NEUROLOGÍA (ENGLISH EDITION) 2021. [DOI: 10.1016/j.nrleng.2020.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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18
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Varicella-zoster-virus vaccination of immunosuppressed children with inflammatory bowel disease or autoimmune hepatitis: A prospective observational study. Vaccine 2020; 38:8024-8031. [PMID: 33160754 DOI: 10.1016/j.vaccine.2020.10.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 10/01/2020] [Accepted: 10/08/2020] [Indexed: 01/02/2023]
Abstract
BACKGROUND AND AIMS Children with inflammatory bowel disease (IBD) and autoimmune hepatitis (AIH) receiving immunosuppressive treatment are at risk for severe varicella zoster virus (VZV)-induced disease. This study evaluated vaccination of susceptible patients with stable disease and documented immunoreactivity without interruption of their current immunosuppression (IS). METHODS This prospective multicentre observational study used a prevaccination checklist to select patients with low-intensity and high-intensity IS for VZV vaccination. Tolerability and safety after immunization were assessed by questionnaire. The immune response was measured by the VZV-IgG concentration, relative avidity index (RAI), and specific lymphocyte proliferative response. RESULTS A total of 29 VZV vaccinations were performed in 17 seronegative patients aged 3-16 years (IBD n = 15, AIH n = 2). Eight patients received high-intensity immunosuppression, another six low-intensity immunosuppression, and three patients interrupted IS before VZV vaccination. All 29 vaccinations were well tolerated; only minor side effects such as fever and abdominal pain, were reported in two patients. One patient experienced a flare of Crohn's disease the day after vaccination. The VZV-IgG-concentration increased significantly (p = 0.018) after vaccination, and a specific lymphocyte response towards VZV in vitro was detected in all tested patients which correlated with the RAI (r = 0.489; p = 0.078). CONCLUSIONS VZV vaccination was well tolerated, safe and immunogenic in children receiving ongoing IS due to IBD and AIH. Ensuring immunoreactivity by clinical and laboratory parameters, rather than the type and dosage of IS, is a reasonable approach to decide on live-attenuated virus vaccinations in immunosuppressed children (German clinical trials DRKS00016357).
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19
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Riva A, Barcella V, Benatti SV, Capobianco M, Capra R, Cinque P, Comi G, Fasolo MM, Franzetti F, Galli M, Gerevini S, Meroni L, Origoni M, Prosperini L, Puoti M, Scarpazza C, Tortorella C, Zaffaroni M, Moiola L. Vaccinations in patients with multiple sclerosis: A Delphi consensus statement. Mult Scler 2020; 27:347-359. [PMID: 32940128 DOI: 10.1177/1352458520952310] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Patients with multiple sclerosis (MS) are at increased risk of infection. Vaccination can mitigate these risks but only if safe and effective in MS patients, including those taking disease-modifying drugs. METHODS A modified Delphi consensus process (October 2017-June 2018) was used to develop clinically relevant recommendations for making decisions about vaccinations in patients with MS. A series of statements and recommendations regarding the efficacy, safety and timing of vaccine administration in patients with MS were generated in April 2018 by a panel of experts based on a review of the published literature performed in October 2017. RESULTS Recommendations include the need for an 'infectious diseases card' of each patient's infectious and immunisation history at diagnosis in order to exclude and eventually treat latent infections. We suggest the implementation of the locally recommended vaccinations, if possible at MS diagnosis, otherwise with vaccination timing tailored to the planned/current MS treatment, and yearly administration of the seasonal influenza vaccine regardless of the treatment received. CONCLUSION Patients with MS should be vaccinated with careful consideration of risks and benefits. However, there is an urgent need for more research into vaccinations in patients with MS to guide evidence-based decision making.
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Affiliation(s)
- Agostino Riva
- III Division of Infectious Diseases, ASST Fatebenefratelli-Sacco, L. Sacco Hospital, Milan, Italy
| | - Valeria Barcella
- Department of Neurology and Multiple Sclerosis Center, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Simone V Benatti
- Department of Infectious Diseases, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Marco Capobianco
- SCDO Neurology and Regional Reference Multiple Sclerosis Center, Azienda Ospedaliero-Universitaria San Luigi Gonzaga, Orbassano, Italy
| | - Ruggero Capra
- Multiple Sclerosis Center, Spedali Civili of Brescia, Montichiari, Italy
| | - Paola Cinque
- Division of Infectious Diseases, San Raffaele Scientific Institute, Milan, Italy/Institute of Experimental Neurology and Multiple Sclerosis Center IRCCS, San Raffaele Hospital, Milan, Italy
| | - Giancarlo Comi
- Institute of Experimental Neurology and Multiple Sclerosis Center IRCCS, San Raffaele Hospital, Milan, Italy
| | - Maria Michela Fasolo
- Division of Infectious Diseases, Department of Infectious Diseases, ASST Fatebenefratelli-Sacco, University Hospital, Milan, Italy
| | - Fabio Franzetti
- Infectious Diseases Unit, Busto Arsizio Hospital, Varese, Italy
| | - Massimo Galli
- Department of Clinical Sciences, Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Simonetta Gerevini
- Division of Neuroradiology, IRCCS San Raffaele Scientific Institute, Milan, Italy; Neuroradiology Department, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Luca Meroni
- III Division of Infectious Diseases, ASST Fatebenefratelli-Sacco, L. Sacco Hospital, Milan, Italy
| | - Massimo Origoni
- Department of Gynecology and Obstetrics, Vita-Salute San Raffaele University, IRCCS Ospedale San Raffaele, Milano, Italy
| | - Luca Prosperini
- Department of Neuroscience, San Camillo-Forlanini Hospital, Rome, Italy
| | - Massimo Puoti
- SC Infectious Diseases, ASST Niguarda Ca' Grande Hospital, Milan, Italy
| | - Cristina Scarpazza
- Multiple Sclerosis Center, Spedali Civili of Brescia, Montichiari, Italy/Department of General Psychology, University of Padova, Padova, Italy
| | - Carla Tortorella
- Department of Neuroscience, San Camillo-Forlanini Hospital, Rome, Italy
| | - Mauro Zaffaroni
- Multiple Sclerosis Center, Hospital of Gallarate, ASST della Valle Olona, Gallarate, Italy
| | - Lucia Moiola
- Multiple Sclerosis Center, IRCCS San Raffaele Hospital, Milan, Italy/Neurology Department, IRCCS San Raffaele Hospital, Milan, Italy
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Seo YB, Moon SJ, Jeon CH, Song JY, Sung YK, Jeong SJ, Kwon KT, Kim ES, Kim JH, Kim HA, Park DJ, Park SH, Park JK, Ahn JK, Oh JS, Yun JW, Lee JH, Lee HY, Choi MJ, Choi WS, Choi YH, Choi JH, Heo JY, Cheong HJ, Lee SS. The Practice Guideline for Vaccinating Korean Patients With Autoimmune Inflammatory Rheumatic Disease. JOURNAL OF RHEUMATIC DISEASES 2020. [DOI: 10.4078/jrd.2020.27.3.182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Yu Bin Seo
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, Hallym University, Chuncheon, Korea
| | - Su-Jin Moon
- Division of Rheumatology, Department of Internal Medicine, Uijeongbu St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea
| | - Chan Hong Jeon
- Division of Rheumatology, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Joon Young Song
- Division of Infectious Diseases, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Yoon-Kyoung Sung
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
| | - Su Jin Jeong
- Division of Infectious Diseases, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Ki Tae Kwon
- Division of Infectious Diseases, Department of Internal Medicine, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Eu Suk Kim
- Division of Infectious Diseases, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jae-Hoon Kim
- Department of Rheumatology, Korea University Guro Hospital, Seoul, Korea
| | - Hyoun-Ah Kim
- Department of Rheumatology, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea
| | - Dong-Jin Park
- Department of Rheumatology, Chonnam National University Medical School and Hospital, Gwangju, Korea
| | - Sung-Hoon Park
- Division of Rheumatology, Department of Internal Medicine, Daegu Catholic University Medical Center, Daegu Catholic University School of Medicine, Daegu, Korea
| | - Jin Kyun Park
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Joong Kyong Ahn
- Division of Rheumatology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ji Seon Oh
- Department of Information Medicine, Asan Medical Center, Seoul, Korea
| | - Jae Won Yun
- Division of Infectious Disease Control, Korea Centers for Disease Control and Prevention, Osong, Korea
| | - Joo-Hyun Lee
- Division of Rheumatology, Department of Internal Medicine, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Hee Young Lee
- Center for Preventive Medicine and Public Health, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Min Joo Choi
- Division of Infectious Disease, Department of Internal Medicine, Catholic Kwandong University International St. Mary’s Hospital, Incheon, Korea
| | - Won Suk Choi
- Division of Infectious Diseases, Department of Internal Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Young Hwa Choi
- Department of Infectious Diseases, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea
| | - Jung-Hyun Choi
- Division of Infectious Diseases, Department of Internal Medicine, The Catholic University of Korea, Eunpyeong St. Mary’s Hospital, Seoul, Korea
| | - Jung Yeon Heo
- Department of Infectious Diseases, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea
| | - Hee Jin Cheong
- Division of Infectious Diseases, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Shin-Seok Lee
- Department of Rheumatology, Chonnam National University Medical School and Hospital, Gwangju, Korea
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21
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Otero-Romero S, Rodríguez-García J, Vilella A, Ara JR, Brieva L, Calles C, Carmona O, Casanova V, Costa-Frossard L, Eichau S, García-Merino JA, Garcia-Vidal C, González-Platas M, Llaneza M, Martínez-Ginés M, Meca-Lallana JE, Prieto JM, Rodríguez-Antigüedad A, Tintoré M, Blanco Y, Moral E. Recommendations for vaccination in patients with multiple sclerosis who are eligible for immunosuppressive therapies: Spanish consensus statement. Neurologia 2020; 36:50-60. [PMID: 32561334 DOI: 10.1016/j.nrl.2020.02.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 02/01/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The recent development of highly effective treatments for multiple sclerosis (MS) and the potential risk of infectious complications require the development of prevention and risk minimisation strategies. Vaccination is an essential element of the management of these patients. This consensus statement includes a series of recommendations and practical scenarios for the vaccination of adult patients with MS who are eligible for highly effective immunosuppressive treatments. METHODOLOGY A formal consensus procedure was followed. Having defined the scope of the statement, we conducted a literature search on recommendations for the vaccination of patients with MS and specific vaccination guidelines for immunosuppressed patients receiving biological therapy for other conditions. The modified nominal group technique methodology was used to formulate the recommendations. DEVELOPMENT Vaccination in patients who are candidates for immunosuppressive therapy should be considered before starting immunosuppressive treatment providing the patient's clinical situation allows. Vaccines included in the routine adult vaccination schedule, as well as some specific ones, are recommended depending on the pre-existing immunity status. If immunosuppressive treatment is already established, live attenuated vaccines are contraindicated. For vaccines with a correlate of protection, it is recommended to monitor the serological response in an optimal interval of 1-2 months from the last dose.
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Affiliation(s)
- S Otero-Romero
- Servicio de Medicina Preventiva, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, España; Centro de Esclerosis Múltiple de Catalunya (Cemcat), Departamento de Neurología/Neuroimmunología, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, España.
| | - J Rodríguez-García
- Servicio de Medicina Preventiva, Hospital Universitari Son Espases, Palma de Mallorca, Islas Baleares, España
| | - A Vilella
- Servicio de Medicina Preventiva, Hospital Clínic, Universidad de Barcelona-ISGlobal, Barcelona, España
| | - J R Ara
- Servicio de Neurología, Hospital Universitario Miguel Servet, Zaragoza, España
| | - L Brieva
- Servicio de Neurología. IRBLLEIDA. Hospital Arnau de Vilanova, Lérida, España
| | - C Calles
- Servicio de Neurología, Hospital Universitario Son Espases, Palma de Mallorca, Islas Baleares, España
| | - O Carmona
- Servicio de Neurología, Fundació Salut Empordà, Figueras, Gerona, España
| | - V Casanova
- Unidad de Esclerosis Múltiple, Hospital Universitario La Fe, Valencia, España
| | - L Costa-Frossard
- Servicio de Neurología, Fundación para la Investigación Biomédica IRyCIS, Hospital Ramón y Cajal, Madrid, España
| | - S Eichau
- Unidad CSUR de Esclerosis Múltiple, Hospital Universitario Virgen Macarena, Sevilla, España
| | | | - C Garcia-Vidal
- Departamento de Enfermedades Infecciosas, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, España
| | - M González-Platas
- Servicio de Neurología, Hospital Universitario de Canarias, Tenerife, España
| | - M Llaneza
- Sección de Neurología, Complejo Hospitalario Universitario de Ferrol, Ferrol, La Coruña, España
| | | | - J E Meca-Lallana
- CSUR Esclerosis Múltiple, Servicio de Neurología, Hospital Clínico Universitario Virgen de la Arrixaca, IMIB-Arrixaca, Cátedra de Neuroinmunología Clínica y Esclerosis Múltiple, Universidad Católica San Antonio, Murcia, España
| | - J M Prieto
- Servicio de Neurología, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, La Coruña, España
| | - A Rodríguez-Antigüedad
- Servicio de Neurología, Hospital Universitario Cruces-Osakidetza, Baracaldo, Vizcaya, España
| | - M Tintoré
- Centro de Esclerosis Múltiple de Catalunya (Cemcat), Departamento de Neurología/Neuroimmunología, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, España
| | - Y Blanco
- Servicio de Neurología, Hospital Clinic, Barcelona, España
| | - E Moral
- Servicio de Neurología, Hospital Moises Broggi y Hospital General de L'Hospitalet, Hospitalet de Llobregat, Barcelona, España
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22
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Predicting, Preventing, and Managing Treatment-Related Complications in Patients With Inflammatory Bowel Diseases. Clin Gastroenterol Hepatol 2020; 18:1324-1335.e2. [PMID: 32059920 DOI: 10.1016/j.cgh.2020.02.009] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 01/17/2020] [Accepted: 02/03/2020] [Indexed: 02/07/2023]
Abstract
Risk of complications from specific classes of drugs for inflammatory bowel diseases (IBDs) can be kept low by respecting contraindications. Patients with IBD frequently develop serious infections resulting from the disease itself or its treatment. At the time of diagnosis, patients' vaccination calendars should be updated according to IBD guidelines-live vaccines should be postponed for patients receiving immunosuppressive drugs. Opportunistic infections should be detected and the vaccine against pneumococcus should be given before patients begin immunosuppressive therapy. Thiopurines promote serious viral infections in particular, whereas tumor necrosis factor (TNF) antagonists promote all types of serious and opportunistic infections. Severe forms of varicella can be prevented by vaccinating seronegative patients against varicella zoster virus. Detection and treatment of latent tuberculosis is mandatory before starting anti-TNF therapy and other new IBD drugs. Tofacitinib promotes herpes zoster infection in a dose- and age-dependent manner. Physicians should consider giving patients live vaccines against herpes zoster before they begin immunosuppressive therapy or a recombinant vaccine, when available, at any time point during treatment. The risk of thiopurine-induced lymphomas can be lowered by limiting the use of thiopurines in patients who are seronegative for Epstein-Barr virus (especially young men) and in older men. The risk of lymphoma related to monotherapy with anti-TNF agents is still unclear. There are no robust data on the carcinogenic effects of recently developed IBD drugs. For patients with previous cancer at substantial risk of recurrence, physicians should try to implement a pause in the use of immunosuppressive therapy (except in patients with severe disease and no therapeutic alternative) and prioritize use of IBD drugs with the lowest carcinogenic effects. Finally, sun protection and skin surveillance from the time of diagnosis are recommended.
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23
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Cagol L, Seitel T, Ehrenberg S, Frivolt K, Krahl A, Lainka E, Gerner P, Lenhartz H, Vermehren J, Radke M, Trenkel S, Mayer B, Koletzko S, Debatin KM, Mertens T, Posovszky C. Vaccination rate and immunity of children and adolescents with inflammatory bowel disease or autoimmune hepatitis in Germany. Vaccine 2020; 38:1810-1817. [DOI: 10.1016/j.vaccine.2019.12.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Revised: 12/09/2019] [Accepted: 12/11/2019] [Indexed: 02/06/2023]
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24
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Zhao C, Zhou J, Meng Y, Shi N, Wang X, Zhou M, Li G, Yang Y. DHA Sensor GPR120 in Host Defense Exhibits the Dual Characteristics of Regulating Dendritic Cell Function and Skewing the Balance of Th17/Tregs. Int J Biol Sci 2020; 16:374-387. [PMID: 32015675 PMCID: PMC6990895 DOI: 10.7150/ijbs.39551] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 11/05/2019] [Indexed: 01/01/2023] Open
Abstract
In addition to functioning as an antioxidant, anti-inflammatory and age-defying cellular component, DHA impacts the immune system by facilitating the pathogen invasion. The mechanism through which DHA regulates immune suppression remains obscure. In our study, we postulated that DHA might interact with GPR120 to shape the dendritic cell (DC) differentiation and subsequently drive T cell proliferation during the virus infection. In vitro, the proportion of costimulatory molecules and HLA-DR on DC that generated from exogenous and endogenous (fad3b expression) DHA supplemented mice were significantly lower than wild-type mice. Given the importance of FAs, DHA is not only a critical cellular constituent but also a cell signaling molecule and FA deficiency reduces DC generation; we used GPR120-/- mice to determine whether DHA receptor deficiency disorders DC maturation processing. Novelty, the expression of GPR120 on DC from wild-type (WT) mice was inversely related to DC activation and DC from the GPR120-/- mice maintained a spontaneous maturation status. In vivo, both the excessive activation of GPR120 by DHA and the deletion of GPR120 effectively skewed the balance of Th17/Tregs and reduced the production of VNA and protection of vaccination. Overall, our results revealed a mechanism that the GPR120 self-regulation plays a crucial role in sensing DHA variation, which provides a new prospect for therapeutic manipulation in autoimmune diseases and the design of a vaccine adjuvant.
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Affiliation(s)
- Caiquan Zhao
- The State Key Laboratory of Reproductive Regulation and Breeding of Grassland Livestock, School of Life Sciences, Inner Mongolia University, Hohhot, 010070, China
| | - Jinxiu Zhou
- The State Key Laboratory of Reproductive Regulation and Breeding of Grassland Livestock, School of Life Sciences, Inner Mongolia University, Hohhot, 010070, China
| | - Yanqing Meng
- The State Key Laboratory of Reproductive Regulation and Breeding of Grassland Livestock, School of Life Sciences, Inner Mongolia University, Hohhot, 010070, China
| | - Niu Shi
- Inner Mongolia People's Hospital, Hohhot, Inner Mongolia, CN 010017
| | - Xiao Wang
- The State Key Laboratory of Reproductive Regulation and Breeding of Grassland Livestock, School of Life Sciences, Inner Mongolia University, Hohhot, 010070, China
| | - Ming Zhou
- The State Key Laboratory of Agricultural Microbiology, College of Veterinary Medicine, Huazhong Agricultural University, Wuhan, 430070, China
| | - Guangpeng Li
- The State Key Laboratory of Reproductive Regulation and Breeding of Grassland Livestock, School of Life Sciences, Inner Mongolia University, Hohhot, 010070, China
| | - Yang Yang
- The State Key Laboratory of Reproductive Regulation and Breeding of Grassland Livestock, School of Life Sciences, Inner Mongolia University, Hohhot, 010070, China
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25
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Seo YB, Moon SJ, Jeon CH, Song JY, Sung YK, Jeong SJ, Kwon KT, Kim ES, Kim JH, Kim HA, Park DJ, Park SH, Park JK, Ahn JK, Oh JS, Yun JW, Lee JH, Lee HY, Choi MJ, Choi WS, Choi YH, Choi JH, Heo JY, Cheong HJ, Lee SS. The Practice Guideline for Vaccinating Korean Patients with Autoimmune Inflammatory Rheumatic Disease. Infect Chemother 2020; 52:252-280. [PMID: 32618150 PMCID: PMC7335656 DOI: 10.3947/ic.2020.52.2.252] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 06/11/2020] [Indexed: 01/03/2023] Open
Abstract
To develop a clinical practice guideline for vaccination in patients with autoimmune inflammatory rheumatic disease (AIIRD), the Korean College of Rheumatology and the Korean Society of Infectious Diseases developed a clinical practice guideline according to the clinical practice guideline development manual. Since vaccination is unlikely to cause AIIRD or worsen disease activities, required vaccinations are recommended. Once patients are diagnosed with AIIRD, treatment strategies should be established and, at the same time, monitor their vaccination history. It is recommended to administer vaccines when the disease enters the stabilized stage. Administering live attenuated vaccines in patients with AIIRD who are taking immunosuppressants should be avoided. Vaccination should be considered in patients with AIIRD, prior to initiating immunosuppressants. It is recommended to administer influenza, Streptococcus pneumoniae, hepatitis A, hepatitis B, herpes zoster, measles-mumps-rubella virus, human papillomavirus, and tetanus-diphtheria-pertussis vaccines in patients with AIIRD; such patients who planned to travel are generally recommended to be vaccinated at the recommended vaccine level of healthy adults. Those who live in a household with patients with AIIRD and their caregivers should also be vaccinated at levels that are generally recommended for healthy adults.
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Affiliation(s)
- Yu Bin Seo
- Division of Infectious Diseases, Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Korea
| | - Su Jin Moon
- Division of Rheumatology, Department of Internal Medicine, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea
| | - Chan Hong Jeon
- Division of Rheumatology, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Joon Young Song
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Guro Hospital, Seoul, Korea
| | - Yoon Kyoung Sung
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
| | - Su Jin Jeong
- Division of Infectious Diseases, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Ki Tae Kwon
- Division of Infectious Diseases, Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, Korea
| | - Eu Suk Kim
- Division of Infectious Diseases, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jae Hoon Kim
- Department of Rheumatology, Korea University Guro Hospital, Seoul, Korea
| | - Hyoun Ah Kim
- Department of Rheumatology, Ajou University School of Medicine, Suwon, Korea
| | - Dong Jin Park
- Department of Rheumatology, Chonnam National University Medical School & Hospital, Gwangju, Korea
| | - Sung Hoon Park
- Division of Rheumatology, Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Jin Kyun Park
- Division of Rheumatology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Joong Kyong Ahn
- Division of Rheumatology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ji Seon Oh
- Department of Information Medicine, Asan Medical Center, Seoul, Korea
| | - Jae Won Yun
- Division of Infectious Disease Control, Korea Centers for Disease Control and Prevention, Osong, Korea
| | - Joo Hyun Lee
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, Inje University Ilsan Paik Hospital, Ilsan, Korea
| | - Hee Young Lee
- Center for Preventive Medicine and Public Health, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Min Joo Choi
- Division of Infectious Disease, Department of Internal Medicine, Catholic Kwandong University, International St. Mary's Hospital, Incheon, Korea
| | - Won Suk Choi
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Ansan Hospital, Ansan, Korea
| | - Young Hwa Choi
- Department of Infectious Diseases, Ajou University School of Medicine, Suwon, Korea
| | - Jung Hyun Choi
- Division of Infectious Diseases, Department of Internal Medicine, The Catholic University of Korea, Eunpyeong St. Mary's Hospital, Seoul, Korea
| | - Jung Yeon Heo
- Department of Infectious Diseases, Ajou University School of Medicine, Suwon, Korea
| | - Hee Jin Cheong
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Guro Hospital, Seoul, Korea.
| | - Shin Seok Lee
- Department of Rheumatology, Chonnam National University Medical School & Hospital, Gwangju, Korea.
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26
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Intongkam S, Samakarnthai P, Pakchotanon R, Narongroeknawin P, Assavatanabodee P, Chaiamnuay S. Efficacy and Safety of Hepatitis B Vaccination in Rheumatoid Arthritis Patients Receiving Disease-Modifying Antirheumatic Drugs and/or Biologics Therapy. J Clin Rheumatol 2019; 25:329-334. [PMID: 31764493 DOI: 10.1097/rhu.0000000000000877] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES The aims of this study were to assess efficacy and safety of the hepatitis B vaccination in rheumatoid arthritis (RA) patients receiving conventional and/or biological disease-modifying antirheumatic drugs (DMARDs). METHODS A longitudinal open-label study was conducted. Of 46 RA patients, 33 received only conventional synthetic DMARDs, and 13 received both conventional synthetic DMARDs and biological DMARDs, and 9 healthy age- and sex-matched control subjects were vaccinated with 20 μg recombinant hepatitis B vaccine (EuVax B) at weeks 0, 4, and 24. Hepatitis B surface antibody levels were measured 8 weeks after the last dose of vaccination. Seroprotection was defined as hepatitis B surface antibody level of 10 mIU/mL or greater. Disease Activity Score in 28 Joints scores were recorded at weeks 0, 4, and 32 in 46 RA patients who received hepatitis B vaccination and 47 treatment-matched RA patients who did not receive it. Adverse events were recorded at each visit.Statistical analyses were performed using SPSS version 16.0. RESULTS Seroprotection was lower in the RA patients than in the control subjects (64% vs. 100%, p = 0.045). Patients receiving biological DMARDs and conventional DMARDs had a lower proportion of seroprotection compared with the control group (50% vs. 100% [p = 0.02] and 69.7% vs. 100% [p = 0.09], respectively). Among RA patients, responders were younger than nonresponders with a mean age of 57.5 (SD, 9.0) years and 64.9 (SD, 10.9) years (p = 0.04) and less likely to be treated with rituximab (6.9% vs. 37.5%, p = 0.01). Overall, hepatitis B vaccination was well tolerated. The rate of RA flare was not increased after hepatitis B vaccination. CONCLUSIONS Patients with RA receiving DMARDs had less humoral response to hepatitis B vaccination as compared with control subjects. Aging and rituximab use were associated with impaired response to hepatitis B vaccination. Hepatitis B vaccination is safe and well tolerated in RA patients.
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Affiliation(s)
- Samanan Intongkam
- From the Rheumatic Disease Unit, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
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27
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Lamb CA, Kennedy NA, Raine T, Hendy PA, Smith PJ, Limdi JK, Hayee B, Lomer MCE, Parkes GC, Selinger C, Barrett KJ, Davies RJ, Bennett C, Gittens S, Dunlop MG, Faiz O, Fraser A, Garrick V, Johnston PD, Parkes M, Sanderson J, Terry H, Gaya DR, Iqbal TH, Taylor SA, Smith M, Brookes M, Hansen R, Hawthorne AB. British Society of Gastroenterology consensus guidelines on the management of inflammatory bowel disease in adults. Gut 2019; 68:s1-s106. [PMID: 31562236 PMCID: PMC6872448 DOI: 10.1136/gutjnl-2019-318484] [Citation(s) in RCA: 1221] [Impact Index Per Article: 244.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Revised: 06/10/2019] [Accepted: 06/10/2019] [Indexed: 02/06/2023]
Abstract
Ulcerative colitis and Crohn's disease are the principal forms of inflammatory bowel disease. Both represent chronic inflammation of the gastrointestinal tract, which displays heterogeneity in inflammatory and symptomatic burden between patients and within individuals over time. Optimal management relies on understanding and tailoring evidence-based interventions by clinicians in partnership with patients. This guideline for management of inflammatory bowel disease in adults over 16 years of age was developed by Stakeholders representing UK physicians (British Society of Gastroenterology), surgeons (Association of Coloproctology of Great Britain and Ireland), specialist nurses (Royal College of Nursing), paediatricians (British Society of Paediatric Gastroenterology, Hepatology and Nutrition), dietitians (British Dietetic Association), radiologists (British Society of Gastrointestinal and Abdominal Radiology), general practitioners (Primary Care Society for Gastroenterology) and patients (Crohn's and Colitis UK). A systematic review of 88 247 publications and a Delphi consensus process involving 81 multidisciplinary clinicians and patients was undertaken to develop 168 evidence- and expert opinion-based recommendations for pharmacological, non-pharmacological and surgical interventions, as well as optimal service delivery in the management of both ulcerative colitis and Crohn's disease. Comprehensive up-to-date guidance is provided regarding indications for, initiation and monitoring of immunosuppressive therapies, nutrition interventions, pre-, peri- and postoperative management, as well as structure and function of the multidisciplinary team and integration between primary and secondary care. Twenty research priorities to inform future clinical management are presented, alongside objective measurement of priority importance, determined by 2379 electronic survey responses from individuals living with ulcerative colitis and Crohn's disease, including patients, their families and friends.
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Affiliation(s)
- Christopher Andrew Lamb
- Newcastle University, Newcastle upon Tyne, UK
- Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Nicholas A Kennedy
- Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
- University of Exeter, Exeter, UK
| | - Tim Raine
- Cambridge University Hospitals NHS FoundationTrust, Cambridge, UK
| | - Philip Anthony Hendy
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
- Imperial College London, London, UK
| | - Philip J Smith
- Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
| | - Jimmy K Limdi
- The Pennine Acute Hospitals NHS Trust, Manchester, UK
- University of Manchester, Manchester, UK
| | - Bu'Hussain Hayee
- King's College Hospital NHS Foundation Trust, London, UK
- King's College London, London, UK
| | - Miranda C E Lomer
- King's College London, London, UK
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Gareth C Parkes
- Barts Health NHS Trust, London, UK
- Barts and the London School of Medicine and Dentistry, London, UK
| | - Christian Selinger
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
- University of Leeds, Leeds, UK
| | | | - R Justin Davies
- Cambridge University Hospitals NHS FoundationTrust, Cambridge, UK
- University of Cambridge, Cambridge, UK
| | - Cathy Bennett
- Systematic Research Ltd, Quorn, UK
- Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland
| | | | - Malcolm G Dunlop
- University of Edinburgh, Edinburgh, UK
- Western General Hospital, Edinburgh, UK
| | - Omar Faiz
- Imperial College London, London, UK
- St Mark's Hospital, Harrow, UK
| | - Aileen Fraser
- University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | | | | | - Miles Parkes
- Cambridge University Hospitals NHS FoundationTrust, Cambridge, UK
| | - Jeremy Sanderson
- King's College London, London, UK
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | | | - Daniel R Gaya
- Glasgow Royal Infirmary, Glasgow, UK
- University of Glasgow, Glasgow, UK
| | - Tariq H Iqbal
- Queen Elizabeth Hospital Birmingham NHSFoundation Trust, Birmingham, UK
- University of Birmingham, Birmingham, UK
| | - Stuart A Taylor
- University College London, London, UK
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Melissa Smith
- Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
- Brighton and Sussex Medical School, Brighton, UK
| | - Matthew Brookes
- Royal Wolverhampton NHS Trust, Wolverhampton, UK
- University of Wolverhampton, Wolverhampton, UK
| | - Richard Hansen
- Royal Hospital for Children Glasgow, Glasgow, UK
- University of Glasgow, Glasgow, UK
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Managing Psoriasis in Patients with HBV or HCV Infection: Practical Considerations. Am J Clin Dermatol 2019; 20:829-845. [PMID: 31222626 DOI: 10.1007/s40257-019-00457-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Considered more efficacious and safer than traditional systemic drugs, biologic therapies have dramatically improved the quality of life of patients with psoriasis. Recently, there has been a proliferation of new targeted treatment options, including anti-interleukin-17, anti-interleukin-12/23, as well as small-molecule drugs such as apremilast. There are nevertheless some concerns regarding their use, especially in patients with chronic infections such as hepatitis B virus (HBV) and hepatitis C virus (HCV). It has been estimated that two billion individuals are infected with HBV worldwide and approximately 240 million have chronic HBV infection. Moreover, there are approximately 71 million individuals with chronic HCV infection worldwide, with a high percentage of them unaware of being infected. As patients with HBV and HCV infections are excluded from controlled clinical trials investigating new drugs, data regarding their safety in patients with psoriasis are based almost exclusively on case reports and small retrospective cohort studies and need to be constantly updated. The risk of HBV reactivation can be defined as: high risk (≥ 10%), moderate risk (1-10%), and low risk (< 1%) depending on the type of immunosuppressive therapy stratified by the presence or absence of hepatitis B surface antigen but positivity to anti-hepatitis B core antigen. Hepatitis B surface antigen-positive patients treated with tumor necrosis factor-α inhibitors, ustekinumab, or cyclosporine carry a high or moderate risk of HBV reactivation and should be considered candidates for prophylactic anti-HBV therapy. Once therapy is commenced, it is important to check HBV DNA levels every 3 months. Hepatitis B virus reactivation typically occurs with immune reconstitution and therefore antiviral therapy should continue for 6-12 months after stopping immunosuppression. Hepatitis B surface antigen-positive patients who are prescribed methotrexate, acitretin, or apremilast have a low risk and need to be monitored for viral reactivation by determining alanine aminotransferase and HBV DNA levels every 3 months. No conclusive data are available for interleukin-17 and interleukin-23 inhibitors. Anti-hepatitis B core antigen-positive patients treated with tumor necrosis factor-α inhibitors, ustekinumab, and cyclosporine are linked to a moderate risk of reactivation, and they should preferably undergo HBV DNA or hepatitis B surface antigen and alanine aminotransferase testing rather than be subjected to routine pre-emptive therapy. Anti-hepatitis B core antigen-positive patients receiving methotrexate, acitretin, or apremilast have a low risk of reactivation and do not require anti-HBV therapy, nor should monitoring be considered mandatory. No conclusive data are available for interleukin-17 and interleukin-23 inhibitors.
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Abstract
Ulcerative colitis and Crohn's disease are the principal forms of inflammatory bowel disease. Both represent chronic inflammation of the gastrointestinal tract, which displays heterogeneity in inflammatory and symptomatic burden between patients and within individuals over time. Optimal management relies on understanding and tailoring evidence-based interventions by clinicians in partnership with patients. This guideline for management of inflammatory bowel disease in adults over 16 years of age was developed by Stakeholders representing UK physicians (British Society of Gastroenterology), surgeons (Association of Coloproctology of Great Britain and Ireland), specialist nurses (Royal College of Nursing), paediatricians (British Society of Paediatric Gastroenterology, Hepatology and Nutrition), dietitians (British Dietetic Association), radiologists (British Society of Gastrointestinal and Abdominal Radiology), general practitioners (Primary Care Society for Gastroenterology) and patients (Crohn's and Colitis UK). A systematic review of 88 247 publications and a Delphi consensus process involving 81 multidisciplinary clinicians and patients was undertaken to develop 168 evidence- and expert opinion-based recommendations for pharmacological, non-pharmacological and surgical interventions, as well as optimal service delivery in the management of both ulcerative colitis and Crohn's disease. Comprehensive up-to-date guidance is provided regarding indications for, initiation and monitoring of immunosuppressive therapies, nutrition interventions, pre-, peri- and postoperative management, as well as structure and function of the multidisciplinary team and integration between primary and secondary care. Twenty research priorities to inform future clinical management are presented, alongside objective measurement of priority importance, determined by 2379 electronic survey responses from individuals living with ulcerative colitis and Crohn's disease, including patients, their families and friends.
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Al-Omar HA, Sherif HM, Mayet AY. Vaccination status of patients using anti-TNF therapy and the physicians' behavior shaping the phenomenon: Mixed-methods approach. PLoS One 2019; 14:e0223594. [PMID: 31584996 PMCID: PMC6777782 DOI: 10.1371/journal.pone.0223594] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 09/24/2019] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE Anti-tumor necrosis factor (Anti-TNF) therapy improves the prognosis and reduces the morbidity and mortality associated with many chronic inflammatory autoimmune diseases. However, as it is linked to an increased infection risk, appropriate vaccination is required. The study aimed at investigating the vaccination status of patients receiving Anti-TNF therapy and physicians' perceptions of and views about vaccinating these patients. METHODS A sequential explanatory mixed-methods approach was used. The study comprised a quantitative, retrospective drug utilization review for determining institutional consumption of Anti-TNF therapy and an assessment of vaccination status in patients prescribed Anti-TNF therapy to audit physicians' adherence to Anti-TNF therapy-related vaccination recommendations. Patient data from electronic medical records (EMRs) obtained from tertiary care hospitals between September 2015 and September 2017 were used. Further, a qualitative study using a phenomenographic approach with semi-structured interviews of 12 physicians was carried out to explore the physicians' perceptions, views, and recommendations of vaccinating patients who are undergoing Anti-TNF therapy and identifying factors that may cause poor adherence to vaccination recommendations. RESULTS Forty-three of 310 patients receiving Anti-TNF therapy were vaccinated. Infliximab was the most frequently prescribed agent, accounting for 96.7% of total orders. Eight of the 12 physicians stated that they were aware of vaccination guidelines and seven viewed pre-Anti-TNF therapy vaccination as essential because of the high infection risk and claimed to incorporate it in their daily practice. Barriers to adherence included ignorance of recommendations, workload, vaccine unavailability, and advanced disease state. CONCLUSION Although the recommendations published by professional medical societies emphasized the importance of vaccination before initiating Anti-TNF therapy, few patients were vaccinated. Medical administration in hospitals should develop policies, procedures, and guidelines for vaccination; implement education programs for physicians and patients and procure vaccines in a timely way to improve their use.
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Affiliation(s)
| | - Hadeel Magdy Sherif
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Ahmed Yaccob Mayet
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
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Risk Factors for the Development of Psoriasis. Int J Mol Sci 2019; 20:ijms20184347. [PMID: 31491865 PMCID: PMC6769762 DOI: 10.3390/ijms20184347] [Citation(s) in RCA: 257] [Impact Index Per Article: 51.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 08/30/2019] [Accepted: 09/03/2019] [Indexed: 12/12/2022] Open
Abstract
Psoriasis is an immune-mediated genetic skin disease. The underlying pathomechanisms involve complex interaction between the innate and adaptive immune system. T cells interact with dendritic cells, macrophages, and keratinocytes, which can be mediated by their secreted cytokines. In the past decade, biologics targeting tumor necrosis factor-α, interleukin (IL)-23, and IL-17 have been developed and approved for the treatment of psoriasis. These biologics have dramatically changed the treatment and management of psoriasis. In contrast, various triggering factors can elicit the disease in genetically predisposed individuals. Recent studies suggest that the exacerbation of psoriasis can lead to systemic inflammation and cardiovascular comorbidity. In addition, psoriasis may be associated with other auto-inflammatory and auto-immune diseases. In this review, we summarize the risk factors, which can be divided into two groups (namely, extrinsic and intrinsic risk factors), responsible for the onset and exacerbation of psoriasis in order to facilitate its prevention.
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Qendro T, de la Torre ML, Panopalis P, Hazel E, Ward BJ, Colmegna I, Hudson M. Suboptimal Immunization Coverage among Canadian Rheumatology Patients in Routine Clinical Care. J Rheumatol 2019; 47:770-778. [PMID: 31308211 DOI: 10.3899/jrheum.181376] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2019] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To assess vaccination coverage and predictors of vaccination among a Canadian population of rheumatology patients in routine clinical care. METHODS In this cross-sectional study, consecutive adult patients presenting to a tertiary rheumatology clinic at the McGill University Health Center between May and September 2015 were asked to fill a survey on vaccination. Patients self-identified as having rheumatoid arthritis (RA), systemic autoimmune rheumatic diseases (SARD), spondyloarthropathies (SpA), or other diseases (OD). Multivariate logistical regression analyses were performed to evaluate patient and physician factors associated with various vaccinations [for influenza, pneumococcus, and hepatitis B virus (HBV)]. Published Quebec general population influenza and pneumococcal vaccination rates in those aged ≥ 65 years were used as comparative baseline rates. RESULTS Three hundred fifty-two patients were included in the analysis (RA: 136, SARD: 113, SpA: 47, OD: 56). Vaccination rates were reported as follows: (1) influenza: RA 48.5%, SARD 42.0%, SpA 31.9%, OD 88.9%, Quebec general population 58.5%; (2) pneumococcal: RA 42.0%, SARD 37.8%, SpA 29.7%, OD 33.3%, Quebec general population 53.2%; (3) HBV: RA 33.6%, SARD 55.6%, SpA 73.5%, OD 36.8%; and (4) herpes zoster: RA 5.6%, SARD 28.6%, SpA 25.0%, OD 16.7%. Physician recommendation was the strongest independent predictor of vaccination across all vaccine types (influenza: OR 8.56, 95% CI 2.80-26.2, p < 0.001; pneumococcal: OR 314, 95% CI 73.0-1353, p < 0.001; HBV: OR 12.8, 95% CI 5.27-31.1, p < 0.001). Disease group, disease duration, comorbidities, treatment type, and being followed by a primary care physician were not significantly associated with vaccination. CONCLUSION There is suboptimal immunization coverage among ambulatory rheumatology patients. An important role for patient and physician education is highlighted in our study, especially because physician recommendation of vaccination was strongly predictive of vaccine uptake.
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Affiliation(s)
- Tedi Qendro
- From the Department of Medicine, McGill University, Montreal; Division of Rheumatology, McGill University Health Center, Montreal; Infectious Diseases and Immunity in Global Health Program, Research Institute of the McGill University Health Center, Montreal; Division of Rheumatology and Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada; Internal Medicine, Rheumatology and Immunology, Centro de Educacion Medica e Investigaciones Clinicas Norberto Quirno, Buenos Aires, Argentina.,T. Qendro, MSc, Department of Medicine, McGill University; M.L. de la Torre, MD, Internal medicine, Rheumatology and Immunology, Centro de Educacion Medica e Investigaciones Clinicas Norberto Quirno; P. Panopalis, MD, Division of Rheumatology, McGill University Health Center; E. Hazel, MD, Division of Rheumatology, McGill University Health Center; B.J. Ward, MD, DTM&H, Infectious Diseases and Immunity in Global Health Program, Research Institute of the McGill University Health Center; I. Colmegna, MD, Division of Rheumatology, McGill University Health Center; M. Hudson, MD, MPH, FRCPC, Division of Rheumatology and Lady Davis Institute for Medical Research, Jewish General Hospital
| | - María Laura de la Torre
- From the Department of Medicine, McGill University, Montreal; Division of Rheumatology, McGill University Health Center, Montreal; Infectious Diseases and Immunity in Global Health Program, Research Institute of the McGill University Health Center, Montreal; Division of Rheumatology and Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada; Internal Medicine, Rheumatology and Immunology, Centro de Educacion Medica e Investigaciones Clinicas Norberto Quirno, Buenos Aires, Argentina.,T. Qendro, MSc, Department of Medicine, McGill University; M.L. de la Torre, MD, Internal medicine, Rheumatology and Immunology, Centro de Educacion Medica e Investigaciones Clinicas Norberto Quirno; P. Panopalis, MD, Division of Rheumatology, McGill University Health Center; E. Hazel, MD, Division of Rheumatology, McGill University Health Center; B.J. Ward, MD, DTM&H, Infectious Diseases and Immunity in Global Health Program, Research Institute of the McGill University Health Center; I. Colmegna, MD, Division of Rheumatology, McGill University Health Center; M. Hudson, MD, MPH, FRCPC, Division of Rheumatology and Lady Davis Institute for Medical Research, Jewish General Hospital
| | - Pantelis Panopalis
- From the Department of Medicine, McGill University, Montreal; Division of Rheumatology, McGill University Health Center, Montreal; Infectious Diseases and Immunity in Global Health Program, Research Institute of the McGill University Health Center, Montreal; Division of Rheumatology and Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada; Internal Medicine, Rheumatology and Immunology, Centro de Educacion Medica e Investigaciones Clinicas Norberto Quirno, Buenos Aires, Argentina.,T. Qendro, MSc, Department of Medicine, McGill University; M.L. de la Torre, MD, Internal medicine, Rheumatology and Immunology, Centro de Educacion Medica e Investigaciones Clinicas Norberto Quirno; P. Panopalis, MD, Division of Rheumatology, McGill University Health Center; E. Hazel, MD, Division of Rheumatology, McGill University Health Center; B.J. Ward, MD, DTM&H, Infectious Diseases and Immunity in Global Health Program, Research Institute of the McGill University Health Center; I. Colmegna, MD, Division of Rheumatology, McGill University Health Center; M. Hudson, MD, MPH, FRCPC, Division of Rheumatology and Lady Davis Institute for Medical Research, Jewish General Hospital
| | - Elizabeth Hazel
- From the Department of Medicine, McGill University, Montreal; Division of Rheumatology, McGill University Health Center, Montreal; Infectious Diseases and Immunity in Global Health Program, Research Institute of the McGill University Health Center, Montreal; Division of Rheumatology and Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada; Internal Medicine, Rheumatology and Immunology, Centro de Educacion Medica e Investigaciones Clinicas Norberto Quirno, Buenos Aires, Argentina.,T. Qendro, MSc, Department of Medicine, McGill University; M.L. de la Torre, MD, Internal medicine, Rheumatology and Immunology, Centro de Educacion Medica e Investigaciones Clinicas Norberto Quirno; P. Panopalis, MD, Division of Rheumatology, McGill University Health Center; E. Hazel, MD, Division of Rheumatology, McGill University Health Center; B.J. Ward, MD, DTM&H, Infectious Diseases and Immunity in Global Health Program, Research Institute of the McGill University Health Center; I. Colmegna, MD, Division of Rheumatology, McGill University Health Center; M. Hudson, MD, MPH, FRCPC, Division of Rheumatology and Lady Davis Institute for Medical Research, Jewish General Hospital
| | - Brian J Ward
- From the Department of Medicine, McGill University, Montreal; Division of Rheumatology, McGill University Health Center, Montreal; Infectious Diseases and Immunity in Global Health Program, Research Institute of the McGill University Health Center, Montreal; Division of Rheumatology and Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada; Internal Medicine, Rheumatology and Immunology, Centro de Educacion Medica e Investigaciones Clinicas Norberto Quirno, Buenos Aires, Argentina.,T. Qendro, MSc, Department of Medicine, McGill University; M.L. de la Torre, MD, Internal medicine, Rheumatology and Immunology, Centro de Educacion Medica e Investigaciones Clinicas Norberto Quirno; P. Panopalis, MD, Division of Rheumatology, McGill University Health Center; E. Hazel, MD, Division of Rheumatology, McGill University Health Center; B.J. Ward, MD, DTM&H, Infectious Diseases and Immunity in Global Health Program, Research Institute of the McGill University Health Center; I. Colmegna, MD, Division of Rheumatology, McGill University Health Center; M. Hudson, MD, MPH, FRCPC, Division of Rheumatology and Lady Davis Institute for Medical Research, Jewish General Hospital
| | - Inés Colmegna
- From the Department of Medicine, McGill University, Montreal; Division of Rheumatology, McGill University Health Center, Montreal; Infectious Diseases and Immunity in Global Health Program, Research Institute of the McGill University Health Center, Montreal; Division of Rheumatology and Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada; Internal Medicine, Rheumatology and Immunology, Centro de Educacion Medica e Investigaciones Clinicas Norberto Quirno, Buenos Aires, Argentina.,T. Qendro, MSc, Department of Medicine, McGill University; M.L. de la Torre, MD, Internal medicine, Rheumatology and Immunology, Centro de Educacion Medica e Investigaciones Clinicas Norberto Quirno; P. Panopalis, MD, Division of Rheumatology, McGill University Health Center; E. Hazel, MD, Division of Rheumatology, McGill University Health Center; B.J. Ward, MD, DTM&H, Infectious Diseases and Immunity in Global Health Program, Research Institute of the McGill University Health Center; I. Colmegna, MD, Division of Rheumatology, McGill University Health Center; M. Hudson, MD, MPH, FRCPC, Division of Rheumatology and Lady Davis Institute for Medical Research, Jewish General Hospital
| | - Marie Hudson
- From the Department of Medicine, McGill University, Montreal; Division of Rheumatology, McGill University Health Center, Montreal; Infectious Diseases and Immunity in Global Health Program, Research Institute of the McGill University Health Center, Montreal; Division of Rheumatology and Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada; Internal Medicine, Rheumatology and Immunology, Centro de Educacion Medica e Investigaciones Clinicas Norberto Quirno, Buenos Aires, Argentina. .,T. Qendro, MSc, Department of Medicine, McGill University; M.L. de la Torre, MD, Internal medicine, Rheumatology and Immunology, Centro de Educacion Medica e Investigaciones Clinicas Norberto Quirno; P. Panopalis, MD, Division of Rheumatology, McGill University Health Center; E. Hazel, MD, Division of Rheumatology, McGill University Health Center; B.J. Ward, MD, DTM&H, Infectious Diseases and Immunity in Global Health Program, Research Institute of the McGill University Health Center; I. Colmegna, MD, Division of Rheumatology, McGill University Health Center; M. Hudson, MD, MPH, FRCPC, Division of Rheumatology and Lady Davis Institute for Medical Research, Jewish General Hospital.
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Kohl SE, Barnett ED. What do we know about travel for children with special health care needs? A review of the literature. Travel Med Infect Dis 2019; 34:101438. [PMID: 31233860 DOI: 10.1016/j.tmaid.2019.06.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 06/19/2019] [Accepted: 06/20/2019] [Indexed: 01/04/2023]
Abstract
BACKGROUND Children travel with their families, including children with chronic illness. We know that adults with chronic illness who travel are more likely than their healthy peers to become sick while traveling. A review of the literature was undertaken to identify what is known about traveling with children with special health care needs and to identify gaps in our knowledge. METHODS An Online search of the PubMed, CINAHL and Google databases of English language literature was conducted June 2016, October 2017, June 2018 and April 2019 using the terms children and travel, air travel, travel health, disabled child, children with special healthcare needs, parents of disabled children, vacations, recreation, international, wheelchairs, planning techniques, asthma, diabetes, altitude, cystic fibrosis, inflammatory bowel disease, sickle cell disease, depression, food allergies, Attention Deficit Hyperactivity Disorder (ADHD), and seizures. The search was limited to years 2000-2019. A secondary search of relevant articles was conducted using the reference sections of articles identified in the primary search. RESULTS 185 papers were examined for travel health related outcomes for children and adults with chronic diseases. Articles were excluded if they addressed the educational needs of students with disabilities traveling abroad, did not directly address travel health (e.g travel skills, travel itineraries), contained outdated policy statements, or were case reports of a single patient. The remaining 84 papers were organized and reviewed by organ systems. The articles were primarily descriptive and did not lend themselves to a systematic review. CONCLUSION Children traveling with chronic and complex health conditions are a heterogeneous group of vulnerable travelers. Closing the knowledge gap about how to best help these travelers requires a multipronged approach. Research is urgently needed to identify best practices for five of the most common chronic childhood diseases: asthma, depression, ADHD, food allergies and autism. For less common illnesses, ones typically cared for in specialty clinics, expert consensus opinion and multi-center studies are needed. Families and disease advocacy societies should be included in the research as they may have already identified the most pressing travel-related health concerns and solutions for these problems.
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Affiliation(s)
- Sarah E Kohl
- University of Pittsburgh School of Medicine, 3550 Terrace Street, Pittsburgh, PA, 15213, USA.
| | - Elizabeth D Barnett
- Boston University School of Medicine, 72 East Concord Street, Boston, MA, 02118, USA
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Poelman SM, Keeling CP, Metelitsa AI. Practical Guidelines for Managing Patients With Psoriasis on Biologics: An Update. J Cutan Med Surg 2019; 23:3S-12S. [PMID: 30789012 DOI: 10.1177/1203475418811347] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The paradigm for treating inflammatory diseases has shifted dramatically in the past 10 to 20 years with the discovery of targeted therapeutics or "biologic" agents. Patients with rheumatoid arthritis, inflammatory bowel disease, psoriatic arthritis, and psoriasis, among others, are reaping the benefits of decades of bench to bedside research, allowing them to live more productive lives with less side effects than traditional systemic therapies. Despite these advances, many physicians unfamiliar with biologics are left to care for the basic needs of these patients and may be unaware of the multisystem comorbidities associated with psoriasis and the screening, monitoring, and other special considerations required of biologics patients. This can be overwhelming to primary care physicians and inadvertently expose patients to undue risks. The aim of this review is to provide a practical approach for all health care providers caring for patients with psoriasis being treated with biologics to facilitate communication with their treating dermatologist and ultimately provide patients with more comprehensive care.
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Affiliation(s)
- Susan M Poelman
- 1 Cumming School of Medicine, Division of Dermatology, University of Calgary, Calgary, AB, Canada
| | - Christopher P Keeling
- 2 Department of Medicine, Division of Dermatology, University of Alberta, and Symmetry Dermatology, Edmonton, AB, Canada
| | - Andrei I Metelitsa
- 1 Cumming School of Medicine, Division of Dermatology, University of Calgary, Calgary, AB, Canada
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Farshidpour M, Charabaty A, Mattar MC. Improving immunization strategies in patients with inflammatory bowel disease. Ann Gastroenterol 2019; 32:247-256. [PMID: 31040621 PMCID: PMC6479655 DOI: 10.20524/aog.2019.0351] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 11/11/2018] [Indexed: 02/06/2023] Open
Abstract
Patients with inflammatory bowel disease (IBD) are susceptible to varieties of opportunistic infections due to immunological changes in the setting of their disease and drug-induced immunosuppression. Even though numerous infections can be prevented by vaccine, vaccination in IBD patients is inadequate. Data showed only 9% were vaccinated against pneumococcal infection and 28% described commonly receiving influenza vaccine. This review article discusses the recent immunizations against influenza virus; pneumococcal infection; human papilloma virus; tetanus, diphtheria and pertussis; measles, mumps and rubella; varicella zoster; and herpes zoster for individuals diagnosed with IBD and those patients with drug-related immunosuppression. In addition, this review discusses concerns about IBD patients planning to travel abroad. Immunization status and screening for opportunistic infection need to be addressed in IBD patients at the time of diagnosis and they should be vaccinated accordingly. Generally, standard vaccination strategies should be pursued in IBD patients, although live vaccines should be avoided while they are not immunocompetent.
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Affiliation(s)
- Maham Farshidpour
- Department of Inpatient Medicine, Banner University Medical Center, University of Arizona, Tucson (Maham Farshidpour), USA
| | - Aline Charabaty
- Division of Gastroenterology, MedStar Georgetown University Hospital, Washington, DC, USA (Aline Charabaty, Mark C. Mattar), USA
| | - Mark C Mattar
- Division of Gastroenterology, MedStar Georgetown University Hospital, Washington, DC, USA (Aline Charabaty, Mark C. Mattar), USA
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Abstract
Hepatobiliary disorders are commonly encountered in patients with inflammatory bowel disease (IBD). Although primary sclerosing cholangitis is the stereotypical hepatobiliary disorder associated with IBD, other diseases, including autoimmune hepatitis and nonalcoholic fatty liver disease, also are encountered in this population. Several agents used for treatment of IBD may cause drug-induced liver injury, although severe hepatotoxicity occurs infrequently. Furthermore, reactivation of hepatitis B virus infection may occur in patients with IBD treated with systemic corticosteroids and biologic agents.
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Affiliation(s)
- Mahmoud Mahfouz
- Department of Internal Medicine, Mount Sinai Medical Center, 4300 Alton Road, Suite 301, Miami Beach, FL 33140, USA
| | - Paul Martin
- Division of Gastroenterology and Hepatology, University of Miami Miller School of Medicine, 1120 Northwest 14 Street #1115, Miami, FL 33136, USA.
| | - Andres F Carrion
- Division of Gastroenterology and Hepatology, University of Miami Miller School of Medicine, 1120 Northwest 14 Street #1115, Miami, FL 33136, USA
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Vaccinations in pediatric kidney transplant recipients. Pediatr Nephrol 2019; 34:579-591. [PMID: 29671067 DOI: 10.1007/s00467-018-3953-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 03/16/2018] [Accepted: 03/22/2018] [Indexed: 12/16/2022]
Abstract
Pediatric kidney transplant (KT) candidates should be fully immunized according to routine childhood schedules using age-appropriate guidelines. Unfortunately, vaccination rates in KT candidates remain suboptimal. With the exception of influenza vaccine, vaccination after transplantation should be delayed 3-6 months to maximize immunogenicity. While most vaccinations in the KT recipient are administered by primary care physicians, there are specific schedule alterations in the cases of influenza, hepatitis B, pneumococcal, and meningococcal vaccinations; consequently, these vaccines are usually administered by transplant physicians. This article will focus on those deviations from the normal vaccine schedule important in the care of pediatric KT recipients. The article will also review human papillomavirus vaccine due to its special importance in cancer prevention. Live vaccines are generally contraindicated in KT recipients. However, we present a brief review of live vaccines in organ transplant recipients, as there is evidence that certain live virus vaccines may be safe and effective in select groups. Lastly, we review vaccination of pediatric KT recipients prior to international travel.
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Haykir Solay A, Eser F. High dose hepatitis B vaccine is not effective in patients using immunomodulatory drugs: a pilot study. Hum Vaccin Immunother 2019; 15:1177-1182. [PMID: 30676860 DOI: 10.1080/21645515.2019.1574151] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
In patients undergoing immunotherapy, the quality of the immune response is reduced, which may negatively affect the efficacy of vaccination. This study was conducted in order to evaluate the efficacy of the hepatitis B virus (HBV) vaccine in patients using immunomodulators. Seronegative patients for HBV who were using biological agents, were included in the study. The vaccination was administered on the standard schedule in 3 doses of 20 or 40 µg/ml. Eighty-two patients (52%) were males and the mean age of all patients was 44,8 ± 10,3 years. Among these 109 patients, 83 had psoriasis, 12 had Crohn's disease, six had rheumatoid arthritis, three had ulcerative colitis, three had hydradenitis supurativa, one had Behcet's disease and one had ankylosing spondylitis. The biological agents that were being used by these patients were adalimumab (62), ustekinumab (25), infliximab (12), etanercept (9) and golimumab (1). Seventy-three of the patients were vaccinated with a dose of 20 µg/ml and 36 with 40 µg/ml. The anti-HBs titers of fifty-eight (53.2%) patients were above 10 mIU/ml. The antibody response rate was lowest in infliximab-users (16.7%) (p = 0.007), which was followed by adalimumab (48.4%), and higher protection rates were achieved in patients using ustekinumab and etanercept (72% and 88.9%, respectively; p < 0.05). The HBV vaccine response rate in patients using immunomodulators was significantly lower than that in immunocompetent patients. Furthermore, high dose vaccination did not increase the response rate. Clinicians should take into account administering HBV vaccination before treatment with biological agent in patients who have negative HBV serology.
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Affiliation(s)
- Asli Haykir Solay
- a Infection Disease and Clinical Microbiology Department , University of Health Sciences, Dışkapı Yıldırım Beyazıt Training and Research Hospital , Ankara , Turkey
| | - Fatma Eser
- a Infection Disease and Clinical Microbiology Department , University of Health Sciences, Dışkapı Yıldırım Beyazıt Training and Research Hospital , Ankara , Turkey
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Fahim C, Kim BW, Bourcier M, Glassman S, Gooderham M, Guenther L, Gulliver W, Lynde C, Poulin Y, Pratt M, Shear N, Vender R, Walsh S, Fahim S. Checklist for the Systemic Treatment of Psoriasis Using Biologics: A Delphi Study. J Cutan Med Surg 2019; 23:282-288. [PMID: 30854878 DOI: 10.1177/1203475419833605] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Despite the complexity of psoriasis treatment using biologic therapy, there does not exist a standardized synoptic reporting form for the initiation of this population. The purpose of this study was to use a modified Delphi approach to develop a standard checklist for the standardized documentation of patients receiving systemic biologic therapy for psoriasis. METHODS A modified Delphi survey was conducted over 3 rounds (February 2017 through January 2018). An expert panel generated a 51-item checklist that was proposed to participants. Items were rated on an anchored 1-7 Likert scale. Consensus was defined apriori as ≥ 70% agreement by respondents. RESULTS A total of 58, 17, and 18 dermatologists participated in 3 consecutive Delphi rounds, respectively. Only half of the dermatologists surveyed reported using a checklist for the management of psoriasis. The final checklist comprised 19, 5, 6, and 9 items pertaining to patient history; physical exam and history of systemic therapy; vaccinations; and lab investigations and bloodwork, respectively. CONCLUSIONS Given the increasing availability and complexity of biologic agents for psoriasis treatment, there is a need to promote standardized documentation for this population. The Checklist for the Systemic Treatment of Psoriasis presents 38 items that should be considered when initiating patients with psoriasis on biologic therapy.
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Affiliation(s)
- Christine Fahim
- 1 Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Ben Whan Kim
- 2 Department of Medicine, University of Ottawa, Canada
| | - Marc Bourcier
- 3 Faculty of Medicine, Sherbrooke University, Canada
| | | | | | - Lyn Guenther
- 5 Department of Medicine, Western University, London, Canada
| | - Wayne Gulliver
- 6 Department of Medicine, Memorial University of Newfoundland, St. John's, Canada
| | - Charles Lynde
- 7 Department of Medicine, University of Toronto, ON, Canada
| | - Yves Poulin
- 8 Department of Medicine, Laval University, Quebec City, Canada
| | - Melanie Pratt
- 2 Department of Medicine, University of Ottawa, Canada
| | - Neil Shear
- 7 Department of Medicine, University of Toronto, ON, Canada
| | - Ronald Vender
- 9 Department of Medicine, McMaster University, Hamilton, ON, Canada.,10 Dermatrials Research Inc and Venderm Innovations in Psoriasis, Hamilton, ON, Canada
| | - Scott Walsh
- 7 Department of Medicine, University of Toronto, ON, Canada
| | - Simone Fahim
- 2 Department of Medicine, University of Ottawa, Canada
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Peremiquel-Trillas P, Leguízamo LM, Asensio Ostos C, Martínez-Gómez X. Vacunas para pacientes en tratamiento con fármacos inmunodepresores, inmunomoduladores o biológicos. Med Clin (Barc) 2018; 151:498-502. [DOI: 10.1016/j.medcli.2018.05.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 05/03/2018] [Accepted: 05/03/2018] [Indexed: 12/14/2022]
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Affiliation(s)
- EEP Htut
- Rheumatology Department, Addenbrooke’s Hospital, Cambridge, UK
| | - F Hall
- Rheumatology Department, Addenbrooke’s Hospital, Cambridge, UK
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Moon A, Veir J. Vaccination and Associated Adverse Events in Dogs Previously Treated for Primary Immune-Mediated Hemolytic Anemia. J Am Anim Hosp Assoc 2018; 55:29-34. [PMID: 30427712 DOI: 10.5326/jaaha-ms-6868] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This study described the rate of vaccine reactions in a population of dogs receiving vaccines after diagnosis of primary immune-mediated hemolytic anemia (IMHA). A secondary objective was to describe the time elapsed between vaccination and initial diagnosis of IMHA. A medical record search identified cases meeting criteria for primary IMHA. Owners and referring veterinarians were surveyed regarding vaccination of the dog following diagnosis. Referring veterinarians were surveyed regarding vaccination prior to diagnosis of IMHA. A completed survey was returned in 44 cases. Twenty-two dogs received vaccinations after diagnosis, and 22 dogs did not. The median time elapsed between vaccination and initial diagnosis was 280 days. No dog was vaccinated within 30 days of diagnosis. Two of the following possible reactions were noted out of 22 dogs vaccinated: vomiting and urticarial eruption in a dog administered a rabies and canine distemper vaccine, and recurrent anemia in a dog administered a rabies vaccine. The rate of vaccine reactions was higher than previously reported, although the time period evaluated was longer than in previous studies. The relationship between initial vaccination and development of IMHA, and between vaccination and vaccine reaction, in this population is uncertain and may reflect coincidence or differences in susceptibility.
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Affiliation(s)
- Alaina Moon
- From the Department of Small Animal Internal Medicine, Carlson College of Veterinary Medicine, Oregon State University, Corvallis, Oregon (A.M.); and Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado (J.V.)
| | - Julia Veir
- From the Department of Small Animal Internal Medicine, Carlson College of Veterinary Medicine, Oregon State University, Corvallis, Oregon (A.M.); and Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado (J.V.)
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Philip V, Soubieres A, Poullis A. Health concerns associated with travelling with inflammatory bowel disease (IBD): a questionnaire survey. Clin Med (Lond) 2018; 18:288-292. [PMID: 30072550 PMCID: PMC6334055 DOI: 10.7861/clinmedicine.18-4-288] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
When travelling, patients with inflammatory bowel disease (IBD) have a higher risk of morbidity. We identified barriers to travel, specific health concerns and several areas for service improvement among patients. In total, 136 patients were given a 32-question service improvement questionnaire. Of these, 89% travelled abroad, 30% reported that IBD limited travel and 40% said it affected choice of destination. Fourty-seven percent of patients travelled abroad without health insurance and 7% were refused. Seventy-eight percent wanted pre-travel advice from doctors in the future. Popular service improvement options included providing written prescriptions (91%) and management plans (75%). Sixty-three percent of patients were unaware of needing to avoid live vaccines while on immunosuppressants. Ninety-two percent were unaware that high altitudes could precipitate flares; 27% travelled abroad to high-altitude destinations, of which 46% subsequently had flare-ups. Existing IBD travel services remain unknown such as the 'Can't wait' card (72%) and 'IBD passport' (96%). Service improvements in the IBD clinic need to be implemented to facilitate safer travel overseas.
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Caporuscio S, Ieraci R, Valesini G, Teloni R, Mariotti S, Spinelli FR, Ferlito C, Salemi S, Picchianti Diamanti A, Meneguzzi G, Markovic M, Sgrulletti M, von Hunolstein C, Ralli L, Pinto A, Salerno G, Canzoni M, Sorgi ML, Laganà B, Di Rosa R, Nisini R, D'Amelio R. Anti-polysaccharide and anti-diphtheria protective antibodies after 13-valent pneumococcal conjugate vaccination in rheumatoid arthritis patients under immunosuppressive therapy. Clin Immunol 2018; 195:18-27. [PMID: 30036638 DOI: 10.1016/j.clim.2018.07.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 06/20/2018] [Accepted: 07/19/2018] [Indexed: 01/22/2023]
Abstract
Immunogenicity of 13-valent pneumococcal polysaccharide (PnPS) conjugate vaccine (PCV13) was evaluated in 38 rheumatoid arthritis patients under immunosuppressive treatment and 20 healthy controls (HC). Antibodies to all PnPS and diphtheria-toxin analogue conjugate protein were measured pre- (T0), 1 (T1), 6 (T2), 12 (T3) months post-immunization. Patients and HC had similar response to individual PnPS. Mean antibody levels to all PnPS but one doubled at T1 compared with T0, with T3 persistence for only 8-7/13 PnPS. Baseline antibody levels was inversely associated with the rate of responders at T1 (T1/T0≥2) to 11/13 PnPS. Few subjects reached protective IgG levels against some serotypes frequently isolated in Italian patients with invasive pneumococcal disease. Antibody response was not influenced by therapy, except the one to PS7F, which was reduced by tumor necrosis factor-α-inhibitors. Vaccination increased also anti-diphtheria IgG. Despite this study substantially confirmed the PCV13 immunogenicity in immunocompromised patients, it also revealed some limitations.
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Affiliation(s)
- Sara Caporuscio
- Sapienza Università di Roma, Azienda Ospedaliera Universitaria Sant'Andrea, Roma, Italy
| | | | - Guido Valesini
- Dipartimento di Medicina Interna e Specialità Mediche, Reumatologia, Università La Sapienza, Roma, Italy
| | - Raffaela Teloni
- Dipartimento Malattie Infettive, Istituto Superiore di Sanità, Roma, Italy
| | - Sabrina Mariotti
- Dipartimento Malattie Infettive, Istituto Superiore di Sanità, Roma, Italy
| | - Francesca Romana Spinelli
- Dipartimento di Medicina Interna e Specialità Mediche, Reumatologia, Università La Sapienza, Roma, Italy
| | - Claudia Ferlito
- Sapienza Università di Roma, Azienda Ospedaliera Universitaria Sant'Andrea, Roma, Italy
| | - Simonetta Salemi
- Sapienza Università di Roma, Azienda Ospedaliera Universitaria Sant'Andrea, Roma, Italy
| | | | - Giorgia Meneguzzi
- Sapienza Università di Roma, Azienda Ospedaliera Universitaria Sant'Andrea, Roma, Italy
| | - Milica Markovic
- Sapienza Università di Roma, Azienda Ospedaliera Universitaria Sant'Andrea, Roma, Italy
| | - Mayla Sgrulletti
- Sapienza Università di Roma, Azienda Ospedaliera Universitaria Sant'Andrea, Roma, Italy
| | - Christina von Hunolstein
- Centro Nazionale per il Controllo e la Valutazione dei Farmaci, Istituto Superiore di Sanità, Roma, Italy
| | - Luisa Ralli
- Centro Nazionale per il Controllo e la Valutazione dei Farmaci, Istituto Superiore di Sanità, Roma, Italy
| | - Antonietta Pinto
- Centro Nazionale per il Controllo e la Valutazione dei Farmaci, Istituto Superiore di Sanità, Roma, Italy
| | - Gerardo Salerno
- Sapienza Università di Roma, Azienda Ospedaliera Universitaria Sant'Andrea, Roma, Italy
| | | | - Maria Laura Sorgi
- Sapienza Università di Roma, Azienda Ospedaliera Universitaria Sant'Andrea, Roma, Italy
| | - Bruno Laganà
- Sapienza Università di Roma, Azienda Ospedaliera Universitaria Sant'Andrea, Roma, Italy
| | - Roberta Di Rosa
- Sapienza Università di Roma, Azienda Ospedaliera Universitaria Sant'Andrea, Roma, Italy
| | - Roberto Nisini
- Dipartimento Malattie Infettive, Istituto Superiore di Sanità, Roma, Italy.
| | - Raffaele D'Amelio
- Sapienza Università di Roma, Azienda Ospedaliera Universitaria Sant'Andrea, Roma, Italy
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Gomez EV, Bishop JL, Jackson K, Muram TM, Phillips D. Response to Tetanus and Pneumococcal Vaccination Following Administration of Ixekizumab in Healthy Participants. BioDrugs 2018; 31:545-554. [PMID: 29116597 PMCID: PMC5696443 DOI: 10.1007/s40259-017-0249-y] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background Ixekizumab (IXE) is an interleukin (IL)-17A antagonist approved for the treatment of adults with moderate-to-severe psoriasis. Objective The objective of this study was to determine if the immune response to tetanus and pneumococcal vaccines in healthy subjects administered IXE was noninferior to control. Methods In a randomized, open-label, parallel-group study, adult subjects received vaccinations alone (N = 42, control) or in combination with 160 mg IXE subcutaneously 2 weeks prior to vaccination and 80 mg IXE on the day of vaccination (N = 41, IXE). Response to tetanus vaccination was defined as anti-tetanus antibodies ≥ 1.0 IU and a ≥ 1.5-fold increase if baseline was ≤ 1.0 IU or a ≥ 2.5-fold increase if baseline was > 1.0 IU. Response to pneumococcal vaccination was defined as a ≥ 2-fold increase from baseline in anti-pneumococcal antibodies against > 50% of the 23 serotypes. The primary outcomes were the percentages of patients with a response to the tetanus and pneumococcal vaccines 4 weeks after vaccination. A noninferiority analysis of IXE to control using a 40% margin was evaluated for the primary outcomes. Safety and pharmacokinetics were also assessed. Results IXE (38 completers) was noninferior to control (41 completers) based on the difference in the proportion of responders to tetanus [1.4%; 90% confidence interval (CI) − 16.6 to 19.2] and pneumococcal (− 0.8%; 90% CI − 12.9 to 11.0) vaccines. Twenty subjects (14 IXE, six control) reported 43 mild treatment-emergent adverse events. Conclusion IXE does not suppress the humoral immune response to non-live vaccines and was well tolerated in healthy subjects. ClinicalTrial.gov identifier: NCT02543918. Electronic supplementary material The online version of this article (doi:10.1007/s40259-017-0249-y) contains supplementary material, which is available to authorized users.
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AlEnizi A, AlSaeid K, Alawadhi A, Hasan E, Husain EH, AlFadhli A, Ghanem A, Abutiban F, Ali Y, Al-Herz A, Mohammed K, Alkandari W, Aldei A, Alhajeri H, Dehrab A, Hayat S. Kuwait Recommendations on Vaccine Use in People with Inflammatory Rheumatic Diseases. Int J Rheumatol 2018; 2018:5217461. [PMID: 29861734 PMCID: PMC5971308 DOI: 10.1155/2018/5217461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 03/28/2018] [Indexed: 01/24/2023] Open
Abstract
People with IRD are at increased risk of infection, and in 2011 EULAR made general recommendations for vaccination in these patients. Global and European perspectives are important, but they cannot accurately reflect the individual situations of patients in different countries and regions. Based on our clinical experience and opinions, we have sought to tailor the original EULAR recommendations to include advice for vaccination with new agents approved in the intervening years-including the new class of targeted synthetic disease-modifying antirheumatic drugs. We have also considered the specific demographic needs of patients in local populations in the Gulf region. The resulting 16 recommendations are grouped into four main categories covering general vaccination guidelines and best-practice for all patients with IRD, followed by a set of recommended vaccines against specific pathogens. The last two categories include recommendations for certain patient subgroups with defined risks and for patients who wish to travel.
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Affiliation(s)
| | - Khaled AlSaeid
- Faculty of Medicine, Kuwait University, Kuwait City, Kuwait
| | - Adel Alawadhi
- Faculty of Medicine, Kuwait University, Kuwait City, Kuwait
| | | | - Entesar H. Husain
- Department of Paediatrics, Faculty of Medicine, Kuwait University, Kuwait City, Kuwait
| | | | | | | | - Yaser Ali
- Mubarak Al-Kabeer Hospital, Jabriya, Kuwait
| | | | | | | | - Ali Aldei
- Al Amiri Hospital, Kuwait City, Kuwait
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Jain VK, Bhashini N, Balajee LK, Sistla S, Parija SC, Negi VS. Effect of disease-modifying antirheumatic drug therapy on immune response to trivalent influenza vaccine in rheumatoid arthritis. Indian J Med Res 2018; 145:464-470. [PMID: 28862177 PMCID: PMC5663159 DOI: 10.4103/ijmr.ijmr_920_15] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Background & objectives: Patients with autoimmune rheumatic diseases may be at an increased risk of infection due to disease and use of disease-modifying antirheumatic drug (DMARD) therapy. The present study was done to evaluate the immune response to influenza vaccination in patients with rheumatoid arthritis (RA). Methods: Fifty one RA patients on stable methotrexate (MTX) therapy (≥15 mg/wk), 51 newly diagnosed DMARD-naïve RA patients and 45 healthy controls received a single dose of inactivated seasonal trivalent influenza vaccine. Blood samples were collected just prior to and four weeks after vaccination. Pre- and post-vaccination antibody titres against the three virus strains were measured by hemagglutination inhibition assay. The impact of age, gender, DMARD treatment and pre-vaccination seroprotection on response to the vaccine was assessed by binary logistic regression analysis for each of the virus strains. Results: Pre-vaccination antibody titres were found to be high in the three study groups for all influenza strains, except for Yamagata strain, the titres for which were low in healthy controls. Trivalent influenza vaccination was found to be safe and stimulated a good antibody response in all study groups. On regression analysis, there was no association of age, gender or MTX therapy with vaccine response, except for Yamagata strain where healthy controls had higher positive immune response (P=0.008; odds ratio – 3.37, 95% confidence interval: 1.36-8.32). Interpretation & conclusions: Our results indicated that influenza vaccination was safe in RA patients with no detrimental effect on disease activity. MTX therapy at a dose ≥15 mg/wk did not affect the vaccine response. Presence of high pre-vaccination seroprotective antibody levels in the study population indicates the need for re-examination of recommended annual influenza vaccination in such subgroups of population.
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Affiliation(s)
- Vikramraj K Jain
- Department of Clinical Immunology, Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry, India
| | - Nandhini Bhashini
- Department of Microbiology, Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry, India
| | - L Karthik Balajee
- Department of Preventive & Social Medicine, Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry, India
| | - Sujatha Sistla
- Department of Microbiology, Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry, India
| | - Subhash Chandra Parija
- Department of Microbiology, Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry, India
| | - Vir Singh Negi
- Department of Clinical Immunology, Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry, India
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Bahuaud M, Beaudouin-Bazire C, Husson M, Molto A, Launay O, Batteux F, Dougados M. Immunogenicity and persistence of a prime-boost re-vaccination strategy for pneumococcal vaccines in patients with rheumatoid arthritis. Hum Vaccin Immunother 2018; 14:1464-1470. [PMID: 29432051 DOI: 10.1080/21645515.2018.1438091] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVES Patients with rheumatoid arthritis (RA) are at an increased risk of Pneumococcal infections. Immunogenicity and persistence of a prime-boost revaccination strategy using 13-valent/23-valent anti-pneumococcal vaccines was evaluated in patients with RA treated by Methotrexate (MTX) and anti-TNF. METHOD Twenty-four patients with RA received one dose of PCV13 (Prevenar13®; Pfizer) followed two months later by one dose of PPV23 (Pneumovax®, Merck). Concentrations of IgG specific for 7 serotypes common to both vaccines and 3 uncommon serotypes, included only in the PPV23 were measured by ELISA and Opsonophagocytic Assay (OPA) at baseline and after 4, 12 and 24 months post-vaccine. RESULTS Similar percentages of protection were found at 4 months (63% vs. 55%), 12 months (54% vs. 50%) and 24 months (52% vs. 55%) for the 7 common and 3 uncommon serotypes when antibody titers were assayed by ELISA. Based on functional antibody measurements by OPA, a decrease of protected patients was observed 24 months after vaccine with only 19% of patients protected compared to 29% at baseline. CONCLUSION Although the combined pneumococcal revaccination strategy induces good protection in the short term in RA patients, this protection does not persist beyond two years with levels of functional antibody decreasing below pre-vaccine levels. We did not observe a higher efficacy of the conjugate vaccine compared to the polysaccharide vaccine. Our results clearly question the advantage of the prime-boost strategy as it highlight the possible hyporesponse induced by PPV23 against the immune response elicited by the primo-injection of the PCV13 vaccine.
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Affiliation(s)
- Mathilde Bahuaud
- a Plateforme d'Immunomonotoring Vaccinal, Laboratoire d'Immunologie , Groupe hospitalier Cochin-Broca-Hôtel Dieu, AP-HP , Paris , France
| | | | - Marine Husson
- a Plateforme d'Immunomonotoring Vaccinal, Laboratoire d'Immunologie , Groupe hospitalier Cochin-Broca-Hôtel Dieu, AP-HP , Paris , France
| | - Anna Molto
- b Service de Rhumatologie B , Groupe hospitalier Cochin-Broca-Hôtel Dieu, APHP , Paris , France
| | - Odile Launay
- c Centre d'Investigation Clinique Cochin-Pasteur (CIC1417) , Groupe hospitalier Cochin-Broca-Hôtel Dieu, AP-HP , Paris , France
| | - Frédéric Batteux
- a Plateforme d'Immunomonotoring Vaccinal, Laboratoire d'Immunologie , Groupe hospitalier Cochin-Broca-Hôtel Dieu, AP-HP , Paris , France
| | - Maxime Dougados
- b Service de Rhumatologie B , Groupe hospitalier Cochin-Broca-Hôtel Dieu, APHP , Paris , France
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Subesinghe S, Bechman K, Rutherford AI, Goldblatt D, Galloway JB. A Systematic Review and Metaanalysis of Antirheumatic Drugs and Vaccine Immunogenicity in Rheumatoid Arthritis. J Rheumatol 2018; 45:733-744. [PMID: 29545454 DOI: 10.3899/jrheum.170710] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2017] [Indexed: 01/25/2023]
Abstract
OBJECTIVE Vaccination is a key strategy to reduce infection risk in patients with rheumatoid arthritis (RA) and is advocated in internationally recognized rheumatology society guidelines. The aim was to evaluate to the effect of antirheumatic drugs on influenza and pneumococcal vaccine immunogenicity. METHODS We conducted a systematic literature review and metaanalysis comparing the humoral response to influenza (pandemic and seasonal trivalent subunit vaccines) and pneumococcal (23-valent pneumococcal polysaccharide vaccine, 7- and 13-valent pneumococcal conjugated vaccines) vaccination in adult patients with RA treated with antirheumatic drugs. Vaccine immunogenicity was assessed by seroprotection rates measured 3 to 6 weeks postimmunization. Risk ratios (RR) and 95% CI were pooled. RESULTS Nine studies were included in the metaanalysis (7 studies investigating antirheumatic drug exposures and influenza humoral response, 2 studies investigating pneumococcal vaccine response). Influenza vaccine responses to all subunit strains (H1N1, H3N2, B strain) were preserved with methotrexate (MTX) and tumor necrosis factor inhibitor (TNFi) drug exposure. MTX but not TNFi drug exposure was associated with reduced 6B and 23F serotype pneumococcal vaccine response (RR 0.42, 95% CI 0.28-0.63 vs RR 0.98, 95% CI 0.58-1.67); however, limited data were available to draw any firm conclusions. Combination of MTX with tocilizumab or tofacitinib was associated with reduced pneumococcal and influenza vaccine responses. CONCLUSION Antirheumatic drugs may limit humoral responses to vaccination as evidenced by pneumococcal responses with MTX exposure; however, they are safe and should not preclude immunization against vaccine-preventable disease. Vaccination should be considered in all patients with RA and encouraged as part of routine care. (Systematic review registration number: PROSPERO 2016: CRD42016048093.).
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Affiliation(s)
- Sujith Subesinghe
- From the Department of Academic Rheumatology, King's College London, Weston Education Centre; Institute of Child Health, University College London, London, UK. .,S. Subesinghe, BSc, MBBS, MSc, MRCP, Clinical Research Fellow and Rheumatology Registrar, Department of Academic Rheumatology, King's College London, Weston Education Centre; K. Bechman, BSc, MBBS, MRCP, Clinical Research Fellow and Rheumatology Registrar, Department of Academic Rheumatology, King's College London, Weston Education Centre; A.I. Rutherford, BSc, MBBS, MSc, MRCP, Clinical Research Fellow and Rheumatology Registrar, Department of Academic Rheumatology, King's College London, Weston Education Centre; D. Goldblatt, MBChB, FRCPCH, FRCP, PhD, Prof, Vaccinology and Immunology, Institute of Child Health, University College London; J.B. Galloway, MBChB, MSc, CHP, FRCP, PhD, FAcadMedEd, Senior Lecturer and Honorary Consultant Rheumatologist, Department of Academic Rheumatology, King's College London, Weston Education Centre.
| | - Katie Bechman
- From the Department of Academic Rheumatology, King's College London, Weston Education Centre; Institute of Child Health, University College London, London, UK.,S. Subesinghe, BSc, MBBS, MSc, MRCP, Clinical Research Fellow and Rheumatology Registrar, Department of Academic Rheumatology, King's College London, Weston Education Centre; K. Bechman, BSc, MBBS, MRCP, Clinical Research Fellow and Rheumatology Registrar, Department of Academic Rheumatology, King's College London, Weston Education Centre; A.I. Rutherford, BSc, MBBS, MSc, MRCP, Clinical Research Fellow and Rheumatology Registrar, Department of Academic Rheumatology, King's College London, Weston Education Centre; D. Goldblatt, MBChB, FRCPCH, FRCP, PhD, Prof, Vaccinology and Immunology, Institute of Child Health, University College London; J.B. Galloway, MBChB, MSc, CHP, FRCP, PhD, FAcadMedEd, Senior Lecturer and Honorary Consultant Rheumatologist, Department of Academic Rheumatology, King's College London, Weston Education Centre
| | - Andrew I Rutherford
- From the Department of Academic Rheumatology, King's College London, Weston Education Centre; Institute of Child Health, University College London, London, UK.,S. Subesinghe, BSc, MBBS, MSc, MRCP, Clinical Research Fellow and Rheumatology Registrar, Department of Academic Rheumatology, King's College London, Weston Education Centre; K. Bechman, BSc, MBBS, MRCP, Clinical Research Fellow and Rheumatology Registrar, Department of Academic Rheumatology, King's College London, Weston Education Centre; A.I. Rutherford, BSc, MBBS, MSc, MRCP, Clinical Research Fellow and Rheumatology Registrar, Department of Academic Rheumatology, King's College London, Weston Education Centre; D. Goldblatt, MBChB, FRCPCH, FRCP, PhD, Prof, Vaccinology and Immunology, Institute of Child Health, University College London; J.B. Galloway, MBChB, MSc, CHP, FRCP, PhD, FAcadMedEd, Senior Lecturer and Honorary Consultant Rheumatologist, Department of Academic Rheumatology, King's College London, Weston Education Centre
| | - David Goldblatt
- From the Department of Academic Rheumatology, King's College London, Weston Education Centre; Institute of Child Health, University College London, London, UK.,S. Subesinghe, BSc, MBBS, MSc, MRCP, Clinical Research Fellow and Rheumatology Registrar, Department of Academic Rheumatology, King's College London, Weston Education Centre; K. Bechman, BSc, MBBS, MRCP, Clinical Research Fellow and Rheumatology Registrar, Department of Academic Rheumatology, King's College London, Weston Education Centre; A.I. Rutherford, BSc, MBBS, MSc, MRCP, Clinical Research Fellow and Rheumatology Registrar, Department of Academic Rheumatology, King's College London, Weston Education Centre; D. Goldblatt, MBChB, FRCPCH, FRCP, PhD, Prof, Vaccinology and Immunology, Institute of Child Health, University College London; J.B. Galloway, MBChB, MSc, CHP, FRCP, PhD, FAcadMedEd, Senior Lecturer and Honorary Consultant Rheumatologist, Department of Academic Rheumatology, King's College London, Weston Education Centre
| | - James B Galloway
- From the Department of Academic Rheumatology, King's College London, Weston Education Centre; Institute of Child Health, University College London, London, UK.,S. Subesinghe, BSc, MBBS, MSc, MRCP, Clinical Research Fellow and Rheumatology Registrar, Department of Academic Rheumatology, King's College London, Weston Education Centre; K. Bechman, BSc, MBBS, MRCP, Clinical Research Fellow and Rheumatology Registrar, Department of Academic Rheumatology, King's College London, Weston Education Centre; A.I. Rutherford, BSc, MBBS, MSc, MRCP, Clinical Research Fellow and Rheumatology Registrar, Department of Academic Rheumatology, King's College London, Weston Education Centre; D. Goldblatt, MBChB, FRCPCH, FRCP, PhD, Prof, Vaccinology and Immunology, Institute of Child Health, University College London; J.B. Galloway, MBChB, MSc, CHP, FRCP, PhD, FAcadMedEd, Senior Lecturer and Honorary Consultant Rheumatologist, Department of Academic Rheumatology, King's College London, Weston Education Centre
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Fortina AB, Bardazzi F, Berti S, Carnevale C, Di Lernia V, El Hachem M, Neri I, Gelmetti CM, Lora V, Mazzatenta C, Milioto M, Moretta G, Patrizi A, Peris K, Villani A. Treatment of severe psoriasis in children: recommendations of an Italian expert group. Eur J Pediatr 2017; 176:1339-1354. [PMID: 28836064 DOI: 10.1007/s00431-017-2985-x] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 07/28/2017] [Accepted: 08/03/2017] [Indexed: 02/01/2023]
Abstract
UNLABELLED This article provides comprehensive recommendations for the systemic treatment of severe pediatric psoriasis based on evidence obtained from a systematic review of the literature and the consensus opinion of expert dermatologists and pediatricians. For each systemic treatment, the grade of recommendation (A, B, C) based on the treatment's approval by the European Medicines Agency for childhood psoriasis and the experts' opinions is discussed. The grade of recommendation for narrow-band-ultraviolet B phototherapy, cyclosporine, and retinoids is C, while that for methotrexate is C/B. The use of adalimumab, etanercept, and ustekinumab has a grade A recommendation. No conventional systemic treatments are approved for pediatric psoriasis. Adalimumab is approved by the European Medicines Agency as a first-line treatment for severe chronic plaque psoriasis in children (≥ 4 years old) and adolescents. Etanercept and ustekinumab are approved as second-line therapy in children ≥ 6 and ≥ 12 years, respectively. CONCLUSION A treatment algorithm as well as practical tools (i.e., tabular summaries of differential diagnoses, treatment mechanism of actions, dosing regimens, control parameters) are provided to assist in therapeutic reasoning and decision-making for individual patients. These treatment recommendations are endorsed by major Italian Pediatric and Dermatology Societies. What is Known: • Guidelines for the treatment of severe pediatric psoriasis are lacking and most traditional systemic treatments are not approved for use in young patients. Although there has been decades of experience with some of the traditional agents such as phototherapy, acitretin, and cyclosporine in children, there are no RCTs on their pediatric use while RCTs investigating new biologic agents have been performed. What is New: • In this manuscript, an Italian multidisciplinary team of experts focused on treatment recommendations for severe forms of psoriasis in children based on an up-to-date review of the literature and experts' opinions.
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Affiliation(s)
- Anna Belloni Fortina
- Pediatric Dermatology Unit, Department of Medicine, University of Padua, Via Gallucci, 4, 35128, Padova, Italy.
| | - Federico Bardazzi
- Dermatology Unit, Department of Specialistic, Diagnostic and Experimental Medicine, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Samantha Berti
- Dermatology Unit, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| | - Claudia Carnevale
- Dermatology Unit, Bambino Gesù Children's Hospital-IRCCS, Rome, Italy
| | - Vito Di Lernia
- Dermatology Unit, Arcispedale S. Maria Nuova IRCCS, Reggio Emilia, Italy
| | - Maya El Hachem
- Dermatology Unit, Bambino Gesù Children's Hospital-IRCCS, Rome, Italy
| | - Iria Neri
- Dermatology Unit, Department of Specialistic, Diagnostic and Experimental Medicine, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Carlo Mario Gelmetti
- Pediatric Dermatology Unit, Fondazione IRCCS Ca' Granda "Ospedale Maggiore Policlinico", Milan Department of Pathophysiology and Transplantation, University of Milan, Milano, Italy
| | - Viviana Lora
- Center for the Study and Treatment of Psoriasis, San Gallicano Dermatologic Institute, IRCCS, Rome, Italy
| | - Carlo Mazzatenta
- Dermatology Unit, "Campo di Marte" Hospital, Azienda USL 2, Lucca, Italy
| | - Mirella Milioto
- Dermatology Unit, Ospedale Civico di Cristina Benfratelli, Palermo, Italy
| | - Gaia Moretta
- Department of Dermatology, Catholic University of the Sacred Heart, Rome, Italy
| | - Annalisa Patrizi
- Dermatology Unit, Department of Specialistic, Diagnostic and Experimental Medicine, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Ketty Peris
- Department of Dermatology, Catholic University of the Sacred Heart, Rome, Italy
| | - Alberto Villani
- General Pediatrics and Infectious Disease, Bambino Gesù Children's Hospital-IRCCS, Rome, Italy
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