1
|
Male C, Ay C, Crevenna R, Eichinger S, Feistritzer C, Füller R, Haushofer A, Kurringer A, Neumeister P, Puchner S, Rettl T, Schindl T, Schuster G, Schwarz R, Sohm M, Streif W, Thom K, Wagner B, Wissmann E, Zwiauer K, Pabinger I. [Treatment of haemophilia in Austria]. Wien Klin Wochenschr 2024; 136:75-102. [PMID: 38743098 DOI: 10.1007/s00508-024-02370-0] [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] [Accepted: 04/17/2024] [Indexed: 05/16/2024]
Abstract
This guideline is intended to provide practical guidance for the diagnosis and treatment of haemophilia in Austria. Few randomized controlled interventional trials are available addressing the treatment of haemophilia, therefore recommendations are usually based on low level of evidence and represent expert consensus.This guideline is based on the WFH guideline, published in 2020, and adapted according to the national circumstances and experience.It includes recommendations and suggestions for diagnosis and follow-up visits and pharmacological therapies for treatment and prophylaxis. Further topics comprise special aspects in children and adults with severe haemophilia, outcome measurement, and management of trauma, special bleedings and interventions, including dental procedures, inhibitors, management of haemophilia carriers, and psychosocial aspects.
Collapse
Affiliation(s)
- Christoph Male
- Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich.
| | - Cihan Ay
- Abteilung für Hämatologie und Hämostaseologie, Universitätsklinik für Innere Medizin I, Medizinische Universität Wien, Wien, Österreich
| | - Richard Crevenna
- Universitätsklinik für Physikalische Medizin, Rehabilitation und Arbeitsmedizin, Medizinische Universität Wien, Wien, Österreich
| | - Sabine Eichinger
- Abteilung für Hämatologie und Hämostaseologie, Universitätsklinik für Innere Medizin I, Medizinische Universität Wien, Wien, Österreich
| | - Clemens Feistritzer
- Abteilung für Innere Medizin V - Hämatologie und Onkologie, Medizinische Universität Innsbruck, Innsbruck, Österreich
| | - Robert Füller
- Österreichische Hämophilie Gesellschaft, Wien, Österreich
| | - Alexander Haushofer
- Institut für Medizinische und Chemische Labordiagnostik, Klinikum Wels-Grieskirchen, Wels-Grieskirchen, Österreich
| | - Andreas Kurringer
- Abteilung für Kinder- und Jugendheilkunde, Landeskrankenhaus Bregenz, Bregenz, Österreich
| | - Peter Neumeister
- Klinische Abteilung für Hämatologie, Medizinische Universität Graz, Graz, Österreich
| | - Stephan Puchner
- Klinische Abteilung für Orthopädie, Universitätsklinik für Orthopädie und Unfallchirurgie, Medizinische Universität Wien, Wien, Österreich
| | - Thomas Rettl
- Abteilung für Innere Medizin und Hämatologie und internistische Onkologie, Klinikum Klagenfurt, Klagenfurt, Österreich
| | - Thomas Schindl
- Österreichische Hämophilie Gesellschaft, Wien, Österreich
| | | | - Rudolf Schwarz
- Abteilung für Kinder- und Jugendheilkunde, Landesklinikum Amstetten, Universität Wien, Wien, Österreich
| | - Michael Sohm
- Universitätsklinik für Kinder- und Jugendheilkunde, Universitätsklinikum St. Pölten, St. Pölten, Österreich
| | - Werner Streif
- Department Kinder- und Jugendheilkunde, Medizinische Universität Innsbruck, Innsbruck, Österreich
| | - Katharina Thom
- Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich
| | - Barbara Wagner
- Universitätsklinik für Physikalische Medizin, Rehabilitation und Arbeitsmedizin, Medizinische Universität Wien, Wien, Österreich
| | - Eva Wissmann
- Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich
| | - Karl Zwiauer
- Universitätsklinik für Kinder- und Jugendheilkunde, Universitätsklinikum St. Pölten, St. Pölten, Österreich
| | - Ingrid Pabinger
- Abteilung für Hämatologie und Hämostaseologie, Universitätsklinik für Innere Medizin I, Medizinische Universität Wien, Wien, Österreich
| |
Collapse
|
2
|
Li Z, Zhou Y, Li K, Zhao Y, Song Y, Xiao J. Present status of scheduled vaccinations and vaccination-related bleeding in Chinese children with haemophilia. J Paediatr Child Health 2024; 60:200-205. [PMID: 38700143 DOI: 10.1111/jpc.16554] [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: 02/14/2023] [Revised: 03/23/2024] [Accepted: 04/16/2024] [Indexed: 05/05/2024]
Abstract
AIM Many countries have detailed recommendations for haemophilia patients to reduce the risk of vaccination-related bleeding. However, data from developing countries are lacking. We investigated scheduled vaccinations and vaccination-related bleeding complications in Chinese children with haemophilia and analysed issues related to vaccinations. METHODS Children with haemophilia in the PUMCH Haemophilia Treatment Centre were contacted via telephone. We distributed a vaccination questionnaire to their parents. The severity of haemophilia, coagulation factor infusions before vaccination, injection mode, and vaccination-related complications were analysed. RESULTS A total of 440 valid questionnaires were received from 27 of 34 provinces in China. 31.3% (138/440) of the children with haemophilia did not receive all of their vaccinations. Among the children who received vaccinations, 48.1% (197/409) experienced bleeding complications. In patients with severe haemophilia, those on regular prophylaxis had a lower incidence of local hematoma compared to those on intermittent or no prophylaxis (14.3% vs. 26.5% vs. 39.7%, P < 0.05). The incidence of local hematomas was lower by subcutaneous (SQ) injections than by intramuscular injections (24.6% vs. 35.3%, P < 0.05). CONCLUSION The vaccination rate is quite insufficient in Chinese children with haemophilia. Missed vaccinations are related to vaccination-related bleeding complications. Prophylaxis before vaccination and SQ injections would help reduce bleeding complications.
Collapse
Affiliation(s)
- Zhuo Li
- Department of Pediatrics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yin Zhou
- Department of International Medical Services, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Kuixing Li
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yongqiang Zhao
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yuqing Song
- Department of Pediatrics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Juan Xiao
- Department of Pediatrics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| |
Collapse
|
3
|
Taşar S, Taşar MA, Saç RÜ, Alioğlu B. Catch-up vaccination and enhanced immunization against hepatitis B, hepatitis A, measles, mumps, rubella and varicella in children with idiopathic thrombocytopenic purpura. J Trop Pediatr 2023; 69:fmad026. [PMID: 37648424 DOI: 10.1093/tropej/fmad026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
BACKGROUND Limited data exist about the vaccination of children with idiopathic thrombocytopenic purpura (ITP) against vaccine preventable diseases. This study identified the vaccination status of children with ITP against hepatitis A, hepatitis B, measles, mumps, rubella and varicella, completed the immunization of children with inadequate immunization, re-evaluated post-vaccination antibody titers and identified probable vaccination-related complications. PATIENTS AND METHODS All of 46 children had chronic ITP were included. Seroconversion of hepatitis A, hepatitis B, varicella, measles, rubella and mumps vaccines was screened. All children with seronegative antibodies against vaccine preventable disease were given a vaccination appointment. Antibody levels were re-measured during a period ranging from 1 to 6 months. Potential complications were detected. RESULTS There were 46 children with a mean age of 12.25 years. All children had chronic ITP and received intravenous immunoglobulin at least once previously. Considering the vaccination status, 50% (23 children) had vaccinations appropriate for their age, 47.8% (22 children) did not know their vaccination status and 2.2% (1 patient) did not have vaccinations. Seven children (15.2%) were seropositive for all antibody types and the remaining 39 children were scheduled for vaccination. Post-vaccination antibody titers confirmed that all children became seropositive for each disease. There was no complication in any patient. CONCLUSION Immunization against hepatitis B, hepatitis A, measles, mumps, rubella and varicella is insufficient in a considerable number of children with ITP, Hepatitis B Virus (HBV) and Hepatitis A Virus (HAV) immunization being the most frequently inadequate. After immunization, adequate seroconversion levels were achievable without complications.
Collapse
Affiliation(s)
- Serçin Taşar
- Department of Pediatrics, Ankara Education and Research Hospital, Ankara 06230, Turkey
| | - Medine Ayşin Taşar
- Department of Pediatric Emergency, Ankara Education and Research Hospital, Ankara 06230, Turkey
| | - Rukiye Ünsal Saç
- Department of Pediatrics, Ankara Education and Research Hospital, Ankara 06230, Turkey
| | - Bülent Alioğlu
- Department of Pediatric Hematology, Ankara Education and Research Hospital, Ankara 06230, Turkey
| |
Collapse
|
4
|
Tiede A, Leise H, Horneff S, Oldenburg J, Halimeh S, Heller C, Königs C, Holstein K, Pfrepper C. Safety of intramuscular COVID-19 vaccination in patients with haemophilia. Haemophilia 2022; 28:687-693. [PMID: 35561276 PMCID: PMC9348084 DOI: 10.1111/hae.14586] [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: 03/06/2022] [Revised: 04/28/2022] [Accepted: 04/29/2022] [Indexed: 11/30/2022]
Abstract
Background Guidelines recommend that patients with haemophilia should preferably receive vaccination subcutaneously. COVID‐19 and other vaccines, however, are only licenced for intramuscular application. Aims To assess the safety of intramuscular COVID‐19 vaccination in patients living with haemophilia. Methods Part A of this prospective observational study enrolled consecutive patients with haemophilia A (HA) and B (HB) of all ages and severities and assessed injection site bleeding and other complications within 30 days of vaccination. Part B enrolled patients providing informed consent for detailed data collection including medication and prophylaxis around the time of vaccination. Logistic regression was performed to assess potential risk factors for bleeding. Results Four hundred and sixty‐one patients were enrolled into part A. The primary endpoint injection site bleeding occurred in seven patients (1.5%, 95% confidence interval .7–3.1%). Comprehensive analysis of 214 patients (404 vaccinations, part B) revealed that 97% of patients with severe haemophilia had prophylaxis before vaccination, either as part of their routine prophylaxis or using additional doses. 56% and 30% of patients with moderate and mild haemophilia, respectively, received prophylaxis before vaccination. Among the seven bleeds recorded, three occurred when intramuscular vaccination was done without prophylaxis (odds ratio 12). Conclusions This is the first prospective study reporting on the safety of intramuscular vaccination in haemophilia. The rate of injection site bleeding was low in mild haemophilia, and in moderate and severe haemophilia if patients received factor prophylaxis.
Collapse
Affiliation(s)
- Andreas Tiede
- Department of Haematology, Haemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
| | - Hendrik Leise
- Department of Haematology, Haemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
| | - Silvia Horneff
- Institute for Experimental Haematology and Transfusion Medicine, University Hospital Bonn, Bonn, Germany
| | - Johannes Oldenburg
- Institute for Experimental Haematology and Transfusion Medicine, University Hospital Bonn, Bonn, Germany
| | | | - Christine Heller
- Clinical and Molecular Haemostasis, Department of Paediatrics and Adolescent Medicine, University Hospital Frankfurt, Frankfurt, Germany
| | - Christoph Königs
- Clinical and Molecular Haemostasis, Department of Paediatrics and Adolescent Medicine, University Hospital Frankfurt, Frankfurt, Germany
| | | | - Christian Pfrepper
- Division of Haemostaseology, Medical Department I, University Hospital Leipzig, Leipzig, Germany
| |
Collapse
|
5
|
Tasar S, Tasar MA, Alioglu B. Vaccination in children with inherited bleeding disorders: Does the use of plasma an d factor affect the response to the vaccine: An institutional registry. Haemophilia 2021; 28:80-85. [PMID: 34799967 DOI: 10.1111/hae.14461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 11/02/2021] [Accepted: 11/02/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION We aimed to evaluate the vaccine seroconversion of paediatric patients with factor deficiency and to complete the missing vaccines. We also emphasize the importance of variables such as recombinant factor and plasma intake frequency. MATERIAL AND METHODS This prospective observational study includes children between 2 and 17 age diagnosed with inhered factor deficiency. Seroconversion of hepatitis A, hepatitis B, varicella, measles, rubella and mumps vaccines were screened according to Ministry of Health Vaccination Schedule, it was completed if there were seronegative vaccines and the vaccine seroconversion was examined after vaccination approximately 1-6 months. RESULTS A total of 61 children were included in the study [mean age 11.2±5.1 years (2-18)], 49 (80.3%) were males. Factor VIII deficiency constituted 60.7%, factor XI 14.8%, factor VII 13.1 %, factor IX 9.8%, factor X 1.6% of the cases. None of the children had clinically important injection site complications such as uncontrollable bleeding or gross hematoma and vaccination does not induce the development of inhibitor. Measles antibody positivity was significantly lower in those who received factor 3 or 4 days times a week compared to those who received it when necessary (p = .049). DISCUSSION AND CONCLUSION This is the first study evaluating the vaccine conversion patients with inherited factor deficiency receiving plasma and plasma derived factor concentrates. It should be considered that children with haemophilia and their families may have vaccination hesitancy; therefore, follow-up of these patients should include a specified vaccination program to ensure adequate immunization of these patients.
Collapse
Affiliation(s)
- Sercin Tasar
- Department of Paediatrics, University of Health Science, Ankara Training and Research Hospital, Ankara, Turkey
| | - Medine Aysin Tasar
- Department of Paediatric Emergency, University of Health Science, Ankara Training and Research Hospital, Ankara, Turkey
| | - Bulent Alioglu
- Department of Paediatric Haematology, University of Health Science, Ankara Training and Research Hospital, Ankara, Turkey
| |
Collapse
|
6
|
Isfordink CJ, van Erpecum KJ, van der Valk M, Mauser-Bunschoten EP, Makris M. Viral hepatitis in haemophilia: historical perspective and current management. Br J Haematol 2021; 195:174-185. [PMID: 33955555 DOI: 10.1111/bjh.17438] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The introduction of clotting factor concentrates has substantially improved the lives of people with clotting factor deficiencies. Unfortunately, the transmission of blood-borne viral infections through these plasma-derived products led to a huge epidemic of human immunodeficiency virus and viral hepatitis in people with haemophilia (PWH). In a significant proportion of PWH exposed to these viruses, the ensuing decades-long chronic infection resulted in excess morbidity and mortality. Fortunately, developments in the safety of blood products, as well as vaccination and highly effective antiviral treatments have improved the prospects of PWH. The present article reviews the background of the viral hepatitis epidemic in PWH, the natural history of hepatitis B and C infections and their long-term management.
Collapse
Affiliation(s)
- Cas J Isfordink
- Van Creveldkliniek, Department of Benign Haematology, University Medical Center Utrecht, Utrecht, the Netherlands.,Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, the Netherlands.,Department of Internal Medicine, Division of Infectious Diseases, Amsterdam Institute for Infection and Immunity, University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - Karel J van Erpecum
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Marc van der Valk
- Department of Internal Medicine, Division of Infectious Diseases, Amsterdam Institute for Infection and Immunity, University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - Evelien P Mauser-Bunschoten
- Van Creveldkliniek, Department of Benign Haematology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Michael Makris
- Sheffield Haemophilia and Thrombosis Centre, Royal Hallamshire Hospital, Sheffield, UK.,Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| |
Collapse
|
7
|
Li Z, Chen Z, Cheng X, Wu X, Li G, Zhen Y, Poon MC, Wu R. A previously treated severe haemophilia A patient developed high-titre inhibitor after vaccinations. Int J Immunopathol Pharmacol 2021; 34:2058738420934618. [PMID: 32627611 PMCID: PMC7338642 DOI: 10.1177/2058738420934618] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
The factor VIII (FVIII)-neutralizing antibody (inhibitor) seen in 25%–30% of
patients with severe haemophilia A (SHA). Vaccination is a non-genetic risk
factor of inhibitor development as ‘danger signal’ which may provide a
pro-inflammatory microenvironment to increase FVIII immunogenicity. We reported
a previously treated SHA patient postponed the first vaccination to 15-month age
received diphtheria-pertussis-tetanus intramuscularly. At 18-month age, the
patient received Hepatitis A intramuscularly and Varicella Zoster Virus
subcutaneously with 2 weeks interval and FVIII infusion was given <24 h prior
for each. Successive bleedings occurred 1 week later with inefficacy of FVIII
replacement. High-titre inhibitor was tested at 117 exposure days. This case
suggested that continuous vaccinations in close proximity to FVIII could induce
inhibitor. The relationship between vaccination and FVIII immunogenicity still
needs to be revealed by further study.
Collapse
Affiliation(s)
- Zekun Li
- Hemophilia Work Group, Hematology Oncology Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Zhenping Chen
- Hemophilia Work Group, Hematology Oncology Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Xiaoling Cheng
- Hemophilia Work Group, Hematology Oncology Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Xinyi Wu
- Hemophilia Work Group, Hematology Oncology Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Gang Li
- Hemophilia Work Group, Hematology Oncology Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Yingzi Zhen
- Hemophilia Work Group, Hematology Oncology Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Man-Chiu Poon
- Departments of Medicine, Pediatrics and Oncology, University of Calgary, Cumming School of Medicine, and Southern Alberta Rare Blood and Bleeding Disorders Comprehensive Care program, Foothills Hospital, Alberta Health Services, Calgary, AB, Canada
| | - Runhui Wu
- Hemophilia Work Group, Hematology Oncology Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| |
Collapse
|
8
|
Pfrepper C, Holstein K, Königs C, Heller C, Krause M, Olivieri M, Bidlingmaier C, Sigl-Kraetzig M, Wendisch J, Halimeh S, Horneff S, Richter H, Wieland I, Klamroth R, Oldenburg J, Tiede A. Consensus Recommendations for Intramuscular COVID-19 Vaccination in Patients with Hemophilia. Hamostaseologie 2021; 41:190-196. [PMID: 33860513 DOI: 10.1055/a-1401-2691] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Currently available coronavirus disease 2019 (COVID-19) vaccines are approved for intramuscular injection and efficacy may not be ensured when given subcutaneously. For years, subcutaneous vaccination was recommended in patients with hemophilia to avoid intramuscular bleeds. Therefore, recommendations for the application of COVID-19 vaccines are needed. METHODS The Delphi methodology was used to develop consensus recommendations. An initial list of recommendations was prepared by a steering committee and evaluated by 39 hemophilia experts. Consensus was defined as ≥75% agreement and strong consensus as ≥95% agreement, and agreement as a score ≥7 on a scale of 1 to 9. After four rounds, a final list of statements was compiled. RECOMMENDATIONS Consensus was achieved that COVID-19 vaccines licensed only for intramuscular injection should be administered intramuscularly in hemophilia patients. Prophylactic factor replacement, given on the day of vaccination with a maximum interval between prophylaxis and vaccination of 24 hours (factor VIII and conventional factor IX concentrates) or 48 hours (half-life extended factor IX), should be provided in patients with moderate or severe hemophilia. Strong consensus was achieved that patients with mild hemophilia and residual factor activity greater than 10% with mild bleeding phenotype or patients on emicizumab usually do not need factor replacement before vaccination. Swelling, erythema, and hyperthermia after vaccination are not always signs of bleeding but should prompt consultation of a hemophilia care center. In case of injection-site hematoma, patients should receive replacement therapy until symptoms disappear. CONCLUSIONS Consensus was achieved on recommendations for intramuscular COVID-19 vaccination after replacement therapy for hemophilia patients depending on disease severity.
Collapse
Affiliation(s)
- Christian Pfrepper
- Division of Hemostaseology, Medical Department I, University Hospital Leipzig, Leipzig, Germany
| | | | - Christoph Königs
- Pediatric Hemostaseology, University Hospital Frankfurt, Frankfurt, Germany
| | - Christine Heller
- Pediatric Hemostaseology, University Hospital Frankfurt, Frankfurt, Germany
| | | | - Martin Olivieri
- Pediatric Thrombosis and Hemostasis Unit, Pediatric Hemophilia Centre, Dr. von Hauner Children's Hospital, LMU, Munich, Germany
| | - Christoph Bidlingmaier
- Pediatric Thrombosis and Hemostasis Unit, Pediatric Hemophilia Centre, Dr. von Hauner Children's Hospital, LMU, Munich, Germany
| | - Michael Sigl-Kraetzig
- Blaubeuren and Hemostasis Center South (Pediatric Practice), Institute for Pediatric Research and Further Education (IPFW), Blaubeuren, Germany
| | - Jörg Wendisch
- Health Department of the City of Dresden, Vaccination Centre, Dresden, Germany
| | | | - Silvia Horneff
- Institute for Experimental Hematology and Transfusion Medicine, University Hospital Bonn, Bonn, Germany
| | | | - Ivonne Wieland
- Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
| | - Robert Klamroth
- Vascular Medicine and Haemostaseology, Vivantes Klinikum im Friedrichshain, Berlin, Germany
| | - Johannes Oldenburg
- Institute for Experimental Hematology and Transfusion Medicine, University Hospital Bonn, Bonn, Germany
| | - Andreas Tiede
- Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
| | | |
Collapse
|
9
|
Abstract
Subcutaneous vaccine (SC) administration is an outmoded practice which complicates vaccine administration recommendations. Local adverse events following immunization (AEFIs) are a recognized determinant of vaccine hesitancy/refusal which can lead to an increased prevalence of vaccine-preventable disease. This extensive narrative review provides high-grade evidence that intramuscular (IM) administration of all vaccine types [adjuvanted, live virus and non-adjuvanted (inactivated whole cell, split cell and subunit)] significantly reduces the likelihood of local adverse events. This, combined with moderate grade evidence that IM injection generates significantly greater immune response compared with SC injection, allows a strong recommendation to be made for the IM injection of all vaccines except BCG and Rotavirus. This will simplify vaccination practice, minimize the inadvertent misadministration of vaccines and potentially improve public trust in vaccination.
Collapse
Affiliation(s)
- Ian F Cook
- Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia
| |
Collapse
|
10
|
Edelman R, Deming ME, Toapanta FR, Heuser MD, Chrisley L, Barnes RS, Wasserman SS, Blackwelder WC, Handwerger BS, Pasetti M, Siddiqui KM, Sztein MB. The SENIEUR protocol and the efficacy of hepatitis B vaccination in healthy elderly persons by age, gender, and vaccine route. Immun Ageing 2020; 17:9. [PMID: 32355503 PMCID: PMC7187507 DOI: 10.1186/s12979-020-00179-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 03/31/2020] [Indexed: 01/27/2023]
Abstract
BACKGROUND Reduced response to hepatitis B vaccines is associated with aging, confounding and comorbid conditions, as well as inadvertent subcutaneous (SC) inoculation. We hypothesized that the antibody and T cell-mediated immune responses (T-CMI) of elderly adults to a vaccine intended for intramuscular (IM) administration would be attenuated when deposited into SC fat, independent of confounding conditions. RESULTS Fifty-two healthy, community dwelling elderly adults (65-82 years), seronegative for HBV, were enrolled in the SENIEUR protocol as a strictly healthy population. These seniors were randomized to receive a licensed alum-adjuvanted recombinant HBV vaccine either SC or IM, with the inoculum site verified by imaging. The response rates, defined as hepatitis B surface antibodies (HBsAb) ≥10 IU/L, were significantly lower in the elderly than in young adults, a group of 12, healthy, 21-34-year-old volunteers. Moreover, elderly participants who received the vaccine IM were significantly more likely to be responders than those immunized SC (54% versus 16%, p = 0.008). The low seroconversion rate in the IM group progressively declined with increasing age, and responders had significantly lower HBsAb titers and limited isotype responses. Moreover, T-CMI (proliferation and cytokine production) were significantly reduced in both percentage of responders and intensity of the response for both Th1 and Th2 subsets in the elderly. CONCLUSIONS Our data demonstrate the blunted immunogenicity of SC inoculation as measured by peak titers and response rates. Further, the qualitative and quantitative deficits in B- and T-CMI responses to primary alum adjuvanted protein antigens persisted even in strictly healthy elderly populations with verified IM placement compared to younger populations. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov, NCT04162223. Registered 14 November 2019. Retrospectively registered.
Collapse
Affiliation(s)
- Robert Edelman
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, USA
- Department of Medicine, University of Maryland School of Medicine, Baltimore, USA
| | - Meagan E. Deming
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, USA
- Department of Medicine, University of Maryland School of Medicine, Baltimore, USA
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, USA
| | - Franklin R. Toapanta
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, USA
- Department of Medicine, University of Maryland School of Medicine, Baltimore, USA
| | - Mark D. Heuser
- Department of Medicine, University of Maryland School of Medicine, Baltimore, USA
- Present Adress: Department of Veterans Affairs, Salisbury VA Health Care System, Salisbury, NC USA
| | - Lisa Chrisley
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, USA
| | - Robin S. Barnes
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, USA
| | - Steven S. Wasserman
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, USA
- Department of Medicine, University of Maryland School of Medicine, Baltimore, USA
- Present Adress: Office of Research, University of Virginia, Charlottesville, USA
| | - William C. Blackwelder
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, USA
| | - Barry S. Handwerger
- Rheumatology and Clinical Immunology, Dept of Medicine, University of Maryland School of Medicine, Baltimore, USA
| | - Marcela Pasetti
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, USA
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, USA
- Department of Microbiology and Immunology, Dept of Medicine, University of Maryland School of Medicine, Baltimore, USA
| | - Khan M. Siddiqui
- Imaging Informatics and Body Magnetic Resonance Imaging unit, Veterans Affairs Maryland Health Care System Baltimore, Baltimore, MD USA
- Present Adress: Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Marcelo B. Sztein
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, USA
- Department of Medicine, University of Maryland School of Medicine, Baltimore, USA
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, USA
- Department of Microbiology and Immunology, Dept of Medicine, University of Maryland School of Medicine, Baltimore, USA
| |
Collapse
|
11
|
Santagostino E, Riva A, Cesaro S, Esposito S, Matino D, Mazzucchelli RI, Molinari AC, Mura R, Notarangelo LD, Tagliaferri A, Di Minno G, Clerici M. Consensus statements on vaccination in patients with haemophilia-Results from the Italian haemophilia and vaccinations (HEVA) project. Haemophilia 2019; 25:656-667. [PMID: 30990961 PMCID: PMC6850056 DOI: 10.1111/hae.13756] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 03/15/2019] [Accepted: 03/15/2019] [Indexed: 12/13/2022]
Abstract
Vaccination against communicable diseases is crucial for disease prevention, but this practice poses challenges to healthcare professionals in patients with haemophilia. Poor knowledge of the vaccination requirements for these patients and safety concerns often result in vaccination delay or avoidance. In order to address this issue, a panel of 11 Italian haemophilia and immunization experts conducted a Delphi consensus process to identify the main concerns regarding the safe use of vaccines in patients with haemophilia. The consensus was based on a literature search of the available evidence, which was used by the experts to design 27 consensus statements. A group of clinicians then rated these statements using the 5-point Likert-type scale (1 = strongly disagree; 5 = strongly agree). The main issues identified by the expert panel included vaccination schedule for haemophilic patients; protocol and optimal route of vaccine administration; vaccination of haemophilic patients with antibodies inhibiting coagulation factor VIII (inhibitors); and vaccination and risk of inhibitor development. This manuscript discusses these controversial areas in detail supported by the available literature evidence and provides evidence- and consensus-based recommendations. Overall, participants agreed on most statements, except those addressing the potential role of vaccination in inhibitor formation. Participants agreed that patients with haemophilia should receive vaccinations according to the institutional schedule for individuals without bleeding disorders; however, vaccination of patients with haemophilia requires comprehensive planning, taking into account disease severity, type and route of vaccination, and bleeding risk. Data also suggest vaccination timing does not need to take into consideration when the patient received factor VIII replacement.
Collapse
Affiliation(s)
- Elena Santagostino
- Fondazione IRCCS Ca’ Granda, Ospedale Maggiore PoliclinicoCentro Emofilia e Trombosi Angelo Bianchi BonomiMilanItaly
| | - Agostino Riva
- III Divisione di Malattie InfettiveOspedale L. Sacco ‐ Polo UniversitarioMilanItaly
| | - Simone Cesaro
- Pediatric Hematology OncologyAzienda Ospedaliera Universitaria IntegrataVeronaItaly
| | - Susanna Esposito
- Department of Surgical and Biomedical Sciences Pediatric ClinicUniversità degli Studi di PerugiaPerugiaItaly
| | - Davide Matino
- Department of Experimental MedicineUniversità degli Studi di PerugiaPerugiaItaly
| | | | | | - Rosamaria Mura
- Pediatric Hematology and Oncology UnitOspedale Pediatrico MicrocitemicoCagliariItaly
| | | | - Annarita Tagliaferri
- Regional Reference Center for Inherited Bleeding DisordersUniversity Hospital of ParmaParmaItaly
| | - Giovanni Di Minno
- Regional Reference Center for Coagulation DisordersFederico II University HospitalNaplesItaly
| | - Mario Clerici
- Department of Pathophysiology and TransplantationUniversità degli Studi di MilanoMilanItaly
- Don C Gnocchi Foundation IRCCSMilanItaly
| |
Collapse
|
12
|
Hochart A, Falaise C, Huguenin Y, Meunier S. Intramuscular vaccination of haemophiliacs: Is it really a risk for bleeding? Haemophilia 2019; 25:e322-e323. [DOI: 10.1111/hae.13808] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 05/28/2019] [Accepted: 05/28/2019] [Indexed: 11/29/2022]
Affiliation(s)
| | - Céline Falaise
- Department of Paediatric Haematology and Oncology, Haemophilia Treatment Centre APHM Marseille France
| | - Yoann Huguenin
- Haemophilia Treatment Centre CHU Bordeaux Bordeaux France
| | - Sandrine Meunier
- Hospices Civils de Lyon – Reference Centre for Haemophilia and Haemorrhagic Constitutional Diseases Cardiologic Hospital Bron France
| |
Collapse
|
13
|
Moorehead PC, Chan AKC, Lemyre B, Winikoff R, Scott H, Hawes SA, Shroff M, Thomas A, Price VE. A Practical Guide to the Management of the Fetus and Newborn With Hemophilia. Clin Appl Thromb Hemost 2018; 24:29S-41S. [PMID: 30373387 PMCID: PMC6714852 DOI: 10.1177/1076029618807583] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Newborns with hemophilia are at risk of intracranial hemorrhage, extracranial hemorrhage,
and other bleeding complications. The safe delivery of a healthy newborn with hemophilia
is a complex process that can begin even before conception, and continues throughout
pregnancy, birth, and the newborn period. This process involves the expectant parents and
a wide variety of health-care professionals: genetic counselors, obstetricians,
neonatologists, pediatricians, radiologists, adult and pediatric hematologists, and nurses
with expertise in hemophilia. Because of this multidisciplinary complexity, the relative
rarity of births of newborns with hemophilia, and the lack of high-quality evidence to
inform decisions, there is considerable variation in practice in this area. We present a
comprehensive multidisciplinary approach, from preconception counseling to discharge
planning after birth, and describe available options for management decisions. We
highlight a number of areas of important uncertainty and controversy, including the
preferred mode of delivery, the appropriate use and timing of neuroimaging tests, and the
appropriate use of clotting factor concentrates in the newborn period. While the approach
presented here will aid clinicians in planning and providing care, further research is
required to optimize the care of newborns with hemophilia.
Collapse
Affiliation(s)
- Paul C Moorehead
- Section of Pediatric Hematology/Oncology, Janeway Children's Health and Rehabilitation Centre, St. John's, Canada.,Discipline of Pediatrics, Faculty of Medicine, Memorial University, St. John's, Canada
| | - Anthony K C Chan
- McMaster Children's Hospital, McMaster University, Hamilton, Canada
| | - Brigitte Lemyre
- Department of Pediatrics, Division of Neonatology, University of Ottawa, Ottawa, Canada
| | - Rochelle Winikoff
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Ste-Justine University Health Center, University of Montreal, Montreal, Canada
| | - Heather Scott
- Department of Obstetrics and Gynecology, Dalhousie University, Halifax, Canada
| | - Sue Ann Hawes
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, IWK Health Centre, Dalhousie University, Halifax, Canada
| | - Manohar Shroff
- Department of Radiology, Hospital for Sick Children, Toronto, Canada.,Department of Medical Imaging, University of Toronto, Toronto, Canada
| | - Aidan Thomas
- Maritime Medical Genetics Service, IWK Health Centre, Halifax, Canada
| | - Victoria E Price
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, IWK Health Centre, Dalhousie University, Halifax, Canada
| |
Collapse
|
14
|
Schaefer BA, Gruppo RA, Mullins ES, Tarango C. Subcutaneous diphtheria and tetanus vaccines in children with haemophilia: A pilot study and review of the literature. Haemophilia 2017; 23:904-909. [PMID: 28780770 DOI: 10.1111/hae.13316] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2017] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Subcutaneous (SQ) vaccination has emerged as standard of care in children with severe bleeding disorders to reduce unnecessary factor exposure and avoid provoking an intramuscular bleed, but little is known about comparative immunogenicity to intramuscular (IM) vaccination. AIM To confirm immunogenicity of Diphtheria Tetanus acellular Pertussis (DTaP) vaccines administered SQ to individuals <6 years old with haemophilia. METHODS We performed a retrospective and prospective pilot study of tetanus and diphtheria antibody titres among patients evaluated at our Haemophilia Treatment Centre between 2015-2016. Children with haemophilia who had received three to four doses of DTaP containing vaccine administered SQ were eligible. RESULTS Eight children met inclusion criteria. The mean age at the time of diphtheria and tetanus antibody testing was 21.1±17.8 months. All children who received SQ diphtheria and tetanus developed a positive antibody titre to both antigens. There was no statistically significant difference in distribution of titre values. The average time between the last dose of vaccine and antibody testing was 6.6±3.9 months among SQ vaccinated subjects. Minor injection site reactions were common with SQ vaccines. CONCLUSION SQ administration of diphtheria and tetanus vaccination appears to be immunogenic in a pilot study of Haemophilia patients and supports this practice as the standard of care for this population.
Collapse
Affiliation(s)
- B A Schaefer
- Cancer and Blood Disease Institute, Cincinnati Children's Hospital Medical Centre, Cincinnati, OH, USA
| | - R A Gruppo
- Cancer and Blood Disease Institute, Cincinnati Children's Hospital Medical Centre, Cincinnati, OH, USA
| | - E S Mullins
- Cancer and Blood Disease Institute, Cincinnati Children's Hospital Medical Centre, Cincinnati, OH, USA
| | - C Tarango
- Cancer and Blood Disease Institute, Cincinnati Children's Hospital Medical Centre, Cincinnati, OH, USA
| |
Collapse
|
15
|
Pabinger I, Heistinger M, Muntean W, Reitter-Pfoertner SE, Rosenlechner S, Schindl T, Schuster G, Streif W, Thom K, Male C. [Treatment of haemophilia in Austria]. Wien Klin Wochenschr 2015; 127 Suppl 3:S115-30. [PMID: 26525378 DOI: 10.1007/s00508-015-0872-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Accepted: 09/16/2015] [Indexed: 11/30/2022]
Abstract
This guideline which is endorsed by the Austrian Society of Haemophilia, the Austrian Society of Paediatrics, and the Austrian Society of Haematology & Medical Oncology is intended to give a clear and practical guidance for diagnosing and treating haemophilia in Austria. In the treatment of haemophilia there are few controlled interventional trials, and recommendations usually have a rather low level of evidence.The main basis for this paper are the new international guidelines by the World Federation of Hemophilia, published in 2013. These were adapted according to the local situation and experience.Covered topics are diagnostics, control visits, pharmacological treatment options, prophylaxis and treatment in children and adults, possible problems arising in haemophilia carriers and special aspects like home therapy, options for venous catheters, management of various traumas, bleedings and interventions, including dental procedures, and last not least inhibitors and their treatment.
Collapse
Affiliation(s)
- Ingrid Pabinger
- Klinische Abteilung für Hämatologie und Hämostaseologie, Universitätsklinik für Innere Medizin I, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich.
| | - Max Heistinger
- 1. Medizinische Abteilung, LKH Klagenfurt, Klagenfurt, Österreich
| | - Wolfgang Muntean
- Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Graz, Graz, Österreich
| | - Sylvia-Elisabeth Reitter-Pfoertner
- Klinische Abteilung für Hämatologie und Hämostaseologie, Universitätsklinik für Innere Medizin I, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich
| | | | - Thomas Schindl
- Österreichische Hämophilie Gesellschaft, Wien, Österreich
| | | | - Werner Streif
- Department für Kinder- und Jugendheilkunde, Medizinische Universität Innsbruck, Innsbruck, Österreich
| | - Katharina Thom
- Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Wien, Wien, Österreich
| | - Christoph Male
- Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Wien, Wien, Österreich
| |
Collapse
|