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Froneman C, Kelleher P, José RJ. Pneumococcal Vaccination in Immunocompromised Hosts: An Update. Vaccines (Basel) 2021; 9:536. [PMID: 34063785 PMCID: PMC8223771 DOI: 10.3390/vaccines9060536] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 05/17/2021] [Accepted: 05/19/2021] [Indexed: 01/04/2023] Open
Abstract
Infections with the pathogen, Streptococcus pneumoniae, are a common cause of morbidity and mortality worldwide. It particularly affects those at the extremes of age and immunocompromised individuals. Preventing pneumococcal disease is paramount in at risk individuals, and pneumococcal vaccination should be offered. Here, we discuss the role of pneumococcal vaccination in specific groups of immunocompromised hosts.
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Affiliation(s)
- Claire Froneman
- Department of Respiratory Medicine, Royal Brompton Hospital, London SW3 6NP, UK; (C.F.); (P.K.)
| | - Peter Kelleher
- Department of Respiratory Medicine, Royal Brompton Hospital, London SW3 6NP, UK; (C.F.); (P.K.)
- Department of Infectious Disease, Imperial College London, South Kensington Campus, London SW7 2AZ, UK
| | - Ricardo J. José
- Department of Respiratory Medicine, Royal Brompton Hospital, London SW3 6NP, UK; (C.F.); (P.K.)
- Centre for Inflammation and Tissue Repair, UCL, London WC1E 6BT, UK
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Li Y, Ma Y, An Z, Yue C, Wang Y, Wang L, Liu Y, Yuan X, Zhang S, Ye Q, Li H, Li K, Yin Z, Wang H. Immunogenicity of 23-Valent Pneumococcal Polysaccharide Vaccine in Patients with Chronic Obstructive Pulmonary Disease - Hebei Province, China, September-December, 2019. China CDC Wkly 2021; 3:331-334. [PMID: 34594878 PMCID: PMC8393071 DOI: 10.46234/ccdcw2021.089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 04/08/2021] [Indexed: 11/14/2022] Open
Abstract
What is already known on this topic? The global burden of chronic obstructive pulmonary disease (COPD) is serious. Pneumococcal infection is associated with acute exacerbations of COPD (AECOPD). The 23-valent pneumococcal polysaccharide vaccine (PPSV23) is recommended for COPD patients to decrease AECOPD due to pneumococcus, but evidence on the immunogenicity of PPSV23 in COPD patients is limited. What is added by this report? This study showed good immunogenicity of one dose of PPSV23 in COPD patients. Antibody levels against all 23 vaccine serotypes were assessed before and four weeks after vaccination of COPD patients with one dose of PPSV23. The percent of COPD patients who had two-fold increases in pneumococcal antibody levels following vaccination ranged from 65.2% (serotype 3) to 94.4% (serotype 2). There were statistically significant differences in immunogenicity by serotype. What are the implications for public health practice? This study supports current recommendations for PPSV23 vaccination of COPD patients in China to provide protection from pneumococcal diseases.
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Affiliation(s)
- Yan Li
- National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Ying Ma
- Kailuan General Hospital, Tangshan, Hebei, China
| | - Zhijie An
- National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Chenyan Yue
- National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yamin Wang
- National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Liye Wang
- Kailuan General Hospital, Tangshan, Hebei, China
| | - Yunqiu Liu
- Kailuan General Hospital, Tangshan, Hebei, China
| | | | | | - Qiang Ye
- National Institute for Food and Drug Control, Beijing, China
| | - Hong Li
- National Institute for Food and Drug Control, Beijing, China
| | - Keli Li
- National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Zundong Yin
- National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Huaqing Wang
- National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing, China
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Tanaka Y, Yamamoto K, Fukuda Y, Umemura A, Yoshida M, Ideguchi S, Ashizawa N, Hirayama T, Tashiro M, Takazono T, Imamura Y, Miyazaki T, Izumikawa K, Yanagihara K, Chang B, Mukae H. An adult case of invasive pneumococcal disease due to serotype 12F-specific polysaccharide antibody failure following a 23-valent polysaccharide vaccination. Emerg Microbes Infect 2020; 9:2266-2268. [PMID: 32990189 PMCID: PMC7594767 DOI: 10.1080/22221751.2020.1830716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
A 68-year-old Japanese man was admitted to our hospital for an acute febrile illness with shivering and impaired consciousness. He was a previous smoker and had a history of chronic obstructive pulmonary disease, for which he inhaled steroid with a long-acting bronchodilator. He had received a 23-valent pneumococcal polysaccharide vaccination 2 years previously. He was intubated and placed on a ventilator in intensive care unit because of acute respiratory failure and hypercapnia. Streptococcus pneumoniae was grown from his blood, sputum, and urine cultures, and he was diagnosed with invasive pneumococcal disease with acute renal failure. He was treated with intravenous beta-lactam and macrolide with continuous hemodiafiltration and was discharged 3 months later. The pneumococcus was identified as serotype 12F, and his serotype-specific IgG and opsonophagocytic index against serotype 12F indicating a lack of protection from IPD among PPV23 serotypes. This case highlights that some individuals may have a serotype-specific polysaccharide antibody failure that makes them susceptible to serotype 12F invasive pneumococcal disease. This case also illustrates the need for serotype-specific IgG and opsonophagocytic index titre cut-offs for each specific pneumococcal serotype in available vaccines to understand the vaccination protection for individual patients better.
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Affiliation(s)
- Yasuhiro Tanaka
- Department of Respiratory Medicine, Nagasaki University Hospital, Nagasaki City, Japan
- Department of Respiratory Medicine, Sasebo City General Hospital, Sasebo City, Japan
| | - Kazuko Yamamoto
- Department of Respiratory Medicine, Nagasaki University Hospital, Nagasaki City, Japan
- Infection Control and Education Center, Nagasaki University Hospital, Nagasaki City, Japan
| | - Yuichi Fukuda
- Department of Respiratory Medicine, Sasebo City General Hospital, Sasebo City, Japan
| | - Asuka Umemura
- Department of Respiratory Medicine, Sasebo City General Hospital, Sasebo City, Japan
| | - Masataka Yoshida
- Department of Respiratory Medicine, Sasebo City General Hospital, Sasebo City, Japan
| | - Shuhei Ideguchi
- Department of Respiratory Medicine, Nagasaki University Hospital, Nagasaki City, Japan
| | - Nobuyuki Ashizawa
- Department of Respiratory Medicine, Nagasaki University Hospital, Nagasaki City, Japan
| | - Tatsuro Hirayama
- Department of Respiratory Medicine, Nagasaki University Hospital, Nagasaki City, Japan
| | - Masato Tashiro
- Infection Control and Education Center, Nagasaki University Hospital, Nagasaki City, Japan
| | - Takahiro Takazono
- Department of Respiratory Medicine, Nagasaki University Hospital, Nagasaki City, Japan
| | - Yoshifumi Imamura
- Department of Respiratory Medicine, Nagasaki University Hospital, Nagasaki City, Japan
| | - Taiga Miyazaki
- Department of Respiratory Medicine, Nagasaki University Hospital, Nagasaki City, Japan
| | - Koichi Izumikawa
- Infection Control and Education Center, Nagasaki University Hospital, Nagasaki City, Japan
| | - Katsunori Yanagihara
- Department of Laboratory Medicine, Nagasaki University Hospital, Nagasaki City, Japan
| | - Bin Chang
- Department of Bacteriology I, National Institute of Infectious Diseases, Shinjuku City, Japan
| | - Hiroshi Mukae
- Department of Respiratory Medicine, Nagasaki University Hospital, Nagasaki City, Japan
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Hata A, Ishioka T, Oishi K, Katayama T, Ohkubo T. Altered immunogenicity of 23-valent pneumococcal polysaccharide vaccine in elderly patients with diabetes who revealed lower responses to concomitant administration of BIKEN varicella zoster vaccine: Results of post hoc analysis of a randomized double-blind trial. J Diabetes Complications 2019; 33:243-248. [PMID: 30579569 DOI: 10.1016/j.jdiacomp.2018.11.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 10/18/2018] [Accepted: 11/05/2018] [Indexed: 10/27/2022]
Abstract
AIMS This double-blind randomized controlled study of 52 elderly patients with diabetes assessed cell-mediated immunity and safety of BIKEN varicella-zoster vaccine (BVZV). Cellular and humoral responses to VZV at 3 months after BVZV and 23-valent polysaccharide pneumococcal vaccine (PPSV23) vaccination elicited poor results. Post-hoc analyses assessed the effects of immunogenicity of PPSV23. METHODS Using standardized enzyme-linked immunosorbent assay, pneumococcal 6B and 23F serotype-specific immunoglobulin G (IgG)-binding antibody concentrations were measured in stored samples retrospectively before administration and 3 months after. Responders increased more than twofold in at least one serotype-specific IgG. RESULTS The geometric mean concentration ratio (GMCR) of serum anti-pneumococcal 6B IgG was 1.76 (95%C.I.: 0.58, 5.34) in patients receiving concurrent PPSV23 and BVZV, compared to 2.39 (95%C.I.: 0.53, 10.76) in patients receiving PPSV23 and placebo (P = .055). The GMCR of serum anti-pneumococcal 23F IgG was 2.54 (95%C.I.: 0.57, 11.43) in PPSV23/BVZV vaccinees compared to 3.34 (95%C.I.: 0.84, 12.92) in PPSV23/placebo vaccinees (P = .424). Responder rates, those who developed antibodies to either/both serotypes, were 68% in the BVZV group and 85% in the placebo group (P = .007). CONCLUSIONS Results suggest that concurrent administration of BVZV influenced humoral responses to PPSV23 in elderly subjects with diabetes.
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Affiliation(s)
- Atsuko Hata
- Department of Infectious Diseases, Kitano Hospital, The Tazuke Kofukai Medical Research Institute, Osaka, Japan.
| | - Taisei Ishioka
- Environmental Hygiene Division, Takasaki General Public Health Center, 5-28 Takamatsucho, Takasaki, Gunma 370-0829, Japan
| | - Kazunori Oishi
- Infectious Disease Surveillance Center, National Institute of Infectious Diseases, 1-23-1 Toyama Shinjuku-ku, Tokyo 162-8640, Japan
| | - Toshiro Katayama
- Department of Engineering, Faculty of Health Sciences, Morinomiya University of Medical Sciences, 1-26-16 Nankokita Suminoe-ku, Osaka 559-8611, Japan
| | - Takayoshi Ohkubo
- Department of Hygiene and Public Health, Teikyo University School of Medicine, 2-11-1 Kaga Itabashi-ku, Tokyo 173-8605, Japan
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Assessment of Postvaccine Immunity against Streptococcus pneumoniae in Patients with Asplenia, including an Analysis of Its Impact on Bacterial Flora of the Upper Respiratory Tract and Incidence of Infections. J Immunol Res 2018; 2018:1691347. [PMID: 30687764 PMCID: PMC6330813 DOI: 10.1155/2018/1691347] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 11/29/2018] [Indexed: 11/29/2022] Open
Abstract
S. pneumoniae is a microorganism that may cause a serious threat in postsplenectomy patients due to a potentially invasive course of infection. In order to assess a protective activity after vaccination with the 23-valent vaccine, we made an analysis of the level of antibodies in patients with asplenia compared to a control group of healthy donors. Additionally, colonization by potentially pathogenic microorganisms of the upper respiratory tract was analyzed to determine the carrier state by strains with vaccine serotype. No such strains were found in the research, yet three non-vaccine-serotype strains were found. Colonization of the upper respiratory tract by potentially pathogenic microorganisms may be connected with increased susceptibility observed and incidence of infections in patients with asplenia. However, colonization by S. pneumoniae may not have an effect on the level of specific antibodies with the 23-valent vaccine against S. pneumoniae (PPV23) in postsplenectomy patients and healthy people. The response to vaccination against S. pneumoniae showed a lower level of specific antibodies in patients with splenectomy performed more than 2 years before the test than in patients with a recently removed spleen, i.e., from 1 month to 2 years before the test. Vaccination against pneumococci also has positive effects on incidence of other etiology infections, which is of high significance in the prophylaxis of infectious diseases in this group of patients.
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Hoffman TW, van Kessel DA, van Velzen-Blad H, Grutters JC, Rijkers GT. Antibody replacement therapy in primary antibody deficiencies and iatrogenic hypogammaglobulinemia. Expert Rev Clin Immunol 2015; 11:921-33. [DOI: 10.1586/1744666x.2015.1049599] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Pneumococcal vaccines: understanding centers for disease control and prevention recommendations. Ann Am Thorac Soc 2015; 11:980-5. [PMID: 25032872 DOI: 10.1513/annalsats.201401-042cme] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Streptococcus pneumoniae infection is a common and serious health problem that is best prevented by the pneumococcal vaccine. The first vaccine approved by the U.S. Federal Drug Administration in 1977 contained 14 polysaccharide antigens. An improved vaccine introduced in 1983 included 23 polysaccharide antigens. Both vaccines were effective for immunocompetent adults; however, young children and immunocompromised adults remained susceptible. A pediatric vaccine was developed consisting of the capsular antigens of seven pneumococcal serotypes commonly found in children. The antigens in this preparation are covalently conjugated to diphtheria protein to make them more antigenic. The conjugate vaccine was expanded to include 13 serotypes by 2010. Although more immunogenic, the conjugate vaccine has fewer serotypes than the older 23-valent vaccine. The U.S. Centers for Disease Control and Prevention recommend that children at risk for pneumococcal pneumonia as defined by the presence of chronic disease should receive the 13-valent conjugated vaccine. Adults at risk for pneumococcal pneumonia, which includes those over 65 years of age and those who have a chronic disease, should receive the 23-polysaccharide vaccine. Immunosuppressed patients of any age should receive both vaccines. Adults should be revaccinated once at age 65 years or older with the 23-polysaccharide vaccine provided that at least 5 years have elapsed since the previous vaccination.
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Evaluation of antibody levels over 3 years after 23-valent pneumococcal polysaccharide vaccination in patients with pulmonary diseases receiving steroids and immunosuppressive agents. Clin Biochem 2014; 48:125-9. [PMID: 25448031 DOI: 10.1016/j.clinbiochem.2014.11.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Accepted: 11/04/2014] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Pneumococcal capsular polysaccharide vaccine is a mainstay for prevention of Streptococcus pneumoniae infection in adults. There is the possibility that this vaccine is less effective in patients undergoing immunosuppressive therapy. In the present study, we aimed to evaluate the immune response following 23-valent pneumococcal polysaccharide vaccination in pulmonary disease patients receiving steroids and immunosuppressive agents (immunosuppressive group). DESIGN AND METHODS Antibody levels were measured over 3 years in the immunosuppressive group (median age: 68.5 years) and in aged-match pulmonary disease patients not being treated with immunosuppressive therapy (control group) using enzyme-linked immunosorbent assays. RESULTS The geometric mean antibody levels were significantly increased after vaccination in both groups (p < 0.05) and remained above baseline for 3 years. The fold increases 1 month after vaccination were 9.4 (95% confidence interval [CI]: 5.7-15.6) and 8.8 (95% CI: 5.8-13.2) in the immunosuppressive and control groups, respectively (p = 0.813). There was no significant difference in the proportion of subjects with a ≥ two-fold increase of antibody level between the immunosuppressive and control groups at any point. CONCLUSIONS These results suggest that immunization with the 23-valent pneumococcal polysaccharide vaccine was effective, even in patients undergoing immunosuppressive therapy and should be recommended for such patients.
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van Kessel DA, Hoffman TW, van Velzen-Blad H, Zanen P, Rijkers GT, Grutters JC. Response to pneumococcal vaccination in mannose-binding lectin-deficient adults with recurrent respiratory tract infections. Clin Exp Immunol 2014; 177:272-9. [PMID: 24547957 DOI: 10.1111/cei.12299] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/11/2014] [Indexed: 12/11/2022] Open
Abstract
Mannose-binding lectin (MBL)-deficiency is associated with an increased susceptibility to pneumococcal infections and other forms of disease. Pneumococcal vaccination is recommended in MBL-deficient patients with recurrent respiratory tract infections (RRTI). The response to pneumococcal vaccination in MBL-deficient individuals has not yet been studied in detail. An impaired response to pneumococcal polysaccharides in MBL-deficient patients might explain the association between MBL deficiency and pneumococcal infections. This study investigates the antibody response to pneumococcal vaccination in MBL-deficient adult patients with RRTI. Furthermore, we investigated whether there was a difference in clinical presentation between MBL-deficient and -sufficient patients with RRTI. Eighteen MBL-deficient and 63 MBL-sufficient adult patients with RRTI were all vaccinated with the 23-valent pneumococcal polysaccharide vaccine and antibodies to 14 pneumococcal serotypes were measured on a Luminex platform. There were no differences observed in the response to pneumococcal vaccination between MBL-sufficient and -deficient patients. Forty-three MBL-sufficient patients could be classified as responders to pneumococcal vaccination and 20 as low responders, compared to 15 responders and three low responders in the MBL-deficient patients. We found no clear difference in clinical, radiological, lung function and medication parameters between MBL-sufficient and -deficient patients. In conclusion, our study suggests that MBL-deficient adults with RRTI have a response to a pneumococcal capsular polysaccharide vaccine comparable with MBL-sufficient patients. Moreover, we did not find a clear clinical role of MBL deficiency in adults with RRTI. As MBL deficiency is associated with an increased susceptibility to pneumococcal infections, pneumococcal vaccination might be protective in MBL-deficient patients with RRTI.
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Affiliation(s)
- D A van Kessel
- Department of Pulmonology, Sint Antonius Hospital, Nieuwegein, the Netherlands; Division of Heart and Lungs, University Medical Center, Utrecht, the Netherlands
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Ohshima N, Nagai H, Matsui H, Akashi S, Makino T, Akeda Y, Oishi K. Sustained functional serotype-specific antibody after primary and secondary vaccinations with a pneumococcal polysaccharide vaccine in elderly patients with chronic lung disease. Vaccine 2013; 32:1181-6. [PMID: 24120483 DOI: 10.1016/j.vaccine.2013.09.060] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2013] [Revised: 09/18/2013] [Accepted: 09/24/2013] [Indexed: 11/27/2022]
Abstract
An observational study was conducted to determine immunogenicity before and after primary and secondary vaccinations with 23-valent pneumococcal polysaccharide vaccine in a cohort of 40 elderly patients with chronic lung diseases. Safety of this vaccine was also compared between primary and secondary vaccination. We analyzed serotype-specific immunoglobulin G (IgG) and the opsonization index (OI) for serotypes 6B, 14, 19F, and 23F and compared adverse local and systemic reactions. The levels of serotype-specific IgG and the OIs significantly increased 1 month after primary and secondary vaccinations. Peak levels of IgG after secondary vaccination were 5-20% lower than those after primary vaccination, while serotype-specific OIs after secondary vaccination were comparable with those after primary vaccination. The levels of serotype-specific IgG required for 50% killing significantly decreased 1 month after vaccination. These values for serotypes 14, 19F, and 23F were slightly elevated immediately before secondary vaccination, but those for serotype 6B did not change. After secondary vaccination, these values declined slightly for serotypes 14, 19F, and 23F and remained low for serotype 6B. Although self-limited local and systemic reactions were more frequent after secondary vaccination compared with primary vaccination, no serious systemic reaction was found after either vaccination. Our data suggest a sustained functional serotype-specific IgG after primary and secondary vaccination and confirmed the safety of secondary vaccination among elderly individuals with chronic lung disease.
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Affiliation(s)
- Nobuharu Ohshima
- Department of Allergy, National Hospital Organization Tokyo National Hospital, Japan
| | - Hideaki Nagai
- Center for Pulmonary Diseases, National Hospital Organization Tokyo National Hospital, Japan
| | - Hirotoshi Matsui
- Center for Pulmonary Diseases, National Hospital Organization Tokyo National Hospital, Japan
| | - Shunsuke Akashi
- Center for Pulmonary Diseases, National Hospital Organization Tokyo National Hospital, Japan
| | - Tomohiko Makino
- Infectious Disease Surveillance Center, National Institute of Infectious Diseases, Japan
| | - Yukihiro Akeda
- International Research Center for Infectious Diseases, Research Institute for Microbial Diseases, Osaka University, Japan
| | - Kazunori Oishi
- Infectious Disease Surveillance Center, National Institute of Infectious Diseases, Japan.
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Persistence of antibody response 1.5 years after vaccination using 7-valent pneumococcal conjugate vaccine in patients with arthritis treated with different antirheumatic drugs. Arthritis Res Ther 2013; 15:R1. [PMID: 23286772 PMCID: PMC3672713 DOI: 10.1186/ar4127] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2012] [Accepted: 01/02/2013] [Indexed: 11/10/2022] Open
Abstract
Introduction The aim of this study was to explore the persistence of an antibody response 1.5 years after vaccination with 7-valent pneumococcal conjugate vaccine in patients with rheumatoid arthritis (RA) or spondyloarthropathy (SpA) treated with different antirheumatic drugs. Methods Of 505 patients initially recruited, data on current antirheumatic treatment and blood samples were obtained from 398 (79%) subjects after mean (SD, range) 1.4 (0.5; 1 to 2) years. Antibody levels against pneumococcal serotypes 23F and 6B were analyzed by using enzyme-linked immunosorbent assay (ELISA). Original treatment groups were as follows: (a) RA receiving methotrexate (MTX); (b) RA taking anti-TNF monotherapy; (c) RA taking anti-TNF+MTX; (d) SpA with anti-TNF monotherapy; (e) SpA taking anti-TNF+MTX; and (f) SpA taking NSAID/analgesics. Geometric mean levels (GMLs; 95% CI) and proportion (percentage) of patients with putative protective antibody levels ≥1 mg/L for both serotypes, calculated in different treatment groups, were compared with results 4 to 6 weeks after vaccination. Patients remaining on initial treatment were included in the analysis. Possible predictors of persistence of protective antibody response were analysed by using logistic regression analysis. Results Of 398 patients participating in the 1.5-year follow up, 302 patients (RA, 163, and SpA, 139) had unchanged medication. Compared with postvaccination levels at 1.5 years, GMLs for each serotype were significantly lower in all groups (P between 0.035 and <0.001; paired-sample t test), as were the proportions of patients with protective antibody levels for both serotypes (P < 0.001; χ2 test). Higher prevaccination antibody levels for both serotypes 23F and 6B were associated with better persistence of protective antibodies (P < 0.001). Compared with patients with protective antibody levels at 1.5 years, those not having protective antibody levels were older, more often women, had longer disease duration and higher HAQ and DAS, and had a lower proportion of initial responders to both serotypes. Concomitant anti-TNF treatment and MTX were identified as negative predictors of the persistence of protective antibodies among RA patients (P = 0.024 and P = 0.065, respectively). Only age 65 years or older (P = 0.017) and not antirheumatic treatment was found to be a negative predictor of protective antibodies in patients with SpA. Conclusions After initial increase, 1.5 years after pneumococcal vaccination with 7-valent conjugate vaccine, postvaccination antibody levels decreased significantly, reaching levels before vaccination in this cohort of patients with established arthritis treated with different antirheumatic drugs. MTX and anti-TNF treatment predicted low persistence of protective immunity among patients with RA. To boost antibody response, early revaccination with conjugate vaccine might be needed in patients receiving potent immunosuppressive remedies. Trial registration number EudraCT EU 2007-006539-29 and NCT00828997.
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Vila-Corcoles A, Ochoa-Gondar O. Pneumococcal vaccination among adults with chronic respiratory diseases: a historical overview. Expert Rev Vaccines 2012; 11:221-36. [PMID: 22309670 DOI: 10.1586/erv.11.176] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Streptococcus pneumoniae, the most common cause of community-acquired pneumonia, remains a major cause of morbidity and mortality worldwide. The presence of chronic respiratory illness is a major risk factor for pneumonia, and smoking (the most common cause of chronic obstructive pulmonary disease) is also an important risk factor for pneumonia and invasive pneumococcal disease. There are currently three established approaches to antipneumococcal vaccination: capsular polysaccharide pneumococcal vaccines (recommended for adults and some children at risk), protein-polysaccharide conjugate pneumococcal vaccines (classically recommended for infants and young children and currently under evaluation for adults aged 50 years or older for the prevention of invasive disease) and experimental protein-based pneumococcal vaccines (under investigation in animal models). Although patients with chronic respiratory diseases are commonly described as an at-risk population for pneumococcal infections, studies on pneumococcal vaccination efficacy in such patients are very limited and vaccination effectiveness remains controversial. This paper reviews available data on the efficacy and effectiveness of polysaccharide pneumococcal vaccination among adults with chronic respiratory diseases.
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Affiliation(s)
- Angel Vila-Corcoles
- Primary Care Service of Tarragona, EPIVAC Study Group, Institut Catala de la Salut, Prat de la Riba 39, 43001, Tarragona, Spain.
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A possible relationship of natural killer T cells with humoral immune response to 23-valent pneumococcal polysaccharide vaccine in clinical settings. Vaccine 2012; 30:3304-10. [DOI: 10.1016/j.vaccine.2012.03.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2011] [Revised: 02/28/2012] [Accepted: 03/04/2012] [Indexed: 11/22/2022]
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Gaillat J. Should patients with chronic obstructive pulmonary disease be vaccinated against pneumococcal diseases? Expert Rev Respir Med 2011; 3:585-96. [PMID: 20477349 DOI: 10.1586/ers.09.53] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Over the past 15 years, no fewer than ten meta-analyses or systematic literature reviews of the efficacy of pneumococcal polysaccharide vaccine in adults have been conducted, including one specifically in chronic obstructive pulmonary disease patients. Their general conclusion is that it is effective in preventing invasive infections, but no conclusions can be drawn for high-risk patients (owing to a highly polymorphic population). Opinions are divided as to its efficacy in pneumonia, with the studies being too heterogeneous to carry sufficient statistical weight. Most conclude that there is no impact on mortality. Chronic obstructive pulmonary disease patients are frequently described as an at-risk population, but controlled studies in such patients are very limited, leaving only case-control or cohort studies to provide information on which to base any decision. The aim of this article is first to discuss the place of pneumococcal polysaccharide vaccination in this risk population, which is increasing in prevalence and in which pneumococcal infections play a considerable role. Pending other vaccines, the polysaccharide vaccine is currently the only preventive approach that has demonstrated an effect, even if it does not match up to expectations. The possibilities of alternative vaccines, such as conjugate vaccines in the near future and perhaps protein vaccines at a later date, will be considered.
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Affiliation(s)
- Jacques Gaillat
- Service des Maladies Infectieuses, Centre hospitalier de la région d'Annecy, 1 Avenue de l'Hôpital Metz-Tessy, 74374 Pringy cedex, France.
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Effectiveness of pneumococcal polysaccharide vaccine against pneumonia and cost analysis for the elderly who receive seasonal influenza vaccine in Japan. Vaccine 2010; 28:7063-9. [DOI: 10.1016/j.vaccine.2010.08.010] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2010] [Revised: 07/29/2010] [Accepted: 08/02/2010] [Indexed: 11/21/2022]
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Sumitani M, Tochino Y, Kamimori T, Fujiwara H, Fujikawa T. Additive inoculation of influenza vaccine and 23-valent pneumococcal polysaccharide vaccine to prevent lower respiratory tract infections in chronic respiratory disease patients. Intern Med 2008; 47:1189-97. [PMID: 18591839 DOI: 10.2169/internalmedicine.47.0799] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND An increased incidence of pneumococcal infection triggered by influenza infection has been reported. OBJECTIVE To examine the effectiveness of the additive inoculation of influenza vaccine (I-V) and 23-valent pneumococcal vaccine (P-V) to prevent lower respiratory tract infections. METHODS 105 Japanese patients with chronic respiratory disease underwent the additive inoculation of I-V and P-V between October 2002 and January 2003, and their medical records were used to retrospectively examine the number of bacterial respiratory infections, number of hospitalizations, and length of hospital stay in the 2 years prior to and after P-V inoculation. Among them [chronic obstructive pulmonary disease (COPD): 45; bronchial asthma: 24; bronchiectasis: 20 (including diffuse panbronchiolitis); and other diseases: 16], 98 patients were evaluated, except for seven patients who died of diseases other than respiratory infections within the 2 years after P-V inoculation. Subjects were 51 to 91 years of age (median: 74 yrs), the male-female ratio was 63:42, and 32 patients were on home oxygen therapy. RESULTS After P-V inoculation, decreases in the number of respiratory infections (3.16 vs. 1.95 infections; p=0.0004) and in the number of hospitalizations (0.79 vs. 0.43 hospitalizations; p=0.001) were observed. Furthermore, an analysis including other factors, i.e., number of patients on home oxygen therapy and influenza season, also revealed a decreased number of hospitalizations. CONCLUSIONS The additive inoculation of I-V and P-V in Japanese patients with chronic respiratory disease prevented the development of bacterial respiratory infections and warrants further study in patients with respiratory disease.
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Affiliation(s)
- Mitsuhiro Sumitani
- Department of Respiratory Medicine, Osaka City General Hospital, Osaka, Japan.
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