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Romão VC, Ávila-Ribeiro P, Gonçalves MJ, Cruz-Machado R, Guerreiro AB, Teixeira V, Valido A, Silva-Dinis J, Vieira-Sousa E, Saavedra MJ, Sacadura-Leite E, Marinho RT, Fonseca JE. Hepatitis B vaccination associated with low response in patients with rheumatic diseases treated with biologics. RMD Open 2023; 9:e003597. [PMID: 38056920 PMCID: PMC10711851 DOI: 10.1136/rmdopen-2023-003597] [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: 08/10/2023] [Accepted: 10/23/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND Hepatitis B virus (HBV) vaccination is recommended for non-immunised patients with rheumatic diseases starting biological disease-modifying antirheumatic drugs (bDMARDs). There is some evidence that HBV vaccination is effective in patients under conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs), but it is currently unclear whether this also applies to bDMARDs. OBJECTIVES To assess the efficacy and safety of HBV vaccination in patients with inflammatory arthritides treated with bDMARDs. METHODS A prospective cohort with inflammatory arthritides treated with bDMARDs, negative for anti-HBs and anti-HBc and never vaccinated for HBV was recruited. Engerix B was administered at 0, 1 and 6 months and anti-HBs was reassessed ≥1 month after last dose. Response was defined as anti-HBs≥10 IU/L and compared against vaccinated healthy controls. Disease flare, serious adverse events and immune-related disorders not previously present were recorded. RESULTS 62 patients, most treated with TNF inhibitors (TNFi), and 38 controls were recruited. Most patients were taking csDMARDs (67.7%) and were in remission/low disease activity (59.4%). Only 20/62 patients (32.3%) had a positive response to vaccination, in comparison to 36/38 age-matched controls (94.7%, p<0.001). Response was seen in 19/51 patients treated with TNFi (37.3%) and in 1/11 (9.1%) patients treated with non-TNFi (p=0.07), including 1/6 treated with tocilizumab (16.7%). Among TNFi, response rates ranged from 4/22 (18.2%) for infliximab to 8/14 (57.1%) for etanercept. No relevant safety issues were identified. CONCLUSIONS HBV vaccination response in patients with rheumatic diseases treated with bDMARDs was poorer than expected. Our data reinforce the recommendation for vaccination prior to starting bDMARDs.
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Affiliation(s)
- Vasco C Romão
- Serviço de Reumatologia e Doenças Ósseas Metabólicas, Centro Hospitalar Universitário Lisboa Norte EPE, Lisboa, Portugal
- Unidade de Investigação em Reumatologia, Universidade de Lisboa Instituto de Medicina Molecular João Lobo Antunes, Lisboa, Portugal
| | - Pedro Ávila-Ribeiro
- Serviço de Reumatologia e Doenças Ósseas Metabólicas, Centro Hospitalar Universitário Lisboa Norte EPE, Lisboa, Portugal
- Unidade de Investigação em Reumatologia, Universidade de Lisboa Instituto de Medicina Molecular João Lobo Antunes, Lisboa, Portugal
| | - Maria João Gonçalves
- Serviço de Reumatologia e Doenças Ósseas Metabólicas, Centro Hospitalar Universitário Lisboa Norte EPE, Lisboa, Portugal
- Unidade de Investigação em Reumatologia, Universidade de Lisboa Instituto de Medicina Molecular João Lobo Antunes, Lisboa, Portugal
| | - Rita Cruz-Machado
- Serviço de Reumatologia e Doenças Ósseas Metabólicas, Centro Hospitalar Universitário Lisboa Norte EPE, Lisboa, Portugal
- Unidade de Investigação em Reumatologia, Universidade de Lisboa Instituto de Medicina Molecular João Lobo Antunes, Lisboa, Portugal
| | - André Bento Guerreiro
- Unidade de Investigação em Reumatologia, Universidade de Lisboa Instituto de Medicina Molecular João Lobo Antunes, Lisboa, Portugal
| | - Vítor Teixeira
- Serviço de Reumatologia e Doenças Ósseas Metabólicas, Centro Hospitalar Universitário Lisboa Norte EPE, Lisboa, Portugal
- Serviço de Reumatologia, Centro Hospitalar Universitário do Algarve, Faro, Portugal
| | - Ana Valido
- Serviço de Reumatologia e Doenças Ósseas Metabólicas, Centro Hospitalar Universitário Lisboa Norte EPE, Lisboa, Portugal
- Unidade de Investigação em Reumatologia, Universidade de Lisboa Instituto de Medicina Molecular João Lobo Antunes, Lisboa, Portugal
| | - Joana Silva-Dinis
- Serviço de Reumatologia e Doenças Ósseas Metabólicas, Centro Hospitalar Universitário Lisboa Norte EPE, Lisboa, Portugal
- Unidade de Investigação em Reumatologia, Universidade de Lisboa Instituto de Medicina Molecular João Lobo Antunes, Lisboa, Portugal
| | - Elsa Vieira-Sousa
- Serviço de Reumatologia e Doenças Ósseas Metabólicas, Centro Hospitalar Universitário Lisboa Norte EPE, Lisboa, Portugal
- Unidade de Investigação em Reumatologia, Universidade de Lisboa Instituto de Medicina Molecular João Lobo Antunes, Lisboa, Portugal
| | - Maria João Saavedra
- Serviço de Reumatologia e Doenças Ósseas Metabólicas, Centro Hospitalar Universitário Lisboa Norte EPE, Lisboa, Portugal
| | - Ema Sacadura-Leite
- Occupational Health Department, Centro Hospitalar Universitário Lisboa Norte EPE, Lisboa, Portugal
| | - Rui Tato Marinho
- Serviço de Gastrenterologia e Hepatologia, Centro Hospitalar Universitário Lisboa Norte EPE, Lisboa, Portugal
| | - João Eurico Fonseca
- Serviço de Reumatologia e Doenças Ósseas Metabólicas, Centro Hospitalar Universitário Lisboa Norte EPE, Lisboa, Portugal
- Unidade de Investigação em Reumatologia, Universidade de Lisboa Instituto de Medicina Molecular João Lobo Antunes, Lisboa, Portugal
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Immunogenicity of Hepatitis B Vaccine in Pediatric Systemic Lupus Erythematosus Patients. Pediatr Infect Dis J 2023; 42:e26-e31. [PMID: 36476533 DOI: 10.1097/inf.0000000000003730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Pediatric patients with systemic lupus erythematosus (SLE) are at increased infectious risk caused by underlying immunologic dysregulation and immunosuppressive therapy. Hepatitis B virus (HBV) could be reactivated during the immunosuppressive treatment in patients with past HBV infections. Information on immunogenicity after hepatitis B (HB) immunization and reimmunization are still scarce. METHODS SLE patients 5-18 years of age who had completed a primary HB immunization were enrolled. Anti-HBs levels at enrollment and after each vaccine dose were determined. Patients with anti-HBs levels < 10 mIU/mL were administered 1 booster dose. After 1 booster dose, patients with negative anti-HBs levels were administered 2 more booster doses. RESULTS Ninety-three SLE patients were enrolled. The prevalence of seroprotection assessed by anti-HBs > 10 mIU/mL after completion of a primary HB immunization was 25.8% (95% CI: 17.2-34.4). Lupus nephritis was associated with unprotective anti-HBs levels [odds ratio (OR): 4.341; 95% CI: 1.044-18.040]. The anti-HBs seroconversion was 72.3% (95% CI: 61.5-83.0) after 1 booster dose and increased up to 93.4% (95% CI: 86.9-98.4) after 3 booster doses. SLE Disease Activity Index-2000 score ≥ 4 (OR: 4.625; 95% CI: 1.45-14.80) was significantly associated with nonseroconversion after the first booster dose. Hypocomplementemia before the first and second booster doses (OR: 27; 95% CI: 1.26-578.35) was significantly associated with nonseroconversion after 3 booster doses. CONCLUSIONS All pediatric SLE patients should be evaluated for HBV serological status before immunosuppressive treatment. SLE patients with SLE Disease Activity Index-2000 score > 4 should need 3 booster doses if their anti-HBs level was < 10 mIU/mL.
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Abstract
The autoimmune/inflammatory syndrome induced by adjuvants (ASIA), also known as Shoenfeld's syndrome, encompasses several autoimmune conditions/phenomena that are triggered following the exposure to materials with an adjuvant activity known to augment an antigen-driven immune response. In some inherently vulnerable patients, they act as second hits to trigger or unmask an autoimmune disorder which ranges from generalized non-specific constitutional symptoms, and autoantibody production, to a new onset, of a fully-fledged autoimmune syndrome. In this manuscript, we present a case of a 37-year-old lady who developed systemic lupus erythematosus characterized by mucocutaneous, musculoskeletal, hematological neurological, and renal involvement a few years after silicone breast implants.
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Affiliation(s)
- Tajamul H Mir
- Nephrology/Lupus and Vasculitis Clinic, 76545Khyber Medical Institute Srinagar, Srinagar, India
| | - Ajaz K Khan
- Rheumatology, Arthritis and Rheumatology Centre, Srinagar, India
| | - M Omar Parvaiz
- Medicine, 469106Holy Family Red Crescent Medical College, Dhaka, Bangladesh
| | - Prasan D Rath
- Rheumatology, Max Superspeciality Institute Saket, New Delhi, India
| | - Alok Sharma
- Renal Pathology and Electron Microscopy, Dr Lal Path Labs. National Reference Lab, New Delhi, India
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Rúa-Figueroa Fernández de Larrinoa Í, Carreira PE, Brito García N, Díaz Del Campo Fontecha P, Pego Reigosa JM, Gómez Puerta JA, Ortega-Castro R, Tejera Segura B, Aguado García JM, Torre-Cisneros J, Valencia-Martín JL, Pereda CA, Nishishinya-Aquino MB, Otón Sánchez MT, Silva Fernández L, Maese Manzano J, Chamizo Carmona E, Correyero Plaza M. Recommendations for prevention of infection in systemic autoimmune rheumatic diseases. REUMATOLOGIA CLINICA 2022; 18:317-330. [PMID: 34607782 DOI: 10.1016/j.reumae.2021.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 04/11/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To develop recommendations for the prevention of infection in adult patients with systemic autoimmune rheumatic diseases (SARD). METHODS Clinical research questions relevant to the objective of the document were identified by a panel of experts selected based on their experience in the field. Systematic reviews of the available evidence were conducted, and evidence was graded according to the Scottish Intercollegiate Guidelines Network criteria. Specific recommendations were made. RESULTS Five questions were selected, referring to prevention of infection by Pneumocystis jirovecii with trimethoprim/sulfamethoxazole, primary and secondary prophylactic measures against hepatitis B virus, vaccination against human papillomavirus, vaccination against Streptococcus pneumoniae and vaccination against influenza virus, making a total of 18 recommendations, structured by question, based on the evidence found for the different SARD and/or expert consensus. CONCLUSIONS There is enough evidence on the safety and efficacy of vaccinations and other prophylactic measures against the microorganisms reviewed in this document to specifically recommend them for patients with SARD.
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Affiliation(s)
| | - Patricia E Carreira
- Servicio de Reumatología, Hospital Universitario 12 de octubre, Madrid, Spain
| | - Noé Brito García
- Unidad de Investigación, Sociedad Española de Reumatología, Madrid, Spain.
| | | | - José María Pego Reigosa
- Servicio de Reumatología, Complexo Hospitalario Universitario de Vigo, Grupo IRIDIS-VIGO (Investigation in Rheumatology and Immune-Mediated Diseases), Instituto de Investigación Sanitaria Galicia Sur (IISGS), Vigo, Spain
| | | | - Rafaela Ortega-Castro
- Unidad de Gestión Clínica de Reumatologia, Hospital Universitario Reina Sofía, Universidad de Córdoba, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
| | | | - José María Aguado García
- Unidad de Enfermedades Infecciosas, Hospital Universitario 12 de Octubre. Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Universidad Complutense Madrid, Madrid, Spain
| | - Julián Torre-Cisneros
- Servicio de Enfermedades Infecciosas, Hospital Universitario Reina Sofía, Instituto Maimónides de Investigación Biomédica (IMIBIC), Departamento de Ciencias Médicas y Quirúrgicas, Universidad de Córdoba, Córdoba, Spain
| | - José L Valencia-Martín
- Servicio de Medicina Preventiva y Salud Pública, Hospital Universitario Ramón y Cajal, Madrid, Spain
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Abstract
Neuroimmunological diseases and their treatment compromise the immune system, thereby increasing the risk of infections and serious illness. Consequently, vaccinations to protect against infections are an important part of the clinical management of these diseases. However, the wide variety of immunotherapies that are currently used to treat neuroimmunological disease — particularly multiple sclerosis and neuromyelitis optica spectrum disorders — can also impair immunological responses to vaccinations. In this Review, we discuss what is known about the effects of various immunotherapies on immunological responses to vaccines and what these effects mean for the safe and effective use of vaccines in patients with a neuroimmunological disease. The success of vaccination in patients receiving immunotherapy largely depends on the specific mode of action of the immunotherapy. To minimize the risk of infection when using immunotherapy, assessment of immune status and exclusion of underlying chronic infections before initiation of therapy are essential. Selection of the required vaccinations and leaving appropriate time intervals between vaccination and administration of immunotherapy can help to safeguard patients. We also discuss the rapidly evolving knowledge of how immunotherapies affect responses to SARS-CoV-2 vaccines and how these effects should influence the management of patients on these therapies during the COVID-19 pandemic. In this Review, the authors discuss how various immunotherapies for neuroimmunological diseases interact with vaccination responses, including responses to SARS-CoV-2 vaccinations, and the implications for the safe and effective use of vaccines in patients with these diseases. Vaccination against infection is an essential part of the management of neuroimmunological diseases. All indicated vaccinations should be administered before initiation of immunotherapy whenever possible; appropriate intervals between vaccination and treatment vary with treatment and vaccination. Inactivated vaccines are considered safe in neuroimmunological diseases but live vaccines are generally contraindicated during immunotherapy. Vaccination responses during immunotherapy can be diminished or abrogated, depending on the treatment and vaccination; antibody titre testing to monitor responses can be considered where appropriate. Vaccinations must be avoided during relapses or exacerbations of neuroimmunological diseases. Vaccination against SARS-CoV-2 is recommended for patients with neuroimmunological disease but some immunotherapies limit the immune response; therefore, timing should be considered carefully.
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Current Take on Systemic Sclerosis Patients' Vaccination Recommendations. Vaccines (Basel) 2021; 9:vaccines9121426. [PMID: 34960174 PMCID: PMC8708328 DOI: 10.3390/vaccines9121426] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 11/26/2021] [Accepted: 11/30/2021] [Indexed: 12/14/2022] Open
Abstract
Systemic sclerosis (SSc) is a rare autoimmune inflammatory rheumatic disease. The prevalence of SSc ranges from 7 to 700 cases per million worldwide. Due to multiple organ involvement and constant inflammatory state, this group of patients presents an increased risk of infectious diseases. This paper aimed to gather the up-to-date evidence on vaccination strategies for patients with SSc and to be a useful tool for the prevention and management of infectious diseases. The authors conducted a scoping review in which each paragraph presents data on a specific vaccine’s safety, immunogenicity, and efficacy. The work deals with the following topics: SARS-CoV-2, seasonal influenza, S. pneumoniae, HAV, HBV, HZV, N. meningitidis, H. influenzae, HPV, and diphtheria-tetanus-pertussis.
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Deepak P, Kim W, Paley MA, Yang M, Carvidi AB, Demissie EG, El-Qunni AA, Haile A, Huang K, Kinnett B, Liebeskind MJ, Liu Z, McMorrow LE, Paez D, Pawar N, Perantie DC, Schriefer RE, Sides SE, Thapa M, Gergely M, Abushamma S, Akuse S, Klebert M, Mitchell L, Nix D, Graf J, Taylor KE, Chahin S, Ciorba MA, Katz P, Matloubian M, O'Halloran JA, Presti RM, Wu GF, Whelan SPJ, Buchser WJ, Gensler LS, Nakamura MC, Ellebedy AH, Kim AHJ. Effect of Immunosuppression on the Immunogenicity of mRNA Vaccines to SARS-CoV-2 : A Prospective Cohort Study. Ann Intern Med 2021; 174:1572-1585. [PMID: 34461029 PMCID: PMC8407518 DOI: 10.7326/m21-1757] [Citation(s) in RCA: 226] [Impact Index Per Article: 75.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Patients with chronic inflammatory disease (CID) treated with immunosuppressive medications have increased risk for severe COVID-19. Although mRNA-based SARS-CoV-2 vaccination provides protection in immunocompetent persons, immunogenicity in immunosuppressed patients with CID is unclear. OBJECTIVE To determine the immunogenicity of mRNA-based SARS-CoV-2 vaccines in patients with CID. DESIGN Prospective observational cohort study. SETTING Two U.S. CID referral centers. PARTICIPANTS Volunteer sample of adults with confirmed CID eligible for early COVID-19 vaccination, including hospital employees of any age and patients older than 65 years. Immunocompetent participants were recruited separately from hospital employees. All participants received 2 doses of mRNA vaccine against SARS-CoV-2 between 10 December 2020 and 20 March 2021. Participants were assessed within 2 weeks before vaccination and 20 days after final vaccination. MEASUREMENTS Anti-SARS-CoV-2 spike (S) IgG+ binding in all participants, and neutralizing antibody titers and circulating S-specific plasmablasts in a subset to assess humoral response after vaccination. RESULTS Most of the 133 participants with CID (88.7%) and all 53 immunocompetent participants developed antibodies in response to mRNA-based SARS-CoV-2 vaccination, although some with CID developed numerically lower titers of anti-S IgG. Anti-S IgG antibody titers after vaccination were lower in participants with CID receiving glucocorticoids (n = 17) than in those not receiving them; the geometric mean of anti-S IgG antibodies was 357 (95% CI, 96 to 1324) for participants receiving prednisone versus 2190 (CI, 1598 to 3002) for those not receiving it. Anti-S IgG antibody titers were also lower in those receiving B-cell depletion therapy (BCDT) (n = 10). Measures of immunogenicity differed numerically between those who were and those who were not receiving antimetabolites (n = 48), tumor necrosis factor inhibitors (n = 39), and Janus kinase inhibitors (n = 11); however, 95% CIs were wide and overlapped. Neutralization titers seemed generally consistent with anti-S IgG results. Results were not adjusted for differences in baseline clinical factors, including other immunosuppressant therapies. LIMITATIONS Small sample that lacked demographic diversity, and residual confounding. CONCLUSION Compared with nonusers, patients with CID treated with glucocorticoids and BCDT seem to have lower SARS-CoV-2 vaccine-induced antibody responses. These preliminary findings require confirmation in a larger study. PRIMARY FUNDING SOURCE The Leona M. and Harry B. Helmsley Charitable Trust, Marcus Program in Precision Medicine Innovation, National Center for Advancing Translational Sciences, and National Institute of Arthritis and Musculoskeletal and Skin Diseases.
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Affiliation(s)
- Parakkal Deepak
- Washington University School of Medicine, St. Louis, Missouri (P.D., W.K., M.A.P., A.A.E., A.H., K.H., B.K., M.J.L., Z.L., L.E.M., D.C.P., R.E.S., S.E.S., M.T., M.G., S.A., S.A., M.K., L.M., D.N., S.C., M.A.C., J.A.O., R.M.P., G.F.W., S.P.W., W.J.B., A.H.E., A.H.K.)
| | - Wooseob Kim
- Washington University School of Medicine, St. Louis, Missouri (P.D., W.K., M.A.P., A.A.E., A.H., K.H., B.K., M.J.L., Z.L., L.E.M., D.C.P., R.E.S., S.E.S., M.T., M.G., S.A., S.A., M.K., L.M., D.N., S.C., M.A.C., J.A.O., R.M.P., G.F.W., S.P.W., W.J.B., A.H.E., A.H.K.)
| | - Michael A Paley
- Washington University School of Medicine, St. Louis, Missouri (P.D., W.K., M.A.P., A.A.E., A.H., K.H., B.K., M.J.L., Z.L., L.E.M., D.C.P., R.E.S., S.E.S., M.T., M.G., S.A., S.A., M.K., L.M., D.N., S.C., M.A.C., J.A.O., R.M.P., G.F.W., S.P.W., W.J.B., A.H.E., A.H.K.)
| | - Monica Yang
- University of California San Francisco, San Francisco, California (M.Y., A.B.C., E.G.D., D.P., N.P., J.G., K.E.T., P.K., M.M.)
| | - Alexander B Carvidi
- University of California San Francisco, San Francisco, California (M.Y., A.B.C., E.G.D., D.P., N.P., J.G., K.E.T., P.K., M.M.)
| | - Emanuel G Demissie
- University of California San Francisco, San Francisco, California (M.Y., A.B.C., E.G.D., D.P., N.P., J.G., K.E.T., P.K., M.M.)
| | - Alia A El-Qunni
- Washington University School of Medicine, St. Louis, Missouri (P.D., W.K., M.A.P., A.A.E., A.H., K.H., B.K., M.J.L., Z.L., L.E.M., D.C.P., R.E.S., S.E.S., M.T., M.G., S.A., S.A., M.K., L.M., D.N., S.C., M.A.C., J.A.O., R.M.P., G.F.W., S.P.W., W.J.B., A.H.E., A.H.K.)
| | - Alem Haile
- Washington University School of Medicine, St. Louis, Missouri (P.D., W.K., M.A.P., A.A.E., A.H., K.H., B.K., M.J.L., Z.L., L.E.M., D.C.P., R.E.S., S.E.S., M.T., M.G., S.A., S.A., M.K., L.M., D.N., S.C., M.A.C., J.A.O., R.M.P., G.F.W., S.P.W., W.J.B., A.H.E., A.H.K.)
| | - Katherine Huang
- Washington University School of Medicine, St. Louis, Missouri (P.D., W.K., M.A.P., A.A.E., A.H., K.H., B.K., M.J.L., Z.L., L.E.M., D.C.P., R.E.S., S.E.S., M.T., M.G., S.A., S.A., M.K., L.M., D.N., S.C., M.A.C., J.A.O., R.M.P., G.F.W., S.P.W., W.J.B., A.H.E., A.H.K.)
| | - Baylee Kinnett
- Washington University School of Medicine, St. Louis, Missouri (P.D., W.K., M.A.P., A.A.E., A.H., K.H., B.K., M.J.L., Z.L., L.E.M., D.C.P., R.E.S., S.E.S., M.T., M.G., S.A., S.A., M.K., L.M., D.N., S.C., M.A.C., J.A.O., R.M.P., G.F.W., S.P.W., W.J.B., A.H.E., A.H.K.)
| | - Mariel J Liebeskind
- Washington University School of Medicine, St. Louis, Missouri (P.D., W.K., M.A.P., A.A.E., A.H., K.H., B.K., M.J.L., Z.L., L.E.M., D.C.P., R.E.S., S.E.S., M.T., M.G., S.A., S.A., M.K., L.M., D.N., S.C., M.A.C., J.A.O., R.M.P., G.F.W., S.P.W., W.J.B., A.H.E., A.H.K.)
| | - Zhuoming Liu
- Washington University School of Medicine, St. Louis, Missouri (P.D., W.K., M.A.P., A.A.E., A.H., K.H., B.K., M.J.L., Z.L., L.E.M., D.C.P., R.E.S., S.E.S., M.T., M.G., S.A., S.A., M.K., L.M., D.N., S.C., M.A.C., J.A.O., R.M.P., G.F.W., S.P.W., W.J.B., A.H.E., A.H.K.)
| | - Lily E McMorrow
- Washington University School of Medicine, St. Louis, Missouri (P.D., W.K., M.A.P., A.A.E., A.H., K.H., B.K., M.J.L., Z.L., L.E.M., D.C.P., R.E.S., S.E.S., M.T., M.G., S.A., S.A., M.K., L.M., D.N., S.C., M.A.C., J.A.O., R.M.P., G.F.W., S.P.W., W.J.B., A.H.E., A.H.K.)
| | - Diana Paez
- University of California San Francisco, San Francisco, California (M.Y., A.B.C., E.G.D., D.P., N.P., J.G., K.E.T., P.K., M.M.)
| | - Niti Pawar
- University of California San Francisco, San Francisco, California (M.Y., A.B.C., E.G.D., D.P., N.P., J.G., K.E.T., P.K., M.M.)
| | - Dana C Perantie
- Washington University School of Medicine, St. Louis, Missouri (P.D., W.K., M.A.P., A.A.E., A.H., K.H., B.K., M.J.L., Z.L., L.E.M., D.C.P., R.E.S., S.E.S., M.T., M.G., S.A., S.A., M.K., L.M., D.N., S.C., M.A.C., J.A.O., R.M.P., G.F.W., S.P.W., W.J.B., A.H.E., A.H.K.)
| | - Rebecca E Schriefer
- Washington University School of Medicine, St. Louis, Missouri (P.D., W.K., M.A.P., A.A.E., A.H., K.H., B.K., M.J.L., Z.L., L.E.M., D.C.P., R.E.S., S.E.S., M.T., M.G., S.A., S.A., M.K., L.M., D.N., S.C., M.A.C., J.A.O., R.M.P., G.F.W., S.P.W., W.J.B., A.H.E., A.H.K.)
| | - Shannon E Sides
- Washington University School of Medicine, St. Louis, Missouri (P.D., W.K., M.A.P., A.A.E., A.H., K.H., B.K., M.J.L., Z.L., L.E.M., D.C.P., R.E.S., S.E.S., M.T., M.G., S.A., S.A., M.K., L.M., D.N., S.C., M.A.C., J.A.O., R.M.P., G.F.W., S.P.W., W.J.B., A.H.E., A.H.K.)
| | - Mahima Thapa
- Washington University School of Medicine, St. Louis, Missouri (P.D., W.K., M.A.P., A.A.E., A.H., K.H., B.K., M.J.L., Z.L., L.E.M., D.C.P., R.E.S., S.E.S., M.T., M.G., S.A., S.A., M.K., L.M., D.N., S.C., M.A.C., J.A.O., R.M.P., G.F.W., S.P.W., W.J.B., A.H.E., A.H.K.)
| | - Maté Gergely
- Washington University School of Medicine, St. Louis, Missouri (P.D., W.K., M.A.P., A.A.E., A.H., K.H., B.K., M.J.L., Z.L., L.E.M., D.C.P., R.E.S., S.E.S., M.T., M.G., S.A., S.A., M.K., L.M., D.N., S.C., M.A.C., J.A.O., R.M.P., G.F.W., S.P.W., W.J.B., A.H.E., A.H.K.)
| | - Suha Abushamma
- Washington University School of Medicine, St. Louis, Missouri (P.D., W.K., M.A.P., A.A.E., A.H., K.H., B.K., M.J.L., Z.L., L.E.M., D.C.P., R.E.S., S.E.S., M.T., M.G., S.A., S.A., M.K., L.M., D.N., S.C., M.A.C., J.A.O., R.M.P., G.F.W., S.P.W., W.J.B., A.H.E., A.H.K.)
| | - Sewuese Akuse
- Washington University School of Medicine, St. Louis, Missouri (P.D., W.K., M.A.P., A.A.E., A.H., K.H., B.K., M.J.L., Z.L., L.E.M., D.C.P., R.E.S., S.E.S., M.T., M.G., S.A., S.A., M.K., L.M., D.N., S.C., M.A.C., J.A.O., R.M.P., G.F.W., S.P.W., W.J.B., A.H.E., A.H.K.)
| | - Michael Klebert
- Washington University School of Medicine, St. Louis, Missouri (P.D., W.K., M.A.P., A.A.E., A.H., K.H., B.K., M.J.L., Z.L., L.E.M., D.C.P., R.E.S., S.E.S., M.T., M.G., S.A., S.A., M.K., L.M., D.N., S.C., M.A.C., J.A.O., R.M.P., G.F.W., S.P.W., W.J.B., A.H.E., A.H.K.)
| | - Lynne Mitchell
- Washington University School of Medicine, St. Louis, Missouri (P.D., W.K., M.A.P., A.A.E., A.H., K.H., B.K., M.J.L., Z.L., L.E.M., D.C.P., R.E.S., S.E.S., M.T., M.G., S.A., S.A., M.K., L.M., D.N., S.C., M.A.C., J.A.O., R.M.P., G.F.W., S.P.W., W.J.B., A.H.E., A.H.K.)
| | - Darren Nix
- Washington University School of Medicine, St. Louis, Missouri (P.D., W.K., M.A.P., A.A.E., A.H., K.H., B.K., M.J.L., Z.L., L.E.M., D.C.P., R.E.S., S.E.S., M.T., M.G., S.A., S.A., M.K., L.M., D.N., S.C., M.A.C., J.A.O., R.M.P., G.F.W., S.P.W., W.J.B., A.H.E., A.H.K.)
| | - Jonathan Graf
- University of California San Francisco, San Francisco, California (M.Y., A.B.C., E.G.D., D.P., N.P., J.G., K.E.T., P.K., M.M.)
| | - Kimberly E Taylor
- University of California San Francisco, San Francisco, California (M.Y., A.B.C., E.G.D., D.P., N.P., J.G., K.E.T., P.K., M.M.)
| | - Salim Chahin
- Washington University School of Medicine, St. Louis, Missouri (P.D., W.K., M.A.P., A.A.E., A.H., K.H., B.K., M.J.L., Z.L., L.E.M., D.C.P., R.E.S., S.E.S., M.T., M.G., S.A., S.A., M.K., L.M., D.N., S.C., M.A.C., J.A.O., R.M.P., G.F.W., S.P.W., W.J.B., A.H.E., A.H.K.)
| | - Matthew A Ciorba
- Washington University School of Medicine, St. Louis, Missouri (P.D., W.K., M.A.P., A.A.E., A.H., K.H., B.K., M.J.L., Z.L., L.E.M., D.C.P., R.E.S., S.E.S., M.T., M.G., S.A., S.A., M.K., L.M., D.N., S.C., M.A.C., J.A.O., R.M.P., G.F.W., S.P.W., W.J.B., A.H.E., A.H.K.)
| | - Patricia Katz
- University of California San Francisco, San Francisco, California (M.Y., A.B.C., E.G.D., D.P., N.P., J.G., K.E.T., P.K., M.M.)
| | - Mehrdad Matloubian
- University of California San Francisco, San Francisco, California (M.Y., A.B.C., E.G.D., D.P., N.P., J.G., K.E.T., P.K., M.M.)
| | - Jane A O'Halloran
- Washington University School of Medicine, St. Louis, Missouri (P.D., W.K., M.A.P., A.A.E., A.H., K.H., B.K., M.J.L., Z.L., L.E.M., D.C.P., R.E.S., S.E.S., M.T., M.G., S.A., S.A., M.K., L.M., D.N., S.C., M.A.C., J.A.O., R.M.P., G.F.W., S.P.W., W.J.B., A.H.E., A.H.K.)
| | - Rachel M Presti
- Washington University School of Medicine, St. Louis, Missouri (P.D., W.K., M.A.P., A.A.E., A.H., K.H., B.K., M.J.L., Z.L., L.E.M., D.C.P., R.E.S., S.E.S., M.T., M.G., S.A., S.A., M.K., L.M., D.N., S.C., M.A.C., J.A.O., R.M.P., G.F.W., S.P.W., W.J.B., A.H.E., A.H.K.)
| | - Gregory F Wu
- Washington University School of Medicine, St. Louis, Missouri (P.D., W.K., M.A.P., A.A.E., A.H., K.H., B.K., M.J.L., Z.L., L.E.M., D.C.P., R.E.S., S.E.S., M.T., M.G., S.A., S.A., M.K., L.M., D.N., S.C., M.A.C., J.A.O., R.M.P., G.F.W., S.P.W., W.J.B., A.H.E., A.H.K.)
| | - Sean P J Whelan
- Washington University School of Medicine, St. Louis, Missouri (P.D., W.K., M.A.P., A.A.E., A.H., K.H., B.K., M.J.L., Z.L., L.E.M., D.C.P., R.E.S., S.E.S., M.T., M.G., S.A., S.A., M.K., L.M., D.N., S.C., M.A.C., J.A.O., R.M.P., G.F.W., S.P.W., W.J.B., A.H.E., A.H.K.)
| | - William J Buchser
- Washington University School of Medicine, St. Louis, Missouri (P.D., W.K., M.A.P., A.A.E., A.H., K.H., B.K., M.J.L., Z.L., L.E.M., D.C.P., R.E.S., S.E.S., M.T., M.G., S.A., S.A., M.K., L.M., D.N., S.C., M.A.C., J.A.O., R.M.P., G.F.W., S.P.W., W.J.B., A.H.E., A.H.K.)
| | - Lianne S Gensler
- University of California San Francisco and San Francisco VA Health Care System, San Francisco, California (L.S.G., M.C.N.)
| | - Mary C Nakamura
- University of California San Francisco and San Francisco VA Health Care System, San Francisco, California (L.S.G., M.C.N.)
| | - Ali H Ellebedy
- Washington University School of Medicine, St. Louis, Missouri (P.D., W.K., M.A.P., A.A.E., A.H., K.H., B.K., M.J.L., Z.L., L.E.M., D.C.P., R.E.S., S.E.S., M.T., M.G., S.A., S.A., M.K., L.M., D.N., S.C., M.A.C., J.A.O., R.M.P., G.F.W., S.P.W., W.J.B., A.H.E., A.H.K.)
| | - Alfred H J Kim
- Washington University School of Medicine, St. Louis, Missouri (P.D., W.K., M.A.P., A.A.E., A.H., K.H., B.K., M.J.L., Z.L., L.E.M., D.C.P., R.E.S., S.E.S., M.T., M.G., S.A., S.A., M.K., L.M., D.N., S.C., M.A.C., J.A.O., R.M.P., G.F.W., S.P.W., W.J.B., A.H.E., A.H.K.)
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8
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Rúa-Figueroa Fernández de Larrinoa Í, Carreira PE, Brito García N, Díaz Del Campo Fontecha P, Pego Reigosa JM, Gómez Puerta JA, Ortega-Castro R, Tejera Segura B, Aguado García JM, Torre-Cisneros J, Valencia-Martín JL, Pereda CA, Nishishinya-Aquino MB, Otón Sánchez MT, Silva Fernández L, Maese Manzano J, Chamizo Carmona E, Correyero Plaza M. Recommendations for prevention of infection in systemic autoimmune rheumatic diseases. REUMATOLOGIA CLINICA 2021; 18:S1699-258X(21)00124-8. [PMID: 34176767 DOI: 10.1016/j.reuma.2021.04.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 04/08/2021] [Accepted: 04/11/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To develop recommendations for the prevention of infection in adult patients with systemic autoimmune rheumatic diseases (SARD). METHODS Clinical research questions relevant to the objective of the document were identified by a panel of experts selected based on their experience in the field. Systematic reviews of the available evidence were conducted, and evidence was graded according to the Scottish Intercollegiate Guidelines Network criteria. Specific recommendations were made. RESULTS Five questions were selected, referring to prevention of infection by Pneumocystis jirovecii with trimethoprim/sulfamethoxazole, primary and secondary prophylactic measures against hepatitis B virus, vaccination against human papillomavirus, vaccination against Streptococcus pneumoniae and vaccination against influenza virus, making a total of 18 recommendations, structured by question, based on the evidence found for the different SARD and/or expert consensus. CONCLUSIONS There is enough evidence on the safety and efficacy of vaccinations and other prophylactic measures against the microorganisms reviewed in this document to specifically recommend them for patients with SARD.
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Affiliation(s)
| | - Patricia E Carreira
- Servicio de Reumatología, Hospital Universitario 12 de octubre, Madrid, España
| | - Noé Brito García
- Unidad de Investigación, Sociedad Española de Reumatología, Madrid, España.
| | | | - José María Pego Reigosa
- Servicio de Reumatología, Complexo Hospitalario Universitario de Vigo, Grupo IRIDIS-VIGO (Investigation in Rheumatology and Immune-Mediated Diseases), Instituto de Investigación Sanitaria Galicia Sur (IISGS), Vigo, España
| | - José Alfredo Gómez Puerta
- Servicio de Reumatología, Complexo Hospitalario Universitario de Vigo, Grupo IRIDIS-VIGO (Investigation in Rheumatology and Immune-Mediated Diseases), Instituto de Investigación Sanitaria Galicia Sur (IISGS), Vigo, España; Servicio de Reumatología, Hospital Clínic de Barcelona, Barcelona, España
| | - Rafaela Ortega-Castro
- Unidad de Gestión Clínica de Reumatologia, Hospital Universitario Reina Sofía, Universidad de Córdoba, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, España
| | | | - José María Aguado García
- Unidad de Enfermedades Infecciosas, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Universidad Complutense de Madrid, Madrid, España
| | - Julián Torre-Cisneros
- Servicio de Enfermedades Infecciosas, Hospital Universitario Reina Sofía, Instituto Maimónides de Investigación Biomédica (IMIBIC), Departamento de Ciencias Médicas y Quirúrgicas, Universidad de Córdoba, Córdoba, España
| | - José L Valencia-Martín
- Servicio de Medicina Preventiva y Salud Pública, Hospital Universitario Ramón y Cajal, Madrid, España
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9
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Mason A, Anver H, Lwin M, Holroyd C, Faust SN, Edwards CJ. Lupus, vaccinations and COVID-19: What we know now. Lupus 2021; 30:1541-1552. [PMID: 34134555 DOI: 10.1177/09612033211024355] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), the virus causing Coronavirus disease 2019 (COVID-19), has had a huge impact on health services, with a high mortality associated with complications including pneumonia and acute respiratory distress syndrome. Patients with systemic lupus erythematosus (SLE) are at increased risk of viral infections, and recent data suggests they may be at an increased risk of poor outcomes with COVID-19. This may be particularly true for those on rituximab or high dose steroids. A huge international effort from the scientific community has so far resulted in the temporary authorisation of three vaccines which offer protection against SARS-CoV-2, with over 30 other vaccines being evaluated in ongoing trials. Although there has historically been concern that vaccines may trigger disease flares of SLE, there is little convincing evidence to show this. In general lupus patients appear to gain good protection from vaccination, although there may be reduced efficacy in those with high disease activity or those on immunosuppressive therapies, such as rituximab or high dose steroids. Recent concerns have been raised regarding rare clotting events with the AstraZeneca/Oxford vaccine and it is currently unknown whether this risk is higher for those patients with secondary antiphospholipid syndrome. With the possibility of annual COVID vaccination programmes in the future, prospective data collection and registries looking at the effect of vaccination on SLE disease control, the incidence of COVID-19 in SLE patients and severity of COVID-19 disease course would all be useful. As mass vaccination programmes begin to roll out across the world, we assess the evidence of the use of vaccines in SLE patients and in particular vaccines targeting SARS-CoV-2.
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Affiliation(s)
- Alice Mason
- Rheumatology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Himashi Anver
- Rheumatology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - May Lwin
- NIHR Southampton Clinical Research Facility and NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Christopher Holroyd
- Rheumatology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Saul N Faust
- NIHR Southampton Clinical Research Facility and NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK.,Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton, UK
| | - Christopher J Edwards
- Rheumatology, University Hospital Southampton NHS Foundation Trust, Southampton, UK.,NIHR Southampton Clinical Research Facility and NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK.,Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton, UK
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10
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Deepak P, Kim W, Paley MA, Yang M, Carvidi AB, El-Qunni AA, Haile A, Huang K, Kinnett B, Liebeskind MJ, Liu Z, McMorrow LE, Paez D, Perantie DC, Schriefer RE, Sides SE, Thapa M, Gergely M, Abushamma S, Klebert M, Mitchell L, Nix D, Graf J, Taylor KE, Chahin S, Ciorba MA, Katz P, Matloubian M, O'Halloran JA, Presti RM, Wu GF, Whelan SPJ, Buchser WJ, Gensler LS, Nakamura MC, Ellebedy AH, Kim AHJ. Glucocorticoids and B Cell Depleting Agents Substantially Impair Immunogenicity of mRNA Vaccines to SARS-CoV-2. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2021:2021.04.05.21254656. [PMID: 33851176 PMCID: PMC8043473 DOI: 10.1101/2021.04.05.21254656] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Individuals with chronic inflammatory diseases (CID) are frequently treated with immunosuppressive medications that can increase their risk of severe COVID-19. While novel mRNA-based SARS-CoV-2 vaccination platforms provide robust protection in immunocompetent individuals, the immunogenicity in CID patients on immunosuppression is not well established. Therefore, determining the effectiveness of SARS-CoV-2 vaccines in the setting of immunosuppression is essential to risk-stratify CID patients with impaired protection and provide clinical guidance regarding medication management. METHODS We conducted a prospective assessment of mRNA-based vaccine immunogenicity in 133 adults with CIDs and 53 immunocompetent controls. Blood from participants over 18 years of age was collected before initial immunization and 1-2 weeks after the second immunization. Serum anti-SARS-CoV-2 spike (S) IgG + binding, neutralizing antibody titers, and circulating S-specific plasmablasts were quantified to assess the magnitude and quality of the humoral response following vaccination. RESULTS Compared to immunocompetent controls, a three-fold reduction in anti-S IgG titers (P=0.009) and SARS-CoV-2 neutralization (p<0.0001) were observed in CID patients. B cell depletion and glucocorticoids exerted the strongest effect with a 36- and 10-fold reduction in humoral responses, respectively (p<0.0001). Janus kinase inhibitors and antimetabolites, including methotrexate, also blunted antibody titers in multivariate regression analysis (P<0.0001, P=0.0023, respectively). Other targeted therapies, such as TNF inhibitors, IL-12/23 inhibitors, and integrin inhibitors, had only modest impacts on antibody formation and neutralization. CONCLUSIONS CID patients treated with immunosuppressive therapies exhibit impaired SARS-CoV-2 vaccine-induced immunity, with glucocorticoids and B cell depletion therapy more severely impeding optimal responses.
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Affiliation(s)
- Parakkal Deepak
- Inflammatory Bowel Diseases Center, Division of Gastroenterology, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Wooseob Kim
- Division of Immunobiology, Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO, USA
| | - Michael A Paley
- Division of Rheumatology, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Monica Yang
- Division of Rheumatology, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Alexander B Carvidi
- Division of Rheumatology, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Alia A El-Qunni
- Division of Rheumatology, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Alem Haile
- Clinical Trials Unit, Washington University School of Medicine, St. Louis, MO, USA
| | - Katherine Huang
- Division of Gastroenterology, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Baylee Kinnett
- Division of Gastroenterology, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Mariel J Liebeskind
- Department of Genetics, Washington University School of Medicine, St. Louis, MO, USA
| | - Zhuoming Liu
- Department of Molecular Microbiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Lily E McMorrow
- Division of Rheumatology, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Diana Paez
- Division of Rheumatology, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Dana C Perantie
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - Rebecca E Schriefer
- Division of Rheumatology, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Shannon E Sides
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - Mahima Thapa
- Division of Immunobiology, Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO, USA
| | - Maté Gergely
- Division of Gastroenterology, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Suha Abushamma
- Division of Gastroenterology, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Michael Klebert
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Lynne Mitchell
- Division of Rheumatology, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Darren Nix
- Division of Gastroenterology, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Jonathan Graf
- Division of Rheumatology, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Kimberly E Taylor
- Division of Rheumatology, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Salim Chahin
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - Matthew A Ciorba
- Inflammatory Bowels Diseases Center, Division of Gastroenterology, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Patricia Katz
- Division of Rheumatology, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Mehrdad Matloubian
- Division of Rheumatology, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Jane A O'Halloran
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Rachel M Presti
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Gregory F Wu
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA; Division of Immunobiology, Department of Pathology and Immunology, Washington, University School of Medicine, St. Louis, MO, USA; The Andrew M. and Jane M. Bursky Center for Human Immunology and Immunotherapy Programs, Washington University School of Medicine, St. Louis, MO, USA
| | - Sean P J Whelan
- Department of Molecular Microbiology, Washington University School of Medicine, St. Louis, MO, USA
| | - William J Buchser
- Department of Genetics, Washington University School of Medicine, St. Louis, MO, USA
| | - Lianne S Gensler
- Division of Rheumatology, Department of Medicine, University of California San Francisco, San Francisco, CA, USA; Arthritis/Immunology Section, San Francisco Veterans Administration Health Care System, San Francisco, CA, USA
| | - Mary C Nakamura
- Division of Rheumatology, Department of Medicine, University of California San Francisco, San Francisco, CA, USA; Arthritis/Immunology Section, San Francisco Veterans Administration Health Care System, San Francisco, CA, USA
| | - Ali H Ellebedy
- Division of Immunobiology, Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO, USA; The Andrew M. and Jane M. Bursky Center for Human Immunology and Immunotherapy Programs, Washington University School of Medicine, St. Louis, MO, USA
| | - Alfred H J Kim
- Division of Rheumatology, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA; Division of Immunobiology, Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO, USA; The Andrew M. and Jane M. Bursky Center for Human Immunology and Immunotherapy Programs, Washington University School of Medicine, St. Louis, MO, USA
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11
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Tang W, Askanase AD, Khalili L, Merrill JT. SARS-CoV-2 vaccines in patients with SLE. Lupus Sci Med 2021; 8:8/1/e000479. [PMID: 33685998 PMCID: PMC7941677 DOI: 10.1136/lupus-2021-000479] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 02/11/2021] [Accepted: 02/20/2021] [Indexed: 02/07/2023]
Abstract
As the Moderna (mRNA-1273) and Pfizer/BioNTech (BNT162b2) vaccines become available to patients with autoimmune diseases and SLE, practitioners will have to inform them about the safety and efficacy of these vaccines. Here we discuss the challenges of applying vaccine data to patients with autoimmune diseases and the evidence available in the literature that may help in the decision process.
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Affiliation(s)
- Wei Tang
- Rheumatology, Columbia University Irving Medical Center, New York, New York, USA
| | - Anca D Askanase
- Rheumatology, Columbia University Irving Medical Center, New York, New York, USA
| | - Leila Khalili
- Rheumatology, Columbia University Irving Medical Center, New York, New York, USA
| | - Joan T Merrill
- Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation Arthritis and Clinical Immunology Research Program, Oklahoma City, Oklahoma, USA
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12
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Aljaberi N, Ghulam E, Smitherman EA, Favier L, Dykes DMH, Danziger-Isakov LA, Brady RC, Huggins J. Maintaining Hepatitis B Protection in Immunocompromised Pediatric Rheumatology and Inflammatory Bowel Disease Patients. J Rheumatol 2020; 48:1314-1321. [PMID: 32739895 DOI: 10.3899/jrheum.200283] [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] [Accepted: 07/16/2020] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Hepatitis B virus (HBV) infection remains a significant public health challenge, particularly for immunocompromised patients. Our aim was to evaluate the serologic immunity in immunocompromised rheumatology and inflammatory bowel disease (IBD) patients, assess factors for serologic nonimmunity, and evaluate their response to 1 HBV booster dose. METHODS Immunocompromised rheumatology and IBD patients with completed HBV screening were identified. A chart review was performed to collect demographics, clinical information, baseline HBV serology results, and serologic response to booster vaccination. Serologic nonimmunity was defined as a negative/indeterminate hepatitis B surface antibody (anti-HBs) level. RESULTS Among 580 patients, 71% were nonimmune. The highest portion of nonimmune patients were 11-18 years old (P = 0.004). There was no significant difference between immune and nonimmune patients with regards to diagnosis (P = 0.34), age at diagnosis (P = 0.64), duration of treatment (P = 0.07), or type of medications (P = 0.08). Sixty-two percent of those who received a booster vaccine were rescreened, and most (68%) seroconverted. In those 18 years or older, only half seroconverted. CONCLUSION Results of this study support the benefit of HBV screening in immunosuppressed patients. Beginning at age 11 years, most patients lacked serologic immunity to HBV. Seroconversion for most patients 11-18 years occurred after 1 booster vaccine. Thus, for immunocompromised patients without recent HBV serologic data, obtaining the HBV serology beginning at age 11 years might be considered. Those 18 years and older were least likely to seroconvert after 1 booster, indicating that they may benefit from receiving the 3-dose HBV vaccine series.
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Affiliation(s)
- Najla Aljaberi
- N. Aljaberi, MBBS, MSc, J. Huggins, MD, Division of Pediatric Rheumatology, Cincinnati Children's Hospital Medical Center, Ohio, USA;
| | - Enas Ghulam
- E. Ghulam, PhD, College of Sciences and Health Professions, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Emily A Smitherman
- E.A. Smitherman, MD, MSc, Division of Pediatric Rheumatology, University of Alabama at Birmingham, Alabama, USA
| | - Leslie Favier
- L. Favier, MD, MSc, Department of Pediatric Rheumatology, Children's Mercy, Kansas City, Missouri, USA
| | - Dana M H Dykes
- D.M. Dykes, MD, Department of Pediatric Gastroenterology, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Lara A Danziger-Isakov
- L.A. Danziger-Isakov, MD, MPH, R.C. Brady, MD, Division of Infectious Diseases, Cincinnati Children's Hospital Medical Center, Ohio, USA
| | - Rebecca C Brady
- L.A. Danziger-Isakov, MD, MPH, R.C. Brady, MD, Division of Infectious Diseases, Cincinnati Children's Hospital Medical Center, Ohio, USA
| | - Jennifer Huggins
- N. Aljaberi, MBBS, MSc, J. Huggins, MD, Division of Pediatric Rheumatology, Cincinnati Children's Hospital Medical Center, Ohio, USA
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13
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Principi N, Esposito S. Do Vaccines Have a Role as a Cause of Autoimmune Neurological Syndromes? Front Public Health 2020; 8:361. [PMID: 32850592 PMCID: PMC7399175 DOI: 10.3389/fpubh.2020.00361] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 06/24/2020] [Indexed: 01/05/2023] Open
Abstract
Vaccines are the most important preventive measure against infectious diseases presently available. Although they have led to the eradication or the elimination of some infectious diseases, concerns about safety are among the main reasons for vaccine hesitancy. In some cases, the biological plausibility of a given damage in association with the temporal association between vaccine administration and disease development makes it difficult to define causality and can justify hesitancy. Only well-conducted epidemiological studies with adequate evaluation of results can clarify whether a true association between vaccines and adverse event development truly exists. Autoimmune neurological syndromes that follow vaccine use are among these. In this narrative review, the potential association between vaccines and the development of these syndromes are discussed. Literature analysis showed that most of the associations between vaccines and nervous system autoimmune syndromes that have been reported as severe adverse events following immunization are no longer evidenced when well-conducted epidemiological studies are carried out. Although the rarity of autoimmune diseases makes it difficult to strictly exclude that, albeit exceptionally, some vaccines may induce an autoimmune neurological disease, no definitive demonstration of a potential role of vaccines in causing autoimmune neurological syndromes is presently available. Consequently, the fear of neurological autoimmune disease cannot limit the use of the most important preventive measure presently available against infectious diseases.
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Affiliation(s)
| | - Susanna Esposito
- Pediatric Clinic, Department of Medicine and Surgery, Pietro Barilla Children's Hospital, University of Parma, Parma, Italy
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14
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Aluminum and vaccines: Current state of knowledge. Med Mal Infect 2020; 50:16-21. [DOI: 10.1016/j.medmal.2019.09.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 09/17/2019] [Indexed: 02/06/2023]
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15
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Abstract
Lupus nephritis (LN) is a form of glomerulonephritis that constitutes one of the most severe organ manifestations of the autoimmune disease systemic lupus erythematosus (SLE). Most patients with SLE who develop LN do so within 5 years of an SLE diagnosis and, in many cases, LN is the presenting manifestation resulting in the diagnosis of SLE. Understanding of the genetic and pathogenetic basis of LN has improved substantially over the past few decades. Treatment of LN usually involves immunosuppressive therapy, typically with mycophenolate mofetil or cyclophosphamide and with glucocorticoids, although these treatments are not uniformly effective. Despite increased knowledge of disease pathogenesis and improved treatment options, LN remains a substantial cause of morbidity and death among patients with SLE. Within 10 years of an initial SLE diagnosis, 5-20% of patients with LN develop end-stage kidney disease, and the multiple comorbidities associated with immunosuppressive treatment, including infections, osteoporosis and cardiovascular and reproductive effects, remain a concern. Clearly, early and accurate diagnosis of LN and prompt initiation of therapy are of vital importance to improve outcomes in patients with SLE.
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16
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MORETTO F, CATHERINE FX, ESTEVE C, BLOT M, PIROTH L. Isolated Anti-HBc: Significance and Management. J Clin Med 2020; 9:E202. [PMID: 31940817 PMCID: PMC7019847 DOI: 10.3390/jcm9010202] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 01/06/2020] [Accepted: 01/07/2020] [Indexed: 12/11/2022] Open
Abstract
Hepatitis B virus (HBV) infection is prevalent worldwide and is associated with dramatic levels of morbidity and mortality. Isolated anti-HBc (IAHBc) is a particular serological pattern that is commonly found in immunocompromised patients. There is ongoing debate regarding the management of patients with IAHBc. Herein, we summarize the current guidelines and the newest evidence. The frequency of IAHBc is variable, with a higher prevalence in some populations, such as persons living with HIV and others immunocompromised patients. The risk of HBV reactivation depends on host factors (including immunosuppression) and viral factors. It is now well established that immunocompromised patients can be classified into three groups for risk according to the type of immunosuppression and/or treatment. In patients at high risk, HBV therapy has to be considered systematically. In patients at moderate risk, the decision is based on the level of HBV DNA (preemptive treatment or monitoring and vaccination). In patients with low risk, HBV vaccination is another possible approach, although further studies are needed to assess the type of preemptive strategy.
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Affiliation(s)
- Florian MORETTO
- Infectious Diseases Department, Dijon University Hospital, 21079 Dijon, France; (F.M.); (F.-X.C.); (C.E.); (M.B.)
| | - François-Xavier CATHERINE
- Infectious Diseases Department, Dijon University Hospital, 21079 Dijon, France; (F.M.); (F.-X.C.); (C.E.); (M.B.)
| | - Clémentine ESTEVE
- Infectious Diseases Department, Dijon University Hospital, 21079 Dijon, France; (F.M.); (F.-X.C.); (C.E.); (M.B.)
| | - Mathieu BLOT
- Infectious Diseases Department, Dijon University Hospital, 21079 Dijon, France; (F.M.); (F.-X.C.); (C.E.); (M.B.)
- INSERM CIC 1432, Module Plurithématique, University of Burgundy, 21079 Dijon, France
| | - Lionel PIROTH
- Infectious Diseases Department, Dijon University Hospital, 21079 Dijon, France; (F.M.); (F.-X.C.); (C.E.); (M.B.)
- INSERM CIC 1432, Module Plurithématique, University of Burgundy, 21079 Dijon, France
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17
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Oliveira DS, Hillal JPD, Cordova DDP, de Araujo DB. The lupus patient traveller: a guide to the rheumatologist. Lupus 2019; 28:1690-1698. [PMID: 31718420 DOI: 10.1177/0961203319888688] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
With an increasing number of international journeys occurring daily, there is also an increase in the need for appropriate medical advice for patients who will undertake such travel. In this context, the lupus patient presents a great challenge to the rheumatologist. However, the demand for such information by patients is low, and it has proven difficult for the medical community to adequately provide it. In this article, we carried out a literature review of the medical recommendations made for the lupus patient in order to guide the rheumatologist through the topic of travel medicine.
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Affiliation(s)
- D S Oliveira
- Internal Medicine Department, Universidade Federal de Pelotas, Brazil
| | - J P D Hillal
- Internal Medicine Department, Universidade Federal de Pelotas, Brazil
| | - D D P Cordova
- Internal Medicine Department, Universidade Federal de Pelotas, Brazil
| | - D B de Araujo
- Internal Medicine Department, Universidade Federal de Pelotas, Brazil
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18
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Rondaan C, Furer V, Heijstek MW, Agmon-Levin N, Bijl M, Breedveld FC, D'Amelio R, Dougados M, Kapetanovic MC, van Laar JM, Ladefoged de Thurah A, Landewé R, Molto A, Müller-Ladner U, Schreiber K, Smolar L, Walker J, Warnatz K, Wulffraat NM, van Assen S, Elkayam O. Efficacy, immunogenicity and safety of vaccination in adult patients with autoimmune inflammatory rheumatic diseases: a systematic literature review for the 2019 update of EULAR recommendations. RMD Open 2019; 5:e001035. [PMID: 31565247 PMCID: PMC6744079 DOI: 10.1136/rmdopen-2019-001035] [Citation(s) in RCA: 86] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 08/01/2019] [Accepted: 08/06/2019] [Indexed: 12/18/2022] Open
Abstract
Aim To present a systematic literature review (SLR) on efficacy, immunogenicity and safety of vaccination in adult patients with autoimmune inflammatory rheumatic diseases (AIIRD), aiming to provide a basis for updating the EULAR evidence-based recommendations. Methods An SLR was performed according to the standard operating procedures for EULAR-endorsed recommendations. Outcome was determined by efficacy, immunogenicity and safety of vaccination in adult patients with AIIRD, including those receiving immunomodulating therapy. Furthermore, a search was performed on the effect of vaccinating household members of patients with AIIRD on the occurrence of vaccine-preventable infections in patients and their household members (including newborns). The literature search was performed using Medline, Embase and the Cochrane Library (October 2009 to August 2018). Results While most investigated vaccines were efficacious and/or immunogenic in patients with AIIRD, some were less efficacious than in healthy control subjects, and/or in patients receiving immunosuppressive agents. Adverse events of vaccination were generally mild and the rates were comparable to those in healthy persons. Vaccination did not seem to lead to an increase in activity of the underlying AIIRD, but insufficient power of most studies precluded arriving at definite conclusions. The number of studies investigating clinical efficacy of vaccination is still limited. No studies on the effect of vaccinating household members of patients with AIIRD were retrieved. Conclusion Evidence on efficacy, immunogenicity and safety of vaccination in patients with AIIRD was systematically reviewed to provide a basis for updated recommendations.
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Affiliation(s)
- Christien Rondaan
- Medical microbiology and infection prevention, UMCG, Groningen, The Netherlands.,Rheumatology and Clinical Immunology, UMCG, Groningen, The Netherlands
| | - Victoria Furer
- Rheumatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Faculty of Medicine, Tel Aviv University Sackler, Tel Aviv, Israel
| | - Marloes W Heijstek
- Internal Medicine and Allergology, Rheumatology and Clinical Immunology, UMC Utrecht, Utrecht, The Netherlands
| | - Nancy Agmon-Levin
- Faculty of Medicine, Tel Aviv University Sackler, Tel Aviv, Israel.,Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, Israel
| | - Marc Bijl
- Internal Medicine, Martini Hospital, Groningen, The Netherlands
| | - Ferdinand C Breedveld
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Raffaele D'Amelio
- Dipartimento di Medicina Clinica e Molecolare, Sapienza University of Rome, Roma, Italy
| | - Maxime Dougados
- Hopital Cochin, Rheumatology, Université Paris Descartes, Paris, France.,Clinical epidemiology and biostatistics, PRES Sorbonne Paris- Cité, Paris, France
| | - Meliha C Kapetanovic
- Department of Clinical Sciences, Section for Rheumatology, Lund University, Lund and Skåne University Hospital, Lund, Sweden
| | - Jacob M van Laar
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Robert Landewé
- Clinical Immunology & Rheumatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.,Rheumatology, Zuyderland Medical Centre, Sittard-Geleen - Heerlen, The Netherlands
| | - Anna Molto
- Hopital Cochin, Rheumatology, Université Paris Descartes, Paris, France
| | - Ulf Müller-Ladner
- Rheumatology and Clinical Immunology, Giessen University, Giessen, Germany
| | - Karen Schreiber
- Department of Thrombosis and Haemophilia, Guy's and Saint Thomas' Hospitals NHS Trust, London, UK.,Rheumatology, King Christian X's Hospital for Rheumatic Diseases in Gråsten, Graasten, Denmark
| | - Leo Smolar
- Patient Research Partner, Tel Aviv, Israel
| | - Jim Walker
- Patient Research Partner, Elgin, Scotland
| | - Klaus Warnatz
- Centre for Chronic Immunodeficiency, University Medical Centre Freiburg, Freiburg, Germany
| | - Nico M Wulffraat
- Pediatric Rheumatology, Wilhelmina Kinderziekenhuis, Utrecht, The Netherlands
| | - Sander van Assen
- Internal medicine (infectious diseases), Treant Care Group, Hoogeveen, The Netherlands
| | - Ori Elkayam
- Rheumatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Faculty of Medicine, Tel Aviv University Sackler, Tel Aviv, Israel
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19
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Vaccination Recommendations for Adults With Autoimmune Inflammatory Rheumatic Diseases in Latin America. J Clin Rheumatol 2019; 24:138-147. [PMID: 29232324 DOI: 10.1097/rhu.0000000000000624] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND/OBJECTIVE Patients with autoimmune inflammatory rheumatic diseases (AIRDs) are at increased risk of contracting severe infections and suffering complications, particularly when they are receiving immunomodulating therapy. Vaccination is an important means to prevent many potential infections and thereby reduce the morbidity and mortality associated with AIRD. The purpose of this consensus document is to provide health care professionals with recommendations for the vaccination of AIRD patients who reside in Latin America. The recommendations were developed by an expert committee from the region based on a review of the literature and their clinical experience. METHODS The Americas Health Foundation (AHF) used PubMed and EMBASE to identify clinicians and scientists with an academic or hospital affiliation and who had published in the field of adult vaccination and rheumatic diseases since 2010. As a result of this effort, AHF convened an 8-member panel of clinical and scientific experts from Latin America. Both the AHF and panel members conducted a careful literature review to identify relevant publications in the areas of adult vaccination and rheumatology, and the sum of the articles identified was provided to the entire panel. Prior to the conference, panelists were each asked to prepare a written response to a salient issue on the subject, identified by AHF. RESULTS AND CONCLUSIONS During the conference, each response was edited by the entire group, through numerous drafts and rounds of discussion until a complete consensus on vaccination recommendations for adult patients with AIRDs was obtained, including 7 key recommendations.
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20
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Furer V, Rondaan C, Heijstek MW, Agmon-Levin N, van Assen S, Bijl M, Breedveld FC, D'Amelio R, Dougados M, Kapetanovic MC, van Laar JM, de Thurah A, Landewé RBM, Molto A, Müller-Ladner U, Schreiber K, Smolar L, Walker J, Warnatz K, Wulffraat NM, Elkayam O. 2019 update of EULAR recommendations for vaccination in adult patients with autoimmune inflammatory rheumatic diseases. Ann Rheum Dis 2019; 79:39-52. [DOI: 10.1136/annrheumdis-2019-215882] [Citation(s) in RCA: 357] [Impact Index Per Article: 71.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 07/19/2019] [Accepted: 07/22/2019] [Indexed: 12/16/2022]
Abstract
To update the European League Against Rheumatism (EULAR) recommendations for vaccination in adult patients with autoimmune inflammatory rheumatic diseases (AIIRD) published in 2011. Four systematic literature reviews were performed regarding the incidence/prevalence of vaccine-preventable infections among patients with AIIRD; efficacy, immunogenicity and safety of vaccines; effect of anti-rheumatic drugs on the response to vaccines; effect of vaccination of household of AIIRDs patients. Subsequently, recommendations were formulated based on the evidence and expert opinion. The updated recommendations comprise six overarching principles and nine recommendations. The former address the need for an annual vaccination status assessment, shared decision-making and timing of vaccination, favouring vaccination during quiescent disease, preferably prior to the initiation of immunosuppression. Non-live vaccines can be safely provided to AIIRD patients regardless of underlying therapy, whereas live-attenuated vaccines may be considered with caution. Influenza and pneumococcal vaccination should be strongly considered for the majority of patients with AIIRD. Tetanus toxoid and human papilloma virus vaccination should be provided to AIIRD patients as recommended for the general population. Hepatitis A, hepatitis B and herpes zoster vaccination should be administered to AIIRD patients at risk. Immunocompetent household members of patients with AIIRD should receive vaccines according to national guidelines, except for the oral poliomyelitis vaccine. Live-attenuated vaccines should be avoided during the first 6 months of life in newborns of mothers treated with biologics during the second half of pregnancy. These 2019 EULAR recommendations provide an up-to-date guidance on the management of vaccinations in patients with AIIRD.
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21
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Guía de práctica clínica para el manejo del lupus eritematoso sistémico propuesta por el Colegio Mexicano de Reumatología. ACTA ACUST UNITED AC 2019; 15:3-20. [DOI: 10.1016/j.reuma.2018.03.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 03/20/2018] [Accepted: 03/21/2018] [Indexed: 12/31/2022]
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22
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Mertoglu S, Sahin S, Beser OF, Adrovic A, Barut K, Yuksel P, Sazak S, Kocazeybek BS, Kasapcopur O. Hepatitis A virus vaccination in childhood-onset systemic lupus erythematosus. Lupus 2018; 28:234-240. [PMID: 30551721 DOI: 10.1177/0961203318819827] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives: Vaccination of systemic lupus erythematosus patients with non-live vaccines may decrease vaccine-preventable infections and mortalities. In the present study, we aimed to compare the immunogenicity and safety of inactivated hepatitis A vaccination in childhood-onset systemic lupus erythematosus and healthy subjects. Methods: A total of 30 childhood-onset systemic lupus erythematosus and 39 healthy participants who were seronegative for hepatitis A received two doses of the hepatitis A vaccine in a 0- and 6-month schedule. Hepatitis A virus (HAV) IgG antibodies were measured before vaccination and 7 months after the vaccination. Results: Although anti-HAV IgG antibody titers after vaccination were found to be somewhat lower in children with systemic lupus erythematosus than that of the healthy subjects ( p < 0.05), the difference in seroconversion rate was insignificant between childhood-onset systemic lupus erythematosus patients ( n = 24/30, 80%) and healthy controls ( n = 33/39, 84.6%). There was no increase in median Systemic Lupus Erythematosus Disease Activity Index (SLEDAI)-2K scores and anti-ds DNA levels after the vaccination procedure. Seroconversion rates in childhood-onset systemic lupus erythematosus patients were not affected by medication, high disease activity (SLEDAI-2K >6) and anti-ds DNA positivity. None of the patients experienced any flare or adverse reaction throughout the study. Conclusions: According to these results, we conclude that inactivated hepatitis A vaccine is safe and well tolerated in childhood-onset systemic lupus erythematosus patients, with no adverse events or increase in activity. Immunogenicity to the hepatitis A vaccine was adequate, with a seropositivity rate of 80%.
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Affiliation(s)
- S Mertoglu
- Department of Pediatric Rheumatology, Istanbul University, Istanbul, Turkey
| | - S Sahin
- Department of Pediatric Rheumatology, Istanbul University, Istanbul, Turkey
| | - O F Beser
- Department of Pediatrics, Okmeydani Education and Training Hospital, Istanbul, Turkey
| | - A Adrovic
- Department of Pediatric Rheumatology, Istanbul University, Istanbul, Turkey
| | - K Barut
- Department of Pediatric Rheumatology, Istanbul University, Istanbul, Turkey
| | - P Yuksel
- Department of Microbiology, Istanbul University, Istanbul, Turkey
| | - S Sazak
- Department of Pediatrics, Okmeydani Education and Training Hospital, Istanbul, Turkey
| | - B S Kocazeybek
- Department of Microbiology, Istanbul University, Istanbul, Turkey
| | - O Kasapcopur
- Department of Pediatric Rheumatology, Istanbul University, Istanbul, Turkey
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23
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Aluminum in vaccines: Does it create a safety problem? Vaccine 2018; 36:5825-5831. [PMID: 30139653 DOI: 10.1016/j.vaccine.2018.08.036] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Revised: 08/03/2018] [Accepted: 08/15/2018] [Indexed: 12/21/2022]
Abstract
For almost a century, aluminum (Al) in the form of Al oxyhydroxide (a crystalline compound), Al hydroxyphosphate (an amorphous Al phosphate hydroxide), Al phosphate, and Al potassium sulfate has been used to improve the immunogenicity of vaccines. Al is currently included in vaccines against tetanus, hepatitis A, hepatitis B, human papillomavirus, Haemophilus influenzae type b, and infections due to Streptococcus pneumoniae and Neisseria meningitidis. Official health authorities consider the inclusion of Al in most of the presently recommended vaccines to be extremely effective and sufficiently safe. However, the inclusion of Al salts in vaccines has been debated for several years because of studies that seem to indicate that chronic Al exposure through vaccine administration can interfere with cellular and metabolic processes leading to severe neurologic diseases. Children, who in their first years of life receive several vaccine doses over a reduced period of time, would be most susceptible to any risk that might be associated with vaccines or vaccine components. The main aim of this paper was to discuss the data presently available regarding Al neurotoxicity and the risk for children receiving vaccines or other pharmaceutical preparations containing Al. Analysis of the literature showed that no apparent reason exists to support the elimination of Al from vaccines for fear of neurotoxicity. The only problem that deserves attention is the suggested relationship between Al oxyhydroxide-containing vaccines and macrophagic myofaciitis or myalgic encephalomyelitis/chronic fatigue syndrome. Currently, definitive conclusions cannot be drawn on these risks and further studies must be conducted. Until then, Al remains the best solution to improve vaccine efficacy.
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24
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Recommendations and barriers to vaccination in systemic lupus erythematosus. Autoimmun Rev 2018; 17:990-1001. [PMID: 30103044 DOI: 10.1016/j.autrev.2018.04.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 04/12/2018] [Indexed: 01/06/2023]
Abstract
Patients with Systemic Lupus Erythematosus (SLE) pose a unique dilemma pertaining to immunization against common pathogens. SLE patients are usually not immunized with vaccines based on the fear of either precipitating infection in this immunosuppressed patient population (with live vaccines) or aggravating autoimmunity and hence lupus flares (with any vaccines). However, elevated vulnerability to infection makes patients with SLE precisely the population that needs protection from vaccine-preventable diseases. A summary of guidelines from the Centers for Disease Control and Prevention, professional societies, review articles and expert opinions regarding use of individual vaccines applicable to adults with SLE is presented in this review.
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25
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Elwood JM, Ameratunga R. Autoimmune diseases after hepatitis B immunization in adults: Literature review and meta-analysis, with reference to 'autoimmune/autoinflammatory syndrome induced by adjuvants' (ASIA). Vaccine 2018; 36:5796-5802. [PMID: 30100071 DOI: 10.1016/j.vaccine.2018.07.074] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 07/20/2018] [Accepted: 07/27/2018] [Indexed: 12/26/2022]
Abstract
BACKGROUND To assess if hepatitis B vaccination in adults is causally associated with autoimmune diseases. Such causation has been claimed based mainly on case reports and uncontrolled studies, and a syndrome 'Autoimmune/autoinflammatory Disorder Induced by Adjuvants' (ASIA) has been claimed to be linked to immunization, particularly hepatitis B vaccination. METHODS Review of peer-reviewed literature from January 1990 to March 2017 identifying controlled studies with documented incidence of autoimmune diseases occurring after hepatitis B vaccinations in adults. From 1297 studies identified, 259 were further assessed and 49 reviewed further; 19 relevant papers reporting 21 results are reviewed here, and 14 results included in a meta-analysis. RESULTS Overall no association between hepatitis B vaccination and the onset of autoimmune diseases was seen. The overall odds ratio was 1.06, with 95% confidence limits of 0.93-1.21, with non-significant heterogeneity. Only one study showed a significant excess risk between hepatitis B immunisation and autoimmune disease. CONCLUSIONS Despite multiple case reports, there is no reliable scientific evidence of autoimmune diseases being caused by hepatitis B vaccinations.
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Affiliation(s)
- J Mark Elwood
- School of Population Health, Faculty of Medicine and Health Sciences, University of Auckland, Private Bag 92019, Auckland Mail Centre, Auckland 1142, New Zealand.
| | - Rohan Ameratunga
- Department of Virology and Immunology, Auckland Hospital, Park Rd, Grafton, Auckland 1010, New Zealand
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26
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Ameratunga R, Gillis D, Langguth D, Hawkes D, Linneberg A, Elwood M. Ad hominem attacks on vaccine safety researchers. Vaccine 2018; 36:3886-3887. [PMID: 29454520 DOI: 10.1016/j.vaccine.2018.01.053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 01/19/2018] [Indexed: 11/25/2022]
Affiliation(s)
- Rohan Ameratunga
- Department of Virology and Immunology, Auckland Hospital, Park Rd, Grafton 1010, Auckland, New Zealand.
| | - David Gillis
- University of Queensland, Brisbane, Queensland, Australia
| | - Daman Langguth
- Sandford Jackson Building, Suite 94, L5 30/30 Chasely St, Auchenflower, QLD 4065, Australia
| | - David Hawkes
- VCS Pathology, Carlton, Australia; Department of Pharmacology and Therapeutics, University of Melbourne, Parkville, Australia
| | - Allan Linneberg
- Research Centre for Prevention and Health, The Capital Region of Denmark, Copenhagen, Denmark; Department of Clinical Experimental Research, Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Mark Elwood
- School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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27
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Ameratunga R, Langguth D, Hawkes D. Perspective: Scientific and ethical concerns pertaining to animal models of autoimmune/autoinflammatory syndrome induced by adjuvants (ASIA). Autoimmun Rev 2018. [DOI: 10.1016/j.autrev.2017.11.033] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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28
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Ameratunga R, Gillis D, Gold M, Linneberg A, Hawkes D, Langguth D, Elwood M. Reply to Crépeaux et al and Blasco. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2018. [PMID: 29525003 DOI: 10.1016/j.jaip.2017.11.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Rohan Ameratunga
- Department of Virology and Immunology, Auckland Hospital, Grafton, Auckland, New Zealand.
| | - David Gillis
- University of Queensland, Brisbane, Queensland, Australia
| | - Michael Gold
- Discipline of Paediatrics, School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - Allan Linneberg
- Research Centre for Prevention and Health, the Capital Region of Denmark, Copenhagen, Denmark; Department of Clinical Experimental Research, Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - David Hawkes
- Victorian Cytology Service, Carlton, Victoria, Australia; Department of Pharmacology and Therapeutics, University of Melbourne, Parkville, Melbourne, Victoria, Australia
| | - Daman Langguth
- Sandford Jackson Building, Suite 94, L5 30/30 Chasely St, Auchenflower, Brisbane, Queensland, Australia
| | - Mark Elwood
- School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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Ameratunga R, Gillis D, Gold M, Linneberg A, Elwood JM. Evidence Refuting the Existence of Autoimmune/Autoinflammatory Syndrome Induced by Adjuvants (ASIA). THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2017; 5:1551-1555.e1. [PMID: 28888842 DOI: 10.1016/j.jaip.2017.06.033] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2017] [Revised: 06/07/2017] [Accepted: 06/30/2017] [Indexed: 12/14/2022]
Abstract
Autoimmune/autoinflammatory syndrome induced by adjuvants (ASIA) was described in 2011. Over time the condition and its triggers have broadened to include several autoimmune disorders, the macrophagic myofasciitis syndrome, the Gulf war syndrome, the sick building syndrome, siliconosis, and the chronic fatigue syndrome. The aluminum-containing adjuvants in the hepatitis B vaccine and the human papillomavirus vaccine in particular have been stated to be the major causes of the disorder. Here, we review the specificity of the diagnostic criteria for ASIA. We also examine relevant human data, pertaining to causation, particularly from patients undergoing allergen-specific immunotherapy (IT). Patients undergoing allergen-specific IT receive 100 to 500 times more injected aluminum over 3 to 5 years, compared with hepatitis B and human papillomavirus vaccine recipients. In a large pharmacoepidemiological study, in contrast to case series of ASIA, patients receiving aluminum-containing allergen IT preparations were shown to have a lower incidence of autoimmune disease. In another clinical trial, there were no increases in exacerbations in a cohort of patients with systemic lupus erythematosus immunized with the hepatitis B vaccine. Current data do not support the causation of ASIA by vaccine adjuvants containing aluminum, which should be of reassurance to patients undergoing routine immunizations as well as to those undergoing allergen-specific IT.
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Affiliation(s)
- Rohan Ameratunga
- Department of Virology and Immunology, Auckland Hospital, Auckland, New Zealand.
| | - David Gillis
- University of Queensland, Brisbane, Queensland, Australia
| | - Michael Gold
- Discipline of Paediatrics, School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - Allan Linneberg
- Research Centre for Prevention and Health, the Capital Region of Denmark, Copenhagen, Denmark; Department of Clinical Experimental Research, Rigshospitalet, Copenhagen, Denmark; Faculty of Health and Medical Sciences, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - J Mark Elwood
- Faculty of Medical and Health Sciences, School of Population Health, University of Auckland, Auckland, New Zealand
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Bragazzi NL, Watad A, Sharif K, Adawi M, Aljadeff G, Amital H, Shoenfeld Y. Advances in our understanding of immunization and vaccines for patients with systemic lupus erythematosus. Expert Rev Clin Immunol 2017; 13:939-949. [DOI: 10.1080/1744666x.2017.1361321] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Nicola Luigi Bragazzi
- School of Public Health, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Abdulla Watad
- Departement of Medicine ‘B’, Sheba Medical Center, Tel-Hashomer, Ramat Gan, Israel
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Kassem Sharif
- Departement of Medicine ‘B’, Sheba Medical Center, Tel-Hashomer, Ramat Gan, Israel
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Mohammad Adawi
- Faculty of Medicine, Baruch Padeh Medical Center, Bar-Ilan University, Israel
| | - Gali Aljadeff
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Howard Amital
- Departement of Medicine ‘B’, Sheba Medical Center, Tel-Hashomer, Ramat Gan, Israel
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Yehuda Shoenfeld
- Departement of Medicine ‘B’, Sheba Medical Center, Tel-Hashomer, Ramat Gan, Israel
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Thomas K, Vassilopoulos D. Immunization in patients with inflammatory rheumatic diseases. Best Pract Res Clin Rheumatol 2016; 30:946-963. [PMID: 27964798 DOI: 10.1016/j.berh.2016.10.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Revised: 10/16/2016] [Accepted: 10/17/2016] [Indexed: 12/25/2022]
Abstract
Immunization represents the most efficient and simplest intervention to prevent certain viral and bacterial infections in the general population as well as in the vulnerable population of patients with inflammatory rheumatic diseases treated with immunosuppressives. Here, we present an updated review of literature data regarding the safety and efficacy of immunizations against different pathogens in rheumatic patients treated with conventional immunosuppressives or the newer biologic agents while at the same time we provide practical guidance for the appropriate vaccine administration in this patient population.
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Affiliation(s)
- Konstantinos Thomas
- Joint Rheumatology Program, Clinical Immunology-Rheumatology Unit, 2nd Department of Medicine and Laboratory, National and Kapodistrian University of Athens School of Medicine, Hippokration General Hospital, 114 Vass. Sophias Ave., 115 27, Athens, Greece
| | - Dimitrios Vassilopoulos
- Joint Rheumatology Program, Clinical Immunology-Rheumatology Unit, 2nd Department of Medicine and Laboratory, National and Kapodistrian University of Athens School of Medicine, Hippokration General Hospital, 114 Vass. Sophias Ave., 115 27, Athens, Greece.
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Gómez Muñoz JM, Gómez Rincón JC, Alí Munive A, Cano Gutierrez CA, Coral Alvarado PX, Coronell Rodríguez W, Cortés Luna J, Duarte Romero M, Londoño Palacio N, Maldonado Chaya I, Palacio Eastman AC, Porras Ramirez A. Guías para la inmunización del adolescente y adulto en Colombia. Documento de actualización, 2016. INFECTIO 2016. [DOI: 10.1016/j.infect.2016.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Banerjee S, Dissanayake PV, Abeyagunawardena AS. Vaccinations in children on immunosuppressive medications for renal disease. Pediatr Nephrol 2016; 31:1437-48. [PMID: 26450774 DOI: 10.1007/s00467-015-3219-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 09/01/2015] [Accepted: 09/03/2015] [Indexed: 12/19/2022]
Abstract
Renal diseases are often treated with immunosuppressive medications, placing patients at risk of infections, some of which are vaccine-preventable. However, in such patients vaccinations may be delayed or disregarded due to complications of the underlying disease process and challenges in its management. The decision to administer vaccines to immunosuppressed children is a risk-benefit balance as such children may have a qualitatively diminished immunological response or develop diseases caused by the vaccine pathogen. Vaccination may cause a flare-up of disease activity or provocation of graft rejection in renal transplant recipients. Moreover, it cannot be assumed that a given antibody level provides the same protection in immunosupressed children as in healthy ones. We have evaluated the safety and efficacy of licensed vaccines in children on immunosuppressive therapy and in renal transplant recipients. The limited evidence available suggests that vaccines are most effective if given early, ideally before the requirement for immunosuppressive therapy, which may require administration of accelerated vaccine courses. Once treatment with immunosuppressive drugs is started, inactivated vaccines are usually considered to be safe when the disease is quiescent, but supplemental doses may be required. In the majority of cases, live vaccines are to be avoided. All vaccines are generally contraindicated within 3-6 months of a renal transplant.
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Wiedermann U, Sitte HH, Burgmann H, Eser A, Falb P, Holzmann H, Kitchen M, Köller M, Kollaritsch H, Kundi M, Lassmann H, Mutz I, Pickl WF, Riedl E, Sibilia M, Thalhammer F, Tucek B, Zenz W, Zwiauer K. [Guidelines for vaccination of immunocompromised individuals]. Wien Klin Wochenschr 2016; 128 Suppl 4:337-76. [PMID: 27457874 DOI: 10.1007/s00508-016-1033-6] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 06/04/2016] [Indexed: 12/14/2022]
Abstract
Immunosuppression of various origins is associated with an increased risk of infection; therefore the prevention of infectious diseases by vaccination is especially important in immunocompromised patients. However, the response to vaccinations is often reduced in these risk groups and the application of live vaccines is contraindicated during immunosuppression.In the following expert statement, recommendations for vaccination were created on the basis of current evidence and theoretical/immunological considerations. A first, general part elaborates on efficacy and safety of vaccinations during immunosuppression, modes of action of immunosuppressive medications and recommended time intervals between immunosuppressive treatments and vaccinations. A core piece of this part is a graduation of immunosuppression into three stages, i. e. no relevant immunosuppression, mild to moderate and severe immunosuppression and the assignment of various medications (including biologicals) to one of those stages; this is followed by an overview of possible and necessary vaccinations in each of those stages.The second part gives detailed vaccination guidelines for common diseases and therapies associated with immunosuppression. Primary immune deficiencies, chronic kidney disease, diabetes mellitus, solid and hematological tumors, hematopoetic stem cell transplantation, transplantation of solid organs, aspenia, rheumatological-, gastroenterologic-, dermatologic-, neurologic diseases, biologicals during pregnancy and HIV infection are dealt with.These vaccination guidelines, compiled for the first time in Austria, aim to be of practical help for physicians to facilitate and improve vaccination coverage in immunocompromised patients and their household members and contact persons.
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Affiliation(s)
- Ursula Wiedermann
- Institut für Spezifische Prophylaxe und Tropenmedizin, Medizinische Universität Wien, Kinderspitalgasse 15, 1090, Wien, Österreich.
| | - Harald H Sitte
- Institut für Pharmakologie, Medizinische Universität Wien, Wien, Österreich
| | - Heinz Burgmann
- Klinische Abteilung für Infektionen und Tropenmedizin, Medizinische Universität Wien, Wien, Österreich
| | - Alexander Eser
- Klinische Abteilung für Gastroenterologie und Hepatologie, Medizinische Universität Wien, Wien, Österreich
| | - Petra Falb
- Medizinmarktaufsicht, Agentur für Gesundheit und Ernährungssicherheit, Wien, Österreich
| | | | - Maria Kitchen
- Universitätsklinik für Dermatologie und Venerologie, Medizinische Universität Innsbruck, Innsbruck, Österreich
| | - Marcus Köller
- Sozialmedizinisches Zentrum Sophienspital, Wien, Österreich
| | - Herwig Kollaritsch
- Institut für Spezifische Prophylaxe und Tropenmedizin, Medizinische Universität Wien, Kinderspitalgasse 15, 1090, Wien, Österreich
| | - Michael Kundi
- Institut für Umwelthygiene, Medizinische Universität Wien, Wien, Österreich
| | - Hans Lassmann
- Abteilung für Neuroimmunologie, Medizinische Universität Wien, Wien, Österreich
| | | | - Winfried F Pickl
- Institut für Immunologie, Medizinische Universität Wien, Wien, Österreich
| | - Elisabeth Riedl
- Universitätsklinik für Dermatologie, Medizinische Universität Wien, Wien, Österreich
| | - Maria Sibilia
- Institut für Krebsforschung, Medizinische Universität Wien, Wien, Österreich
| | - Florian Thalhammer
- Klinische Abteilung für Infektionen und Tropenmedizin, Medizinische Universität Wien, Wien, Österreich
| | - Barbara Tucek
- Medizinmarktaufsicht, Agentur für Gesundheit und Ernährungssicherheit, Wien, Österreich
| | - Werner Zenz
- Klinische Abteilung für allgemeine Pädiatrie, Medizinische Universität Graz, Graz, Österreich
| | - Karl Zwiauer
- Klinische Abteilung für Kinder- und Jugendheilkunde, Universitätsklinikum St. Pölten, St. Pölten, Österreich
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Watanabe R, Ishii T, Harigae H. Pretreatment Screening for Hepatitis B Virus Infection in Patients with Systemic Lupus Erythematosus. TOHOKU J EXP MED 2016; 237:9-15. [PMID: 26288957 DOI: 10.1620/tjem.237.9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Hepatitis B virus (HBV) infection is one of the most common diseases, and approximately two billion people are infected with HBV in the world. Until recently, hepatitis B surface antigen (HBsAg)-negative patients, carrying hepatitis B surface antibody (anti-HBs) and/or hepatitis B core antibody (anti-HBc), have been considered to have achieved the resolution of HBV infection; however, among those patients, the reactivation of HBV has been increasingly reported after chemotherapy, hematopoietic stem cell transplantation, or immunosuppressive therapy. The reactivation of HBV can cause lethal hepatitis called de novo hepatitis B. Therefore, serological examination for HBV infection before starting immunosuppressive therapy is now recommended for all patients with rheumatic diseases. Systemic lupus erythematosus (SLE) is one of the autoimmune diseases characterized by the production of autoantibodies and usually requires immunosuppressive therapy. However, to date, a few reports are available regarding the prevalence and time course of HBV infection in patients with SLE under immunosuppressive therapy. In this review, we update the prevalence and time course of HBV infection in lupus patients using our data and previous papers available, with a special emphasis on occult HBV infection and a decrease of HBV-related antibodies (anti-HBs and anti-HBc) under immunosuppressive therapy. This review also highlights the screening and management of HBV infection currently recommended and the potential role of HBV infection in the pathogenesis of SLE. Throughout the present review, we recommend the pretreatment screening for HBV infection in patients with SLE as well as patients with other rheumatic diseases.
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Affiliation(s)
- Ryu Watanabe
- Department of Hematology and Rheumatology, Tohoku University Graduate School of Medicine
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36
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Mathian A, Arnaud L, Adoue D, Agard C, Bader-Meunier B, Baudouin V, Belizna C, Bonnotte B, Boumedine F, Chaib A, Chauchard M, Chiche L, Daugas E, Ghali A, Gobert P, Gondran G, Guettrot-Imbert G, Hachulla E, Hamidou M, Haroche J, Hervier B, Hummel A, Jourde-Chiche N, Korganow AS, Kwon T, Le Guern V, Le Quellec A, Limal N, Magy-Bertrand N, Marianetti-Guingel P, Martin T, Martin Silva N, Meyer O, Miyara M, Morell-Dubois S, Ninet J, Pennaforte JL, Polomat K, Pourrat J, Queyrel V, Raymond I, Remy P, Sacre K, Sibilia J, Viallard JF, Viau Brabant A, Hanslik T, Amoura Z. Prévention des infections au cours du lupus systémique chez l’adulte et l’adolescent : élaboration de recommandations pour la pratique clinique, à partir d’une analyse de la littérature et de l’avis d’experts. Rev Med Interne 2016; 37:307-20. [DOI: 10.1016/j.revmed.2016.01.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Revised: 01/03/2016] [Accepted: 01/05/2016] [Indexed: 12/21/2022]
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Grein IHR, Groot N, Lacerda MI, Wulffraat N, Pileggi G. HPV infection and vaccination in Systemic Lupus Erythematosus patients: what we really should know. Pediatr Rheumatol Online J 2016; 14:12. [PMID: 26956735 PMCID: PMC4782298 DOI: 10.1186/s12969-016-0072-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 02/25/2016] [Indexed: 12/30/2022] Open
Abstract
Patients with Systemic Lupus Erythematosus (SLE) are at increased risk for infections. Vaccination is a powerful tool to prevent infections, even in immunocompromised patients. Most non-live vaccines are immunogenic and safe in patients with SLE, even if antibody titres are frequently lower than those of healthy controls. Human papillomavirus (HPV) infections are more prevalent in SLE patients when compared to the healthy population. Low-risk types of this virus cause anogenital warts, while high risk types are strongly related to pre-malignant cervical abnormalities and cervical cancer. HPV vaccines have been developed to prevent these conditions. Although little is known about HPV vaccination in SLE, few studies in patients with autoimmune rheumatic diseases (AIRDs) have shown that HPV vaccines are safe, and capable to induce an immunogenic response in this group of patients. To date, available data suggest that HPV vaccines can be given safely to SLE patients. Given the increased incidence of cervical abnormalities due to HPV in SLE patients, this vaccination should be encouraged.
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Affiliation(s)
- Ingrid Herta Rotstein Grein
- Department of Pediatric Immunology and Rheumatology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Room number KC 03.063.0, PO BOX 85090, 3508 AB, Utrecht, The Netherlands.
- Department of Pediatric Rheumatology, Pequeno Príncipe Hospital, Curitiba, Brazil.
| | - Noortje Groot
- Department of Pediatric Immunology and Rheumatology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Room number KC 03.063.0, PO BOX 85090, 3508 AB, Utrecht, The Netherlands.
- Department of Pediatric Immunology, Sophia Children's Hospital - Erasmus MC, Rotterdam, The Netherlands.
| | | | - Nico Wulffraat
- Department of Pediatric Immunology and Rheumatology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Room number KC 03.063.0, PO BOX 85090, 3508 AB, Utrecht, The Netherlands.
| | - Gecilmara Pileggi
- Department of Pediatric, Division of Immunology and Rheumatology, School of Medicine of Ribeirão Preto - University of São Paulo, São Paulo, Brazil.
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Murdaca G, Orsi A, Spanò F, Faccio V, Puppo F, Durando P, Icardi G, Ansaldi F. Vaccine-preventable infections in Systemic Lupus Erythematosus. Hum Vaccin Immunother 2016; 12:632-43. [PMID: 26750996 PMCID: PMC4964666 DOI: 10.1080/21645515.2015.1107685] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Revised: 09/29/2015] [Accepted: 10/09/2015] [Indexed: 12/26/2022] Open
Abstract
Systemic Lupus Erythematosus (SLE) is characterized by abnormal autoantibody production and clearance. Infections are among the most important causes of morbidity and mortality in SLE patients; they have an increased frequency of severe bacterial and viral infections possibly due to inherited genetic and immunologic defects and to immunosuppressive therapies. In addition, infectious agents can switch on lupus disease expression and activity. Among the strategies to reduce the risk of infection, vaccination can be considered the most reliable option. Most vaccines are effective and safe in SLE patients, although in certain cases immunogenicity may be sub-optimal and vaccination can trigger a flare. Although these issues are currently unresolved, the risk benefit balance is in favor for vaccination to reduce the risk of infection in SLE patients. In the present review we discuss the preventive strategies currently recommended to reduce bacterial and viral infections in SLE.
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Affiliation(s)
- Giuseppe Murdaca
- Department of Internal Medicine, University of Genoa, Genoa, Italy and Clinical Immunology Unit, I.R.C.C.S. University Hospital San Martino - IST National Institute for Cancer Research, Genoa, Italy
| | - Andrea Orsi
- Department of Health Sciences, University of Genoa, Genoa, Italy and Hygiene Unit, I.R.C.C.S. University Hospital San Martino - IST National Institute for Cancer Research, Genoa, Italy
| | - Francesca Spanò
- Department of Internal Medicine, University of Genoa, Genoa, Italy and Clinical Immunology Unit, I.R.C.C.S. University Hospital San Martino - IST National Institute for Cancer Research, Genoa, Italy
| | - Valeria Faccio
- Department of Health Sciences, University of Genoa, Genoa, Italy and Hygiene Unit, I.R.C.C.S. University Hospital San Martino - IST National Institute for Cancer Research, Genoa, Italy
| | - Francesco Puppo
- Department of Internal Medicine, University of Genoa, Genoa, Italy and Clinical Immunology Unit, I.R.C.C.S. University Hospital San Martino - IST National Institute for Cancer Research, Genoa, Italy
| | - Paolo Durando
- Department of Health Sciences, University of Genoa, Genoa, Italy and Occupational Medicine Unit, I.R.C.C.S. University Hospital San Martino - IST National Institute for Cancer Research, Genoa, Italy
| | - Giancarlo Icardi
- Department of Health Sciences, University of Genoa, Genoa, Italy and Hygiene Unit, I.R.C.C.S. University Hospital San Martino - IST National Institute for Cancer Research, Genoa, Italy
| | - Filippo Ansaldi
- Department of Health Sciences, University of Genoa, Genoa, Italy and Hygiene Unit, I.R.C.C.S. University Hospital San Martino - IST National Institute for Cancer Research, Genoa, Italy
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Szczygielska I, Hernik E, Kwiatkowska M, Rutkowska-Sak L, Kołodziejczyk B, Gazda A. Assessment of the level of vaccine-induced anti-HBs antibodies in children with inflammatory systemic connective tissue diseases treated with immunosuppression. Reumatologia 2015; 53:56-60. [PMID: 27407228 PMCID: PMC4847274 DOI: 10.5114/reum.2015.51503] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 03/31/2015] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVES Protective vaccinations are the most effective method of prevention of type B virus hepatitis. The aim of the study was to determine whether in children receiving immunosuppressive therapy due to inflammatory systemic connective tissue diseases the protective concentration of the anti-HBs antibodies produced after vaccination against type B virus hepatitis in infancy is maintained. MATERIAL AND METHODS The concentration of anti-HBs antibodies was assessed in the sera of 50 children with inflammatory connective tissue diseases - 37 girls (74%) and 13 boys (26%), aged 1.5-17.5 years - during the immunosuppressive treatment, which lasted at least 6 months. The control group consisted of 50 healthy children - 28 girls (56%) and 22 boys (44%) aged 2-17 years. All children were vaccinated in infancy with Engerix B vaccine according to the 0-1-6 months schedule. The antibody concentration of ≥ 10 mIU/ml in patients is regarded as protective. RESULTS No protective antibody concentrations were found in 25 cases (50%) in the group of diseased children and only in 2 children in the control group (4%). CONCLUSIONS The concentration of vaccine-induced antibodies should be assessed in children with inflammatory systemic connective tissue diseases and, in case of the absence of a protective concentration, revaccination should be started. The use of glucocorticosteroids, synthetic and biological disease-modifying antirheumatic drugs is no contraindication to vaccination against hepatitis B.
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Affiliation(s)
- Izabela Szczygielska
- Department and Polyclinic of Rheumatology of Developmental Age, Institute of Rheumatology in Warsaw, Poland
| | - Elżbieta Hernik
- Department and Polyclinic of Rheumatology of Developmental Age, Institute of Rheumatology in Warsaw, Poland
| | - Małgorzata Kwiatkowska
- Department and Polyclinic of Rheumatology of Developmental Age, Institute of Rheumatology in Warsaw, Poland
| | - Lidia Rutkowska-Sak
- Department and Polyclinic of Rheumatology of Developmental Age, Institute of Rheumatology in Warsaw, Poland
| | - Beata Kołodziejczyk
- Department and Polyclinic of Rheumatology of Developmental Age, Institute of Rheumatology in Warsaw, Poland
| | - Agnieszka Gazda
- Department and Polyclinic of Rheumatology of Developmental Age, Institute of Rheumatology in Warsaw, Poland
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Abstract
Patients with autoimmune inflammatory rheumatic diseases (AIRDs) are at increased risk of infections. This risk has been further increased by the introduction of biologic agents over the past two decades. One of the most effective strategies to prevent infection is vaccination. However, patients with an AIRD have a compromised immune system, which is further impaired by medication. Another important issue is the possibility of triggering a broad nonspecific response by vaccination, potentially resulting in increased activity of the underlying autoimmune disease. In this Review, we provide an analysis of data on vaccination of patients with an AIRD. Both the efficacy and the safety of vaccination are addressed, together with the epidemiology of vaccine-preventable infectious diseases in different subgroups of adults with AIRDs. Special attention is given to vaccination of patients who are treated with biologic agents.
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41
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Kobayashi I, Mori M, Yamaguchi KI, Ito S, Iwata N, Masunaga K, Shimojo N, Ariga T, Okada K, Takei S. Pediatric Rheumatology Association of Japan recommendation for vaccination in pediatric rheumatic diseases. Mod Rheumatol 2014; 25:335-43. [DOI: 10.3109/14397595.2014.969916] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Soriano A, Nesher G, Shoenfeld Y. Predicting post-vaccination autoimmunity: who might be at risk? Pharmacol Res 2014; 92:18-22. [PMID: 25277820 DOI: 10.1016/j.phrs.2014.08.002] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2014] [Revised: 08/12/2014] [Accepted: 08/14/2014] [Indexed: 01/06/2023]
Abstract
Vaccinations have been used as an essential tool in the fight against infectious diseases, and succeeded in improving public health. However, adverse effects, including autoimmune conditions may occur following vaccinations (autoimmune/inflammatory syndrome induced by adjuvants--ASIA syndrome). It has been postulated that autoimmunity could be triggered or enhanced by the vaccine immunogen contents, as well as by adjuvants, which are used to increase the immune reaction to the immunogen. Fortunately, vaccination-related ASIA is uncommon. Yet, by defining individuals at risk we may further limit the number of individuals developing post-vaccination ASIA. In this perspective we defined four groups of individuals who might be susceptible to develop vaccination-induced ASIA: patients with prior post-vaccination autoimmune phenomena, patients with a medical history of autoimmunity, patients with a history of allergic reactions, and individuals who are prone to develop autoimmunity (having a family history of autoimmune diseases; asymptomatic carriers of autoantibodies; carrying certain genetic profiles, etc.).
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Affiliation(s)
- Alessandra Soriano
- Department of Clinical Medicine and Rheumatology, Campus Bio-Medico University, Rome, Italy
| | - Gideon Nesher
- Department of Internal Medicine A, Shaare Zedek Medical Center, and the Hebrew University Medical School, Jerusalem, Israel.
| | - Yehuda Shoenfeld
- The Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Sackler Faculty of Medicine, Incumbent of the Laura Schwarz-Kip Chair for Research of Autoimmune Diseases, Tel-Aviv University, Israel
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Grimaldi-Bensouda L, Le Guern V, Kone-Paut I, Aubrun E, Fain O, Ruel M, Machet L, Viallard JF, Magy-Bertrand N, Daugas E, Rossignol M, Abenhaim L, Costedoat-Chalumeau N. The Risk of Systemic Lupus Erythematosus Associated With Vaccines: An International Case-Control Study. Arthritis Rheumatol 2014; 66:1559-67. [DOI: 10.1002/art.38429] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Accepted: 02/13/2014] [Indexed: 01/05/2023]
Affiliation(s)
| | - Veronique Le Guern
- Université Paris Descartes and AP-HP, Centre Hospitalier Universitaire (CHU) Cochin; Paris France
| | | | | | - Olivier Fain
- Université Paris Nord, Sorbonne Paris-Cité, Paris, France, and AP-HP, CHU Jean Verdier; Bondy France
| | | | - Laurent Machet
- INSERM U930, CNRS ERL 3106, Université François Rabelais de Tours, and Centre Hospitalier Régional Universitaire de Tours; Tours France
| | | | | | | | - Michel Rossignol
- McGill University and LA-SER Center for Risk Research, Montreal; Quebec Canada
| | - Lucien Abenhaim
- LA-SER Europe Ltd. and London School of Hygiene and Tropical Medicine; London UK
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Goldacker S, Gause AM, Warnatz K. [Vaccination in adult patients with chronic inflammatory rheumatic diseases]. Z Rheumatol 2014; 72:690-4, 696-700, 702-4. [PMID: 23929239 DOI: 10.1007/s00393-013-1155-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Patients with chronic inflammatory rheumatic diseases often have an intrinsic and therapy associated increased susceptibility to infections which substantially contributes to morbidity and mortality of the patients. A large proportion of these infections are preventable by vaccination. For this reason in 2005 the standing vaccination committee (STIKO) recommended for patients with immunosuppression vaccination against pneumococcus, influenza, Haemophilus influenza b and meningococcus in addition to standard vaccinations, independent of age. Every patient should therefore be informed about a possible increase in susceptibility to infections and the recommended prevention by vaccination before implementation of immunosuppressive therapy.
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Affiliation(s)
- S Goldacker
- Centrum für Chronische Immmundefizienz, Universitätsklinikum Freiburg und Universität Freiburg, Breisacher Str. 117 - 2. OG, 79106, Freiburg, Deutschland.
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Caza T, Oaks Z, Perl A. Interplay of Infections, Autoimmunity, and Immunosuppression in Systemic Lupus Erythematosus. Int Rev Immunol 2014; 33:330-63. [DOI: 10.3109/08830185.2013.863305] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Papadopoulou D, Sipsas NV. Comparison of national clinical practice guidelines and recommendations on vaccination of adult patients with autoimmune rheumatic diseases. Rheumatol Int 2013; 34:151-63. [PMID: 24322451 DOI: 10.1007/s00296-013-2907-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2013] [Accepted: 11/15/2013] [Indexed: 12/15/2022]
Abstract
The aim of the study is to identify and compare national recommendations on vaccination of adult patients with autoimmune rheumatic diseases (ARDs) in Europe, North America, and Australia. We conducted a search for recommended immunizations in adult patients with ARDs in the Medline database and the Web sites of National Rheumatologic Societies, Ministries of Health, National Advisory Committees on Immunization, and other relevant National Scientific Societies. We compared national guidelines and identified points of agreement and differences. Guidelines on vaccination of adult patients with ARDs were identified in 21 countries. Points of agreement include administering influenza and pneumococcal vaccines in addition to inactivated age-appropriate or travel-related vaccines, and avoiding the use of live vaccines in immunocompromised patients with ARDs. The most important differences concern the steroid dose that induces immunosuppression, the time interval between live vaccines and the initiation of immunosuppressive treatment, herpes zoster vaccination, and the preferred pneumococcal vaccine in patients with ARDs. We observed significant differences among national recommendations on immunizations in patients with ARDs, reflecting the lack of evidence-based data.
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Affiliation(s)
- Despoina Papadopoulou
- Pain and Palliative Care Clinic, Aretaieion Hospital and Medical School, National and Kapodistrian University of Athens, Vasilisis Sofias 76, 11528, Athens, Greece,
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Rubin LG, Levin MJ, Ljungman P, Davies EG, Avery R, Tomblyn M, Bousvaros A, Dhanireddy S, Sung L, Keyserling H, Kang I. 2013 IDSA clinical practice guideline for vaccination of the immunocompromised host. Clin Infect Dis 2013; 58:e44-100. [PMID: 24311479 DOI: 10.1093/cid/cit684] [Citation(s) in RCA: 543] [Impact Index Per Article: 49.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
An international panel of experts prepared an evidenced-based guideline for vaccination of immunocompromised adults and children. These guidelines are intended for use by primary care and subspecialty providers who care for immunocompromised patients. Evidence was often limited. Areas that warrant future investigation are highlighted.
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Affiliation(s)
- Lorry G Rubin
- Division of Pediatric Infectious Diseases, Steven and Alexandra Cohen Children's Medical Center of New York of the North Shore-LIJ Health System, New Hyde Park
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Soybilgic A, Onel KB, Utset T, Alexander K, Wagner-Weiner L. Safety and immunogenicity of the quadrivalent HPV vaccine in female Systemic Lupus Erythematosus patients aged 12 to 26 years. Pediatr Rheumatol Online J 2013; 11:29. [PMID: 23924237 PMCID: PMC3751269 DOI: 10.1186/1546-0096-11-29] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Accepted: 07/28/2013] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Women with SLE have higher rates of persistent human papilloma virus (HPV) infections and precancerous lesions than healthy women. HPV vaccine is safe and effective in healthy females aged 9-26 years. There are limited data on the safety and immunogenicity of HPV vaccine in females with SLE, and none in adolescents with SLE. Our study evaluates the safety and immunogenicity of recombinant quadrivalent HPV vaccine, Gardasil, in adolescents and young women with SLE. METHODS This is a prospective, open-label study. Exclusion criteria included disease exacerbation within past 30 days; rituximab or cyclophosphamide within 6 months; pregnancy. Vaccine was administered at months 0, 2, and 6. Physical examination, SLEDAI scores and laboratory studies were performed at months 0, 2, 4, 6 and 7. Each patient's SLEDAI scores and laboratory profile in the year prior to vaccine administration were used as controls for that patient. Primary outcome measures were change in SLEDAI and mean HPV antibody titers. RESULTS 27 patients, 12 to 26 years, were enrolled; 20 completed the study. Nine had mild/moderate lupus flares. Mean SLEDAI scores decreased from 6.14 pre-vaccination to 4.49 post-vaccination (p = 0.01). Of 12 patients with lupus nephritis, two experienced worsening renal function during/after the study and progressed to renal failure within 18 months of the study. Both had Class IV lupus nephritis with high chronicity scores (≥ 8) on renal biopsies performed within one year prior to study entry. Seropositivity post-vaccine was >94% for HPV 6, 11, 16 and 18. CONCLUSIONS Quadrivalent HPV vaccine seems generally safe and well tolerated in this series of adolescents and young women with SLE, with no increase in mean SLEDAI scores. Progression to renal failure in two patients was most likely secondary to pre-existing severe renal chronicity and not secondary to HPV vaccination. Immunogenicity to the quadrivalent HPV vaccine was excellent, with the seropositivity rate >94% in all four HPV types.
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Ferbas J, Belouski SS, Horner M, Kaliyaperumal A, Chen L, Boyce M, Colaço CB, McHugh N, Quick V, Nicholl RJ, Siu G, Chung J. A novel assay to measure B cell responses to keyhole limpet haemocyanin vaccination in healthy volunteers and subjects with systemic lupus erythematosus. Br J Clin Pharmacol 2013; 76:188-202. [PMID: 23731388 PMCID: PMC3731594 DOI: 10.1111/bcp.12172] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2012] [Accepted: 05/17/2013] [Indexed: 12/22/2022] Open
Abstract
The aim of the study was to characterize performance of a complementary set of assays to measure antigen-specific immune responses in subjects immunized with a neoantigen. Healthy volunteers (HV) (n = 8) and patients with systemic lupus erythematosus (SLE) (n = 6) were immunized with keyhole limpet haemocyanin (KLH) on days 1 and 29. Serum antibodies were detected using a flow cytometric bead array (CBA) that multiplexed the KLH response alongside pre-existing anti-tetanus antibodies. Peripheral blood mononuclear cells were studied by B cell ELISPOT. These assays were built upon precedent assay development in cynomolgus monkeys, which pointed towards their utility in humans. Primary anti-KLH IgG responses rose to a mean of 65-93-fold above baseline for HV and SLE patients, respectively, and secondary responses rose to a mean of 260-170-fold above baseline. High levels of anti-tetanus IgG were detected in pre-immunization samples and their levels did not change over the course of study. Anti-KLH IgG1-4 subclasses were characterized by a predominant IgG1 response, with no significant differences in subclass magnitude or distribution between HV and SLE subjects. Anti-KLH IgM levels were detectable, although the overall response was lower. IgM was not detected in two SLE subjects whodid generate an IgG response. All subjects responded to KLH by B cell ELISPOT, with no significant differences observed between HV and SLE subjects. The CBA and B cell ELISPOT assays reliably measured anti-KLH B cell responses, supporting use of this approach and these assays to assess the pharmacodynamic and potential safety impact of marketed/investigational immune-therapeutics.
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Affiliation(s)
- John Ferbas
- Department of Medical Sciences, Amgen, Inc, Thousand Oaks, CA 91320, USA.
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Abstract
The number of patients with impaired immune response has been steadily increasing within the last years, not only with the onset of the AIDS epidemic, but also due to increasing numbers of subjects on immunosuppressive therapies. These patients are at an increased risk for infections, many of which are preventable by immunization. Inactivated vaccines are generally safe in subjects with underlying immunosuppression. However, immune response and protection may be hampered, depending on the extent of immunosuppression. In contrast, live vaccines such as yellow fever, measles, rubella, herpes zoster, and cholera may lead to severe reactions in immunocompromised patients and have been shown to deteriorate some immune-mediated diseases such as multiple sclerosis. Data on the efficacy of vaccines in biological therapies is scarce. Where necessary vaccines should be updated before immunosuppressive therapies are started. To improve the vaccination status several guidelines exist for immunosuppressed patients at risk such as those with rheumatic diseases, asplenia or solid organ and hematopoietic stem cell transplantation.
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