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Virgilio E, Trevisan C, Abbatecola A, Malara A, Palmieri A, Fedele G, Stefanelli P, Leone P, Schiavoni I, Maggi S, Volpato S, Antonelli Incalzi R, Onder G. Diabetes Affects Antibody Response to SARS-CoV-2 Vaccination in Older Residents of Long-term Care Facilities: Data From the GeroCovid Vax Study. Diabetes Care 2022; 45:2935-2942. [PMID: 36201657 DOI: 10.2337/dc22-1255] [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] [Received: 06/26/2022] [Accepted: 09/13/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Type 2 diabetes may affect the humoral immune response after vaccination, but data concerning coronavirus disease 19 (COVID-19) vaccines are scarce. We evaluated the impact of diabetes on antibody response to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination in older residents of long-term care facilities (LTCFs) and tested for differences according to antidiabetic treatment. RESEARCH DESIGN AND METHODS For this analysis, 555 older residents of LTCFs participating in the GeroCovid Vax study were included. SARS-CoV-2 trimeric S immunoglobulin G (anti-S IgG) concentrations using chemiluminescent assays were tested before the first dose and after 2 and 6 months. The impact of diabetes on anti-S IgG levels was evaluated using linear mixed models, which included the interaction between time and presence of diabetes. A second model also considered diabetes treatment: no insulin therapy (including dietary only or use of oral antidiabetic agents) and insulin therapy (alone or in combination with oral antidiabetic agents). RESULTS The mean age of the sample was 82.1 years, 68.1% were women, and 25.2% had diabetes. In linear mixed models, presence of diabetes was associated with lower anti-S IgG levels at 2 (β = -0.20; 95% CI -0.34, -0.06) and 6 months (β = -0.22; 95% CI -0.37, -0.07) after the first vaccine dose. Compared with those without diabetes, residents with diabetes not using insulin had lower IgG levels at 2- and 6-month assessments (β = -0.24; 95% CI -0.43, -0.05 and β = -0.30; 95% CI -0.50, -0.10, respectively), whereas no differences were observed for those using insulin. CONCLUSIONS Older residents of LTCFs with diabetes tended to have weaker antibody response to COVID-19 vaccination. Insulin treatment might buffer this effect and establish humoral immunity similar to that in individuals without diabetes.
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Affiliation(s)
- Enrico Virgilio
- Center for Diabetes Research, Medical Faculty, Université Libre de Bruxelles, Brussels, Belgium
| | - Caterina Trevisan
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy.,Department of Medicine, University of Padua, Padua, Italy.,Aging Research Center, Karolinska Institutet, Stockholm, Sweden
| | - Angela Abbatecola
- Alzheimer's Disease Day Clinic, Azienda Sanitaria Locale, Frosinone, Italy
| | - Alba Malara
- Associazione Nazionale Strutture Territoriali e per la Terza Età (ANASTE)-Humanitas Foundation, Rome, Italy
| | | | | | | | | | | | - Stefania Maggi
- Institute of Neuroscience, National Research Council, Padua, Italy
| | - Stefano Volpato
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | | | - Graziano Onder
- Istituto Superiore di Sanità, Roma, Italy.,Università Cattolica Sacro Cuore, Rome, Italy
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ÖZARSLAN F, BARAN AKSAKAL FN. Altmışbeş Yaş ve Üzeri Erişkinlerde Pnömokok Bağışıklaması ve Ülkemizdeki Pnömokok Aşı Uygulamaları. KAHRAMANMARAŞ SÜTÇÜ İMAM ÜNIVERSITESI TIP FAKÜLTESI DERGISI 2022. [DOI: 10.17517/ksutfd.1082905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Abstract
Sorunu ortaya çıkmadan önlemek şüphesiz tedaviye göre kolay ve ucuz bir yöntemdir. Birinci basamak sağlık hizmetlerinin esasını oluşturan koruyucu sağlık hizmetlerinden aşılama, aşı ile önlenebilir hastalıkların önlenmesi ve bu hastalıklara bağlı kayıpların azaltılabilmesi için olmazsa olmazdır. Yaşlılarda ve yüksek riskli erişkinlerde önemli morbidite ve mortaliteye sebep olan pnömokok infeksiyonlarına karşı ülkemizde uygulanan iki tip aşı vardır: konjuge pnömokok aşısı ve polisakkarid pnömokok aşısı. Erişkinlerde pnömokok aşılarının yararı kanıtlanmış olmasına rağmen aşı uygulanma oranları hedeflenen düzeyde olmadığı için iyileştirme çalışmalarına ihtiyaç vardır. Birinci basamak çalışanları başta olmak üzere aşı uygulayıcılarının eğitilmesi ve farkındalığının artırılması, topluma aşıların yararları ve olası riskleri hakkında yeterli bilgi verilmesi, sağlık kontrollerinin ve kayıtların düzenli olması, aşıların yeterli miktarda ve ücretsiz olarak sağlanması gerekmektedir.
Bu derleme erişkinlerde pnömokok aşı uygulamalarında mevcut durumu gözden geçirmek ve aşılama oranlarını arttırmak için yapılması gereken uygulamaları vurgulamak amacıyla yazılmıştır.
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Vyse A, Campling J, Czudek C, Ellsbury G, Mendes D, Reinert RR, Slack M. A review of current data to support decision making for introduction of next generation higher valency pneumococcal conjugate vaccination of immunocompetent older adults in the UK. Expert Rev Vaccines 2021; 20:1311-1325. [PMID: 34550850 DOI: 10.1080/14760584.2021.1984888] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION The burden of pneumococcal disease in older UK adults remains substantial. Higher valency pneumococcal conjugate vaccines (PCVs) are currently in development with adult formulations for two of these anticipated to become available in 2022. This article collates and reviews relevant candidate data now available that may be used to support cost effectiveness assessments of vaccinating immunocompetent UK adults aged ≥65-years with PCVs. AREAS COVERED This article uses published data from surveillance systems, randomized controlled trials and observational studies. It focuses on local data from the UK but where these are either limited or not available relevant global data are considered. EXPERT OPINION The body of relevant data now available suggests the UK is well placed to assess the cost effectiveness of vaccinating immunocompetent ≥65-year olds with new generation higher valency PCVs. Recent contemporary data provide important new and robust insights into the epidemiology of pneumococcal disease in older UK adults and help to address much of the uncertainty and data gaps associated with previous analyses. Using these data to make informed decisions about use of new higher valency PCVs for routine use in older adults will be important for public health in the UK.
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Affiliation(s)
- Andrew Vyse
- Medical Affairs, Pfizer Ltd, Walton Oaks, Tadworth, KT20 7NS, UK
| | - James Campling
- Medical Affairs, Pfizer Ltd, Walton Oaks, Tadworth, KT20 7NS, UK
| | - Carole Czudek
- Medical Affairs, Pfizer Ltd, Walton Oaks, Tadworth, KT20 7NS, UK
| | - Gillian Ellsbury
- Medical Affairs, Pfizer Ltd, Walton Oaks, Tadworth, KT20 7NS, UK
| | - Diana Mendes
- Health & Value, Pfizer Ltd, Walton Oaks, Tadworth, KT20 7NS, UK
| | | | - Mary Slack
- School of Medicine & Dentistry, Griffith University, Gold Coast Campus, Queensland 4222, Australia
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4
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Klein NP, Peyrani P, Yacisin K, Caldwell N, Xu X, Scully IL, Scott DA, Jansen KU, Gruber WC, Watson W. A phase 3, randomized, double-blind study to evaluate the immunogenicity and safety of 3 lots of 20-valent pneumococcal conjugate vaccine in pneumococcal vaccine-naive adults 18 through 49 years of age. Vaccine 2021; 39:5428-5435. [PMID: 34315611 DOI: 10.1016/j.vaccine.2021.07.004] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 07/02/2021] [Accepted: 07/05/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Introduction of pneumococcal conjugate vaccines (PCVs), including the 13-valent PCV (PCV13), has considerably reduced pneumococcal disease burden. However, additional serotypes not in PCV13 continue to present a substantial disease burden. The 20-valent PCV (PCV20) was developed to expand protection against pneumococcal disease beyond PCV13. As part of the phase 3 clinical development program, the current study assessed consistency of immune responses across 3 lots of PCV20 and described the safety profile of PCV20. METHODS This phase 3, randomized, multicenter, double-blind study of pneumococcal vaccine-naive adults 18-49 years of age randomized 1710 participants in a 2:2:2:1 ratio to receive 1 of 3 lots of PCV20 or PCV13. Immunogenicity was assessed through serotype-specific opsonophagocytic activity (OPA) titers before and approximately 1 month (28-42 days) after vaccination. Reported local reactions within 10 days, systemic events within 7 days, adverse events (AEs) within 30 days, and serious AEs (SAEs) and newly diagnosed chronic medical conditions (NDCMCs) within 6 months after vaccination were evaluated. RESULTS Equivalence in immune responses (OPA geometric mean titers) for all 20 vaccine serotypes was demonstrated across the 3 PCV20 lots. Robust responses, assessed by OPA geometric mean fold rises, percentage of participants achieving ≥4-fold rises, and percentage of participants with OPA titers ≥lower limit of quantitation, were observed after PCV20. Reported rates of local reactions, systemic events, and AEs were similar between the pooled PCV20 lots and PCV13; most events were mild or moderate. Reported rates of SAEs and NDCMCs were low and similar between the PCV20 and PCV13 groups. CONCLUSIONS Three different lots of PCV20 demonstrated robust and consistent immunogenicity. The safety and tolerability of PCV20 was acceptable and similar to that of PCV13. (Clinicaltrials.gov: NCT03828617).
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Affiliation(s)
- Nicola P Klein
- Kaiser Permanente Vaccine Study Center, Oakland, CA 94612, USA.
| | - Paula Peyrani
- Vaccine Medical Development and Scientific/Clinical Affairs, Pfizer Inc, Collegeville, PA 19426, USA.
| | - Kari Yacisin
- Vaccine Research and Development, Pfizer Inc, Collegeville, PA 19426, USA.
| | - Nicole Caldwell
- Vaccine Research and Development, Pfizer Inc, Collegeville, PA 19426, USA.
| | - Xia Xu
- Vaccine Research and Development, Pfizer Inc, Collegeville, PA 19426, USA.
| | - Ingrid L Scully
- Vaccine Research and Development, Pfizer Inc, Pearl River, NY 10965, USA.
| | - Daniel A Scott
- Vaccine Research and Development, Pfizer Inc, Collegeville, PA 19426, USA.
| | - Kathrin U Jansen
- Vaccine Research and Development, Pfizer Inc, Pearl River, NY 10965, USA.
| | - William C Gruber
- Vaccine Research and Development, Pfizer Inc, Pearl River, NY 10965, USA.
| | - Wendy Watson
- Vaccine Research and Development, Pfizer Inc, Collegeville, PA 19426, USA.
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5
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Otero-Romero S, Sánchez-Montalvá A, Vidal-Jordana A. Assessing and mitigating risk of infection in patients with multiple sclerosis on disease modifying treatment. Expert Rev Clin Immunol 2021; 17:285-300. [PMID: 33543657 DOI: 10.1080/1744666x.2021.1886924] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Introduction: The important development that the multiple sclerosis (MS) treatment field has experienced in the last years comes along with the need of dealing with new adverse events such as the increase risk of infections. In the shared therapeutic decision-making process, the MS expert neurologist should also balance the risks of specific infections under each particular treatment and be familiar with new mitigation strategies.Areas covered: In this review, the authors provide an up-to-date review of the infection risk associated with MS treatments with a specific focus on risk mitigating strategies. The search was conducted using Pubmed® database (2000 - present) to identify publications that reported infection rates and infection complications for each treatment (interferon beta, glatiramer acetate, teriflunomide, dimethyl fumarate, fingolimod, cladribine, natalizumab, alemtuzumab, rituximab, and ocrelizumab).Expert opinion: Since the emergence of the first natalizumab-related PML case, the arrival of new MS therapies has come hand in hand with new infectious complications. MS-specialist neurologist has to face new challenges regarding the management of immunosuppression-related infectious complications. The implementation of patient-centered management focus on preventive and mitigating strategies with a multidisciplinary approach should be seen in the future as a marker of excellence of MS management.
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Affiliation(s)
- Susana Otero-Romero
- Department of Preventive Medicine and Epidemiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Adrián Sánchez-Montalvá
- Department of Infectious Diseases. Hospital Universitari Vall d'Hebron, International Health Program Catalan Institute of Health (PROSICS), Universitat Autònoma De Barcelona, Barcelona, Spain.,Micobacteria Infections Study Group (GEIM) of the Spanish Society of Infectious Diseases (SEIMC), Spain
| | - Angela Vidal-Jordana
- Department of Neurology-Neuroimmunology and Multiple Sclerosis Centre of Catalonia (Cemcat). Hospital Universitari Vall d'Hebron, Universitat Autònoma De Barcelona, Barcelona, Spain
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6
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Vila-Corcoles A, Ochoa-Gondar O, Vila-Rovira A, Aragon M, Esteban-Julvez L, Chamorro N, Hospital I, Satue E, Blade J, de Diego C, Gomez-Bertomeu F, Raga X. Incidence and Risk of Pneumococcal Pneumonia in Adults with Distinct Underlying Medical Conditions: A Population-Based Study. Lung 2020; 198:481-489. [PMID: 32253492 DOI: 10.1007/s00408-020-00349-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 03/16/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE This study investigated the incidence of pneumococcal pneumonia requiring hospitalisation among middle-aged and older adults with and without specific underlying medical conditions, evaluating the influence of these conditions in the risk of developing pneumonia. METHODS Population-based prospective cohort study included 2,025,730 individuals ≥ 50 years around Catalonia, Spain. The Catalonian information system for the development of research in primary care (SIDIAP) was used to establish baseline characteristics of the cohort (comorbidities and underlying medical conditions). Hospitalisations from pneumococcal pneumonia occurred among cohort members between 01/01/2015 and 31/12/2015 were collected from hospital discharge codes of 68 reference Catalonian hospitals. Cox regression was used to estimate the association between baseline conditions and the risk of developing pneumonia. RESULTS Global incidence rate (IR) of hospitalised pneumococcal pneumonia was 82.8 cases per 100,000 persons-year. Maximum IRs (per 100,000 persons-year) emerged among persons with haematological neoplasia (837.4), immunodeficiency (709.2), HIV infection (474.7), severe renal disease (407.5) and chronic pulmonary disease (305.7). In the multivariable analyses, apart from increasing age, HIV infection (hazard ratio [HR] 6.78), haematological neoplasia (HR 6.30), prior all-cause pneumonia (HR 5.27), immunodeficiency (HR 4.57) and chronic pulmonary disease (HR 2.89) were the conditions most strongly associated with an increasing risk. Pneumococcal vaccination did not emerge associated with a reduced risk in our study population (nor PPsV23 neither PCV13). CONCLUSION Old age, immunocompromising conditions and chronic pulmonary/respiratory disease are major risk factors for pneumococcal pneumonia in adults. Our data underline the need for better prevention strategies in these persons.
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Affiliation(s)
- A Vila-Corcoles
- Primary Health Care Service "Camp de Tarragona", Institut Catala de La Salut, Rambla Nova 124, D, 1ºA., 43001, Tarragona, Spain
| | - O Ochoa-Gondar
- Primary Health Care Service "Camp de Tarragona", Institut Catala de La Salut, Rambla Nova 124, D, 1ºA., 43001, Tarragona, Spain.
| | - A Vila-Rovira
- Unitat de Suport a La Recerca of Tarragona, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Tarragona, Spain
| | - M Aragon
- Information System for the Improvement of Research in Primary Care (SIDIAP), Primary Care Research Institute Jordi Gol, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - L Esteban-Julvez
- Departament of Pneumology, Hospital Joan XXIII, Tarragona, Spain
| | - N Chamorro
- Departament of Pneumology, Hospital Joan XXIII, Tarragona, Spain
| | - I Hospital
- Primary Health Care Service "Camp de Tarragona", Institut Catala de La Salut, Rambla Nova 124, D, 1ºA., 43001, Tarragona, Spain
| | - E Satue
- Primary Health Care Service "Camp de Tarragona", Institut Catala de La Salut, Rambla Nova 124, D, 1ºA., 43001, Tarragona, Spain
| | - J Blade
- Primary Health Care Service "Camp de Tarragona", Institut Catala de La Salut, Rambla Nova 124, D, 1ºA., 43001, Tarragona, Spain
| | - C de Diego
- Primary Health Care Service "Camp de Tarragona", Institut Catala de La Salut, Rambla Nova 124, D, 1ºA., 43001, Tarragona, Spain
| | - F Gomez-Bertomeu
- Department of Laboratory and Microbiology, Hospital Joan XXIII, Tarragona, Spain
| | - X Raga
- Department of Laboratory and Microbiology, Hospital Santa Tecla, Tarragona, Spain
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7
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Albrich WC, Rassouli F, Waldeck F, Berger C, Baty F. Influence of Older Age and Other Risk Factors on Pneumonia Hospitalization in Switzerland in the Pneumococcal Vaccine Era. Front Med (Lausanne) 2019; 6:286. [PMID: 31867337 PMCID: PMC6906144 DOI: 10.3389/fmed.2019.00286] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 11/21/2019] [Indexed: 01/04/2023] Open
Abstract
Background: Pneumococcal pneumonia is a disease of the extremes of age. However, as other traditional risk factors for pneumococcal pneumonia also increase with older age, it is unclear if older age itself should be an indication for pneumococcal vaccination. Therefore, we assessed the effect of age on risk for hospitalization for pneumonia and for pneumococcal pneumonia. Methods: Using a national hospitalization dataset, all patients ≥16 years hospitalized in a Swiss hospital with a diagnosis of pneumonia or pneumococcal pneumonia between 2002 and 2015 were included. Multivariable logistic regression analysis was used to test the association between age (≥50 or ≥65 years) and hospitalization for pneumonia or pneumococcal pneumonia after adjusting for pneumococcal vaccine indications. Similar analyses were performed for effect of age on length of stay (LOS) and mortality. Results: Among a total of 17,619,016 hospitalizations a diagnosis of pneumonia was present in 421,760 (2.4%) and a diagnosis of pneumococcal pneumonia in 21,610 (0.12%). Age ≥50 years (OR: 3.52 and 2.12, respectively; p for both <0.001) and age ≥65 years (OR: 2.98 and 1.80, respectively; p for both <0.001) as well as most Swiss pneumococcal vaccine indications were independent predictors of hospitalization with a pneumonia and pneumococcal pneumonia diagnosis, respectively. Older age with both age cut-offs were associated with increased LOS (≥50 years: aRR: 1.19 and 1.24, respectively; age ≥65 years: aRR: 1.60 and 1.20, respectively; p < 0.001 for all) and mortality (≥50 years: aOR: 4.73 and 2.84, respectively; age ≥65 years: aOR: 2.38 and 2.69, respectively, p < 0.001 for all) in patients with a pneumonia and pneumococcal pneumonia diagnosis, respectively. The effects of pneumococcal vaccine indications decreased with older age. The incidences of hospitalizations with a pneumonia diagnosis and a pneumococcal pneumonia diagnosis increased significantly from the pre-vaccine era to the PCV7 era and the PCV13 era (p for trend for both analyses <0.001). Conclusion: This study confirms the Swiss indications for pneumococcal vaccination as independent risk factors for pneumonia hospitalizations. Older age itself should be considered as an additional vaccine indication. Pneumonia and pneumococcal pneumonia in adults have increased despite pneumococcal vaccination in children.
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Affiliation(s)
- Werner C Albrich
- Division Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Frank Rassouli
- Department of Pulmonary and Sleep Medicine, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Frederike Waldeck
- Division Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Christoph Berger
- Division of Infectious Diseases and Hospital Epidemiology, University Children's Hospital Zürich, Zurich, Switzerland
| | - Florent Baty
- Department of Pulmonary and Sleep Medicine, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
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Pasiarski M, Sosnowska-Pasiarska B, Grywalska E, Stelmach-Gołdyś A, Kowalik A, Góźdź S, Roliński J. Immunogenicity And Safety Of The 13-Valent Pneumococcal Conjugate Vaccine In Patients With Monoclonal Gammopathy Of Undetermined Significance - Relationship With Selected Immune And Clinical Parameters. Clin Interv Aging 2019; 14:1741-1749. [PMID: 31631993 PMCID: PMC6790629 DOI: 10.2147/cia.s220423] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Accepted: 09/02/2019] [Indexed: 12/20/2022] Open
Abstract
Purpose Patients with monoclonal gammopathy of undetermined significance (MGUS) have an increased risk of developing infections. Streptococcus pneumoniae vaccinations are recommended for immunocompromised patients, including patients with lymphoproliferative disorders such as MGUS. The objective of the study was to assess the immune response to the 13-valent pneumococcal conjugate vaccine (PCV13) in treatment-naive MGUS patients versus healthy subjects. All study groups were evaluated for the levels of specific pneumococcal antibodies, the levels of IgG and IgG subclasses, and selected peripheral blood lymphocyte subpopulations, including the proportion of plasmablasts before and after immunization. Patients and methods A total of 22 previously untreated patients with MGUS and 15 healthy age- and sex-matched volunteers were included in the study. All participants were immunized with PCV13 Prevenar13 (Pfizer). The following parameters were assessed: 1) serum-specific pneumococcal antibody titers before and 30 days after vaccination, 2) percentage of plasmablasts, defined as CD19+/IgD-/CD27++, before and 7 days after vaccination, 3) serum total IgG and IgG1, IgG2, IgG3, IgG4 levels before and 30 days after vaccination. Results and conclusion PCV13 vaccination in MGUS patients is safe and effectively protects against S. pneumoniae infection. In unvaccinated individuals, vaccination should be carried out as soon as possible after diagnosis. It can protect patients against serious infectious complications, which can contribute to extending the time to progression and transformation into more aggressive diseases. PCV13 vaccination is more effective in MGUS patients with a lower concentration of M protein. Serum M protein concentration in patients diagnosed with MGUS may be a useful predictor of the effectiveness of vaccination.
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Affiliation(s)
- Marcin Pasiarski
- Department of Hematology, Holycross Cancer Center, Kielce, Poland.,Department of Immunology, Faculty of Health Sciences, Jan Kochanowski University, Kielce, Poland
| | | | - Ewelina Grywalska
- Department of Clinical Immunology and Immunotherapy, Medical University of Lublin, Lublin, Poland.,Clinical Immunology Department, St. John's Cancer Center, Lublin, Poland
| | | | - Artur Kowalik
- Department of Molecular Diagnostics, Holycross Cancer Center, Kielce, Poland
| | - Stanisław Góźdź
- Department of Immunology, Faculty of Health Sciences, Jan Kochanowski University, Kielce, Poland.,Department of Oncology, Holycross Cancer Center, Kielce, Poland
| | - Jacek Roliński
- Department of Clinical Immunology and Immunotherapy, Medical University of Lublin, Lublin, Poland.,Clinical Immunology Department, St. John's Cancer Center, Lublin, Poland
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9
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MacIntyre CR, Ridda I, Trent MJ, McIntyre P. Persistence of immunity to conjugate and polysaccharide pneumococcal vaccines in frail, hospitalised older adults in long-term follow up. Vaccine 2019; 37:5016-5024. [DOI: 10.1016/j.vaccine.2019.07.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 06/26/2019] [Accepted: 07/01/2019] [Indexed: 01/01/2023]
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10
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Evaluating clinical effectiveness of 13-valent pneumococcal conjugate vaccination against pneumonia among middle-aged and older adults in Catalonia: results from the EPIVAC cohort study. BMC Infect Dis 2018; 18:196. [PMID: 29699550 PMCID: PMC5921259 DOI: 10.1186/s12879-018-3096-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 04/16/2018] [Indexed: 12/18/2022] Open
Abstract
Background Benefits using the 13-valent pneumococcal conjugate vaccine (PCV13) in adults are controversial. This study investigated clinical effectiveness of PCV13 vaccination in preventing hospitalisation from pneumonia among middle-aged and older adults. Methods Population-based cohort study involving 2,025,730 individuals ≥50 years in Catalonia, Spain, who were prospectively followed from 01/01/2015 to 31/12/2015. Primary outcomes were hospitalisation for pneumococcal or all-cause pneumonia and death from any cause. Cox regression models were used to evaluate the association between PCV13 vaccination and the risk of each outcome, adjusting for age, sex and major comorbidities/underlying risk conditions. Results Cohort members were observed for a total of 1,990,701 person-years, of which 6912 person-years were PCV13 vaccinated. Overall, crude incidence rates (per 100,000 person-years) were 82.8 (95% confidence interval [CI]: 77.7–88.1) for pneumococcal pneumonia, 637.9 (95% CI: 599.0–678.7) for all-cause pneumonia and 2367.2 (95% CI: 2222.8–2518.7) for all-cause death. After multivariable adjustments we found that the PCV13 vaccination did not alter significantly the risk of pneumococcal pneumonia (multivariable-adjusted hazard ratio [mHR]: 1.17; 95% CI: 0.75–1.83; p = 0.493) and all-cause death (mHR: 1.07; 95% CI: 0.97–1.18; p = 0.190), although it remained significantly associated with an increased risk of all-cause pneumonia (mHR: 1.69; 95% CI: 1.48–1.94; p < 0.001). In stratified analyses focused on middle-aged or elderly persons and immunocompromised or immunocompetent subjects, PCV13 vaccination did not appear effective either. Conclusion Our data does not support clinical benefits of PCV13 vaccination against pneumonia among adults in Catalonia. It must be closely monitored in future studies involving more vaccinated person-time at-observation.
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11
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Alharbi NS, Al-Barrak AM, Al-Moamary MS, Zeitouni MO, Idrees MM, Al-Ghobain MO, Al-Shimemeri AA, Al-Hajjaj MS. The Saudi Thoracic Society pneumococcal vaccination guidelines-2016. Ann Thorac Med 2016; 11:93-102. [PMID: 27168856 PMCID: PMC4854068 DOI: 10.4103/1817-1737.177470] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2016] [Accepted: 02/19/2016] [Indexed: 01/19/2023] Open
Abstract
Streptococcus pneumoniae (pneumococcus) is the leading cause of morbidity and mortality worldwide. Saudi Arabia is a host to millions of pilgrims who travel annually from all over the world for Umrah and the Hajj pilgrimages and are at risk of developing pneumococcal pneumonia or invasive pneumococcal disease (IPD). There is also the risk of transmission of S. pneumoniae including antibiotic resistant strains between pilgrims and their potential global spread upon their return. The country also has unique challenges posed by susceptible population to IPD due to people with hemoglobinopathies, younger age groups with chronic conditions, and growing problem of antibiotic resistance. Since the epidemiology of pneumococcal disease is constantly changing, with an increase in nonvaccine pneumococcal serotypes, vaccination policies on the effectiveness and usefulness of vaccines require regular revision. As part of the Saudi Thoracic Society (STS) commitment to promote the best practices in the field of respiratory diseases, we conducted a review of S. pneumoniae infections and the best evidence base available in the literature. The aim of the present study is to develop the STS pneumococcal vaccination guidelines for healthcare workers in Saudi Arabia. We recommend vaccination against pneumococcal infections for all children <5 years old, adults ≥50 years old, and people ≥6 years old with certain risk factors. These recommendations are based on the presence of a large number of comorbidities in Saudi Arabia population <50 years of age, many of whom have risk factors for contracting pneumococcal infections. A section for pneumococcal vaccination before the Umrah and Hajj pilgrimages is included as well.
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Affiliation(s)
- N. S. Alharbi
- Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - A. M. Al-Barrak
- Department of Internal Medicine, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - M. S. Al-Moamary
- Department of Medicine, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - M. O. Zeitouni
- Department of Medicine, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - M. M. Idrees
- Department of Internal Medicine, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - M. O. Al-Ghobain
- Department of Medicine, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - A. A. Al-Shimemeri
- Department of Medicine, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Mohamed S. Al-Hajjaj
- Department of Clinical Sciences, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
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Persistent immune alterations and comorbidities in splenectomized patients with Gaucher disease. Blood Cells Mol Dis 2016; 59:8-15. [PMID: 27282561 DOI: 10.1016/j.bcmd.2016.02.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 02/08/2016] [Accepted: 02/09/2016] [Indexed: 01/18/2023]
Abstract
Gaucher disease (GD) is an autosomal recessive disorder caused by mutations in the gene encoding acid-β-glucosidase, resulting in functional disruptions in degradation of glycosphingolipids and lysosomal accumulation of the substrates. The most frequent clinical presentations of GD are thrombocytopenia, splenomegaly and bone pain. Prior to advent of enzyme replacement therapy, splenectomy was performed for complications of hypersplenism such as severe thrombocytopenia and transfusion dependency. Though there is evidence about worsening bone disease after splenectomy, there is no systematic study to assess its effects on the immune system in GD patients. In order to investigate the long-term immunological effects of splenectomy, we used flow cytometry to compare the immunophenotypes of GD patients who had undergone splenectomy (SGD) to those with intact spleen. The results show that SGD patients have significantly fewer CD27(+)/IgM(+) B-cells but more CD4(+)/CD45RO(+) and CD8(+)/CD45RO(+) T-cells. The most surprising finding was an almost complete absence of circulating dendritic cells in SGD patients. In addition, splenectomized subjects had comorbidities, the most common being monoclonal gammopathy of undetermined significance (MGUS). Taken together, these results highlight the persistence of multiple immune alterations and comorbidities coexisting in higher frequency in the SGD group and they are not affected by GD specific therapy.
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Al-Hajjaj M, Alharbi NS, Zeitouni MO, Idrees MM, Al-Barrak AM, Al-Moamary MS, Al-Ghobain MO, Al-Shimemeri AA. The Saudi Thoracic Society pneumococcal vaccination guidelines-2016. Ann Thorac Med 2016. [DOI: 10.4103/1817-1737.180030] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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