[Vaccination in rheumatology: Evolution of views on the problem]

[The effectiveness of vaccination against pneumococcal infection in patients with severe bronchial asthma]

INTRODUCTION

The article discusses topical issues of the use of conjugated 13-valent pneumococcal vaccine Prevenar®13 (PCV13) in patients with severe bronchial asthma (SBA), including those receiving targeted therapy with genetically engineered biological drugs (GEBD).

AIM

To study the effectiveness of vaccination against pneumococcal infection (PI) in patients with SBA.

MATERIALS AND METHODS

The study included 381 patients with SBA. The average age in the study groups was 45.5 (42.0; 52.5) years. All patients underwent clinical and instrumental studies, including spirography with bronchodilation test. After confirming the diagnosis of BA, the patients were divided into 2 observation groups. Group 1 (n=191) consisted of patients undergoing treatment with GEBD. Group 2 included patients with asthma receiving standard therapy, according to the 4th-5th stage according to the criteria of the Global Initiative for Asthma 2022 (Global Initiative for Asthma - GINA). The observation group consisted of 190 patients. In each group, there are subgroups of patients who have been vaccinated against PI and have not been vaccinated for various reasons. The following criteria were used as the main endpoints of observation for 12 months to assess the effectiveness: the number of pneumonia during the observation period, the number of exacerbations of asthma (severe, non-severe), the number of hospitalizations, the duration of exacerbations, the level of control according to the Asthma Control Questionnaire (ACQ5), functional indicators.

RESULTS

The coverage of PI vaccination in patients with BA remains quite low, further organizational and methodological work is required to increase their involvement in vaccination. Immunization of PCV13 in patients with SBA at the 4th-5th stage of therapy reduces the risk of community-acquired pneumonia by at least 28.5%. PCV13 vaccination may be an additional effective tool for controlling the symptoms of SBA, including in patients undergoing treatment with GEBD. Vaccination allows to normalize the functional parameters of respiratory function in patients with SBA. PCV13 is well tolerated and does not cause any significant allergic reactions in patients with asthma.

CONCLUSION

PCV13 vaccination is an effective tool for reducing the risk of community-acquired pneumonia in patients with severe bronchial asthma, including those on targeted therapy with genetically engineered biological drugs.

VACCINATION IN RHEUMATIC DISEASES: AN ALLY OR AN ENEMY?

The importance of comorbid infections in rheumatology has recently increased substantially, particularly due to the introduction of biological agents into clinical practice. One of the ways to solve the above problem is to investigate and actively use different vaccines. The paper deals with the issues concerning the use of vaccines against influenza and pneumococcal infections in rheumatic patients. It discusses the safety and immunogenicity of vaccination in preventing respiratory infections as the most common cause of an adverse outcome in rheumatic diseases. Main areas for future investigations of the considered problem are shown.