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Prelog M, Almanzar G, Stern R, Robrade K, Holzer MT, Winzig C, Kleines M, Stiasny K, Meyer T, Speth F, Haas JP. Humoral and cellular immune response to tick-borne-encephalitis (TBE) vaccination depends on booster doses in patients with Juvenile Idiopathic Arthritis (JIA). Vaccine 2021; 39:5918-5927. [PMID: 34462165 DOI: 10.1016/j.vaccine.2021.08.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 07/29/2021] [Accepted: 08/06/2021] [Indexed: 11/15/2022]
Abstract
Juvenile Idiopathic Arthritis (JIA) patients living in areas with high prevalence of tick-borne-encephalitis-virus-(TBEV)-infection are recommended for administration of inactivated TBE-vaccination. However, there are serious concerns regarding protective vaccine-induced immune responses against TBEV in immunocompromised patients. The present study aimed to analyze the humoral and cellular immune response to TBE-vaccination in previously TBE-vaccinated JIA patients compared to healthy controls (HC) including investigation of IgG-anti-TBEV avidity, neutralization capacity, cellular reactivity by IFNgamma-ELISPOT and cytokine secretion assays. Similar IgG-anti-TBEV antibody concentrations, neutralization titers and cellular reactivity were found between JIA and HC. The number and the early timing of booster vaccinations after primary vaccination had the most prominent effect on neutralizing antibodies in JIA and on IgG-anti-TBEV concentrations in both JIA and HC. Administration of booster vaccinations made it more likely for JIA patients to have IgG-anti-TBEV concentrations ≥165 VIEU/ml and avidities >60%. TNF-alpha inhibitors had a positive and MTX administration a negative effect on humoral immune responses. In conclusion, irrespective of having JIA or not, vaccinated children showed similar humoral and cellular immunity against TBEV several years after primary TBE-vaccination. However, in JIA, booster vaccinations mounted a significantly higher humoral immune response than in JIA without boosters. Our results highlight the need for timely administration of boosters particularly in JIA. Although immunosuppressive treatment at vaccinations in diagnosed JIA had a negative effect mainly on TBEV-specific cellular immunity, most JIA patients mounted a favorable humoral immune response which was maintained over time. Thus, successful TBE-vaccination seems highly feasible in JIA patients with immunosuppressive regimens.
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Affiliation(s)
- M Prelog
- Department of Pediatrics, University Hospital Wuerzburg, Josef-Schneider-Straße 2, 97080 Wuerzburg, Germany.
| | - G Almanzar
- Department of Pediatrics, University Hospital Wuerzburg, Josef-Schneider-Straße 2, 97080 Wuerzburg, Germany
| | - R Stern
- Department of Pediatrics, University Hospital Wuerzburg, Josef-Schneider-Straße 2, 97080 Wuerzburg, Germany
| | - K Robrade
- Department of Pediatrics, University Hospital Wuerzburg, Josef-Schneider-Straße 2, 97080 Wuerzburg, Germany
| | - M T Holzer
- Department of Pediatrics, University Hospital Wuerzburg, Josef-Schneider-Straße 2, 97080 Wuerzburg, Germany
| | - C Winzig
- Department of Pediatrics, University Hospital Wuerzburg, Josef-Schneider-Straße 2, 97080 Wuerzburg, Germany
| | - M Kleines
- Department of Medical Microbiology, RWTH Aachen, Pauwelsstraße 30, 52074 Aachen, Germany
| | - K Stiasny
- Department of Virology, Medical University Vienna, Kinderspitalgasse 15, 1090 Vienna, Austria
| | - T Meyer
- Pediatric Surgery Unit, Department of Surgery, University Hospital Wuerzburg, Josef-Schneider-Straße 2, 97080 Wuerzburg, Germany
| | - F Speth
- German Center of Pediatric and Adolescent Rheumatology, Gehfeldstraße 24, 82467 Garmisch-Partenkirchen, Germany
| | - J P Haas
- German Center of Pediatric and Adolescent Rheumatology, Gehfeldstraße 24, 82467 Garmisch-Partenkirchen, Germany
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Janda A, Schuetz C, Heeg M, Minden K, Hedrich CM, Kallinich T, Hinze C, Schulz A, Speth F. [COVID-19: treatment strategies of German-speaking pediatric rheumatologists : Results of an online survey]. Z Rheumatol 2020; 79:710-717. [PMID: 32809050 PMCID: PMC7432543 DOI: 10.1007/s00393-020-00854-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Hintergrund Zuverlässige Daten zu Verlauf und Therapie von COVID-19 („corona virus disease 2019“) bei Kindern mit rheumatischen Erkrankungen unter Immunsuppression fehlen. Ziel der Arbeit Abbildung individueller Strategien der Mitglieder der Gesellschaft für Kinder- und Jugendrheumatologie (GKJR) im Umgang mit COVID-19. Methodik Mittels Online-Umfrage wurden im Mai 2020 das Meinungsbild der GKJR-Mitglieder zum Umgang mit DMARDs („disease-modifying anti-rheumatic drugs“) bei COVID-19-Erkrankung sowie die Bereitschaft zum Einsatz spezieller Therapieansätze bei Patienten mit unterschiedlicher Schwere von COVID-19 erhoben. Ergebnisse Es nahmen 71 Kollegen (27,3 % aller befragten ärztlichen Mitglieder) an der Umfrage teil; davon hatten 28,2 % bereits Patienten mit COVID-19 betreut. Über 95 % der Teilnehmer lehnten eine präventive Anpassung der antirheumatischen Therapie im Rahmen der SARS-CoV-2-Pandemie ab. Bei ambulanten Patienten unter Immunsuppression mit nachgewiesener COVID-19-Erkrankung würden mehr als 50 % der Teilnehmer folgende Therapien aussetzen: intravenöse hoch dosierte Steroide, Cyclophosphamid, Anti-CD20-Antikörper, sowie eine BAFF-, CTLA-4-, TNF-α-Blockade. Hingegen würden nichtsteroidale Antiphlogistika, Hydroxychloroquin (HCQ), orale Steroide, Mycophenolat, IL-1-Blockade sowie Immunglobuline (Ig) von >70 % der Kollegen weiter fortgeführt. Bei stationären Patienten mit COVID-19 würden insgesamt 74,6 % der Kollegen eine COVID-19-gerichtete Therapie erwägen. Bei stabilem Verlauf unter O2-Therapie (Stufe I) würden am häufigsten HCQ (18,3 %), Azithromycin (16,9 %) und Ig (9,9 %) in Betracht gezogen. Bei drohendem (Stufe II) bzw. manifestem Zytokinsturm (Stufe III) würden am häufigsten Anakinra (40,8 % bei Stufe II bzw. 46,5 % bei Stufe III), Tocilizumab (26,8 % bzw. 40,8 %), Steroide (25,4 % bzw. 33,8 %) und Remdesivir (29,6 % bzw. 38,0 %) eingesetzt. Von vielen Kollegen wurde betont, dass die Therapiestrategie individuell und der klinischen Situation entsprechend angepasst werden soll. Diskussion Die Ergebnisse der Online-Umfrage sind vor dem Hintergrund einer aktuell in Deutschland niedrigen Prävalenz von COVID-19 zu sehen und spiegeln somit theoretische Überlegungen der Befragten wider. Da Kinder derzeit nicht im Fokus von prospektiven COVID-19-Studien stehen, scheint der kontinuierliche und kritische kollegiale Fachaustausch bei Therapieentscheidungen umso wichtiger zu sein.
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Affiliation(s)
- A Janda
- Klinik für Kinder- und Jugendmedizin, Universitätsklinikum Ulm, Eythstr. 24, 89075, Ulm, Deutschland.
| | - C Schuetz
- Klinik und Poliklinik für Kinder- und Jugendmedizin, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Deutschland
| | - M Heeg
- Institut für Immundefizienz und Zentrum für Kinder- und Jugendmedizin, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - K Minden
- Charité Universitätsmedizin Berlin und Deutsches Rheuma-Forschungszentrum Berlin, Berlin, Deutschland
| | - C M Hedrich
- Department of Women's & Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool & Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust Hospital, Liverpool, Großbritannien
| | - T Kallinich
- Charité Universitätsmedizin Berlin und Deutsches Rheuma-Forschungszentrum Berlin, Berlin, Deutschland
| | - C Hinze
- Klinik für Pädiatrische Rheumatologie und Immunologie, Universitätsklinikum Münster, Münster, Deutschland
| | - A Schulz
- Klinik für Kinder- und Jugendmedizin, Universitätsklinikum Ulm, Eythstr. 24, 89075, Ulm, Deutschland
| | - F Speth
- Zentrum für Geburtshilfe, Kinder- und Jugendmedizin, Sektion Pädiatrische Stammzelltransplantation und Immunologie, Abteilung Kinderrheumatologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
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Heinrich A, Hauenstein C, Speth F, Weber MA. [Chronic nonbacterial osteomyelitis : Imaging and differential diagnoses]. Radiologe 2020; 60:863-876. [PMID: 32856134 DOI: 10.1007/s00117-020-00731-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Chronic nonbacterial osteomyelitis (CNO) is an autoinflammatory bone disease in childhood and adolescence with a preference for the female gender. It is manifested with multiple osseous lesions, with a predilection for the metaphyseal end zones of the long bones of the lower extremities. These bone lesions usually occur multifocally, can recur and develop a different appearance depending on the bone structure affected. Patients present with a longer disease history, changing clinical symptoms and unspecific paraclinical signs. Magnetic resonance imaging (MRI) is the imaging of choice and particularly as a whole body examination can speed up the diagnosis and is an important component of follow-up controls. Differential diagnoses include numerous inflammatory, benign and malignant bone diseases. Therefore, it is essential to know the diagnosis of CNO and to take it into consideration in cases of an unclear inflammatory bone process in young patients.
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Affiliation(s)
- A Heinrich
- Institut für Diagnostische und Interventionelle Radiologie, Kinder- und Neuroradiologie, Universitätsmedizin Rostock, Ernst-Heydemann-Str. 6, 18057, Rostock, Deutschland.
| | - C Hauenstein
- Institut für Diagnostische und Interventionelle Radiologie, Kinder- und Neuroradiologie, Universitätsmedizin Rostock, Ernst-Heydemann-Str. 6, 18057, Rostock, Deutschland
| | - F Speth
- Kinder- und Jugendklinik, Universitätsmedizin Rostock, Rostock, Deutschland
| | - M-A Weber
- Institut für Diagnostische und Interventionelle Radiologie, Kinder- und Neuroradiologie, Universitätsmedizin Rostock, Ernst-Heydemann-Str. 6, 18057, Rostock, Deutschland
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Speth F, Hinze CH, Schranz P, Miller-Wiegart E, Haefner R. Combination of rituximab and abatacept as an exit strategy for repetitive B-cell depletion in children with severe autoimmune diseases: a report of three cases. Lupus 2018; 27:1996-1998. [PMID: 29958501 DOI: 10.1177/0961203318783057] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- F Speth
- 1 Department of Pediatric Rheumatology, University Hospital for Children, Rostock, Germany
| | - C H Hinze
- 2 Department of Pediatric Rheumatology and Immunology, University Hospital Münster, Münster, Germany
| | - P Schranz
- 3 MVZ Labor PD Dr Volkmann und Kollegen, Karlsruhe, Germany
| | - E Miller-Wiegart
- 4 Department for Pediatric Rheumatology, University Hospital for Children Munich (TUM), Munich, Germany
| | - R Haefner
- 5 German Center for Pediatric and Adolescent Rheumatology, Garmisch-Partenkirchen, Germany
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Speth F, Hinze C, Häfner R. Combination of ofatumumab and fresh frozen plasma in hypocomplementemic systemic lupus erythematosus: a case report. Lupus 2018; 27:1395-1396. [PMID: 29439647 DOI: 10.1177/0961203318756289] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- F Speth
- 1 Department of Pediatric Rheumatology, Universitatsmedizin Rostock Kinder und Jugendklinik, Rostock, Germany
| | - C Hinze
- 2 Department of Pediatric Rheumatology and Immunology, University Hospital Münster, Münster, Germany
| | - R Häfner
- 3 Children's Hospital, German Center for Pediatric and Adolescent Rheumatology, Garmisch-Partenkirchen, Germany
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Abstract
BACKGROUND Children and adolescents with inflammatory rheumatic diseases have a disease and treatment-related increased risk of infections. This risk includes vaccine-preventable diseases; therefore, vaccinations represent an important preventive measure against infection in these patients. However, approximately one in three patients with a juvenile rheumatic disease is nowadays still inadequately vaccinated, mostly due to uncertainty regarding the efficacy and safety of vaccination in these patients. OBJECTIVES This paper summarizes the available evidence regarding the efficacy and safety of vaccinations in children and adolescents with rheumatic diseases and gives recommendations for the clinical practice. RESULTS AND PERSPECTIVES Almost 2000 children and adolescents with rheumatic diseases were examined in the more than 30 previously published vaccination studies, comprising nearly all standard vaccinations in the immunization schedule. The immunogenicity was usually sufficient and there was no evidence of a relevant aggravation of the underlying disease. Recommendations for the clinical practice are given also considering data beyond pediatric rheumatology; however, a final benefit-risk assessment is not yet possible.
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Affiliation(s)
- K Minden
- Universitätskinderklinik Charité, Campus Virchow, Otto-Heubner-Centrum, SPZ, Deutsches Rheuma-Forschungszentrum Berlin, Augustenburger Platz 1, 13353, Berlin, Deutschland,
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Robrade K, Stern R, Almanzar G, Kleines M, Speth F, Hügle B, Haas J, Prelog M. AB0030 Persistence of Humoral and Cellular Immunity Against Tick-Borne-Encephalitis Vaccination in Patients with Juvenile Idiopathic Arthritis (JIA). Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.5567] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Speth F, Hinze C, Loeber S, Haas JP. OP0069 Varicella Vaccination in Patients with Paediatric Rheumatic Diseases Receiving Immunosuppression: Proposal of a Pre-Vaccination Check List to Ensure Safety. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.5163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Speth F, Hinze C, Haas JP. SAT0503 A Prospective Single-Centre Study on Indicators of Infectious Risk After Rituximab Therapy in Children and Adolescents with Rheumatic Diseases. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.5908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Abstract
The increasing use of combination therapies, including disease-modifying antirheumatic drugs (DMARD) and biologicals has improved the outcome for children and adolescents in several rheumatic diseases. However, this strategy has increased the risk of drug-specific side-effects, such as an increased risk of infections. Furthermore, the underlying rheumatic disease itself often includes an increased risk of infections and some patients additionally present with immunological or organic comorbidities (e.g. complement deficiency and interstitial pulmonary disease) further increasing the susceptibility to infections. The presented review is based on an analysis of the currently available literature proposing a checklist of diagnostic procedures and immunological laboratory tests specific for the detection of patients prone to infections. The combined stratification of the underlying disease, comorbidities and the immunological mechanisms of the medication enables (1) an individual risk stratification of planned immunosuppressive therapy and (2) a prediction of the risks of infection for the patient.
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Affiliation(s)
- F Speth
- Deutschen Zentrum für Kinder- und Jugendrheumatologie (DZKJR), Gehfeldstr. 24, 82467, Garmisch-Partenkirchen, Deutschland,
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Schuetz C, Hoenig M, Gatz S, Speth F, Benninghoff U, Schulz A, Debatin KM, Friedrich W. Hematopoietic stem cell transplantation from matched unrelated donors in chronic granulomatous disease. Immunol Res 2009; 44:35-41. [PMID: 18846320 PMCID: PMC7102039 DOI: 10.1007/s12026-008-8068-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
We report on 12 patients with chronic granulomatous disease transplanted with hematopoietic stem cells from matched unrelated (n = 9) or matched sibling donors (n = 3). The most common infectious complication was pulmonary aspergillosis, which nine patients had previously developed. Only 5 of 12 individuals had normal lung function prior to transplantation. At a mean follow-up of 53 months 9 of the 12 patients are alive including 7 of 9 following matched unrelated donor (MUD) transplantation. One patient died from ARDS, another from systemic BK virus infection, the third from complications of chronic graft-versus-host disease. Seven of nine surviving patients have normal lung function now. HSCT from a MUD is an option worth considering when no matched family donor is available. Restricted lung function prior to HSCT does not appear to be a limiting factor for such treatment.
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Affiliation(s)
- C Schuetz
- Department of Paediatrics, University Hospital Ulm, Paediatrics Eythstrasse 24, 89075, Ulm, Germany.
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