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Nakafero G, Grainge MJ, Card T, Mallen CD, Nguyen Van-Tam JS, Abhishek A. Uptake and safety of pneumococcal vaccination in adults with immune-mediated inflammatory diseases: a UK wide observational study. Rheumatology (Oxford) 2025; 64:962-968. [PMID: 38479823 PMCID: PMC11879285 DOI: 10.1093/rheumatology/keae160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 03/05/2024] [Indexed: 03/06/2025] Open
Abstract
OBJECTIVE The uptake and safety of pneumococcal vaccination in people with immune-mediated inflammatory diseases (IMIDs) is poorly understood. We investigated the UK-wide pneumococcal vaccine uptake in adults with IMIDs and explored the association between vaccination and IMID flare. METHODS Adults with IMIDs diagnosed on or before 1 September 2018, prescribed steroid-sparing drugs within the last 12 months and contributing data to the Clinical Practice Research Datalink Gold, were included. Vaccine uptake was assessed using a cross-sectional study design. Self-controlled case series analysis investigated the association between pneumococcal vaccination and IMID flare. The self-controlled case series observation period was up to 6 months before and after pneumococcal vaccination. This was partitioned into a 14-day pre-vaccination induction, 90 days post-vaccination exposed and the remaining unexposed periods. RESULTS We included 32 277 patients, 14 151 with RA, 13 631 with IBD, 3804 with axial SpA and 691 with SLE. Overall, 57% were vaccinated against pneumococcus. Vaccine uptake was lower in those younger than 45 years old (32%), with IBD (42%) and without additional indication(s) for vaccination (46%). In the vaccine safety study, data for 1067, 935 and 451 vaccinated patients with primary-care consultations for joint pain, autoimmune rheumatic disease flare and IBD flare, respectively, were included. Vaccination against pneumococcal pneumonia was not associated with primary-care consultations for joint pain, autoimmune rheumatic disease flare and IBD flare in the exposed period, with incidence rate ratios (95% CI) 0.95 (0.83-1.09), 1.05 (0.92-1.19) and 0.83 (0.65-1.06), respectively. CONCLUSION Uptake of pneumococcal vaccination in UK patients with IMIDs was suboptimal. Vaccination against pneumococcal disease was not associated with IMID flare.
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Affiliation(s)
- Georgina Nakafero
- Academic Rheumatology, School of Medicine, University of Nottingham, Nottingham, UK
- Nottingham NIHR BRC, Nottingham
| | - Matthew J Grainge
- Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Tim Card
- Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK
- Nottingham Digestive Diseases Centre, Translational Medical Sciences, School of Medicine, University of Nottingham, Nottingham, UK
| | - Christian D Mallen
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, UK
| | | | - Abhishek Abhishek
- Academic Rheumatology, School of Medicine, University of Nottingham, Nottingham, UK
- Nottingham NIHR BRC, Nottingham
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Kariniotaki C, Bertsias G, Galanakis E, Perdikogianni C. Vaccination Coverage and Attitudes in Children and Adults on Biologic Therapies: Cocooning Strategies, Undervaccination Factors and Predictors of Favorable Attitudes. Vaccines (Basel) 2025; 13:152. [PMID: 40006699 PMCID: PMC11861045 DOI: 10.3390/vaccines13020152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2024] [Revised: 01/20/2025] [Accepted: 01/28/2025] [Indexed: 02/27/2025] Open
Abstract
BACKGROUND Infections pose a significant risk of morbidity and mortality to patients on biologics, with the vaccination of both patients and their close contacts serving as a key preventive measure. Despite its importance, there are limited data on the vaccination coverage for this group, and no studies have examined the vaccination status of patients' close contacts. OBJECTIVES To assess vaccination rates among patients on biologics and their household contacts, identifying reasons for inadequate vaccination and examining factors influencing vaccination status and attitudes is crucial. METHODS A cross-sectional study was conducted from September 2022 to February 2023 at the two hospitals in Heraklion, Crete, including adult and pediatric patients on biologics. Data were collected through medical records and interviews and analyzed using Microsoft Excel 2016 and MedCalc2006. RESULTS Among the 446 adults, vaccination rates were as follows: 83% for COVID-19, 73.8% for influenza, 64.5% for the pneumococcal conjugate vaccine, 29.6% for the pneumococcal polysaccharide vaccine, and 4% for Tdap. Among the 26 children included, those with basic immunization schedule coverage exceeded 96%, but rates for the vaccines usually administered at adolescence were lower (Tdap: 47.8%, HPV: 42.1%, MenACWY: 66.7%). COVID-19 vaccination was at 38.5%. Regarding the additional vaccines recommended due to treatment-induced immunosuppression, 69.2% of pediatric patients received the annual influenza vaccine, while only 19.2% received the pneumococcal polysaccharide vaccine. Household contacts demonstrated low vaccination rates (<59%), except for COVID-19 (81%). Female gender (p < 0.007) and older age (by 1 year, p < 0.001) were associated with favorable attitudes and higher coverage in adults, while in pediatric patients, no statistically significant associations were found. A lack of physician recommendation was the primary reported reason for not being vaccinated. CONCLUSIONS Significant vaccination gaps exist among patients on biologics and their close contacts, largely due to inadequate physician recommendations. Raising awareness and strengthening healthcare provider roles are essential to improve coverage in this high-risk group.
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Affiliation(s)
- Charikleia Kariniotaki
- Department of Pediatrics, University Hospital of Heraklion, Medical School, University of Crete, 71003 Heraklion, Greece; (C.K.); (E.G.)
| | - George Bertsias
- Department of Rheumatology and Clinical Immunology, University Hospital of Heraklion, Medical School, University of Crete, 71003 Heraklion, Greece;
| | - Emmanouil Galanakis
- Department of Pediatrics, University Hospital of Heraklion, Medical School, University of Crete, 71003 Heraklion, Greece; (C.K.); (E.G.)
| | - Chrysoula Perdikogianni
- Department of Pediatrics, University Hospital of Heraklion, Medical School, University of Crete, 71003 Heraklion, Greece; (C.K.); (E.G.)
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Schwaneck EC, Harasim AS, Tony HP, Gawlik M, Witte T, Joos S, Gernert M, Schmalzing M, Morbach H, Fröhlich M, Krone M. Vaccination status of patients with primary immunodeficiencies in Germany-a multicentric epidemiologic analysis. Z Rheumatol 2025; 84:68-74. [PMID: 39174715 DOI: 10.1007/s00393-024-01549-0] [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] [Accepted: 07/01/2024] [Indexed: 08/24/2024]
Abstract
BACKGROUND Vaccinations represent an easily accessible, safe, and important method for preventing infections. Patients with primary immunodeficiencies (PID) are more susceptible to infections and should receive an extended spectrum of immunizations in many countries. METHODS Between January 2019 and May 2020, vaccination certificates of 70 patients with PID from the regions of Würzburg and Hanover in Germany were evaluated. The patients were additionally surveyed regarding their attitude towards vaccinations and the communication with their physicians. Medical records were analyzed. RESULTS Of the 70 patients, 54 (77%) suffered from common variable immunodeficiency, 30 (43%) were diagnosed with accompanying autoimmunity, 62 (89%) had an increased susceptibility to infections, and 56 (80%) were on immunoglobulin substitution therapy. Seven patients (10%) had neither a vaccination certificate nor were they able to recollect of their last vaccination. Only 55 (79%) and 43 (61%) patients stated that their rheumatologist or immunologist had recommended an influenza and a pneumococcal vaccination, respectively. When asked about their overall trust in vaccinations on a scale of 0 to 10 (0 = very low, 10 = very high), the mean value was 7.8. The most common vaccination was against tetanus in 63 (90%) patients, 49 (70%) had received vaccination against pneumococci, and 39 (56%) had received an influenza vaccination. Interestingly, 26 patients (37%) were vaccinated against measles, even though this is contraindicated in most PID patients. CONCLUSION Our data suggest that vaccination rates in this at-risk population are insufficient. Healthcare providers should emphasize vaccinations routinely when caring for these patients.
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Affiliation(s)
- Eva C Schwaneck
- Division of Rheumatology/Immunology, University Hospital Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany.
- MVZ Rheumatologie und Autoimmunmedizin, Mönckebergstraße 27, 20095, Hamburg, Germany.
| | - Anna S Harasim
- Division of Rheumatology/Immunology, University Hospital Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany
| | - Hans-Peter Tony
- Division of Rheumatology/Immunology, University Hospital Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany
| | - Micha Gawlik
- Department of Psychiatry and Psychotherapy, University of Würzburg, Margarete-Höppel-Platz 1, 97080, Würzburg, Germany
- Helios Fachkliniken Hildburghausen, Hildburghausen, Deutschland
| | - Torsten Witte
- Department of Rheumatology and Clinical Immunology, Hanover Medical School, Carl-Neuberg-Straße 1, 30625, Hanover, Germany
| | - Stefanie Joos
- Institute for General Practice and Interprofessional Healthcare, Eberhardt-Karls-University, Osianderstraße 5, 72076, Tübingen, Germany
| | - Michael Gernert
- Division of Rheumatology/Immunology, University Hospital Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany
| | - Marc Schmalzing
- Division of Rheumatology/Immunology, University Hospital Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany
| | - Henner Morbach
- Pediatric Immunology, Department of Pediatrics, University Hospital Würzburg, Josef-Schneider-Straße 2, 97080, Würzburg, Germany
| | - Matthias Fröhlich
- Division of Rheumatology/Immunology, University Hospital Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany
| | - Manuel Krone
- Institute for Hygiene and Microbiology, University of Würzburg, Josef-Schneider-Straße 2/E1, 97080, Würzburg, Germany
- Infection Control and Antimicrobial Stewardship Unit, University Hospital Würzburg, Josef-Schneider-Straße 2/E1, 97080, Würzburg, Germany
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Niederstein E, Underwood J, de Wit M, Reinwald M, Schwarzlose-Schwarck S, Dammermann W, Deckert PM, Kiderlen TR. Streptococcus pneumoniae and influenza vaccination rates in oncological patients - data from Germany. Support Care Cancer 2024; 32:813. [PMID: 39570461 PMCID: PMC11582192 DOI: 10.1007/s00520-024-09023-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 11/12/2024] [Indexed: 11/22/2024]
Abstract
OBJECTIVES Due to disease- or therapy-associated immunosuppression, oncological patients suffer from significantly higher morbidity and mortality due to infections transmitted by respiratory pathogens such as Streptococcus pneumoniae and influenza virus. Although the German Standing Committee on Vaccination (STIKO) provides specific recommendations for vaccination against these pathogens, there is no data on vaccination rates in this high-risk population. METHODS Data from the interventional EVO study were analyzed to provide information on vaccination rates against Streptococcus pneumoniae and influenza virus in oncological patients. Numbers presented in this publication summarize baseline and follow-up data of the control group; thus, data were not influenced by the intervention. RESULTS Data of 370 patients were analyzed; 20.5% of patients were treated for hematological malignancies and 79.5% for solid cancer. 28.1% of patients had received vaccination against influenza and 32.2% against Streptococcus pneumoniae; for the latter only 7.3% according recommendations. While vaccination rates where even lower for patients with thoracic carcinoma (influenza 26.7% and Streptococcus pneumoniae 6.0% according to STIKO recommendations), rates in patients with multiple myeloma were remarkably higher (39.0% and 14.6%). CONCLUSIONS Despite strong recommendations to vaccinate and the clear clinical need to prevent infections in the vulnerable group of oncological patients, only the minority was vaccinated against Streptococcus pneumoniae or influenza, underlining the urgent need for better vaccination strategies in this high-risk population.
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Affiliation(s)
- Emma Niederstein
- Faculty of Medicine and Psychology, Brandenburg Medical School Theodor Fontane, 14770, Brandenburg an der Havel, Germany.
| | - Journey Underwood
- Faculty of Medicine and Psychology, Brandenburg Medical School Theodor Fontane, 14770, Brandenburg an der Havel, Germany
| | - Maike de Wit
- Department of Hematology, Oncology and Palliative Care, Vivantes Hospital Neukoelln, 12351, Berlin, Germany
- Department of Oncology, Vivantes Auguste-Viktoria-Hospital, 12157, Berlin, Germany
| | - Mark Reinwald
- Faculty of Medicine and Psychology, Brandenburg Medical School Theodor Fontane, 14770, Brandenburg an der Havel, Germany
- Department of Hematology and Oncology, University Hospital Brandenburg an der Havel, 14770, Brandenburg an der Havel, Germany
| | - Sandra Schwarzlose-Schwarck
- Faculty of Medicine and Psychology, Brandenburg Medical School Theodor Fontane, 14770, Brandenburg an der Havel, Germany
- Department of Hematology and Oncology, University Hospital Brandenburg an der Havel, 14770, Brandenburg an der Havel, Germany
| | - Werner Dammermann
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, 14770, Brandenburg an der Havel, Germany
| | - P Markus Deckert
- Faculty of Medicine and Psychology, Brandenburg Medical School Theodor Fontane, 14770, Brandenburg an der Havel, Germany
- Department of Hematology and Oncology, University Hospital Brandenburg an der Havel, 14770, Brandenburg an der Havel, Germany
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, 14770, Brandenburg an der Havel, Germany
| | - Til Ramón Kiderlen
- Department of Oncology, Vivantes Auguste-Viktoria-Hospital, 12157, Berlin, Germany
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, 14770, Brandenburg an der Havel, Germany
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Abavisani M, Ansari B, Ebadpour N, Sahebkar A. How does geographical diversity shape vaccine efficacy? Clin Exp Vaccine Res 2024; 13:271-300. [PMID: 39525670 PMCID: PMC11543789 DOI: 10.7774/cevr.2024.13.4.271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2024] [Revised: 05/22/2024] [Accepted: 06/04/2024] [Indexed: 11/16/2024] Open
Abstract
Vaccination is a cornerstone of public health, saving millions of lives each year by preventing a variety of infectious diseases. Yet, despite global vaccination efforts, emerging research highlights significant geographical disparities in vaccine efficacy and immunogenicity. These variations underscore the critical interplay between immunological factors and environmental, genetic, and nutritional elements across different populations. Our review article aimed to explore the multifactorial reasons behind geographical variations in vaccine efficacy. Also, this study has shown how important host factors like age, obesity, gender, and genetic diversity, especially within the major histocompatibility complex, are in determining how well a vaccine works. Nutritional status, namely deficiencies in micronutrients such as vitamins and zinc, and lifestyle factors including stress, sleep, alcohol consumption, and physical activity are also shown to have profound effects on vaccine-induced immunity. Importantly, our paper also brought to light the influence of microbial and ecological factors, such as the gut microbiome and environmental pollutants, on the immune system's response to vaccination. The findings emphasize the importance of tailoring vaccination strategies to accommodate the unique immunological landscapes shaped by geographical and societal factors. This tailored approach could enhance vaccine efficacy, reduce disparities in vaccine response, and ultimately contribute to the global fight against infectious diseases.
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Affiliation(s)
- Mohammad Abavisani
- Student Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Bahareh Ansari
- Immunology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Negar Ebadpour
- Immunology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Amirhossein Sahebkar
- Center for Global Health Research, Saveetha Medical College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, India
- Biotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran
- Applied Biomedical Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
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Stephan B, Meineke A, Augustin M, Sorbe C. Vaccination Rates in Patients with Chronic Inflammatory Skin Diseases and Immunomodulatory Systemic Therapies-Vaccinations against SARS-CoV-2, Influenza Virus or Varicella Zoster Virus. Life (Basel) 2024; 14:1157. [PMID: 39337940 PMCID: PMC11433363 DOI: 10.3390/life14091157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2024] [Accepted: 09/09/2024] [Indexed: 09/30/2024] Open
Abstract
INTRODUCTION The national guidelines and the Standing Committee on Vaccination (STIKO) of the Robert Koch Institute (RKI) in Germany support preventive vaccinations for patients under immunomodulatory treatments. MATERIAL AND METHODS Retrospective analysis of data from patients with chronic inflammatory skin diseases from December 2021 to December 2022 with a focus on preventive vaccinations against influenza virus, varicella zoster virus, or SARS-CoV-2. RESULTS Patients with chronic inflammatory skin diseases were referred to our university outpatient's clinic for recommendations of systemic therapy. Vaccinations against influenza virus, varicella zoster virus, or SARS-CoV-2 were documented in 7365 analyzed patient files. A total of 79.7% were completely vaccinated against SARS-CoV-2, 49.7% patients were vaccinated against the influenza virus, and only 9.2% were completely vaccinated against varicella zoster virus. DISCUSSION In our patients who came for counselling before or during systemic treatment, vaccination rates against SARS-CoV-2, varicella zoster virus, or influenza virus were low. Patients age 60 and above had higher rates than the average German population of the same age, but still no satisfying protection. CONCLUSIONS We suggest informing patients about preventive vaccination before and during systemic immunomodulatory treatments and emphasize the need for active communication in this vulnerable patient group.
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Affiliation(s)
- Brigitte Stephan
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), 20251 Hamburg, Germany; (A.M.); (M.A.); (C.S.)
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Kanatoula DD, Bodner E, Ghoreschi K, Meier K, Solimani F. Non-biologic immunosuppressive drugs for inflammatory and autoimmune skin diseases. J Dtsch Dermatol Ges 2024; 22:400-421. [PMID: 38259085 DOI: 10.1111/ddg.15270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 09/08/2023] [Indexed: 01/24/2024]
Abstract
Non-biologic immunosuppressive drugs, such as azathioprine, dapsone or methotrexate are fundamental treatment options for a wide range of autoimmune and chronic inflammatory skin diseases. Some of these drugs were initially used for malignancies (e.g., azathioprine or methotrexate) or infectious diseases (e.g., hydroxychloroquine or dapsone) but are nowadays mostly used for their immunosuppressive/immunomodulating action. Although dermatologists have years of clinical experience with these drugs, some of the mechanisms of action are not fully understood and are the subject of research. Although these drugs are commonly used, lack of experience or knowledge regarding their safety profiles and management leads to skepticism among physicians. Here, we summarize the mechanism of action and detailed management of adverse effects of the most commonly used immunosuppressive drugs for skin diseases. Furthermore, we discuss the management of these drugs during pregnancy and breastfeeding, as well as their interaction and handling during vaccination.
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Affiliation(s)
- Danai Dionysia Kanatoula
- Department of Dermatology, Venereology and Allergology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
| | - Euna Bodner
- Department of Dermatology, Venereology and Allergology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
| | - Kamran Ghoreschi
- Department of Dermatology, Venereology and Allergology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
| | - Katharina Meier
- Department of Dermatology, Venereology and Allergology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
| | - Farzan Solimani
- Department of Dermatology, Venereology and Allergology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, BIH Biomedical Innovation Academy, BIH Charité Clinician Scientist Program, Berlin, Germany
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Kanatoula DD, Bodner E, Ghoreschi K, Meier K, Solimani F. Nicht-Biologika-Immunsuppressiva bei entzündlichen und autoimmunen Hautkrankheiten: Non-biologic immunosuppressive drugs for inflammatory and autoimmune skin diseases. J Dtsch Dermatol Ges 2024; 22:400-423. [PMID: 38450929 DOI: 10.1111/ddg.15270_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 09/08/2023] [Indexed: 03/08/2024]
Abstract
ZusammenfassungNicht‐Biologika‐Immunsuppressiva wie Azathioprin, Dapson oder Methotrexat sind grundlegende Behandlungsmöglichkeiten für ein breites Spektrum von Autoimmunerkrankungen und chronisch‐entzündlichen Hauterkrankungen. Einige dieser Medikamente wurden ursprünglich bei malignen Erkrankungen (zum Beispiel Azathioprin oder Methotrexat) oder Infektionskrankheiten (zum Beispiel Hydroxychloroquin oder Dapson) eingesetzt, werden aber heute hauptsächlich wegen ihrer immunsuppressiven/immunmodulierenden Wirkung verwendet. Obwohl Dermatologen über jahrelange klinische Erfahrung mit diesen Arzneimitteln verfügen, sind einige der Wirkmechanismen noch nicht vollständig geklärt und noch Gegenstand der Forschung. Obwohl diese Medikamente häufig eingesetzt werden, führen mangelnde Erfahrung oder fehlendes Wissen über ihre Sicherheitsprofile und ihr Management zu einer skeptischen Haltung bei den Ärzten. Hier fassen wir den Wirkmechanismus und das detaillierte Management der Nebenwirkungen der am häufigsten verwendeten immunsuppressiven Medikamente für Hautkrankheiten zusammen. Darüber hinaus diskutieren wir den Umgang mit diesen Medikamenten während der Schwangerschaft und Stillzeit sowie ihre Wechselwirkung und Handhabung im Zusammenhang mit Impfungen.
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Affiliation(s)
- Danai Dionysia Kanatoula
- Abteilung für Dermatologie, Venerologie und Allergologie, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin
| | - Euna Bodner
- Abteilung für Dermatologie, Venerologie und Allergologie, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin
| | - Kamran Ghoreschi
- Abteilung für Dermatologie, Venerologie und Allergologie, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin
| | - Katharina Meier
- Abteilung für Dermatologie, Venerologie und Allergologie, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin
| | - Farzan Solimani
- Abteilung für Dermatologie, Venerologie und Allergologie, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin
- BIH Biomedical Innovation Academy, Berlin Institute of Health, Charité - Universitätsmedizin Berlin
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Pappa M, Panagiotopoulos A, Thomas K, Fanouriakis A. Systemic Lupus Erythematosus and COVID-19. Curr Rheumatol Rep 2023; 25:192-203. [PMID: 37477841 PMCID: PMC10504107 DOI: 10.1007/s11926-023-01110-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2023] [Indexed: 07/22/2023]
Abstract
PURPOSE OF REVIEW To describe the current state of knowledge regarding COVID-19 in patients with systemic lupus erythematosus (SLE). We focus on (i) SARS-CoV-2 vaccination uptake, immunogenicity and safety, and (ii) outcomes of COVID-19 in patients with SLE and pertinent risk factors for adverse sequelae. RECENT FINDINGS Notwithstanding the potential concern of patients about possible post-vaccination side-effects, the safety of anti-SARS-CoV-2 vaccines in patients with SLE has been undisputedly confirmed in numerous studies. Humoral immunogenicity is generally attained in SLE, although affected by the use of background immunosuppressive drugs, especially rituximab. The latter has also clearly been implicated with adverse COVID-19 outcomes in SLE, including need for hospitalization, mechanical ventilation and death. Although the wide adoption of vaccination has significantly improved COVID-19 outcomes, patients with SLE continue to pose challenges during the pandemic, mainly owing to administered immunosuppressive medications.
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Affiliation(s)
- Maria Pappa
- 1st Department of Propaedeutic Internal Medicine, Medical School National and Kapodistrian University of Athens, Athens, Greece
| | - Alexandros Panagiotopoulos
- 1st Department of Propaedeutic Internal Medicine, Medical School National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos Thomas
- 4th Department of Internal Medicine, "Attikon" University Hospital, Medical School National and Kapodistrian University of Athens, Athens, Greece
| | - Antonis Fanouriakis
- Rheumatology and Clinical Immunology, "Attikon" University Hospital of Athens, Medical School National and Kapodistrian University of Athens, Athens, Greece.
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Wegener GS, Hummers E, Müller F, Schröder D, Roder S, Dopfer-Jablonka A, Behrens GM, Steffens S, Schmachtenberg T. How do immunocompromised people experience the changes in their working lives during the COVID-19 pandemic? Results from a mixed-methods study in Germany. Heliyon 2023; 9:e20344. [PMID: 37771534 PMCID: PMC10522935 DOI: 10.1016/j.heliyon.2023.e20344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 09/14/2023] [Accepted: 09/19/2023] [Indexed: 09/30/2023] Open
Abstract
Background and aims The COVID-19 pandemic has a major impact on many areas of life, including many people's job situations. Not everyone is affected in the same way - people with chronic conditions may experience increased mental stress and social problems. In this study, we focus on immunocompromised people (ICP), who are at high risk for a severe course of COVID-19. Our aim was to investigate the level of social participation during the pandemic, focusing on how ICPs perceive changes in their working lives. Methods We applied a mixed-methods concurrent triangulation design with qualitative interviews (N = 13) and a quantitative cross-sectional survey with N = 179 participants. This approach allowed us to gain deep insights into the experience of occupational-social participation. Results Qualitative results show that working from home during the COVID-19 pandemic was seen as a relief by many, as medical necessities could be integrated more easily into everyday life. Understanding and consideration of their professional social network were essential for all respondents. Our interview data hint at an influence of the family situation (e.g., having children) and the relationship of the ICP to coworkers on the perception of changes to their work environment. The quantitative results indicate an interaction between mental health and employment status on social participation, with employment reducing the negative impact of poorer mental health on social participation after adjusting for sociodemographic variables. Conclusions Our results indicate changes necessary to integrate people with chronic conditions into working life, even under pandemic conditions. This includes the possibility of flexible working hours and compliance with hygiene measures at the workplace.
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Affiliation(s)
- Greta S. Wegener
- Department of General Practice, University Medical Center Göttingen (UMG), Humboldtallee 38, 37073 Göttingen, Germany
| | - Eva Hummers
- Department of General Practice, University Medical Center Göttingen (UMG), Humboldtallee 38, 37073 Göttingen, Germany
| | - Frank Müller
- Department of General Practice, University Medical Center Göttingen (UMG), Humboldtallee 38, 37073 Göttingen, Germany
- Department of Family Medicine, Michigan State University, College of Human Medicine, 15 Michigan St NE, Grand Rapids MI 49503, USA
| | - Dominik Schröder
- Department of General Practice, University Medical Center Göttingen (UMG), Humboldtallee 38, 37073 Göttingen, Germany
| | - Sascha Roder
- Department of General Practice, University Medical Center Göttingen (UMG), Humboldtallee 38, 37073 Göttingen, Germany
| | - Alexandra Dopfer-Jablonka
- Department of Rheumatology and Immunology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
- German Center for Infection Research, Partner Site Hannover-Braunschweig, Feodor-Lynen-Str. 26, 30625 Hannover, Germany
| | - Georg M.N. Behrens
- Department of Rheumatology and Immunology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
- German Center for Infection Research, Partner Site Hannover-Braunschweig, Feodor-Lynen-Str. 26, 30625 Hannover, Germany
- Centre for Individualized Infection Medicine (CiiM), Feodor-Lynen-Straße 7, 30625, Hannover, Germany
| | - Sandra Steffens
- Department of Rheumatology and Immunology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
- Dean's Office - Curriculum Development, Hannover Medical School, Carl-Neuberg-Straße 1. 30625 Hannover, Germany
- Department of Urology, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149 Münster, Germany
| | - Tim Schmachtenberg
- Department of General Practice, University Medical Center Göttingen (UMG), Humboldtallee 38, 37073 Göttingen, Germany
- Department of Rheumatology and Immunology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
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11
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Buja A, Grotto G, Taha M, Cocchio S, Baldo V. Use of Information and Communication Technology Strategies to Increase Vaccination Coverage in Older Adults: A Systematic Review. Vaccines (Basel) 2023; 11:1274. [PMID: 37515089 PMCID: PMC10384530 DOI: 10.3390/vaccines11071274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 07/14/2023] [Accepted: 07/19/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Coverage rates of routinely recommended vaccines in older adults still fall below the targets established by international and national advisory committees. As a result, related diseases still have a high incidence, morbidity, and mortality. Information and Communication Technologies (ICT) could provide useful tools to improve immunization rates by bringing information directly to the target user at a relatively low cost. The present research aims to systematically review recent literature on interventions applying ICT to improve the uptake of influenza, pneumococcal, COVID-19 and herpes zoster immunization rates among older adults. METHODS Studies published in English between 1 January 2000 and 10 November 2022 were identified by searching electronic medical databases (PubMed, Scopus) and were independently reviewed by two different authors. A total of 22 studies were included in this review. FINDINGS Interventions applied the following ICT tools: phone calls, text messages, messages sent via personal electronic medical records, automated phone calls, remote patient monitoring in a home telehealth program and emails. In terms of the vaccines promoted, 11 studies prompted the influenza vaccine, four prompted the influenza and pneumococcal vaccines, three the pneumococcal vaccine, two the herpes zoster vaccine, one the COVID-19 vaccine and one both the pneumococcal and herpes zoster vaccines. Overall, more than half of the studies (n = 12) found some level of effectiveness of these ICT strategies in increasing vaccination rates among older adults, while five studies were partially effective (for specific vaccines or population subgroups), and five reported no significant effect. CONCLUSIONS Prevention programs using ICT tools could be effective in promoting immunizations among older adults.
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Affiliation(s)
- Alessandra Buja
- Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padua, 35131 Padua, Italy
| | - Giulia Grotto
- Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padua, 35131 Padua, Italy
| | - Mustapha Taha
- Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padua, 35131 Padua, Italy
| | - Silvia Cocchio
- Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padua, 35131 Padua, Italy
| | - Vincenzo Baldo
- Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padua, 35131 Padua, Italy
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12
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Greffe S, Guerrisi C, Souty C, Vilcu AM, Hayem G, Costantino F, Padovano I, Bourgault I, Trad S, Ponsoye M, Vilaine E, Debin M, Turbelin C, Blanchon T, Hanslik T. Influenza-like illness in individuals treated with immunosuppressants, biologics, and/or systemic corticosteroids for autoimmune or chronic inflammatory disease: A crowdsourced cohort study, France, 2017-2018. Influenza Other Respir Viruses 2023; 17:e13148. [PMID: 37380174 DOI: 10.1111/irv.13148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 05/03/2023] [Accepted: 05/04/2023] [Indexed: 06/30/2023] Open
Abstract
BACKGROUND Influenza-like illness (ILI) incidence estimates in individuals treated with immunosuppressants and/or biologics and/or corticosteroid for an autoimmune or chronic inflammatory disease are scarce. We compared the ILI incidence among immunocompromised population and the general population. METHOD We conducted a prospective cohort study during the 2017-2018 seasonal influenza epidemic, on the GrippeNet.fr electronic platform, which allows the collection of epidemiological crowdsourced data on ILI, directly from the French general population. The immunocompromised population were adults treated with systemic corticosteroids, immunosuppressants, and/or biologics for an autoimmune or chronic inflammatory disease, recruited directly on GrippeNet.fr and also among patients of the departments of a single university hospital that were asked to incorporate GrippeNet.fr. The general population consisted of adults reporting none of the above treatments or diseases participating in GrippeNet.fr. The incidence of ILI was estimated on a weekly basis and compared between the immunocompromised population and the general population, during the seasonal influenza epidemic. RESULTS Among the 318 immunocompromised patients assessed for eligibility, 177 were included. During the 2017-2018 seasonal influenza epidemic period, immunocompromised population had 1.59 (95% CI: 1.13-2.20) higher odds to experience an ILI episode, compared to the general population (N = 5358). An influenza vaccination was reported by 58% of the immunocompromised population, compared to 41% of the general population (p < 0.001). CONCLUSION During a seasonal influenza epidemic period, the incidence of influenza-like illness was higher in patients treated with immunosuppressants, biologics, and/or corticosteroids for an autoimmune or chronic inflammatory disease, compared to the general population.
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Affiliation(s)
- Ségolène Greffe
- Department of Internal Medicine, Ambroise-Paré Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Boulogne-Billancourt, France
| | - Caroline Guerrisi
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique (IPLESP), Paris, France
| | - Cécile Souty
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique (IPLESP), Paris, France
| | - Ana-Maria Vilcu
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique (IPLESP), Paris, France
| | - Gilles Hayem
- Department of Rheumatology, Ambroise-Paré Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Boulogne-Billancourt, France
- Department of Rheumatology, Saint-Joseph Hospital, Paris, France
| | - Félicie Costantino
- Department of Rheumatology, Ambroise-Paré Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Boulogne-Billancourt, France
- "Simone Veil - Santé" Medical School, Université de Versailles Saint-Quentin-en-Yvelines, Université Paris Saclay, Montigny-le-Bretonneux, France
- Université Paris-Saclay, UVSQ, Inserm U1173, Infection et inflammation, Laboratory of Excellence INFLAMEX, Montigny-Le-Bretonneux, France
| | - Ilaria Padovano
- Department of Rheumatology, Ambroise-Paré Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Boulogne-Billancourt, France
| | - Isabelle Bourgault
- "Simone Veil - Santé" Medical School, Université de Versailles Saint-Quentin-en-Yvelines, Université Paris Saclay, Montigny-le-Bretonneux, France
- Department of Dermatology, Ambroise-Paré Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Boulogne-Billancourt, France
| | - Salim Trad
- Department of Internal Medicine, Ambroise-Paré Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Boulogne-Billancourt, France
| | - Matthieu Ponsoye
- Department of Internal Medicine, Ambroise-Paré Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Boulogne-Billancourt, France
- "Simone Veil - Santé" Medical School, Université de Versailles Saint-Quentin-en-Yvelines, Université Paris Saclay, Montigny-le-Bretonneux, France
- Department of Internal Medicine, Foch Hospital, Suresnes, France
| | - Eve Vilaine
- Department of Nephrology, Ambroise-Paré Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Boulogne-Billancourt, France
| | - Marion Debin
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique (IPLESP), Paris, France
| | - Clément Turbelin
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique (IPLESP), Paris, France
| | - Thierry Blanchon
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique (IPLESP), Paris, France
| | - Thomas Hanslik
- Department of Internal Medicine, Ambroise-Paré Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Boulogne-Billancourt, France
- "Simone Veil - Santé" Medical School, Université de Versailles Saint-Quentin-en-Yvelines, Université Paris Saclay, Montigny-le-Bretonneux, France
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13
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Chinwong S, Taesotikul S, Koenkaew D, Thanomjit T, Phrommintikul A, Chinwong D. Influenza Vaccination among Patients with Diabetes or Ischemic Heart Disease in Thailand: Coverage, Knowledge and Associated Factors. Vaccines (Basel) 2023; 11:vaccines11040794. [PMID: 37112706 PMCID: PMC10144710 DOI: 10.3390/vaccines11040794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 03/26/2023] [Accepted: 03/30/2023] [Indexed: 04/29/2023] Open
Abstract
An influenza vaccination is recommended for patients with diabetes mellitus (DM) or ischemic heart disease (IHD) to prevent cardiovascular events, but the vaccination coverage remains low. This cross-sectional study sought to investigate vaccination coverage, knowledge level on influenza and factors associated with influenza vaccination in patients with DM or IHD treated at a tertiary hospital in northern Thailand. Patients were interviewed from August to October 2017. Of 150 patients interviewed (51.3% women, mean age of 66.7 ± 8.3 years, 35.3% DM, 35.3% IHD, 29.3% DM and IHD), 45.3% (68/150) were vaccinated against influenza. The mean knowledge score was 9.68 ± 1.35 (total: 11) and did not differ between those receiving the immunization and those who did not (p = 0.056). Two factors remained significantly associated with their vaccination after multivariable logistic regression analysis: knowing their right to receive free vaccinations (adjusted OR 2.32, 95% CI: 1.06-5.10, p-value: 0.035), and needing to be vaccinated (adjusted OR 3.50, 95% CI: 1.51-8.12, p-value: 0.003). Overall, the vaccine coverage was low; less than one-half of patients received the influenza vaccine, but their knowledge level was high. Possessing the right and having a need were two factors associated with vaccination. Such factors should be carefully considered to encourage patients with DM and IDH to receive the influenza vaccination.
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Affiliation(s)
- Surarong Chinwong
- Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai 50200, Thailand
- Center of Excellence for Innovation in Analytical Science and Technology for Biodiversity-Based Economic and Society (I-ANALY-S-T_B.BES-CMU), Chiang Mai University, Chiang Mai 50200, Thailand
| | - Suthinee Taesotikul
- Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai 50200, Thailand
- Pharmaceutical Care Training Center (PCTC), Faculty of Pharmacy, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Duangruthai Koenkaew
- Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Thanannat Thanomjit
- Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Arintaya Phrommintikul
- Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Dujrudee Chinwong
- Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai 50200, Thailand
- Center of Excellence for Innovation in Analytical Science and Technology for Biodiversity-Based Economic and Society (I-ANALY-S-T_B.BES-CMU), Chiang Mai University, Chiang Mai 50200, Thailand
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14
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Fuochi E, Anastasio L, Lynch EN, Campani C, Dragoni G, Milani S, Galli A, Innocenti T. Main factors influencing long-term outcomes of liver transplantation in 2022. World J Hepatol 2023; 15:321-352. [PMID: 37034235 PMCID: PMC10075010 DOI: 10.4254/wjh.v15.i3.321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 11/24/2022] [Accepted: 02/22/2023] [Indexed: 04/11/2023] Open
Abstract
Liver transplant (LT) outcomes have markedly improved in the recent decades, even if long-term morbidity and mortality are still considerable. Most of late deaths are independent from graft function and different comorbidities, including complications of metabolic syndrome and de novo neoplasms, seem to play a key role in determining long-term outcomes in LT recipients. This review discusses the main factors associated with late mortality and suggests possible strategies to improve long-term management and follow-up after liver transplantation. In particular, the reduction of drug toxicity, the use of tools to identify high-risk patients, and setting up a multidisciplinary team also for long-term management of LT recipients may further improve survival after liver transplantation.
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Affiliation(s)
- Elisa Fuochi
- Gastroenterology Research Unit, Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, Florence 50134, Italy
| | - Lorenzo Anastasio
- Gastroenterology Research Unit, Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, Florence 50134, Italy
| | - Erica Nicola Lynch
- Gastroenterology Research Unit, Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, Florence 50134, Italy
| | - Claudia Campani
- Department of Experimental and Clinical Medicine, University of Florence, Florence 50134, Italy
| | - Gabriele Dragoni
- Gastroenterology Research Unit, Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, Florence 50134, Italy
- Department of Medical Biotechnologies, University of Siena, Siena 53100, Italy
| | - Stefano Milani
- Gastroenterology Research Unit, Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, Florence 50134, Italy
| | - Andrea Galli
- Gastroenterology Research Unit, Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, Florence 50134, Italy
| | - Tommaso Innocenti
- Gastroenterology Research Unit, Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, Florence 50134, Italy
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15
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Maertzdorf K, Rietman M, Lambooij M, Verschuren W, Picavet H. Willingness to get vaccinated against influenza, pneumococcal disease, pertussis, and herpes zoster - A pre-COVID-19 exploration among the older adult population. Vaccine 2023; 41:1254-1264. [PMID: 36639273 PMCID: PMC9810548 DOI: 10.1016/j.vaccine.2023.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 12/22/2022] [Accepted: 01/01/2023] [Indexed: 01/05/2023]
Abstract
BACKGROUND Older adults are at increased risk for adverse health outcomes when having an influenza, pneumococcal disease, pertussis, or herpes zoster infection. Despite the ability of vaccinations to prevent these adverse outcomes, vaccination coverage is low in the European Union. This study aimed to explore the sociodemographic, lifestyle, and health-related characteristics associated with vaccination willingness for these vaccine-preventable diseases. METHODS Cross-sectional data from wave 6 (years 2013-2017) of the population-based Doetinchem Cohort Study was analysed, with 3063 participants aged 46-86 years included. The outcome was the self-reported willingness to get vaccinated against influenza, pneumococcal disease, pertussis, and herpes zoster (willing, neutral, not willing). Multinomial logistic regression was used to investigate the socio-demographic, lifestyle and health characteristics associated with vaccination willingness. RESULTS For influenza 36 % was willing to get vaccinated, 35 % was neutral and 28 % was not willing to get vaccinated. The willingness to get vaccinated for the relatively unfamiliar vaccine-preventable diseases was lower: 26 % for pneumococcal disease (neutral: 50 %, not willing: 23 %), 26 % for pertussis (neutral 53 %, not willing: 22 %), and 23 % for herpes zoster (neutral 54 %, not willing: 24 %). A relative lower willingness was found among those 46-64 years old (compared to those 65 years or older). Women, having a high SES, being employed and having a good health were all associated with lower willingness to get vaccinated, which was the case for all vaccine-preventable diseases. CONCLUSIONS Older adults were generally more willing to get vaccinated against influenza than for the three less familiar diseases. Characteristics of those less willing may be used to improve strategies to increase vaccination coverage. Additional studies are needed to investigate the willingness to get vaccinated during and after the COVID-19 pandemic that may have changed the feel of urgency for vaccination.
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Affiliation(s)
- K.M. Maertzdorf
- Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - M.L. Rietman
- Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - M.S. Lambooij
- Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - W.M.M. Verschuren
- Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, the Netherlands,Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - H.S.J. Picavet
- Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, the Netherlands,Corresponding author at: Centre for Prevention and Health Services Research, National Institute for Public Health and the Environment, P.O. Box 1, 3720 BA Bilthoven, the Netherlands
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16
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Chen Y, Chen B, Shen X, Zhou A, Liang Y, Wang Y, Chen H. A survey of systemic lupus erythematosus patients' attitudes toward influenza and pneumococcal vaccination in Southwest China. Front Public Health 2022; 10:1018899. [PMID: 36605245 PMCID: PMC9807807 DOI: 10.3389/fpubh.2022.1018899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 11/08/2022] [Indexed: 12/24/2022] Open
Abstract
Introduction Vaccination is the most effective measure for prevention against infectious diseases in patients with systemic lupus erythematosus (SLE). Therefore, it is important to know SLE patients' attitudes toward influenza and pneumococcal vaccination. This study aimed to investigate the attitude toward influenza and pneumococcal vaccination among SLE patients in Southwest China and its influencing factors. Methods A web-based questionnaire was conducted to collect data regarding SLE patients' demographics, history of infections, medications, comorbidities, attitudes toward infection and vaccination, rates of influenza and pneumococcal vaccination, and role of health professionals in promoting vaccination. Univariate and multivariate logistic regression analyses were conducted to assess the vaccination willingness-associated factors. Results A total of 251 patients participated in the survey and 240 questionnaires were completed and statistically analyzed. The influenza and pneumococcal vaccination rates were 8.3 and 1.7%, respectively. The top three reasons for non-vaccination were worrying about the SLE exacerbation or flare resulting from the vaccine or its adjuvants, being concerned about adverse events, and the lack of awareness of vaccine availability. More than half of the participants were willing to be vaccinated against influenza (56.2%) and pneumococcus (52.9%). Factors associated to the willingness to receive the influenza vaccine and pneumococcal vaccine were being afraid of infection, believing in the efficacy of influenza vaccination, lower family income, less perceived care from family members, perceived susceptibility to pneumococcal infection, and perceiving influenza and pneumococcal vaccination as beneficial for health. Conclusions The influenza and pneumococcal vaccination rates are low among SLE patients in Southwest China. The positive perspective of vaccination on health represented the most impacting factor on their willingness to undergo influenza and pneumococcal vaccination. Non-vaccinated patients were mainly concerned about exacerbation of the disease or adverse events caused by vaccines. It is important to improve the compliance with the guideline-recommended roles of health professionals and to promote the collaboration between rheumatology and primary care teams.
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Affiliation(s)
- Yanling Chen
- West China School of Nursing, Department of Rheumatology and Immunology, West China Hospital, Sichuan University, Chengdu, China
| | - Bo Chen
- Department of Rheumatology and Immunology, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaolin Shen
- West China School of Nursing, Department of Rheumatology and Immunology, West China Hospital, Sichuan University, Chengdu, China
| | - Aiping Zhou
- West China School of Nursing, Department of Rheumatology and Immunology, West China Hospital, Sichuan University, Chengdu, China
| | - Yan Liang
- West China School of Nursing, Department of Rheumatology and Immunology, West China Hospital, Sichuan University, Chengdu, China
| | - Ying Wang
- West China School of Nursing, Department of Rheumatology and Immunology, West China Hospital, Sichuan University, Chengdu, China
| | - Hong Chen
- West China School of Nursing, West China Hospital, Sichuan University, Chengdu, China,*Correspondence: Hong Chen
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17
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Shapiro Ben David S, Goren I, Mourad V, Cahan A. Vaccination Coverage among Immunocompromised Patients in a Large Health Maintenance Organization: Findings from a Novel Computerized Registry. Vaccines (Basel) 2022; 10:vaccines10101654. [PMID: 36298519 PMCID: PMC9612260 DOI: 10.3390/vaccines10101654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 09/28/2022] [Accepted: 09/30/2022] [Indexed: 11/05/2022] Open
Abstract
Immune-compromised patients (IPs) are at high risk for infections, some of which are preventable by vaccines. Specific vaccines are recommended for IP; however, the vaccination rate is suboptimal. The aim of this study is to describe the development of an IP registry and to assess vaccination rates in this population. A population-based registry of IPs was developed using an automated extraction of patient electronic health-record data in Maccabi Healthcare Services (MHS), an Israeli health maintenance organization serving over 2.4 million members. Included in the registry were patients receiving immunosuppressive therapy (IT); patients living with HIV (PLWH); solid organ and bone marrow transplant recipients (TR); patients with advanced kidney disease (AKD), and asplenic patients. We evaluated the full schedule for each vaccine's uptake rates for influenza, pneumococcal, meningococcal, and hepatitis B. On 1 October 2019, 32,637 adult immune-compromised patients were identified by the registry. Of them, 1647 were PLWH; 2354 were asplenic; 5317 had AKD; 23,216 were on IT; and 1824 were TR. Their mean age was 57 and 52.4% were females. The crude rate of immune compromise among adult MHS members was 2%. Vaccine coverage rate was overall low for PCV13, with only 11.9% of all IPs in the registry having received one dose. Influenza and PPV23 vaccination rates were higher (45% and 39.4%, respectively). Only 5.3% of all IPs received all three vaccines. Overall, low vaccination coverage was found among IPs. Our registry can serve to identify target-patient populations for interventions and monitor their effectiveness.
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Affiliation(s)
- Shirley Shapiro Ben David
- Health Division, Maccabi Healthcare Services, Tel Aviv 6812509, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Correspondence: ; Tel.: +972-37952830
| | - Iris Goren
- Health Division, Maccabi Healthcare Services, Tel Aviv 6812509, Israel
| | - Vered Mourad
- Health Division, Maccabi Healthcare Services, Tel Aviv 6812509, Israel
| | - Amos Cahan
- Infectious Diseases Unit, Samson Assuta Ashdod University Hospital, Ashdod 7747629, Israel
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18
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Nasreen S, Gebretekle GB, Lynch M, Kurdina A, Thomas M, Fadel S, Houle SKD, Waite NM, Crowcroft NS, Allin S. Understanding predictors of pneumococcal vaccine uptake in older adults aged 65 years and older in high-income countries across the globe: A scoping review. Vaccine 2022; 40:4380-4393. [PMID: 35781171 DOI: 10.1016/j.vaccine.2022.06.056] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 05/31/2022] [Accepted: 06/20/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND Pneumococcal disease causes substantial morbidity and mortality in older adults. Pneumococcal polysaccharide vaccine (PPV23) is routinely recommended to reduce the disease burden in this population. However, the vaccination coverage in older adults remains suboptimal in high-income countries. OBJECTIVES We sought to understand the current landscape of published literature on the predictors of pneumococcal vaccine uptake in older adults aged 65 years and older in high-income countries, and to identify the gaps in literature to inform future research. METHODS We conducted a scoping review employing the Arksey and O'Malley framework and Joanna Briggs Methods. We searched Medline, EMBASE, CINAHL, PsycInfo and Cochrane databases. We included quantitative and qualitative studies on predictors of pneumococcal vaccination in older adults that reported older adult- and pneumococcal vaccine-specific results, conducted in high-income settings, and published in English between January 2015 and April 2020. We excluded studies assessing interventions to improve vaccine uptake. We followed the Strategic Advisory Group of Experts on Immunization Working Group Vaccine Hesitancy Determinants Matrix to map the predictors within contextual, individual and social group, and vaccine and vaccination-specific influence determinants. Studies on providers and institutions were also included and results summarized separately. RESULTS We included 52 publications in our review. Most of the predictors in 39 quantitative studies belonged to the individual and social group influences (n = 12), followed by contextual influences (n = 11) and vaccine and vaccination-specific issues (n = 3). Few qualitative studies explored the barriers to pneumococcal vaccination. Only five studies examined predictors from the healthcare providers' perspective. Three studies examined the institutional characteristics as the predictors of pneumococcal vaccination in older adults. CONCLUSIONS We identified enablers and barriers of pneumococcal vaccination among older adults in high-income settings. We also identified gaps in the literature and provide recommendations for future research to address the gaps.
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Affiliation(s)
- Sharifa Nasreen
- Centre for Vaccine Preventable Diseases, University of Toronto, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Ontario, Canada.
| | - Gebremedhin B Gebretekle
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, Ontario, Canada
| | - Meghan Lynch
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Anna Kurdina
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Madeleine Thomas
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Shaza Fadel
- Centre for Vaccine Preventable Diseases, University of Toronto, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
| | | | - Nancy M Waite
- School of Pharmacy, University of Waterloo, Waterloo, Ontario, Canada
| | - Natasha S Crowcroft
- Centre for Vaccine Preventable Diseases, University of Toronto, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
| | - Sara Allin
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Webb NJ, Lindsley J, Stockbridge EL, Workman A, Reynolds CD, Miller TL, Charles J, Carletti M, Casperson S, Weis S. Effectiveness of an intervention to overcome influenza vaccine hesitancy in specialty clinic patients. Medicine (Baltimore) 2022; 101:e29786. [PMID: 35905271 PMCID: PMC9333474 DOI: 10.1097/md.0000000000029786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Individuals on immunosuppressive therapies experience greater morbidity and mortality due to vaccine-preventable illnesses, but there are low rates of adherence to immunization guidelines within this population. OBJECTIVE To determine the effectiveness of clinician-led education, patient-centered dialogue, and immediately available immunization on influenza vaccination uptake in patients taking immunosuppressive therapies. METHOD We used a controlled before-and-after quasi-experimental design to evaluate our quality improvement intervention occurring from September 2019 to March 2020, with follow-up through July 2020. The study included 2 dermatology practices wherein nursing staff offered influenza vaccination during patient rooming (standard care). Within each practice, clinicians either implemented the intervention or provided only standard care. Patients received the intervention or standard care depending on the clinician they visited. Patients seen at the 2 clinics during the intervention period were included in analyses if they were taking or newly prescribed immunosuppressant medication at the time of their visit. We examined influenza immunization status for 3 flu seasons: 2017-2018 (preintervention), 2018-2019 (preintervention), and 2019-2020 (intervention). INTERVENTION Immunosuppressed patients initially declining an influenza vaccine were provided dermatologist-led education on the benefits of immunization. Dermatologists explored and addressed individual patients' immunization concerns. Influenza vaccination was then offered immediately postdialogue. RESULTS Analyses included 201 dermatology patients who were prescribed or currently taking immunosuppressive medication (intervention group [72.6%], comparison group [27.4%]). During the intervention period, 91.1% of the intervention group received influenza vaccination compared to 56.4% of the comparison group. Vaccination trends from 2018-2019 (preintervention) to 2019-2020 (intervention) differed significantly between groups (χ2 = 22.92, P < .001), with greater improvement in the intervention group. In 2019-2020, influenza vaccination was more likely in the intervention group relative to the comparison group (odds ratio: 16.22, 95% confidence interval: 5.55-47.38). In the subset of patients that had never received an influenza vaccine, influenza immunization in 2019-2020 was more common in the intervention group (75.8%, 25/33) relative to the comparison group (13.3%, 2/15, P < .001). CONCLUSION The intervention successfully addressed vaccine hesitancy and improved influenza immunization rates in an immunosuppressed population receiving care from a specialty clinic. Implementing a similar model across specialty clinics may improve vaccination rates for influenza, coronavirus disease 2019, and other vaccine-preventable illnesses in other populations.
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Affiliation(s)
- Nathaniel J. Webb
- Department of Health Behavior and Health Systems, School of Public Health, University of North Texas Health Science Center, Fort Worth, Texas, United States
| | - Joshua Lindsley
- Department of Internal Medicine, Texas College of Osteopathic Medicine, University of North Texas Health Science Center, Fort Worth, Texas, United States
| | - Erica L. Stockbridge
- Department of Internal Medicine, Texas College of Osteopathic Medicine, University of North Texas Health Science Center, Fort Worth, Texas, United States
- *Correspondence: Erica L. Stockbridge, Department of Internal Medicine, Texas College of Osteopathic Medicine, University of North Texas Health Science Center, 855 Montgomery Street, Health Pavilion – 4th Floor, Fort Worth, TX 76107, United States (e-mail: )
| | - Ashleigh Workman
- Department of Dermatology, Medical City Weatherford, Weatherford, Texas, United States
| | - Conner D. Reynolds
- Department of Internal Medicine, Texas College of Osteopathic Medicine, University of North Texas Health Science Center, Fort Worth, Texas, United States
| | - Thaddeus L. Miller
- Department of Health Behavior and Health Systems, School of Public Health, University of North Texas Health Science Center, Fort Worth, Texas, United States
| | - Jean Charles
- Department of Dermatology, Medical City Weatherford, Weatherford, Texas, United States
| | - Michael Carletti
- Department of Internal Medicine, Texas College of Osteopathic Medicine, University of North Texas Health Science Center, Fort Worth, Texas, United States
- Department of Dermatology, Medical City Weatherford, Weatherford, Texas, United States
| | - Stefanie Casperson
- John Peter Smith Hospital, JPS Health Network, Fort Worth, Texas, United States
| | - Stephen Weis
- Department of Internal Medicine, Texas College of Osteopathic Medicine, University of North Texas Health Science Center, Fort Worth, Texas, United States
- Department of Dermatology, Medical City Weatherford, Weatherford, Texas, United States
- John Peter Smith Hospital, JPS Health Network, Fort Worth, Texas, United States
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Wyplosz B, Fernandes J, Sultan A, Roche N, Roubille F, Loubet P, Fougère B, Moulin B, Duhot D, Vainchtock A, Raguideau F, Lortet-Tieulent J, Blanc E, Moïsi J, Goussiaume G. Pneumococcal and influenza vaccination coverage among at-risk adults: A 5-year French national observational study. Vaccine 2022; 40:4911-4921. [PMID: 35811205 DOI: 10.1016/j.vaccine.2022.06.071] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 06/24/2022] [Accepted: 06/26/2022] [Indexed: 10/17/2022]
Abstract
INTRODUCTION The risk of developing pneumococcal infections increases with certain chronic conditions and in immunocompromised patients. We aimed to monitor pneumococcal vaccination coverage in at-risk patients and to examine factors associated with pneumococcal vaccination in France. MATERIAL AND METHODS In this annual cross-sectional study, at-risk patients were extracted between 2014 and 2018 from the National Health Insurance's (NHI) General scheme's claims database with their vaccine reimbursements. Descriptive analyses and a logistic model were performed to assess the influence of healthcare use and medical and demographic factors on pneumococcal vaccination. RESULTS AND DISCUSSION In 2018, 4.5% of 4,045,021 at-risk adults were up to date with their pneumococcal vaccination. During the study period, the number of patients with chronic medical conditions (86% of 4,045,021) increased by 10.1%, but vaccination coverage decreased from 12.9% to 2.9%. The population with immunocompromised status (14% of 4,045,021) increased by 16.2% and vaccination coverage from 10.3% to 18.8%. Influenza vaccination coverage was much higher and stable (around 45.0%). Factors associated with pneumococcal vaccination were: immunocompromised status vs. having a chronic medical condition (odds ratio [OR] 4.72), influenza vaccination (OR 2.36-3.42), hepatitis B vaccination (OR 2.82), DTPolio vaccination (OR 1.52), ≥5 specialist physicians' visits (OR 1.17), and age above 74 (OR 1.12). Pneumococcal vaccine dispensing was extremely low (median of 9per GP,1per specialist over 9 years) despite frequent healthcare visits. CONCLUSION Pneumococcal and influenza vaccination coverage of adults at risk of pneumococcal disease fell well below public health expectations. Invitations for pneumococcal vaccination should be sent by the NHI to high-risk patients. Patient management protocols should include pneumococcal vaccination. Patients with multiple comorbidities are a high-priority population given the large potential health gains offered by pneumococcal vaccination. Commitment of both scientific societies and health authorities is urgently needed to increase vaccination coverage in at-risk populations.
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Affiliation(s)
- Benjamin Wyplosz
- AP-HP, Bicêtre University Hospital, Service de maladies infectieuses et tropicales, Centre de vaccinations internationales et de l'immunodéprimé, Le Kremlin-Bicêtre, France.
| | - Jérôme Fernandes
- Medical Information Department, Bayonne Hospital, Bayonne, France.
| | - Ariane Sultan
- PhyMedExp, University Montpellier, CNRS, INSERM, Endocrinology-Diabetology-Nutrition Department, University Montpellier, 34295 Montpellier, France.
| | | | | | - Paul Loubet
- Service des Maladies infectieuses et Tropicales, CHU de Nîmes - INSERM U1047 - Université de Montpellier, Nîmes (France).
| | - Bertrand Fougère
- Division of Geriatric Medicine, Tours University Hospital, Tours, France.
| | - Bruno Moulin
- Nephrology and Transplantation, Strasbourg University Hospital, Strasbourg, France.
| | - Didier Duhot
- Société Française de Médecine Générale, Issy les Moulineaux, France.
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21
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Müller F, Heinemann S, Hummers E, Noack EM, Heesen G, Dopfer-Jablonka A, Mikuteit M, Niewolik J, Steffens S, Schröder D. [Immunosuppressed people's beliefs, expectations, and experiences with COVID-19 vaccinations : Results of a longitudinal study]. Z Rheumatol 2022; 82:342-354. [PMID: 35523964 PMCID: PMC9075708 DOI: 10.1007/s00393-022-01213-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Immunocompromised people are less likely to be vaccinated, despite an increased benefit of many vaccinations in terms of benefit-risk assessment, including the vaccines against SARS CoV-2 (COVID-19). Attitudes, expectations, and experiences with previous vaccinations influence the decision to get vaccinated. OBJECTIVE To explore the attitudes of immunocompromised people towards vaccinations in general and COVID-19 vaccination in particular and their experiences with COVID-19 vaccinations. MATERIAL AND METHODS As part of the CoCo Immune study, immunocompromised participants were surveyed in the spring and summer of 2021 (1 November 2021-7 September 2021) using questionnaires. Initially, they were asked about their expectations concerning a COVID-19 vaccination and followed up about their experience after COVID-19 vaccination. In addition, sociodemographic data, general attitudes toward vaccinations and experiences with previous vaccinations were collected. Analysis was performed using descriptive and bivariate statistics. RESULTS The 243 participants mostly approved vaccinations and expected the COVID-19 vaccination to be effective and well-tolerated. Women were more concerned about the safety of vaccinations and were more often worried about side effects. Older persons felt better informed than younger persons. Participants who reported subjective side effects of previous vaccinations were more skeptical about vaccinations as well as the government institutions that recommend vaccinations. They less often agreed with the statement "in retrospect, the COVID-19 vaccination has been harmless for me so far". DISCUSSION The participants mostly expressed a positive attitude and anticipation towards COVID-19 vaccinations; however, the age and sex differences found suggest that there are different information needs which should be addressed when educating individuals about vaccinations or designing vaccination campaigns.
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Affiliation(s)
- Frank Müller
- Institut für Allgemeinmedizin, Universitätsmedizin Göttingen, Humboldtallee 38, 37073, Göttingen, Deutschland.
| | - Stephanie Heinemann
- Institut für Allgemeinmedizin, Universitätsmedizin Göttingen, Humboldtallee 38, 37073, Göttingen, Deutschland
| | - Eva Hummers
- Institut für Allgemeinmedizin, Universitätsmedizin Göttingen, Humboldtallee 38, 37073, Göttingen, Deutschland
| | - Eva Maria Noack
- Institut für Allgemeinmedizin, Universitätsmedizin Göttingen, Humboldtallee 38, 37073, Göttingen, Deutschland
| | - Gloria Heesen
- Institut für Allgemeinmedizin, Universitätsmedizin Göttingen, Humboldtallee 38, 37073, Göttingen, Deutschland
| | - Alexandra Dopfer-Jablonka
- Klinik für Rheumatologie und Immunologie, Medizinische Hochschule Hannover, Hannover, Deutschland
- Deutsches Zentrum für Infektionsforschung, Hannover-Braunschweig, Deutschland
| | - Marie Mikuteit
- Klinik für Rheumatologie und Immunologie, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - Jacqueline Niewolik
- Klinik für Rheumatologie und Immunologie, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - Sandra Steffens
- Klinik für Rheumatologie und Immunologie, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - Dominik Schröder
- Institut für Allgemeinmedizin, Universitätsmedizin Göttingen, Humboldtallee 38, 37073, Göttingen, Deutschland
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22
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Suresh S, Zafack J, Pham-Huy A, Derfalvi B, Sadarangani M, McConnell A, Tapiéro B, Halperin SA, De Serres G, M Pernica J, Top KA. Physician vaccination practices in mild to moderate inborn errors of immunity and retrospective review of vaccine completeness in IEI: results from the Canadian Immunization Research Network. ALLERGY, ASTHMA, AND CLINICAL IMMUNOLOGY : OFFICIAL JOURNAL OF THE CANADIAN SOCIETY OF ALLERGY AND CLINICAL IMMUNOLOGY 2022; 18:32. [PMID: 35397595 PMCID: PMC8994318 DOI: 10.1186/s13223-022-00667-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 03/08/2022] [Indexed: 11/26/2022]
Abstract
Background and objectives Safety and effectiveness concerns may preclude physicians from recommending vaccination in mild/moderate inborn errors of immunity (IEI). This study describes attitudes and practices regarding vaccination among physicians who care for patients with mild/moderate B cell or mild/moderate combined immunodeficiencies (CID) and vaccination completeness among patients diagnosed with IEIs. Methods Canadian physicians caring for children with IEI were surveyed about attitudes and practices regarding vaccination in mild/moderate IEI. Following informed consent, immunization records of pediatric patients with IEI evaluated before 7 years of age were reviewed. Vaccine completeness was defined at age 2 years as 4 doses of diphtheria-tetanus-pertussis (DTaP), 3 doses pneumococcal conjugate (PCV), and 1 dose measles-mumps-rubella (MMR) vaccines. At 7 years 5 doses of DTP and 2 doses MMR were required. Results Forty-five physicians from 8 provinces completed the survey. Most recommended inactivated vaccines for B cell deficiency: (84% (38/45) and CID (73% (33/45). Fewer recommended live attenuated vaccines (B cell: 53% (24/45), CID 31% (14/45)). Of 96 patients with IEI recruited across 7 centers, vaccination completeness at age 2 was 25/43 (58%) for predominantly antibody, 3/13 (23%) for CID, 7/35 (20%) for CID with syndromic features, and 4/4 (100%) for innate/phagocyte defects. Completeness at age 7 was 15%, 17%, 5%, and 33%, respectively. Conclusion Most physicians surveyed recommended inactivated vaccines in children with mild to moderate IEI. Vaccine completeness for all IEI was low, particularly at age 7. Further studies should address the reasons for low vaccine uptake among children with IEI and whether those with mild-moderate IEI, where vaccination is recommended, eventually receive all indicated vaccines. Supplementary Information The online version contains supplementary material available at 10.1186/s13223-022-00667-1.
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Affiliation(s)
- Sneha Suresh
- Division of Immunology, Department of Pediatrics, Edmonton Clinic Health Academy, 3-529, 11405 87 Ave, Edmonton, AB, T6G 1C9, Canada. .,Division of Infectious Disease and IHOPE, Department of Paediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, Canada.
| | | | - Anne Pham-Huy
- Division of Infectious Diseases, Immunology and Allergy, Department of Paediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Canada
| | - Beata Derfalvi
- Division of Immunology, Departments of Paediatrics and Microbiology and Immunology, IWK Health Centre, Dalhousie University, Halifax, Canada
| | - Manish Sadarangani
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, Department of Pediatrics, University of British Columbia, Vancouver, Canada
| | - Athena McConnell
- Division of Infectious Diseases, Department of Pediatrics, Jim Pattison Children's Hospital, University of Saskatchewan, Saskatoon, Canada
| | - Bruce Tapiéro
- Division of Infectious Diseases, Department of Pediatrics, CHU Sainte Justine, Université de Montreal, Montreal, Canada
| | - Scott A Halperin
- Departments of Paediatrics and Microbiology and Immunology, Canadian Center for Vaccinology IWK Health Centre, Dalhousie University, Halifax, Canada
| | - Gaston De Serres
- Department of Social and Preventive Medicine, Institut Nationale de Santé Publique du Québec, Université Laval, Québec, Canada
| | - Jeffrey M Pernica
- Division of Infectious Diseases, Department of Pediatrics, McMaster University, Hamilton, Canada
| | - Karina A Top
- Departments of Pediatrics and Community Health and Epidemiology, Canadian Center for Vaccinology, IWK Health Centre, Dalhousie University, Halifax, Canada.
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23
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Sim JJL, Lim CC. Influenza Vaccination in Systemic Lupus Erythematosus: Efficacy, Effectiveness, Safety, Utilization, and Barriers. Am J Med 2022; 135:286-296.e9. [PMID: 34563493 DOI: 10.1016/j.amjmed.2021.08.038] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 08/26/2021] [Accepted: 08/27/2021] [Indexed: 12/19/2022]
Abstract
Influenza increases morbidity and mortality in systemic lupus erythematosus (SLE) and lupus nephritis but is preventable through vaccination. This systematic review of PubMed, Embase, CENTRAL, WHO Clinical Trials, and ClinicalTrials.gov publications until August 2021 identified 45 reports (16,596 patients), including 8.5% with renal involvement or lupus nephritis: 9 studies (10,446 patients) on clinical effectiveness, 20 studies (1327 patients) on vaccine efficacy, 22 studies (1116 patients) on vaccine safety, 14 studies (4619 patients) on utilization rates, and 5 studies (3220 patients) on barriers. Pooled seroconversion rates ranged between 46% and 56%, while seroprotection rates ranged from 68% to 73% and were significantly associated with age and disease duration. Influenza infection was lower in vaccinated patients with systemic lupus erythematosus compared with unvaccinated patients. Disease activity scores did not change significantly after vaccination and reported flares were mild to moderate. Pooled current vaccination rate was 40.0% (95% confidence interval [CI]: 33.7%-46.5%) with significant heterogeneity and associated with the gross domestic product (P = .002) and disease duration (P = .001). Barriers to vaccination were the lack of doctor recommendation (57.4%) and concerns over the safety or efficacy of the vaccine (12.7%).
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Affiliation(s)
- Jackie Jia Lin Sim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Cynthia Ciwei Lim
- Department of Renal Medicine, Singapore General Hospital, Singapore.
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24
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Tharwat S, Abdelsalam HA, Abdelsalam A, Nassar MK. COVID-19 Vaccination Intention and Vaccine Hesitancy among Patients with Autoimmune and Autoinflammatory Rheumatological Diseases: A Survey. Int J Clin Pract 2022; 2022:5931506. [PMID: 35685586 PMCID: PMC9159235 DOI: 10.1155/2022/5931506] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 11/21/2021] [Accepted: 11/23/2021] [Indexed: 12/21/2022] Open
Abstract
Background Coronavirus disease 2019 (COVID-19) vaccine hesitancy or refusal has arisen as a major global public health concern. The aim of this study was to address the attitudes of patients with autoimmune and autoinflammatory rheumatological diseases (AIIRDs) about COVID-19 vaccination and investigate the factors that influence their decision. Methods This interview-based cross-sectional study was carried out on AIIRD patients at the period between 15 August and 15 September 2021. The questionnaire included socioeconomic data, intention to receive COVID-19 vaccine, AIIRD subtype, disease duration, associated comorbidities, history of COVID-19, beliefs and attitudes towards COVID-19, and conventional vaccination in general and COVID-19 vaccine in particular, in addition to COVID-19 vaccination status. Results A total of 206 AIIRD patients were included, with a mean age of 37.61 years (SD = 10.67), and 84% were females. The percentage of vaccine acceptance was 70.39%, while only 16.02% were hesitant and 13.59% were resistant to COVID-19 vaccination. About one-fourth of patients reported getting infected with COVID-19. Of them, 15.1% were hospitalized and 5.7% were admitted at the intensive care unit (ICU). Most of the AIIRD patients (77.2%) believed that they are at a higher risk of getting COVID-19. The main motivation for vaccine acceptance was the fear of being infected (41.4%). About 40% of vaccine nonacceptants fear about the serious side effects of COVID-19 vaccine. Conclusion There is a high acceptability rate of COVID-19 vaccination among AIIRD patients. Public health workers and policymakers must emphasize efficient COVID-19 vaccine acceptance messaging for all AIIRD patients.
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Affiliation(s)
- Samar Tharwat
- Rheumatology & Immunology Unit, Department of Internal Medicine, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Haidy Adel Abdelsalam
- Mansoura Manchester Programme for Medical Education, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Adel Abdelsalam
- Rheumatology & Immunology Unit, Department of Internal Medicine, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Mohammed Kamal Nassar
- Mansoura Nephrology & Dialysis Unit (MNDU), Department of Internal Medicine, Faculty of Medicine, Mansoura University, Mansoura, Egypt
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25
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Murdaca G, Noberasco G, Olobardi D, Lunardi C, Maule M, Delfino L, Triggiani M, Cardamone C, Benfaremo D, Moroncini G, Vacca A, Susca N, Gangemi S, Quattrocchi P, Sticchi L, Icardi G, Orsi A. Current Take on Systemic Sclerosis Patients' Vaccination Recommendations. Vaccines (Basel) 2021; 9:1426. [PMID: 34960174 PMCID: PMC8708328 DOI: 10.3390/vaccines9121426] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [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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Affiliation(s)
- Giuseppe Murdaca
- Departments of Internal Medicine, University of Genova, 16132 Genova, Italy
| | - Giovanni Noberasco
- Department of Health Sciences, University of Genova, 16132 Genova, Italy; (G.N.); (D.O.); (L.S.); (G.I.); (A.O.)
| | - Dario Olobardi
- Department of Health Sciences, University of Genova, 16132 Genova, Italy; (G.N.); (D.O.); (L.S.); (G.I.); (A.O.)
| | - Claudio Lunardi
- Department of Medicine, University of Verona, 37129 Verona, Italy; (C.L.); (M.M.); (L.D.)
| | - Matteo Maule
- Department of Medicine, University of Verona, 37129 Verona, Italy; (C.L.); (M.M.); (L.D.)
| | - Lorenzo Delfino
- Department of Medicine, University of Verona, 37129 Verona, Italy; (C.L.); (M.M.); (L.D.)
| | - Massimo Triggiani
- Division of Allergy and Clinical Immunology, University of Salerno, 84084 Salerno, Italy; (M.T.); (C.C.)
| | - Chiara Cardamone
- Division of Allergy and Clinical Immunology, University of Salerno, 84084 Salerno, Italy; (M.T.); (C.C.)
| | - Devis Benfaremo
- Clinica Medica, Ospedali Riuniti Ancona, 60126 Ancona, Italy; (D.B.); (G.M.)
- Dipartimento di Scienze Cliniche e Molecolari, Università Politecnica delle Marche, 60126 Ancona, Italy
| | - Gianluca Moroncini
- Clinica Medica, Ospedali Riuniti Ancona, 60126 Ancona, Italy; (D.B.); (G.M.)
- Dipartimento di Scienze Cliniche e Molecolari, Università Politecnica delle Marche, 60126 Ancona, Italy
| | - Angelo Vacca
- “Guido Baccelli” Unit of Internal Medicine, Department of Biomedical Sciences and Human Oncology, School of Medicine, Aldo Moro University of Bari, 70121 Bari, Italy; (A.V.); (N.S.)
| | - Nicola Susca
- “Guido Baccelli” Unit of Internal Medicine, Department of Biomedical Sciences and Human Oncology, School of Medicine, Aldo Moro University of Bari, 70121 Bari, Italy; (A.V.); (N.S.)
| | - Sebastiano Gangemi
- Department of Clinical and Experimental Medicine, School and Operative Unit of Allergy and Clinical Immunology, University of Messina, 98124 Messina, Italy; (S.G.); (P.Q.)
| | - Paola Quattrocchi
- Department of Clinical and Experimental Medicine, School and Operative Unit of Allergy and Clinical Immunology, University of Messina, 98124 Messina, Italy; (S.G.); (P.Q.)
| | - Laura Sticchi
- Department of Health Sciences, University of Genova, 16132 Genova, Italy; (G.N.); (D.O.); (L.S.); (G.I.); (A.O.)
- Hygiene Unit, “Ospedale Policlinico San Martino IRCCS”, 16132 Genova, Italy
| | - Giancarlo Icardi
- Department of Health Sciences, University of Genova, 16132 Genova, Italy; (G.N.); (D.O.); (L.S.); (G.I.); (A.O.)
- Hygiene Unit, “Ospedale Policlinico San Martino IRCCS”, 16132 Genova, Italy
| | - Andrea Orsi
- Department of Health Sciences, University of Genova, 16132 Genova, Italy; (G.N.); (D.O.); (L.S.); (G.I.); (A.O.)
- Hygiene Unit, “Ospedale Policlinico San Martino IRCCS”, 16132 Genova, Italy
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26
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Pierron A, Bozon F, Berceanu A, Fontan J, Brion A, Deconinck E, Chirouze C, Brunel AS. Vaccination coverage in hematological patients undergoing chemotherapy: Should we move towards personalized vaccination? Vaccine 2021; 39:7036-7043. [PMID: 34740475 DOI: 10.1016/j.vaccine.2021.10.040] [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] [Received: 06/01/2021] [Revised: 10/15/2021] [Accepted: 10/18/2021] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Immunocompromised patients are at high-risk for severe influenza and invasive pneumococcal diseases (IPD). Despite the French Public Health Council (FPHC) and the 7th European Conference on Infections in Leukaemia (ECIL7) recommendations, vaccination coverage remains insufficient. This study aimed to estimate the coverage and determinants of influenza, pneumococcal and diphtheria-tetanus-poliomyelitis (dTP) vaccinations in hematological patients underlying chemotherapy. METHODS A survey was distributed to all patients of the hematology day hospital assessing vaccine uptakes and general opinion about vaccination. Vaccine uptakes were collected from medical and vaccination records; knowledge of and attitudes towards vaccinations in immunocompromised patients were evaluated for each general practitioner (GP) by phone call. Adequacy between vaccine uptakes and indication or not to vaccinate according to ECIL7 guidelines was assessed. Factors associated with vaccine uptakes were assessed by multivariate logistic regression. RESULTS Among 145 patients, 66 % were aged 65 years or older, 40 % were followed for lymphoma and 38 % for multiple myeloma, 39 % were treated with anti-CD20 antibodies. Vaccination coverage was suboptimal for influenza (45-56 %), dTP (44 %) and IPD (16-19 %) regardless of the guidelines followed, with a wide variation in rates by information source (19-76 %). Adequacy rate with ECIL7 recommendations were 63 % and 87 % for influenza and IPD respectively. Information of patients on specific vaccinations was positively associated with flu and IPD vaccinations, as well as favorable attitude toward vaccination and age ≥ 65 years for flu vaccination, and recommendation by hematologist for pneumococcal vaccination. CONCLUSION Despite vaccination opportunities, the complexity of these specific recommendations and the lack of communication between the health actors could explain the suboptimal vaccination coverage in this high-risk population. A proactive attitude of all actors in the city and hospital, including better patient information and a personalized and evolving vaccination schedule to help GPs to coordinate vaccination would allow to improve vaccine coverage.
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Affiliation(s)
- Alix Pierron
- Infectious Diseases Unit, Besancon University Hospital, Besancon, France
| | - Fabienne Bozon
- Infectious Diseases Unit, Besancon University Hospital, Besancon, France
| | - Ana Berceanu
- Hematology Unit, Besancon University Hospital, Besancon, France
| | - Jean Fontan
- Hematology Unit, Besancon University Hospital, Besancon, France
| | - Annie Brion
- Hematology Unit, Besancon University Hospital, Besancon, France
| | - Erick Deconinck
- Hematology Unit, Besancon University Hospital, Besancon, France
| | - Catherine Chirouze
- Infectious Diseases Unit, Besancon University Hospital, Besancon, France
| | - Anne-Sophie Brunel
- Infectious Diseases Unit, Besancon University Hospital, Besancon, France.
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Loubet P, Rouvière J, Merceron A, Launay O, Sotto A, on behalf of the AVNIR Group. Patients' Perception and Knowledge about Influenza and Pneumococcal Vaccination during the COVID-19 Pandemic: An Online Survey in Patients at Risk of Infections. Vaccines (Basel) 2021; 9:vaccines9111372. [PMID: 34835303 PMCID: PMC8623007 DOI: 10.3390/vaccines9111372] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 11/16/2021] [Accepted: 11/17/2021] [Indexed: 01/23/2023] Open
Abstract
INTRODUCTION The objective of our study was to assess, in an at-risk population, perception and knowledge about influenza and pneumococcal vaccinations. METHODS An anonymous web-based survey was submitted to patients recruited in France, from both an Ipsos internal panel and AVNIR patient associations. The study was conducted between July and October 2020, in the context of the COVID-19 pandemic. RESULTS Overall, 2177 questionnaires from patients at risk of infection were analyzed. Almost all respondents (86%, 1869/2177) declared themselves to be favorable to vaccination. Nearly half of the patients (49%, 1069/2177) were aware of which vaccine was recommended for their specific situation. This percentage was significantly (p < 0.001) higher for members of a patient association and for people affected by multiple chronic conditions and varied according to the type of condition. Almost two-thirds of patients (1373/2177) declared having been vaccinated during the 2019/2020 influenza season, and 41% (894/2177) were certain about being up to date with the pneumococcal vaccination. The main barriers to vaccination for influenza are the fear of side effects, doubt regarding the efficacy of the vaccine and for pneumococcal vaccination, and the absence of suggestions by the healthcare professionals (HCPs), as 64% of respondents were not recommended to obtain pneumococcal vaccination. To improve vaccine coverage, information is of prime importance and GPs are recognized as the main HCP to inform about vaccination. Nearly two-thirds (62%, 1360/2177) of patients declared that the COVID-19 pandemic convinced them to have all the recommended vaccines. CONCLUSION Our study highlighted the nonoptimal vaccine coverage in at-risk populations despite a highly positive perception of vaccines and confirmed that physicians are on the front lines to suggest and recommend these vaccinations, especially in the current pandemic context, which may be used to promote other vaccines.
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Affiliation(s)
- Paul Loubet
- INSERM U1047, Department of Infectious and Tropical Diseases, CHU Nîmes, Université Montpellier, 30900 Nîmes, France;
- Correspondence: ; Tel.: +33-4-66-68-41-49
| | | | | | - Odile Launay
- Faculté de Médecine Paris Descartes, Université de Paris, AP-PH, Inserm, CIC Cochin Pasteur, 75231 Paris, France;
| | - Albert Sotto
- INSERM U1047, Department of Infectious and Tropical Diseases, CHU Nîmes, Université Montpellier, 30900 Nîmes, France;
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Rosamilia F, Noberasco G, Olobardi D, Orsi A, Icardi G, Lantieri F, Murdaca G. Flu and Pneumococcal Vaccine Coverage in Scleroderma Patients Still Need to Be Prompted: A Systematic Review. Vaccines (Basel) 2021; 9:1330. [PMID: 34835261 PMCID: PMC8617735 DOI: 10.3390/vaccines9111330] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 11/02/2021] [Accepted: 11/04/2021] [Indexed: 01/14/2023] Open
Abstract
Systemic sclerosis (scleroderma, SSc) is an autoimmune connective tissue disease characterized by excessive production of collagen and multiorgan involvement. Scleroderma patients are at increased risk of influenza complications and pneumonia; thus, vaccinations are recommended. This systematic review evaluated the influenza and pneumococcus vaccination coverage for SSc patients. We included all studies from Pubmed reporting on influenza and pneumococcal vaccination rate in Scleroderma patients up to May 2021. The 14 studies thus selected identified a suboptimal vaccination rate in autoimmune and SSc patients, ranging from 28 to 59% for the flu vaccine, and from 11 to 58% for the pneumo vaccine in absence of specific vaccination campaigns, variously considering also other variables such as age, gender, vaccination settings, and possible vaccination campaigns. We also considered the reasons for low coverage and the approaches that might increase the vaccination rates. A lack of knowledge about the importance of vaccination in these patients and their doctors underlined the need to increase the awareness for vaccination in this patients' category. Current guidelines recommend vaccination in elderly people and people affected by particular conditions that widely overlap with SSc, yet autoimmune diseases are not always clearly mentioned. Improving this suboptimal vaccination rate with clear guidelines is crucial for SSc patients and for clinicians to immunize these categories based principally on the pathology, prior to the age. Recommendations by the immunologist and the direct link to the vaccine providers can highly improve the vaccine coverage.
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Affiliation(s)
- Francesca Rosamilia
- Biostatistics Unit, Health Science Department (DISSAL), University of Genova, Via Pastore 1, 16132 Genova, Italy; (F.R.); (F.L.)
| | - Giovanni Noberasco
- Vaccines and Clinical Trials Unit, Department of Health Sciences, University of Genova, 16132 Genova, Italy; (G.N.); (D.O.); (A.O.); (G.I.)
| | - Dario Olobardi
- Vaccines and Clinical Trials Unit, Department of Health Sciences, University of Genova, 16132 Genova, Italy; (G.N.); (D.O.); (A.O.); (G.I.)
| | - Andrea Orsi
- Vaccines and Clinical Trials Unit, Department of Health Sciences, University of Genova, 16132 Genova, Italy; (G.N.); (D.O.); (A.O.); (G.I.)
- Hygiene Unit, Ospedale Policlinico San Martino IRCCS, 16132 Genova, Italy
| | - Giancarlo Icardi
- Vaccines and Clinical Trials Unit, Department of Health Sciences, University of Genova, 16132 Genova, Italy; (G.N.); (D.O.); (A.O.); (G.I.)
- Hygiene Unit, Ospedale Policlinico San Martino IRCCS, 16132 Genova, Italy
| | - Francesca Lantieri
- Biostatistics Unit, Health Science Department (DISSAL), University of Genova, Via Pastore 1, 16132 Genova, Italy; (F.R.); (F.L.)
| | - Giuseppe Murdaca
- Departments of Internal Medicine, University of Genova, 16132 Genova, Italy
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Asai N, Mikamo H. Recent Topics of Pneumococcal Vaccination: Indication of Pneumococcal Vaccine for Individuals at a Risk of Pneumococcal Disease in Adults. Microorganisms 2021; 9:2342. [PMID: 34835468 PMCID: PMC8623678 DOI: 10.3390/microorganisms9112342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 11/05/2021] [Accepted: 11/06/2021] [Indexed: 11/16/2022] Open
Abstract
Pneumococcal disease is one of the most common and severe vaccine-preventable diseases (VPDs). Despite the advances in antimicrobial treatment, pneumococcal disease still remains a global burden and exhibits a high mortality rate among people of all ages worldwide. The immunization program of the pneumococcal conjugate vaccine (PCV) in children has decreased pneumococcal disease incidence in several countries. However, there are several problems regarding the pneumococcal vaccine, such as indications for immunocompetent persons with underlying medical conditions with a risk of pneumococcal disease, the balance of utility and cost, i.e., cost-effectiveness, vaccine coverage rate, serotype replacement, and adverse events. Especially for individuals aged 19-64 at risk of pneumococcal disease, physicians and vaccine providers should make a rational decision whether the patients should be vaccinated or not, since there is insufficient evidence supporting it. We describe this review regarding topics and problems regarding pneumococcal vaccination from the clinician's point of view.
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Affiliation(s)
- Nobuhiro Asai
- Department of Clinical Infectious Diseases, Aichi Medical University Hospital, Nagakute 480-1195, Japan;
- Department of Infection Control and Prevention, Aichi Medical University Hospital, Nagakute 480-1195, Japan
- Department of Pathology, University of Michigan, Ann Arbor, MI 48109, USA
| | - Hiroshige Mikamo
- Department of Clinical Infectious Diseases, Aichi Medical University Hospital, Nagakute 480-1195, Japan;
- Department of Infection Control and Prevention, Aichi Medical University Hospital, Nagakute 480-1195, Japan
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Blanc E, Chaize G, Fievez S, Féger C, Herquelot E, Vainchtock A, Timsit JF, Gaillat J. The impact of comorbidities and their stacking on short- and long-term prognosis of patients over 50 with community-acquired pneumonia. BMC Infect Dis 2021; 21:949. [PMID: 34521380 PMCID: PMC8442401 DOI: 10.1186/s12879-021-06669-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 08/28/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The prognosis of patients hospitalized with community-acquired pneumonia (CAP) with regards to intensive care unit (ICU) admission, short- and long-term mortality is correlated with patient's comorbidities. For patients hospitalized for CAP, including P-CAP, we assessed the prognostic impact of comorbidities known as at-risk (AR) or high-risk (HR) of pneumococcal CAP (P-CAP), and of the number of combined comorbidities. METHODS Data on hospitalizations for CAP among the French 50+ population were extracted from the 2014 French Information Systems Medicalization Program (PMSI), an exhaustive national hospital discharge database maintained by the French Technical Agency of Information on Hospitalization (ATIH). Their admission diagnosis, comorbidities (nature, risk type and number), other characteristics, and their subsequent hospital stays within the year following their hospitalization for CAP were analyzed. Logistic regression models were used to assess the associations between ICU transfer, short- and 1-year in-hospital mortality and all covariates. RESULTS From 182,858 patients, 149,555 patients aged ≥ 50 years (nonagenarians 17.8%) were hospitalized for CAP in 2014, including 8270 with P-CAP. Overall, 33.8% and 90.5% had ≥ 1 HR and ≥ 1 AR comorbidity, respectively. Cardiac diseases were the most frequent AR comorbidity (all CAP: 77.4%). Transfer in ICU occurred for 5.4% of CAP patients and 19.4% for P-CAP. Short-term and 1-year in-hospital mortality rates were 10.9% and 23% of CAP patients, respectively, significantly lower for P-CAP patients: 9.2% and 19.8% (HR 0.88 [95% CI 0.84-0.93], p < .0001). Both terms of mortality increased mostly with age, and with the number of comorbidities and combination of AR and HR comorbidities, in addition of specific comorbidities. CONCLUSIONS Not only specific comorbidities, but also the number of combined comorbidities and the combination of AR and HR comorbidities may impact the outcome of hospitalized CAP and P-CAP patients.
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Affiliation(s)
| | | | | | - C Féger
- EMIBiotech, Paris, France
- ICUREsearch, Paris, France
| | | | | | - J F Timsit
- Medical and Infectious Diseases ICU, Bichat-Claude Bernard Hospital, APHP, Paris, France
- UMR 1137-IAME Team 5-DeSCID: Decision SCiences in Infectious Diseases Control and Care INSERM/University of Paris, Paris, France
| | - J Gaillat
- Infectious Diseases Department, Annecy-Genevois Hospital, Annecy, France.
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Effectiveness of a Multifaceted Informational-Based and Text Message Reminders on Pneumococcal and Influenza Vaccinations in Hospital Emergency Departments: A Cluster-Randomized Controlled Trial. Vaccines (Basel) 2021; 9:vaccines9090962. [PMID: 34579199 PMCID: PMC8473355 DOI: 10.3390/vaccines9090962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 08/19/2021] [Accepted: 08/24/2021] [Indexed: 12/02/2022] Open
Abstract
Objectives. We aimed to evaluate the effectiveness of a multifaceted procedure in improving pneumococcal and influenza vaccinations 6 months after an emergency department (ED) visit among patients aged 65 years and older. Methods. We conducted a cluster-randomized, controlled, parallel-group, open-label implementation trial in 18 EDs in France and Monaco. Participants were recruited from November 2015 to September 2016. EDs were randomly assigned with a 1:1 ratio to provide either a multifaceted procedure that combined structured information about pneumococcal and influenza vaccines and three text message reminders sent to patients every two weeks (intervention arm) or nonstructured information only (control arm). The outcomes were self-reported pneumococcal vaccination and influenza vaccination rates within 6 months of enrollment. Results. A total of 9 EDs were randomized to the intervention arm (n = 780 patients) and 9 to the control arm (n = 695 patients). The median age for all enrolled patients was 74 years (25–75th percentiles, 69 to 82): 50.1% were male, 34.9% had at least one underlying condition, and 30.7% were at risk for invasive pneumococcal infection. In the intention-to-treat analysis, the multifaceted intervention did not alter the pneumococcal vaccination rate (6.4% versus 4.6%, absolute difference: 1.8; 95% CI: [−0.9 to 4.4]; p = 0.19), whereas it improved the influenza vaccination rate (52.1% versus 40.0%, absolute difference: 12.1; 95% CI: [2.4 to 21.8]; p = 0.01). At 12 months, mortality did not differ between the intervention (9.7%) and control (11.2%) arms (p = 0.35). Conclusions. A multifaceted intervention based on text message reminders provides an opportunity to increase anti-influenza vaccination among elderly patients visiting the ED. Efforts are warranted to provide better information on pneumococcal diseases and the benefits of pneumococcal vaccines, especially in the elderly.
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Ko T, Dendle C, Woolley I, Morand E, Antony A. SARS-COV-2 vaccine acceptance in patients with rheumatic diseases: a cross-sectional study. Hum Vaccin Immunother 2021; 17:4048-4056. [PMID: 34357827 DOI: 10.1080/21645515.2021.1958611] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES To evaluate severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine acceptance among patients with rheumatic diseases (RMD). METHODS All rheumatology patients attending a large suburban health network were invited to participate in an anonymized online survey. The primary outcome of interest was SARS-COV-2 vaccine acceptance. RESULTS The mean (SD) age of respondents (n = 641) was 52.7 (15.1) years and 74.4% (n = 474) were female. Sixty-five percent were willing to have a SARS-COV-2 vaccine, while 34.4% were vaccine-hesitant (unwilling or undecided). On multivariate analysis, vaccine acceptance was associated with smoking (OR: 2.25 [95% CI: 1.22-4.15; p = .009]), history of malignancy (OR: 2.51 [95% CI: 1.19-5.26; p = .015]), influenza or pneumococcal vaccination in the preceding year (OR: 2.69 [95% CI: 1.78-4.05; p < .001]) and number of COVID-Safe measures practiced (OR: 1.54 [95% CI: 1.05-2.26; p = .027]). Vaccine acceptance correlated with positive beliefs regarding vaccine efficacy (r = 0.40; p < .001) and safety (r = 0.36; p < .001). Vaccine acceptance correlated negatively with concerns regarding side-effects (r = -0.30; p < .001) and vaccine-associated RMD flare (r = -0.21; p < .001). In vaccine-hesitant respondents, 39.2% were more likely to accept vaccination if given a choice of which vaccine they receive and 54.5% if their rheumatologist recommended it. Twenty-seven percent of patients on immunomodulators were willing to withhold medications while 42.1% were willing if advised by their rheumatologist. CONCLUSION SARS-COV-2 vaccine hesitancy is prevalent amongst RMD patients and associated with concerns regarding vaccine safety, efficacy, side effects and RMD flare. Clinician recommendation, vaccine choice and communications targeting patient concerns could facilitate vaccine acceptance.Significance and Innovations Vaccine hesitancy is prevalent in RMD patientsVaccine acceptance is associated with beliefs regarding vaccine safety and efficacy and concerns regarding RMD flare and vaccine-associated side effectsVaccine choice and clinician recommendation have the potential to improve vaccine acceptance in patients who are hesitant.
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Affiliation(s)
- Tina Ko
- Department of Rheumatology, Monash Health, Clayton, Australia
| | - Claire Dendle
- Department of Infectious Diseases, Monash Health, Clayton, Australia.,School of Clinical Sciences, Monash University, Clayton, Australia
| | - Ian Woolley
- Department of Infectious Diseases, Monash Health, Clayton, Australia.,School of Clinical Sciences, Monash University, Clayton, Australia
| | - Eric Morand
- Department of Rheumatology, Monash Health, Clayton, Australia.,School of Clinical Sciences, Monash University, Clayton, Australia
| | - Anna Antony
- Department of Rheumatology, Monash Health, Clayton, Australia.,School of Clinical Sciences, Monash University, Clayton, Australia
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Sim J, Lim CC. Coronavirus disease 2019 (COVID-19) vaccination in systemic lupus erythematosus and anti-neutrophil cytoplasmic antibody-associated vasculitis. Clin Rheumatol 2021; 40:2517-2518. [PMID: 33928459 PMCID: PMC8084413 DOI: 10.1007/s10067-021-05750-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 04/20/2021] [Accepted: 04/22/2021] [Indexed: 12/02/2022]
Affiliation(s)
- Jackie Sim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Cynthia Ciwei Lim
- Department of Renal Medicine, Singapore General Hospital, Singapore, Singapore.
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Huang ST, Yu TM, Chuang YW, Chen CH, Wu MJ, Wang IK, Li CY, Lin CL, Kao CH. Pneumococcal pneumonia in adult hospitalised solid organ transplant recipients: Nationwide, population-based surveillance. Int J Clin Pract 2021; 75:e14126. [PMID: 33638887 DOI: 10.1111/ijcp.14126] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 02/26/2021] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Pneumococcal disease poses a burden to the community in high risk population. Most early studies focused on invasive pneumococcal disease. However, the epidemiology of pneumococcal pneumonia (PP) requiring hospitalisation in solid organ transplant recipients (SOTRs) is poorly defined. METHODS We conducted a retrospective cohort study (January 1, 2000 and December 31, 2012) to evaluate the risk of PP requiring hospitalisation in SOTRs. SOTRs and non-SOT cohorts, propensity score-matched at a 1:1 ratio for age, sex, index date and underlying comorbidities, were identified from the National Health Insurance Research Database. RESULTS Each cohort consisted of 7507 patients. In the SOT cohort, 26 episodes of PP requiring hospitalisation were identified (incidence rate of 52.4 per 100,000 person-years). The risk of PP requiring hospitalisation in the SOT cohort was 1.50 times greater than in the non-SOT cohort [adjusted hazard ratio: 1.50, 95% confidence interval = 1.31-1.71, P < .001]. The nested case control study identified older age, kidney transplant, and concomitant chronic obstructive pulmonary disease, chronic kidney disease and heart failure as predictors of PP requiring hospitalisation in the SOT cohort. The highest risk period for PP requiring hospitalisation occurred within the first year of transplantation (36.47 per 1000 patients). Amongst kidney transplant recipients, patients with PP requiring hospitalisation exhibited higher cumulative incidences of graft failure than those without PP (log-rank test: P value = .004). CONCLUSIONS SOTRs are at risk of PP requiring hospitalisation with its attendant morbidity. Strategies to reduce risk of PP requiring hospitalisation using preventive vaccinations warrant further study.
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Affiliation(s)
- Shih-Ting Huang
- Division of Nephrology, Taichung Veterans General Hospital, Taichung, Taiwan
- Graduate Institute of Public Health, China Medical University, Taichung, Taiwan
| | - Tung-Min Yu
- Division of Nephrology, Taichung Veterans General Hospital, Taichung, Taiwan
- Graduate Institute of Biomedical Sciences, College of Medicine, China Medical University, Taichung, Taiwan
| | - Ya-Wen Chuang
- Division of Nephrology, Taichung Veterans General Hospital, Taichung, Taiwan
- Graduate Institute of Public Health, China Medical University, Taichung, Taiwan
| | - Cheng-Hsu Chen
- Division of Nephrology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Ming-Ju Wu
- Division of Nephrology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - I-Kuan Wang
- Graduate Institute of Biomedical Sciences, College of Medicine, China Medical University, Taichung, Taiwan
- Division of Nephrology, China Medical University Hospital, Taichung, Taiwan
| | - Chi-Yuan Li
- Graduate Institute of Biomedical Sciences, College of Medicine, China Medical University, Taichung, Taiwan
- Division of Anesthesiology, China Medical University Hospital, Taichung, Taiwan
| | - Cheng-Li Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
- College of Medicine, China Medical University, Taichung, Taiwan
| | - Chia-Hung Kao
- Graduate Institute of Biomedical Sciences, College of Medicine, China Medical University, Taichung, Taiwan
- Department of Nuclear Medicine and PET Center, China Medical University, Taichung, Taiwan
- Department of Bioinformatics and Medical Engineering, Asia University, Taichung, Taiwan
- Center of Augmented Intelligence in Healthcare, China Medical University Hospital, Taichung, Taiwan
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Garcia Garrido HM, Knol MJ, Heijmans J, van Sorge NM, Sanders EAM, Klümpen HJ, Grobusch MP, Goorhuis A. Invasive pneumococcal disease among adults with hematological and solid organ malignancies: A population-based cohort study. Int J Infect Dis 2021; 106:237-245. [PMID: 33781907 DOI: 10.1016/j.ijid.2021.03.072] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 03/23/2021] [Accepted: 03/24/2021] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES To determine the risk of invasive pneumococcal disease (IPD) in adult cancer patients stratified by type of underlying malignancy, age, and capsular serotype and to assess herd effects of childhood pneumococcal vaccination. METHODS All adult IPD cases reported to the Dutch pneumococcal surveillance system between 2004 and 2016 were included in this study. IPD incidence rates (IR) stratified by subtype of malignancy were calculated per 100 000 patient-years of follow-up. Incidence rate ratios (IRR) were calculated to compare IRs between groups. RESULTS A total of 7167 IPD cases were included, of which 1453 were in patients with malignancies. For patients with hematological malignancies (HM) and solid organ malignancies (SOM), IRs were 482/100 000 and 79/100 000, respectively, compared with 15/100 000 in controls. The highest incidence was observed among patients with multiple myeloma, non-Hodgkin lymphoma, chronic lymphocytic leukemia, pancreatic cancer, and lung cancer (3299/100 000, 2717/100 000, 538/100 000, 559/100 000, and 393/100 000, respectively), and in patients ≥50 years old. Among HM patients, the incidence of IPD declined significantly after the implementation of infant pneumococcal vaccination (IRR 0.65, 95% confidence interval 0.51-0.84); among SOM patients, the decline was not statistically significant (IRR 0.88, 95% confidence interval 0.72-1.07). CONCLUSIONS The IPD disease burden in cancer patients remains high. Large differences in IPD incidence between the different types of cancer demand tailored guidance regarding pneumococcal vaccination.
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Affiliation(s)
- Hannah M Garcia Garrido
- Amsterdam UMC, University of Amsterdam, Centre of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam Institute for Infection and Immunity, Meibergdreef 9, Amsterdam, The Netherlands.
| | - Mirjam J Knol
- Centre for Infectious Disease Control Netherlands (CIb), National Institute for Public Health and the Environment (RIVM), Antonie van Leeuwenhoeklaan 9, Bilthoven, The Netherlands
| | - Jarom Heijmans
- Amsterdam UMC, University of Amsterdam, Department of Hematology, Amsterdam Institute for Infection and Immunity, Cancer Center Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Nina M van Sorge
- Amsterdam AMC, University of Amsterdam, Department of Medical Microbiology and Infection Prevention and Netherlands Reference Laboratory for Bacterial Meningitis, Amsterdam Institute for Infection and Immunity, Meibergdreef 9, Amsterdam, The Netherlands
| | - Elisabeth A M Sanders
- Centre for Infectious Disease Control Netherlands (CIb), National Institute for Public Health and the Environment (RIVM), Antonie van Leeuwenhoeklaan 9, Bilthoven, The Netherlands
| | - Heinz-Josef Klümpen
- Amsterdam UMC, University of Amsterdam, Department of Medical Oncology, Cancer Center Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Martin P Grobusch
- Amsterdam UMC, University of Amsterdam, Centre of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam Institute for Infection and Immunity, Meibergdreef 9, Amsterdam, The Netherlands
| | - Abraham Goorhuis
- Amsterdam UMC, University of Amsterdam, Centre of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam Institute for Infection and Immunity, Meibergdreef 9, Amsterdam, The Netherlands
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Richi P, Yuste J, Navío T, González-Hombrado L, Salido M, Thuissard-Vasallo I, Jiménez-Díaz A, Llorente J, Cebrián L, Lojo L, Steiner M, Cobo T, Martín MD, García-Castro M, Castro P, Muñoz-Fernández S. Impact of Biological Therapies on the Immune Response after Pneumococcal Vaccination in Patients with Autoimmune Inflammatory Diseases. Vaccines (Basel) 2021; 9:vaccines9030203. [PMID: 33671007 PMCID: PMC7997274 DOI: 10.3390/vaccines9030203] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 02/19/2021] [Accepted: 02/23/2021] [Indexed: 12/19/2022] Open
Abstract
Patients with different autoimmune inflammatory diseases (AIID) on biological therapy are at risk of pneumococcal disease. Adults with inflammatory arthropathies, connective tissue diseases, psoriasis, or inflammatory bowel disease on biological therapy such as anti-TNFα, rituximab, tocilizumab, abatacept, or anakinra were included in this study. Patients completed a protocol combining the pneumococcal vaccines PCV13 and PPV23. Immune response against pneumococcal serotypes 1, 3, 7F, 14, 19A, and 19F were assessed evaluating functional antibodies by an opsonophagocytosis killing assay (OPKA). In this study, 182 patients with AIID completed the sequential vaccination protocol. Patients on etanercept tended to achieve OPKA titers against a larger number of serotypes than the rest of patients on other biological therapies, while adalimumab was associated to a lower number of serotypes with OPKA titers. Rituximab was not associated with a worse response when compared with the rest of biological agents. Not glucocorticoids, nor synthetic disease-modifying antirheumatic drugs, interfered with the immune response. OPKA titers against serotype 3 which is one of the most prevalent, was obtained in 44% of patients, increasing up to 58% in those on etanercept. Hence, almost 50% of patients on biological therapy achieved functional antibodies after the administration of a complete pneumococcal vaccination protocol.
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Affiliation(s)
- Patricia Richi
- Rheumatology Unit, Hospital Universitario Infanta Sofía San Sebastián de los Reyes, 28702 Madrid, Spain; (A.J.-D.); (M.S.); (T.C.); (S.M.-F.)
- School of Medicine, Universidad Europea, 28670 Madrid, Spain
- Correspondence: (P.R.); (J.Y.)
| | - Jose Yuste
- Spanish Pneumococcal Reference Laboratory, National Center for Microbiology, Instituto de Salud Carlos III, 28220 Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Correspondence: (P.R.); (J.Y.)
| | - Teresa Navío
- Rheumatology Unit, Hospital Universitario Infanta Leonor, 28031 Madrid, Spain; (T.N.); (L.C.); (L.L.)
| | | | - Marina Salido
- Rheumatology Unit, Hospital Universitario Infanta Cristina, Parla, 28981 Madrid, Spain; (M.S.); (P.C.)
| | | | - Ana Jiménez-Díaz
- Rheumatology Unit, Hospital Universitario Infanta Sofía San Sebastián de los Reyes, 28702 Madrid, Spain; (A.J.-D.); (M.S.); (T.C.); (S.M.-F.)
| | - Jesús Llorente
- Pharmacy Department, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, 28702 Madrid, Spain;
| | - Laura Cebrián
- Rheumatology Unit, Hospital Universitario Infanta Leonor, 28031 Madrid, Spain; (T.N.); (L.C.); (L.L.)
| | - Leticia Lojo
- Rheumatology Unit, Hospital Universitario Infanta Leonor, 28031 Madrid, Spain; (T.N.); (L.C.); (L.L.)
| | - Martina Steiner
- Rheumatology Unit, Hospital Universitario Infanta Sofía San Sebastián de los Reyes, 28702 Madrid, Spain; (A.J.-D.); (M.S.); (T.C.); (S.M.-F.)
- School of Medicine, Universidad Europea, 28670 Madrid, Spain
| | - Tatiana Cobo
- Rheumatology Unit, Hospital Universitario Infanta Sofía San Sebastián de los Reyes, 28702 Madrid, Spain; (A.J.-D.); (M.S.); (T.C.); (S.M.-F.)
- School of Medicine, Universidad Europea, 28670 Madrid, Spain
| | - María Dolores Martín
- BR Salud Laboratories, Bacteriology Department, San Sebastián de los Reyes, 28702 Madrid, Spain;
| | - Marta García-Castro
- Rheumatology Unit, Hospital del Tajo, Aranjuez, 28300 Madrid, Spain; (L.G.-H.); (M.G.-C.)
| | - Patricia Castro
- Rheumatology Unit, Hospital Universitario Infanta Cristina, Parla, 28981 Madrid, Spain; (M.S.); (P.C.)
| | - Santiago Muñoz-Fernández
- Rheumatology Unit, Hospital Universitario Infanta Sofía San Sebastián de los Reyes, 28702 Madrid, Spain; (A.J.-D.); (M.S.); (T.C.); (S.M.-F.)
- School of Medicine, Universidad Europea, 28670 Madrid, Spain
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37
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Vaccination against COVID-19: Expectations and concerns of patients with autoimmune and rheumatic diseases. LANCET RHEUMATOLOGY 2021; 3:e243-e245. [PMID: 33655219 PMCID: PMC7906671 DOI: 10.1016/s2665-9913(21)00039-4] [Citation(s) in RCA: 90] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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38
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Larsen L, Bistrup C, Sørensen SS, Boesby L, Nguyen MTT, Johansen IS. The coverage of influenza and pneumococcal vaccination among kidney transplant recipients and waiting list patients: A cross-sectional survey in Denmark. Transpl Infect Dis 2020; 23:e13537. [PMID: 33258216 DOI: 10.1111/tid.13537] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 10/30/2020] [Accepted: 11/22/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND To characterize level and predictors of influenza and pneumococcal vaccine uptake among Danish kidney transplant recipients (KTR) and kidney transplant waiting list patients (WLP). METHODS A cross-sectional survey based on self-reported vaccine uptake including WLP and KTR ≤ 1½ years post transplantation. Descriptive statistics and logistic regression analyses identifying factors associated with influenza vaccine uptake in the latest season were performed. RESULTS A total of 220 participants were included in the study, 54% KTR and 46% WLP. Self-reported influenza vaccine uptake in the latest season was overall 41.8%. Uptake of influenza vaccine on any prior season apart from the latest season was 53.2% and significantly higher among WLP than KTR (P = .007). Pneumococcal vaccine uptake was only 4% overall. The only factor positively associated with influenza vaccine uptake in the latest season was any prior influenza vaccine uptake (OR 5.79, CI95 2.44-13.76) (P < .001). Recommendations given by other persons (non-physician) were negatively associated with receiving the influenza vaccination in the latest season (OR 0.34, CI95 0.13-0.92) (P = .03). Reasons for not being vaccinated were primarily lack of information, perception of own good health, and fear of adverse reactions. CONCLUSIONS Influenza and pneumococcal vaccine uptakes were suboptimal among Danish WLP and KTR. Increased awareness about guidelines and physicians´ education are warranted.
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Affiliation(s)
- Lykke Larsen
- Department of Infectious Diseases, Odense University Hospital, Odense, Denmark.,Research Unit for Infectious Diseases, Odense University Hospital, University of Southern Denmark, Denmark.,OPEN, Open Patient data Explorative Network, Odense University Hospital, Region of Southern Denmark, Denmark
| | - Claus Bistrup
- Department of Nephrology, Odense University Hospital, Odense, Denmark.,Clinical Institute, University of Southern Denmark, Odense, Denmark
| | - Søren Schwartz Sørensen
- Department of Nephrology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Lene Boesby
- Department of Medicine, Zealand University Hospital Roskilde, Roskilde, Denmark
| | | | - Isik Somuncu Johansen
- Department of Infectious Diseases, Odense University Hospital, Odense, Denmark.,Research Unit for Infectious Diseases, Odense University Hospital, University of Southern Denmark, Denmark
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39
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Nakafero G, Grainge MJ, Myles PR, Mallen CD, Zhang W, Doherty M, Nguyen-Van-Tam JS, Abhishek A. Effectiveness of inactivated influenza vaccine in autoimmune rheumatic diseases treated with disease-modifying anti-rheumatic drugs. Rheumatology (Oxford) 2020; 59:3666-3675. [PMID: 32160295 PMCID: PMC7733714 DOI: 10.1093/rheumatology/keaa078] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 01/28/2020] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVES The effectiveness of inactivated influenza vaccine in people with autoimmune rheumatic disease (AIRDs) is not known. We investigated whether the influenza vaccine is effective in preventing respiratory morbidity, mortality and all-cause mortality in AIRD patients. METHODS Adults with AIRDs treated with DMARDs prior to 1 September of each year between 2006 and 2009, and 2010 and 2015 were identified from the Clinical Practice Research Datalink. Exposure and outcome data were extracted. Data from multiple seasons were pooled. Propensity score (PS) for vaccination was calculated. Cox-proportional hazard ratios (HRs) and 95% CIs were calculated, and were (i) adjusted, (ii) matched for PS for vaccination. RESULTS Data for 30 788 AIRD patients (65.7% female, 75.5% with RA, 61.1% prescribed MTX) contributing 125 034 influenza cycles were included. Vaccination reduced risk of influenza-like illness [adjusted HR (aHR) 0.70], hospitalization for pneumonia (aHR 0.61) and chronic obstructive pulmonary disease exacerbations (aHR 0.67), and death due to pneumonia (aHR 0.56) on PS-adjusted analysis in the influenza active periods (IAPs). The associations were of similar magnitude and remained statistically significant on PS-matched analysis except for protection from influenza-like illness, which became non-significant. Sub-analysis restricted to pre-IAP, IAP and post-IAP did not yield evidence of residual confounding on influenza-like illness and death due to pneumonia. Vaccination reduced risk of all-cause mortality, although IAP-restricted analysis demonstrated residual confounding for this outcome. CONCLUSION Influenza vaccine associates with reduced risk of respiratory morbidity and mortality in people with AIRDs. These findings call for active promotion of seasonal influenza vaccination in immunosuppressed people with AIRDs by healthcare professionals.
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Affiliation(s)
- Georgina Nakafero
- Academic Rheumatology, School of Medicine, University of Nottingham, Nottingham
| | - Matthew J Grainge
- Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham
| | - Puja R Myles
- Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham
| | | | - Weiya Zhang
- Academic Rheumatology, School of Medicine, University of Nottingham, Nottingham
| | - Michael Doherty
- Academic Rheumatology, School of Medicine, University of Nottingham, Nottingham
| | | | - Abhishek Abhishek
- Academic Rheumatology, School of Medicine, University of Nottingham, Nottingham
- Nottingham NIHR Biomedical Research Centre, Nottingham, UK
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40
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Watanabe K, Asai Y, Tsurikisawa N, Oshikata C, Kaneko T. Factors associated with pneumococcal vaccine uptake in elderly subjects referred to the respiratory department. NAGOYA JOURNAL OF MEDICAL SCIENCE 2020; 82:469-476. [PMID: 33132431 PMCID: PMC7548246 DOI: 10.18999/nagjms.82.3.469] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Streptococcus pneumoniae is the most common pathogen for community-acquired pneumonia and is also common in nursing and healthcare-associated pneumonia. Pneumococcal vaccine shows clinical benefit and 23-valent pneumococcal polysaccharide vaccine (PPSV23) has been introduced in a routine immunization program in Japan. However, uptake of PPSV23 remains low, at 40%. One opportunity for capturing unvaccinated subjects is hospital referrals. Identifying factors associated with pneumococcal vaccination among referred subjects is thus important so that pulmonologists can maximize the capture of unvaccinated subjects. We retrospectively reviewed the records of subjects with a first referral to the Department of Respiratory Medicine at Hiratsuka City Hospital from September 2017 to March 2018. Subjects who were ≥65 years old and lived in Hiratsuka were included in this study. We compared the backgrounds of subjects and investigated factors associated with pneumococcal vaccination. A total of 142 individuals were included in this study and the pneumococcal vaccination rate was 44.4% (95% confidence interval (CI), 36.0–52.9%). Of these, 127 subjects regularly visited clinics and/or hospitals for any diseases and their pneumococcal vaccine rate was 44.1% (95%CI, 35.3–53.2%). In multivariate analysis, chronic respiratory diseases (odds ratio 5.7; 95%CI, 2.2–14.9, P<0.001) and receipt of PPSV23 notification (odds ratio 8.5; 95%CI, 2.5–29.0, P<0.001) were positively associated with pneumococcal vaccination. In conclusion, chronic respiratory diseases and receipt of PPSV23 notification were positively associated with pneumococcal vaccination. However, pneumococcal vaccination rates remain relatively low, even in subjects regularly visiting clinics and/or hospitals.
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Affiliation(s)
- Keisuke Watanabe
- Department of Pulmonology, Yokohama City University Graduate School of Medicine, Yokohama, Japan.,Department of Respiratory Medicine, Hiratsuka City Hospital, Hiratsuka, Japan
| | - Yoshihito Asai
- Department of Respiratory Medicine, Hiratsuka City Hospital, Hiratsuka, Japan
| | - Naomi Tsurikisawa
- Department of Respiratory Medicine, Hiratsuka City Hospital, Hiratsuka, Japan
| | - Chiyako Oshikata
- Department of Respiratory Medicine, Hiratsuka City Hospital, Hiratsuka, Japan
| | - Takeshi Kaneko
- Department of Pulmonology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
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41
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Schreiner D, Zepp F. [General principles of vaccination under immunosuppression]. Z Rheumatol 2020; 79:848-854. [PMID: 33034682 DOI: 10.1007/s00393-020-00891-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2020] [Indexed: 11/25/2022]
Abstract
The number of patients suffering from immunodeficiency is increasing; however, the vaccination rate of these patients is below average. Administration of inactivated vaccines is harmless but does not reliably trigger a persistent immune response. Live vaccines provide a reliable protection but can cause severe disease in immunocompromised patients. Live vaccines can be administered under defined levels of immunosuppression, e.g. against measles, mumps, rubella and varicella (MMRV). In addition, the immunization of the domestic environment plays an important role in preventing infectious diseases.
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Affiliation(s)
- D Schreiner
- Zentrum für Kinder- und Jugendmedizin, Universitätsmedizin Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland
| | - F Zepp
- Zentrum für Kinder- und Jugendmedizin, Universitätsmedizin Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland.
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42
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Braun J, Kiltz U, Müller-Ladner U. [Is complete immunity against measles a realistic target for patients with rheumatic diseases and how can it possibly be achieved?]. Z Rheumatol 2020; 79:922-928. [PMID: 32945951 PMCID: PMC7647971 DOI: 10.1007/s00393-020-00877-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2020] [Indexed: 02/07/2023]
Abstract
Measles outbreaks occur rather frequently in Germany. Patients with chronic inflammatory diseases are often treated with immunosuppressants. A recent study showed that about 7% of such patients are not protected against measles according to the lack of documentation in the vaccination card or the absence of protective antibodies. The Standing Committee on Immunization (STIKO) recommends a first vaccination against measles as a measles-mumps-rubella combined vaccination (MMR) in children aged 11-14 months and a second vaccination at 14-23 months. For adults born after 1970, vaccination against measles is recommended if they have not yet been vaccinated against measles or have only been vaccinated once against measles or if their vaccination status is unclear. In April 2019, STIKO published instructions for vaccinations recommended for immunodeficiency. Since March 1, 2020, measles vaccination have been compulsory in Germany.
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Affiliation(s)
- J Braun
- Rheumazentrum Ruhrgebiet, Herne und Ruhr-Universität Bochum, Claudiusstr 45, 44649, Herne, Deutschland. .,St. Elisabeth Gruppe GmbH, Herne, Deutschland.
| | - U Kiltz
- Rheumazentrum Ruhrgebiet, Herne und Ruhr-Universität Bochum, Claudiusstr 45, 44649, Herne, Deutschland
| | - U Müller-Ladner
- Abteilung für Rheumatologie und Klinische Immunologie, Kerckhoff-Klinik, Bad Nauheim, Deutschland
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43
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Mohme S, Schmalzing M, Müller CSL, Vogt T, Goebeler M, Stoevesandt J. Immunizations in immunocompromised patients: a guide for dermatologists. J Dtsch Dermatol Ges 2020; 18:699-723. [PMID: 32713146 DOI: 10.1111/ddg.14156] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 06/05/2020] [Indexed: 12/11/2022]
Abstract
The increasingly frequent use of immunomodulatory agents in dermatology requires the observance of specific recommendations for immunization. These recommendations are developed and regularly updated by the German Standing Committee on Vaccination (STIKO), an independent advisory group at the Robert Koch Institute. Dermatological patients on immunosuppressive treatment should ideally receive all vaccinations included in the standard immunization schedule. Additionally, it is recommended that they also undergo vaccination against the seasonal flu, pneumococci, and herpes zoster (inactivated herpes zoster subunit vaccine for patients ≥ 50 years). Additional immunizations against Haemophilus influenzae type B, hepatitis B and meningococci may be indicated depending on individual comorbidities and exposure risk. Limitations of use, specific contraindications and intervals to be observed between vaccination and immunosuppression depend on the immunosuppressive agent used and its dosing. Only under certain conditions may live-attenuated vaccines be administered in patients on immunosuppressive therapy. Given its strong suppressive effect on the humoral immune response, no vaccines - except for flu shots - should be given within six months after rituximab therapy. This CME article presents current recommendations on immunization in immunocompromised individuals, with a special focus on dermatological patients. Its goal is to enable readers to provide competent counseling and to initiate necessary immunizations in this vulnerable patient group.
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Affiliation(s)
- Sophia Mohme
- Department of Dermatology, Venereology and Allergology, University Hospital, Würzburg, Germany
| | - Marc Schmalzing
- Department of Medicine II, Rheumatology/Clinical Immunology, University Hospital, Würzburg, Germany
| | - Cornelia S L Müller
- Department of Dermatology, Venereology and Allergology, Saarland University, Homburg/Saar, Germany
| | - Thomas Vogt
- Department of Dermatology, Venereology and Allergology, Saarland University, Homburg/Saar, Germany
| | - Matthias Goebeler
- Department of Dermatology, Venereology and Allergology, University Hospital, Würzburg, Germany
| | - Johanna Stoevesandt
- Department of Dermatology, Venereology and Allergology, University Hospital, Würzburg, Germany
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44
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Determinants of Vaccination Uptake in Risk Populations: A Comprehensive Literature Review. Vaccines (Basel) 2020; 8:vaccines8030480. [PMID: 32867126 PMCID: PMC7563537 DOI: 10.3390/vaccines8030480] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 08/13/2020] [Accepted: 08/19/2020] [Indexed: 12/14/2022] Open
Abstract
Vaccination uptake has decreased globally in recent years, with a subsequent rise of vaccine-preventable diseases. Travellers, immunocompromised patients (ICP), and healthcare workers (HCW) are groups at increased risk for (severe) infectious diseases due to their behaviour, health, or occupation, respectively. While targeted vaccination guidelines are available, vaccination uptake seems low. In this review, we give a comprehensive overview of determinants-based on the integrated change model-predicting vaccination uptake in these groups. In travellers, low perceived risk of infection and low awareness of vaccination recommendations contributed to low uptake. Additionally, ICP were often unaware of the recommended vaccinations. A physician's recommendation is strongly correlated with higher uptake. Furthermore, ICP appeared to be mainly concerned about the risks of vaccination and fear of deterioration of their underlying disease. For HCW, perceived risk of (the severity of) infection for themselves and for their patients together with perceived benefits of vaccination contribute most to their vaccination behaviour. As the determinants that affect uptake are numerous and diverse, we argue that future studies and interventions should be based on multifactorial health behaviour models, especially for travellers and ICP as only a limited number of such studies is available yet.
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45
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New Insights into Immunological Involvement in Congenital Disorders of Glycosylation (CDG) from a People-Centric Approach. J Clin Med 2020; 9:jcm9072092. [PMID: 32635232 PMCID: PMC7408855 DOI: 10.3390/jcm9072092] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 06/27/2020] [Accepted: 06/28/2020] [Indexed: 02/08/2023] Open
Abstract
Congenital disorders of glycosylation (CDG) are rare diseases with variable phenotypes and severity. Immunological involvement remains a largely uncharted topic in CDG, mainly due to lack of robust data. To better characterize immune-related manifestations’ prevalence, relevance, and quality-of-life (QoL) impact, we developed electronic questionnaires targeting (1) CDG patients and (2) the general “healthy” population. Two-hundred and nine CDG patients/caregivers and 349 healthy participants were included in this study. PMM2-CDG was the most represented CDG (n = 122/209). About half of these participants (n = 65/122) described relevant infections with a noteworthy prevalence of those affecting the gastrointestinal tract (GI) (63.1%, n = 41/65). Infection burden and QoL impact were shown as infections correlated with more severe clinical phenotypes and with a set of relevant non-immune PMM2-CDG signs. Autoimmune diseases had only a marginal presence in PMM2-CDG (2.5%, n = 3/122), all being GI-related. Allergy prevalence was also low in PMM2-CDG (33%, n = 41/122) except for food allergies (26.8%, n = 11/41, of PMM2-CDG and 10.8%, n = 17/158, of controls). High vaccination compliance with greater perceived ineffectiveness (28.3%, n = 17/60) and more severe adverse reactions were described in PMM2-CDG. This people-centric approach not only confirmed literature findings, but created new insights into immunological involvement in CDG, namely by highlighting the possible link between the immune and GI systems in PMM2-CDG. Finally, our results emphasized the importance of patient/caregiver knowledge and raised several red flags about immunological management.
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46
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Mohme S, Schmalzing M, Müller CSL, Vogt T, Goebeler M, Stoevesandt J. Impfen bei Immunsuppression: ein Leitfaden für die dermatologische Praxis. J Dtsch Dermatol Ges 2020; 18:699-725. [PMID: 32713144 DOI: 10.1111/ddg.14156_g] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 06/05/2020] [Indexed: 12/15/2022]
Affiliation(s)
- Sophia Mohme
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Würzburg
| | - Marc Schmalzing
- Medizinische Klinik und Poliklinik II, Rheumatologie/Klinische Immunologie, Universitätsklinikum Würzburg
| | - Cornelia S L Müller
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universität des Saarlandes, Homburg/Saar
| | - Thomas Vogt
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universität des Saarlandes, Homburg/Saar
| | - Matthias Goebeler
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Würzburg
| | - Johanna Stoevesandt
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Würzburg
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47
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Tubiana S, Launay O, Galtier F, Tattevin P, Postil D, Vanhems P, Lenzi N, Verger P, Duval X. Attitudes, knowledge, and willingness to be vaccinated against seasonal influenza among patients hospitalized with influenza-like-illness: impact of diagnostic testing. Hum Vaccin Immunother 2020; 16:851-857. [PMID: 31589554 DOI: 10.1080/21645515.2019.1674598] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Influenza vaccine adherence remains low. Communication of virological diagnosis to adults hospitalized with influenza-like illness (ILI) could improve their willingness to be subsequently vaccinated. We prospectively assessed, in adults hospitalized with ILI in six French university hospitals, their willingness to be vaccinated against influenza in the subsequent season, both before and after the communication of RT-PCR Influenza laboratory result; we identified then the determinants associated with the willingness to be vaccinated.A total of 309 patients were included during the 2012-2013 and 2013-2014 influenza seasons; 43.8% reported being vaccinated against influenza for the current season; before communication of influenza laboratory results, 65.1% reported willingness to be vaccinated during the subsequent season. Influenza was virologically confirmed in 103 patients (33.3%). The rate of vaccine willingness increased to 70.4% (p = .02) after communication of influenza laboratory results. Factors independently associated with the willingness to be vaccinated were the perception of influenza vaccine benefits (adjusted relative risk (aRR): 1.06, 95%CI 1.02-1.10), cues to action (aRR: 1.08, 95%CI 1.03-1.12), current season influenza vaccination (aRR: 1.38, 95%CI 1.20-1.59) and communication of a positive influenza laboratory result (aRR: 1.18, 95%CI 1.03-1.34). This last was associated with the willingness to be vaccinated only in the subpopulation of patients not vaccinated (aRR: 1.53, 95%CI 1.19-1.96).In patients hospitalized with ILI, communication of a positive influenza diagnostic led to a better appreciation of the disease's severity and increased the willingness to be vaccinated. This approach might be particularly beneficial in patients who do not have a history of influenza vaccination.
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Affiliation(s)
- Sarah Tubiana
- Inserm CIC1425 Bichat, Hôpital Bichat-Claude Bernard, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France.,IAME, UMR1137, Sorbonne Paris Cité, Paris, France
| | - Odile Launay
- Université Paris Descartes, Sorbonne Paris Cité, Inserm, Paris, France.,Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Cochin, CIC Cochin Pasteur, Paris, France.,Inserm, F-CRIN, Innovative clinical research network in vaccinology (I-REIVAC), Paris, France
| | - Florence Galtier
- Inserm, F-CRIN, Innovative clinical research network in vaccinology (I-REIVAC), Paris, France.,CIC 1411, Hôpital Saint-Eloi, CHU de Montpellier, Montpellier, France
| | - Pierre Tattevin
- Inserm, F-CRIN, Innovative clinical research network in vaccinology (I-REIVAC), Paris, France.,Faculté de Médecine, Hôpital Pontchaillou, INSERM U835, Université Rennes 1, Rennes, France
| | - Deborah Postil
- Inserm, F-CRIN, Innovative clinical research network in vaccinology (I-REIVAC), Paris, France.,CIC de Limoges, CHU Dupuytren, Limoges, Limoges, France
| | - Philippe Vanhems
- Inserm, F-CRIN, Innovative clinical research network in vaccinology (I-REIVAC), Paris, France.,Service d'Hygiène, Epidémiologie et Prévention, Groupement Hospitalier Edouard Herriot, Lyon, and Emerging Pathogens Laboratory - Fondation Mérieux, Centre International de Recherche en Infectiologie (CIRI) Inserm U1111, Lyon, France
| | - Nezha Lenzi
- Inserm, F-CRIN, Innovative clinical research network in vaccinology (I-REIVAC), Paris, France
| | - Pierre Verger
- Inserm, F-CRIN, Innovative clinical research network in vaccinology (I-REIVAC), Paris, France.,UMR VITROME (Vecteurs, Infections TROpicales et MEditerranéennes), Aix Marseille Univ, INSERM, IRD, Marseille, France.,ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d׳Azur, Marseille, France
| | - Xavier Duval
- Inserm CIC1425 Bichat, Hôpital Bichat-Claude Bernard, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France.,IAME, UMR1137, Sorbonne Paris Cité, Paris, France.,Inserm, F-CRIN, Innovative clinical research network in vaccinology (I-REIVAC), Paris, France
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48
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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 RB, 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 2020; 79:39-52. [PMID: 31413005 DOI: 10.1136/annrheumdis-2019-215882] [Citation(s) in RCA: 483] [Impact Index Per Article: 96.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [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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Affiliation(s)
- Victoria Furer
- Rheumatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Tel Aviv University Sackler Faculty of Medicine, Tel Aviv, Israel
| | - Christien Rondaan
- Medical Microbiology and Infection Prevention, University Medical Centre Groningen, Groningen, The Netherlands
- Rheumatology and Clinical Immunology, University Medical Centre Groningen, Groningen, The Netherlands
| | - Marloes W Heijstek
- Internal Medicine and Allergology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Nancy Agmon-Levin
- Tel Aviv University Sackler Faculty of Medicine, Tel Aviv, Israel
- Zabludowicz Center for Autoimmune Diseases, Chaim Sheba Medical Center, Tel HaShomer, Ramat Gan, Israel
| | - Sander van Assen
- Department of Internal Medicine (Infectious Diseases), Treant Care Group, Hoogeveen, The Netherlands
| | - Marc Bijl
- Rheumatology and Clinical Immunology, Martini Hospital Groningen, Groningen, The Netherlands
| | | | - Raffaele D'Amelio
- Dipartimento di Medicina Clinica e Molecolare, Sapienza Università di Roma, Rome, Italy
| | - Maxime Dougados
- Hopital Cochin, Rheumatology, Université Paris Descartes, Paris, France
| | | | - Jacob M van Laar
- Rheumatology & Clinical Immunology, University Medical Centre Utrecht and Utrecht University, Utrecht, The Netherlands
| | - A de Thurah
- Rheumatology, Aarhus University Hospital, Aarhus, Denmark
| | - Robert Bm Landewé
- Amsterdam Rheumatology Center, AMC, Amsterdam, The Netherlands
- Rheumatology, Zuyderland MC, Heerlen, The Netherlands
| | - Anna Molto
- Hopital Cochin, Rheumatology, Université Paris Descartes, Paris, France
| | - Ulf Müller-Ladner
- Rheumatology and Clinical Immunology, Giessen University, Bad Nauheim, Germany
| | - Karen Schreiber
- Department of Thrombosis and Haemophilia, Guy's and St Thomas' Hospital, London, UK
- Department of Rheumatology, King Christian X's Hospital for Rheumatology Diseases, Graasten, Denmark
| | - Leo Smolar
- Patient Research Partner, Tel Aviv, Israel
| | | | - Klaus Warnatz
- Center for Chronic Immunodeficiency (CCI), University Medical Center Freiburg, Freiburg, Germany
| | - Nico M Wulffraat
- Department of Pediatrics Immunology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ori Elkayam
- Rheumatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Tel Aviv University Sackler Faculty of Medicine, Tel Aviv, Israel
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Monier A, Puyade M, Hernanz MPG, Bouchaert P, Leleu X, Tourani JM, Roblot F, Rammaert B. Observational study of vaccination in cancer patients: How can vaccine coverage be improved? Med Mal Infect 2019; 50:263-268. [PMID: 31848105 DOI: 10.1016/j.medmal.2019.11.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Revised: 03/04/2019] [Accepted: 11/25/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Chemotherapy increases the risk of infections, often severe, and some of them are vaccine-preventable infections. We aimed to assess vaccination coverage and associated factors in oncology and hematology patients. METHODS Consecutive adult patients followed in a French university hospital for hematological malignancy or solid cancer voluntarily completed an anonymous questionnaire in September and October 2016. It included questions on underlying disease, chemotherapy, flu, and pneumococcal vaccination uptakes, and attitudes toward vaccination. Factors associated with vaccination uptake were assessed by multivariate logistic regression. RESULTS The response rate was 41.9% (N=671) among 1,600 questionnaires distributed; 232 patients had underlying hematological malignancy and 439 had solid cancer. Half of the patients were aged over 65 years. Chemotherapy was ongoing or discontinued for less than one year in 74.7% of patients. In patients aged <65 years undergoing chemotherapy, flu vaccination rate was 19.9% whereas patients aged >65 years had coverage of 47%. Pneumococcal vaccine uptake was 7.3%. However, 64.7% of patients were favorable to vaccination. Vaccine uptake was associated with age >65 years (OR 4.5 [2.9-7.0]), information about vaccination delivered by the family physician (OR 12.9 [5.5-30.1]), follow-up in hematology unit (OR 2.0 [1.3-3.1]), and positive opinion about vaccination (OR 2.0 [1.3-3.1]). CONCLUSION Despite specific recommendations regarding immunocompromised patients, anti-pneumococcal and flu vaccinations were rarely conducted, even in elderly patients. Targeted information campaigns to family physicians, oncologists, and patients should be implemented to improve vaccine coverage in patients with underlying malignancies.
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Affiliation(s)
- A Monier
- Faculté de médecine et pharmacie, University of Poitiers, Poitiers, France; Service de maladies infectieuses et tropicales, CHU de Poitiers, Poitiers, France
| | - M Puyade
- Service de médecine interne, CHU de Poitiers, Poitiers, France
| | - M P Gallego Hernanz
- Service d'hématologie et thérapie cellulaire, CHU de Poitiers, Poitiers, France
| | - P Bouchaert
- Service d'oncologie médicale, CHU de Poitiers, Poitiers, France
| | - X Leleu
- Service d'hématologie et thérapie cellulaire, CHU de Poitiers, Poitiers, France; Inserm CIC 1402, Poitiers, France
| | - J M Tourani
- Service d'oncologie médicale, CHU de Poitiers, Poitiers, France
| | - F Roblot
- Faculté de médecine et pharmacie, University of Poitiers, Poitiers, France; Service de maladies infectieuses et tropicales, CHU de Poitiers, Poitiers, France; Inserm U1070, Poitiers, France
| | - B Rammaert
- Faculté de médecine et pharmacie, University of Poitiers, Poitiers, France; Service de maladies infectieuses et tropicales, CHU de Poitiers, Poitiers, France; Inserm U1070, Poitiers, France.
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50
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Reuken PA, Grunert P, Stallmach A. Prävention von Infektionen und infektiösen Komplikationen bei chronisch-entzündlichen Darmerkrankungen. DER GASTROENTEROLOGE 2019; 14:451-461. [DOI: 10.1007/s11377-019-00390-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2025]
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