Vaccination of Patients with Immune-Mediated Diseases

A special issue of Vaccines (ISSN 2076-393X). This special issue belongs to the section "Innate and Adaptive Immunity in Vaccination".

Deadline for manuscript submissions: 20 September 2024 | Viewed by 4546

Special Issue Editors

Department of Hospital Pediatrics, Saint Petersburg State Pediatric Medical University, Ministry of Health of Russia 2, Litovskaya St., Saint Petersburg 194100, Russia
Interests: pediatric rheumatology; juvenile idiopathic arthritis; systemic lupus erythematosus; immunocompromised chidlren; vaccination of children with immune-mediated diseases
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Centre for Rheumatic Disease, King's College London, London, UK
Interests: rheumatoid arthritis; inflammatory arthritis and biologic therapy; immune
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1. Department of Medicine, Nazarbayev University School of Medicine, Nur-Sultan 010000, Kazakhstan
2. Clinical Academic Department of Pediatrics, National Research Center of Maternal and Child Health, University Medical Center, Nur-Sultan 010000, Kazakhstan
Interests: autoimmunity; pediatrics; rheumatology; gastroenterology; immunology
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Special Issue Information

Dear Colleagues,

Patients with immune-mediated diseases are at increased risk of developing infections, due to disease-related immune dysfunction and applying of immunosuppressive drugs. Additional factors of increased infection risk include disease activity, malnutrition, surgical interventions, and concomitant chronic diseases, such as obesity, diabetes mellitus, atopic dermatitis, asthma, and others. Biologic therapy with and without immune suppressors can reliably control inflammatory activity in many patients with immune-mediated diseases. Infections are the most common complications associated with biological treatment and immune suppressors. Vaccination is a well-known and effective tool, which allows for reducing the frequency and severity of infectious episodes, and indirectly might reduce the risks of disease flare and failure to achieve remission, and significantly improve disease course and outcomes. This research topic is devoted to theoretical and practical experience of vaccinations of immune mediated pediatric and adult diseases. The original manuscripts, review manuscripts and cases reports are welcome to this section. Reports about vaccine-controlled infections in immune-mediated cases, as well unusual vaccine-associted reaction and vaccine-associated adverse events case reports are also encouraged.

Prof. Dr. Mikhail Kostik
Dr. James Galloway
Dr. Dimitri Poddighe
Guest Editors

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Keywords

  • vaccines
  • immune deficiency
  • rheumatic diseases
  • immune mediated diseases
  • vaccination of immune compromised patients
  • immunosupressors

Published Papers (4 papers)

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13 pages, 1637 KiB  
Article
Do Not Leave Your Patients in the Dark—Using American College of Rheumatology and European Alliance of Associations for Rheumatology Recommendations for Vaccination in Polish Adult Patients with Autoimmune Inflammatory Rheumatic Diseases
by Jakub Wroński, Karolina Palej, Sandra Stańczyk, Marta Łosoś, Joanna Werońska-Tatara, Małgorzata Stasiek, Marta Wysmołek, Agnieszka Olech and Anna Felis-Giemza
Vaccines 2023, 11(12), 1854; https://doi.org/10.3390/vaccines11121854 - 14 Dec 2023
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Abstract
(1) Introduction: Patients with autoimmune inflammatory rheumatic diseases (AIIRD) face a higher infectious risk compared to the general population. As per the ACR and EULAR recommendations, vaccinations against influenza, COVID-19, pneumococci, and tetanus are recommended for most patients with AIIRD. (2) Objectives: This [...] Read more.
(1) Introduction: Patients with autoimmune inflammatory rheumatic diseases (AIIRD) face a higher infectious risk compared to the general population. As per the ACR and EULAR recommendations, vaccinations against influenza, COVID-19, pneumococci, and tetanus are recommended for most patients with AIIRD. (2) Objectives: This study aimed to assess vaccination coverage among Polish AIIRD patients and identify factors influencing it. (3) Patients and Methods: This study was conducted at the reference rheumatological center in Poland between May 2023 and October 2023. The study participants completed a questionnaire covering their knowledge of vaccination recommendations, actual vaccination status, factors affecting their decision to vaccinate, and their perspectives on immunization. (4) Results: This study involved 300 AIIRD patients and 60 controls. Both groups exhibited comparably low vaccination rates for all diseases (the highest for COVID-19—52% in both groups and the lowest for pneumococci—7.7% and 10%, respectively). Knowledge about recommended vaccinations was limited among patients in both groups. AIIRD patients were also not aware that they should avoid live vaccines. The primary motivators for vaccination among AIIRD patients were fear of infection (up to 75%) and medical advice (up to 74.6%). Conversely, the predominant reasons for non-vaccination were a lack of knowledge that vaccination is recommended (up to 74.7%) and concerns about potential adverse effects (up to 48.6%). Many patients reported not receiving vaccination recommendations from either primary care physicians or rheumatologists. (5) Conclusions: To enhance vaccination coverage among AIIRD patients in Poland, it is essential to educate them about vaccinations during routine medical consultations, emphasizing the increased risk of infection, informing them about recommended vaccinations, and clarifying doubts about adverse effects. Full article
(This article belongs to the Special Issue Vaccination of Patients with Immune-Mediated Diseases)
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11 pages, 250 KiB  
Article
MAURIVAX: A Vaccination Campaign Project in a Hospital Environment for Patients Affected by Autoimmune Diseases and Adult Primary Immunodeficiencies
by Irene Ridolfi, Luca Lo Sardo, Stefania Nicola, Richard Borrelli, Ludovica Comola, Valentina Marmora, Iuliana Badiu, Federica Corradi, Maria Carmen Rita Azzolina and Luisa Brussino
Vaccines 2023, 11(10), 1579; https://doi.org/10.3390/vaccines11101579 - 11 Oct 2023
Cited by 1 | Viewed by 825
Abstract
Background: Patients with autoimmune diseases (ADs) and primary immunodeficiencies (PIDs) are characterized by an increased risk of noninvasive and widespread infections as they are considered frail patients. In addition, many flares of the underlying disease are reported after routine vaccinations. To date, the [...] Read more.
Background: Patients with autoimmune diseases (ADs) and primary immunodeficiencies (PIDs) are characterized by an increased risk of noninvasive and widespread infections as they are considered frail patients. In addition, many flares of the underlying disease are reported after routine vaccinations. To date, the vaccination rate in these two populations is suboptimal. According to the latest guidelines, targeted interventions are needed, such as strengthening the network of vaccination activities. Our project aimed to propose a pilot network for carrying out the recommended vaccinations in frail patients. Methods: The Allergy and Immunology Center of the Mauriziano Hospital in Turin, Italy started the “Maurivax” project, a facilitated pathway for frail patients to administer the recommended vaccinations in the setting of a dedicated structure where they could be properly followed up. Results: From June 2022 to February 2023, 49 patients underwent a vaccination consultation: 45 of them (91.8%) were subsequently vaccinated. Among these, 36 subjects (80%) were affected by an active AD and were already in treatment with immunosuppressive therapy or about to start it. Seven patients (15.5%) had a confirmed diagnosis of PID or showed a clinical presentation that was highly suggestive of that condition. Overall, twenty-seven patients (60%) showed a high-grade immunosuppression and six (13.3%) had a low-grade immunosuppression. No patients had a disease flare within 30 days from vaccination and no severe reactions after vaccination was observed. Conclusions: Adherence and vaccination safety at our immunology hospital vaccine clinic dedicated to patients with ADs and PIDs were high. We propose an effective model for managing vaccinations in frail patients in a specialist hospital setting. Full article
(This article belongs to the Special Issue Vaccination of Patients with Immune-Mediated Diseases)
13 pages, 2333 KiB  
Article
A Nationwide Digital Multidisciplinary Intervention Aimed at Promoting Pneumococcal Vaccination in Immunocompromised Patients
by Shirley Shapiro Ben David, Orna Shamai-Lubovitz, Vered Mourad, Iris Goren, Erica Cohen Iunger, Tamar Alcalay, Angela Irony, Shira Greenfeld, Limor Adler and Amos Cahan
Vaccines 2023, 11(8), 1355; https://doi.org/10.3390/vaccines11081355 - 11 Aug 2023
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Abstract
Immunocompromised patients (IPs) are at high risk for infections, some of which are vaccine-preventable. The Israeli Ministry of Health recommends pneumococcal conjugate vaccine 13 (PCV13) and pneumococcal polysaccharide vaccine 23 (PPSV23) for IP, but vaccine coverage is suboptimal. We assessed the project’s effectiveness [...] Read more.
Immunocompromised patients (IPs) are at high risk for infections, some of which are vaccine-preventable. The Israeli Ministry of Health recommends pneumococcal conjugate vaccine 13 (PCV13) and pneumococcal polysaccharide vaccine 23 (PPSV23) for IP, but vaccine coverage is suboptimal. We assessed the project’s effectiveness in improving the pneumococcal vaccination rate among IP. An automated population-based registry of IP was developed and validated at Maccabi Healthcare Services, an Israeli health maintenance organization serving over 2.6 million members. Included were transplant recipients, patients with asplenia, HIV or advanced kidney disease; or those receiving immunosuppressive therapy. A personalized electronic medical record alert was activated reminding clinicians to consider vaccination during IP encounters. Later, IP were invited to get vaccinated via their electronic patient health record. Pre- and post-intervention vaccination rates were compared. Between October 2019 and October 2021, overall PCV13 vaccination rates among 32,637 IP went up from 11.9% (n = 3882) to 52% (n = 16,955) (p < 0.0001). The PPSV23 vaccination rate went up from 39.4% (12,857) to 57.1% (18,652) (p < 0.0001). In conclusion, implementation of targeted automated patient- and clinician-facing alerts, a remarkable increase in pneumococcal vaccine uptake was observed among IP. The outlined approach may be applied to increase vaccination uptake in large health organizations. Full article
(This article belongs to the Special Issue Vaccination of Patients with Immune-Mediated Diseases)
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11 pages, 2452 KiB  
Systematic Review
A Systematic Review and Meta-Analysis of Anti-Rheumatic Drugs and Pneumococcal Vaccine Immunogenicity in Inflammatory Arthritis
by Deepak Nagra, Katie Bechman, Maryam Adas, Zijing Yang, Edward Alveyn, Sujith Subesinghe, Andrew Rutherford, Victoria Allen, Samir Patel, Mark D. Russell, Andrew Cope, Sam Norton and James Galloway
Vaccines 2023, 11(11), 1680; https://doi.org/10.3390/vaccines11111680 - 02 Nov 2023
Cited by 1 | Viewed by 1097
Abstract
Background: Pneumococcal pneumonia is an important cause of morbidity and mortality amongst patients with inflammatory arthritis. Vaccination is recommended by the National Institute for Health and Care Excellence (NICE) but it remains unclear how vaccine efficacy is impacted by different immunosuppressive agents. Our [...] Read more.
Background: Pneumococcal pneumonia is an important cause of morbidity and mortality amongst patients with inflammatory arthritis. Vaccination is recommended by the National Institute for Health and Care Excellence (NICE) but it remains unclear how vaccine efficacy is impacted by different immunosuppressive agents. Our objective was to compare the chance of a seroconversion following vaccination against pneumococcus in patients with inflammatory arthritis to that in the general population, as well as to compare the chance of seroconversion across different targeted therapies. Methods: We searched MEDLINE, Embase and the Cochrane Library databases from inception until 20 June 2023. We included randomized controlled trials and observational studies. Aggregate data were used to undertake a pairwise meta-analysis. Our primary outcome of interest was vaccine seroconversion. We accepted the definition of serological response reported by the authors of each study. Results: Twenty studies were identified in the systematic review (2807 patients) with ten reporting sufficient data to be included in the meta-analysis (1443 patients). The chance of seroconversion in patients receiving targeted therapies, relative to the general population, was 0.61 (95% CI 0.35 to 1.08). The reduced odds of response were skewed strongly by the effects of abatacept and rituximab with no difference between patients on TNF inhibitors (TNFis) or IL-6 inhibition and healthy controls. Within different inflammatory arthritis populations the findings remained consistent, with rituximab having the strongest negative impact on vaccine response. TNF inhibition monotherapy was associated with a greater chance of vaccine response compared with methotrexate (2.25 (95% CI 1.28 to 3.96)). JAK inhibitor (JAKi) studies were few in number and did not present comparable vaccine response endpoints to include in the meta-analysis. The information available does not suggest any significant detrimental effects of JAKi on vaccine response. Conclusion: This updated meta-analysis confirms that, for most patients with inflammatory arthritis, pneumococcal vaccine can be administered with confidence and that it will achieve comparable seroconversion rates to the healthy population. Patients on rituximab were the group least likely to achieve a response and further research is needed to explore the value of multiple-course pneumococcal vaccination schedules in this population. Full article
(This article belongs to the Special Issue Vaccination of Patients with Immune-Mediated Diseases)
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