COVID-19 vaccine use in immunocompromised patients: A commentary on evidence and recommendations
COVID-19 vaccine use in immunocompromised patients: A commentary on evidence and recommendations
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DOI：
10.1093/ajhp/zxab344
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发表时间：
2021-09-21
影响因子：
2.7
通讯作者：
Bhat, Shubha
中科院分区：
文献类型：
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作者：
Duly, Kristine;Farraye, Francis A.;Bhat, Shubha
目的.虽然COVID-19疫苗紧急使用授权（EUA）认为疫苗对公众使用是有效和安全的，但导致EUA的III期试验主要排除了免疫功能低下的患者。免疫功能低下的患者占人口的很大比例，鉴于最近的大规模疫苗接种工作，我们的目标是审查目前的证据和建议的COVID-19疫苗在4个免疫功能低下的疾病或条件的患者人群：人类免疫缺陷病毒（HIV）感染，实体器官移植，类风湿性关节炎和炎症性肠病。鉴于有关已批准的COVID-19疫苗在免疫功能低下人群中的安全性和有效性的数据不断变化，药剂师和其他免疫提供者必须了解当前的数据和建议，并为公众提供准确的信息。迄今为止，第三期COVID-19疫苗试验中唯一包括的免疫功能低下亚组是HIV感染者。然而，最近的回顾性试验提供了关于COVID-19疫苗在免疫功能低下患者中安全性的可靠数据，Moderna 3期试验的中期分析产生了关于艾滋病毒感染患者疗效的有希望的数据。目前，美国疾病控制和预防中心、英国免疫学会以及其他各种政府和专业学会和组织支持在免疫功能低下人群中接种COVID-19疫苗。虽然需要更多的数据来确定免疫损害疾病和免疫抑制药物对疫苗有效性的影响，但预计疫苗接种的益处超过理论风险。因此，目前建议免疫功能低下的患者接种COVID-19疫苗，提供者应努力通过教育和保证减少这一人群的疫苗犹豫。
Purpose. While COVID-19 vaccine emergency use authorization (EUA) deemed the vaccines to be effective and safe for public use, the phase 3 trials leading to EUA predominantly excluded patients with immunocompromising conditions. Immunocompromised patients make up a significant proportion of the population, and in light of recent mass vaccination efforts, we aim to review current evidence and recommendations of COVID-19 vaccines in 4 patient populations with immunocompromising disorders or conditions: human immunodeficiency virus (HIV) infection, solid organ transplantation, rheumatoid arthritis, and inflammatory bowel disease.Summary. Given the evolving data on the safety and efficacy of the approved COVID-19 vaccines in the immunocompromised population, it is vital that pharmacists and other immunizing providers understand the current data and recommendations and provide the public with accurate information. To date, the only immunocompromised subgroup included in phase 3 COVID-19 vaccine trials have been those with HIV infection. However, recent retrospective trials have provided reassuring data on the safety of the COVID-19 vaccine in immunocompromised patients, and the interim analysis of the Moderna phase 3 trial produced promising data on efficacy in HIV-infected patients. Presently, the US Centers for Disease Control and Prevention, British Society for Immunology, and various other governmental and professional societies and organizations endorse COVID-19 vaccination in the immunocompromised population.Conclusion. While additional data is needed to determine the effects of immunocompromising medical conditions and immunosuppressing medications on the efficacy of the vaccine, the benefits of vaccination is anticipated to outweigh theoretical risks. Thus, COVID-19 vaccination is recommended for immunocompromised patients at this time, and providers should make efforts to decrease vaccine hesitancy in this population through education and reassurance.