Pneumococcal polysaccharide vaccination in adults undergoing immunosuppressive treatment for inflammatory diseases - a longitudinal study
Pneumococcal polysaccharide vaccination in adults undergoing immunosuppressive treatment for inflammatory diseases - a longitudinal study
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DOI：
10.1186/s13075-015-0663-9
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发表时间：
2015-06-06
影响因子：
4.9
通讯作者：
Ribi, Camillo
中科院分区：
文献类型：
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作者：
Fischer, Lara;Gerstel, Patricia Francis;Ribi, Camillo
导言：接受免疫抑制治疗的患者感染风险增加。社区获得性肺炎和侵袭性肺炎球菌病是这一人群发病率和死亡率的主要原因，可通过接种疫苗加以预防。理想情况下，肺炎球菌抗原免疫应在免疫抑制治疗开始前进行。然而，治疗往往不能拖延。在免疫抑制治疗期间，对肺炎球菌疫苗的疗效知之甚少。本研究的目的是确定未接种疫苗、免疫抑制的患有炎症性疾病的成年人对肺炎链球菌有免疫保护的百分比，并评估与23价肺炎球菌多糖疫苗（PPV）在血清阴性受试者中的免疫原性、临床影响和安全性相关的因素。方法：本观察性研究纳入18岁及以上接受强的松>= 20mg /天或其他免疫抑制药物治疗的患者。排除标准为前5年服用PPV、静脉注射免疫球蛋白和妊娠。测定6种肺炎球菌血清型血清免疫球蛋白G （IgG）抗体水平。血清阳性定义为6种血清型中至少4种IgG≥0.5 μ g/ml。血清阴性患者接受PPV治疗，血清阳性患者作为对照组。4-8周后评估疫苗反应和耐受性。疾病活动度根据医师全球评估评分进行评估。1年后再次进行血清学检查，并收集任何需要就医的感染信息。结果是接种疫苗和未接种疫苗的患者血清阳性和感染的比例。结果：201例患者中35例接受大剂量皮质激素治疗，181例接受免疫抑制药物治疗。60例（30%）患者的基线血清阴性与皮质治疗和较低的总IgG有关。在PPV后，81%的患者的疾病活动性保持不变或下降，87%的患者血清呈阳性。1年后，67%的接种者血清呈阳性，而90%的观察者血清呈阳性（p < 0.001），而两组之间的感染率没有差异。那些仍然服用强的松= 10毫克/天的人往往有较差的血清学反应和明显更多的感染。结论：基于血清学反应，PPV是安全且中等有效的。肺炎球菌抗原血清阳性显著降低感染风险。持续高剂量皮质类固醇与疫苗反应差和更多感染相关。
Introduction: Patients undergoing immunosuppressive therapy are at increased risk of infection. Community-acquired pneumonia and invasive pneumococcal disease account for substantial morbidity and mortality in this population and may be prevented by vaccination. Ideally, immunization to pneumococcal antigens should take place before the start of immunosuppressive treatment. Often, however, the treatment cannot be delayed. Little is known about the efficacy of pneumococcal vaccines during immunosuppressive treatment. The objectives of this study were to determine the percentage of vaccine-naive, immunosuppressed adults with inflammatory diseases seroprotected against Streptococcus pneumoniae and to assess factors associated with the immunogenicity, clinical impact and safety of 23-valent pneumococcal polysaccharide vaccine (PPV) in seronegative subjects.Methods: This observational study included patients 18 years of age and older who were receiving prednisone >= 20 mg/day or other immunosuppressive drugs. Exclusion criteria were PPV administration in the previous 5 years, intravenous immunoglobulins and pregnancy. Serum immunoglobulin G (IgG) antibody levels against six pneumococcal serotypes were measured. Seropositivity was defined as IgG of 0.5 mu g/ml or greater for at least four of six serotypes. Seronegative patients received PPV, and seropositive patients were included as a comparison group. Vaccine response and tolerance were assessed after 4-8 weeks. Disease activity was evaluated on the basis of the Physician Global Assessment scores. Serology was repeated after 1 year, and information on any kind of infection needing medical attention was collected. Outcomes were the proportion of seropositivity and infections between vaccinated and unvaccinated patients.Results: Of 201 included patients, 35 received high-dose corticosteroids and 181 were given immunosuppressive drugs. Baseline seronegativity in 60 (30 %) patients was associated with corticotherapy and lower total IgG. After PPV, disease activity remained unchanged or decreased in 81 % of patients, and 87 % became seropositive. After 1 year, 67 % of vaccinated compared with 90 % of observed patients were seropositive (p < 0.001), whereas the rate of infections did not differ between groups. Those still taking prednisone = 10 mg/day tended to have poorer serological responses and had significantly more infections.Conclusions: PPV was safe and moderately effective based on serological response. Seropositivity to pneumococcal antigens significantly reduced the risk of infections. Sustained high-dose corticosteroids were associated with poor vaccine response and more infections.