Pneumococcal Vaccine In Patients Research Articles

Do JAK inhibitors affect immune response to COVID-19 vaccination? Data from the MAJIK-SFR Registry.

Do JAK inhibitors affect immune response to COVID-19 vaccination? Data from the MAJIK-SFR Registry.

Vaccination for Respiratory Infections in Patients with Heart Failure.

Bronchopulmonary infections are a major trigger of cardiac decompensation and are frequently associated with hospitalizations in patients with heart failure (HF). Adverse cardiac effects associated with respiratory infections, more specifically Streptococcus pneumoniae and influenza infections, are the consequence of inflammatory processes and thrombotic events. For both influenza and pneumococcal vaccinations, large multicenter randomized clinical trials are needed to evaluate their efficacy in preventing cardiovascular events, especially in HF patients. No study to date has evaluated the protective effect of the COVID-19 vaccine in patients with HF. Different guidelines recommend annual influenza vaccination for patients with established cardiovascular disease and also recommend pneumococcal vaccination in patients with HF. The Heart Failure group of the French Society of Cardiology recently strongly recommended vaccination against COVID-19 in HF patients. Nevertheless, the implementation of vaccination recommendations against respiratory infections in HF patients remains suboptimal. This suggests that a national health policy is needed to improve vaccination coverage, involving not only the general practitioner, but also other health providers, such as cardiologists, nurses, and pharmacists. This review first summarizes the pathophysiology of the interrelationships between inflammation, infection, and HF. Then, we describe the current clinical knowledge concerning the protective effect of vaccines against respiratory diseases (influenza, pneumococcal infection, and COVID-19) in patients with HF and finally we propose how vaccination coverage could be improved in these patients.

Evaluation on effectiveness of community-based comprehensive intervention and internet-based intervention for vaccination among patients with chronic diseases

To evaluate the effectiveness of community-based comprehensive intervention and internet-based intervention on influenza and pneumococcal vaccination in patients with diabetes or chronic obstructive pulmonary disease (COPD) in communities. Before the onset of influenza in 2015 and 2016, five demonstration areas for comprehensive prevention and control of chronic diseases were selected in the study. Patients aged 35 years old and above with diabetes and COPD were selected from selected demonstration areas as study participants. Two communities were selected from each demonstration area and randomly divided into Group A with the community-based comprehensive intervention and Group B with the combination of community-based comprehensive intervention and internet-based intervention within 6 months. The differences of vaccination knowledge, vaccination intention and vaccination proportion in study participants between the two groups before and after interventions were analyzed and compared. A total of 15 226 patients were included in the study. After the intervention the increase in the vaccine knowledge score, vaccination intention and vaccination proportion of patients in the two groups were all higher than those before the intervention. After intervention, the increase of the median score of vaccine knowledge in group B (50.00 points) was higher than that in Group A (42.86 points). The increase of influenza vaccination intention in Group B (6.91%) was higher than that in Group A (4.16%). The increase of proportion of influenza vaccination in Group B (7.35%) was lower than that in Group A (16.61%). The increase of pneumococcal vaccination intention in Group B (7.90%) was lower than that in Group A (9.08%). The proportion of pneumococcal vaccination in Group B (3.37%) was lower than that in Group A (4.06%). Community-based comprehensive intervention could improve the level of vaccine knowledge, vaccination intention and vaccination proportion of patients in this study. Combined with community-based intervention, internet-based intervention could have a better effect on improving vaccine knowledge and influenza vaccination intention, but its impact on vaccination proportion needs to be further explored.

Pneumococcal vaccine in patients with idiopathic juvenile arthritis in treatment with tumor necrosis factor inhibitors.

Juvenile idiopathic arthritis (JIA) is the most common rheumatological disease of childhood. The therapy with tumor necrosis factor (TNF) inhibitors (TNFi) in JIA patients has demonstrated efficacy and safety. The most reported adverse event is the high susceptibility to infections. Preventive vaccination helps to decrease these risks. The information on response to vaccines in JIA patients having treatment with anti-TNF is limited. To evaluate the response to pneumococcal vaccine in JIA patients undergoing treatment with mAb. Analytical observational mixed cohort study. Data obtained from the clinical records of an immunorheumatology polyclinic of a metropolitan hospital in Santiago (Chile). Treatments, pneumococcal vaccine schedules, immunological laboratory, and measurement of specific antibodies against 10 pneumococcal serotypes were recorded. Nineteen patients were included; average age was 13.8 years; and average evolution time of the disease was 46.2 months. Adalimumab (Humira®) was indicated in case of 13 patients (68.4%) and etanercept (Enbrel®) to 6 (31.5%). The most indicated scheme was a dose of 13-valent pneumococcal conjugate vaccine (PCV13) followed at 8 weeks by a dose of pneumococcal polysaccharide vaccine (PPSV23) in nine (47.3%) patients. Seventeen (89.4%) patients were on immunosuppressive treatment at the time of vaccination. Only one patient did not meet the criteria for response to vaccine. The pneumococcal vaccine induces protective levels of serum antibodies in JIA patients undergoing TNFi treatment. The vaccination schedule and the lymphocyte count could influence the response capacity.

Analysis of vaccination characteristics and influencing factors of influenza vaccine and pneumococcal vaccine in patients with frequent acute exacerbation phenotype COPD.

article: Analysis of vaccination characteristics and influencing factors of influenza vaccine and pneumococcal vaccine in patients with frequent acute exacerbation phenotype COPD - Panminerva Medica 2021 Jul 09 - Minerva Medica - Journals

Safety and efficacy of 23-valent polysaccharide pneumococcal vaccine in patients with systemic lupus erythematosus

Objective: to study the safety and efficacy of the 23-valent polysaccharide pneumococcal vaccine (PPV-23) in patients with systemic lupus erythematosus (SLE).Patients and methods. The study included 75 patients with definite diagnosis of SLE at the age of 19–68 years, 10 (13%) of them had high SLE activity, 18 (24%) – moderate, 42 (56%) – low, in 5 (7%) patients the disease was in remission. PPV-23 was injected subcutaneously in a single dose of 0.5 ml. In 60 patients the follow-up period was ≥12 months, in 15 – from 2 to 6 months. Patients were examined before and 1, 3 and 12 months after immunization.Results and discussion. In 38 (50.7%) patients, standard local vaccination reactions of mild and moderate severity were noted, in 1 (1.3%) – a general reaction of mild severity, in 2 (2.7%) – mild diarrhea during 1 day, in 1 (1.3%) – a hyperergic reaction of the Artyus phenomenon type, the symptoms were relieved within 7 days. During 12 months of follow-up, neither exacerbations of SLE, reliably associated with vaccination, nor new autoimmune phenomena, were detected. After 1 year of observation, the number of responders to vaccination was 58%, non-responders – 42%. The duration and activity of the disease, age over 50 years, glucocorticoid therapy > 10 mg per day, did not significantly affect the vaccine response. There was a decrease in the immune response in patients on biologic DMARDs (bDMARDs) therapy compared to patients without such treatment (43 and 68% of cases, respectively), p=0.058. There was no difference between rituximab and belimumab treated subjects. There was a tendency for the prevalence of vaccination responses among patients, who received bDMARDs <1 year before immunization, as well as among patients in whom this therapy was initiated after the administration of PPV-23. There was a positive trend in decrease of pneumonia, acute and exacerbations of chronic bronchitis episodes and sinusitis.Conclusion. Sufficient immunogenicity, good tolerability and clinical efficacy of PPV-23 in patients with SLE, including those who received combined immunosuppressive therapy, have been shown. The use of bDMARDs reduces the number of patients with a vaccine response. The number of responders to vaccination increases when immunization is carried out before the initiation of therapy with bDMARDs or when this therapy is initiated <1 year before immunization. Further long-term prospective studies in large patient cohorts are required.

Impact of Biological Therapies on the Immune Response after Pneumococcal Vaccination in Patients with Autoimmune Inflammatory Diseases.

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.

Clinical and Immunological Aspects of Pneumococcal Vaccination in Patients with Multiple Myeloma

Relevance. Among the groups at high risk of developing invasive pneumococcal infections, patients with multiple myeloma (MM) stand out among the highest rates of morbidity and mortality due to the presence of profound immunosuppression. Aims: to outline the current state of the problem of vaccine prevention of pneumococcal infection in patients receiving treatment for multiple myeloma, to present the evidence base for vaccination with conjugated pneumococcal vaccine. A continuous data review method was used to evaluate the studies on vaccination approaches against pneumococcal infection in patients with multiple myeloma. Conclusions. The article presents modern epidemiological data, as well as the results of original studies of clinical and immunological aspects of pneumococcal vaccination in patients with MM receiving new targeted agents and immunotherapy. The effectiveness of the use of the conjugated pneumococcal vaccine in patients treated with MM with bortezomib, lenalidomide, and ixazomib was indicated. An independent protective effect of pneumococcal vaccination has been shown as a preventive measure in a cohort of patients with MM, against the background of treatment with new targeted drugs.

Efficacy of pneumococcal vaccination in patients with multiple myeloma receiving novel agents: Results of a prospective clinical study

Efficacy of pneumococcal vaccination in patients with multiple myeloma receiving novel agents: Results of a prospective clinical study

Accuracy of Self-Reported Vaccination Status in a Cohort of Patients with Inflammatory Bowel Disease.

Background and AimsPrevention of vaccine-preventable diseases is important in the care of patients with inflammatory bowel disease (IBD). Thus, accurate immunization histories are critical. Many providers rely on patient self-report when assessing immunization status. The primary aim of our study was to determine the accuracy of self-reported influenza vaccination status in a cohort of patients with IBD.MethodsWe conducted a prospective study of patients with IBD who answered a vaccination status questionnaire and compared their responses to the Wisconsin Immunization Registry, a state-wide electronic immunization information system. The primary outcome was the sensitivity and specificity of self-reported influenza vaccination status. A secondary outcome evaluated the sensitivity and specificity of pneumococcal vaccination status.ResultsA total of 200 patients with IBD were included in the study. Documented immunization rates were 74.5% for influenza vaccinations and 79.9% for pneumococcal vaccinations. Influenza vaccination self-report had a sensitivity of 98.7%, a specificity of 90.2%, a positive predictive value (PPV) of 96.7% and a negative predictive value (NPV) of 95.8%. In comparison, the sensitivity for pneumococcal vaccination was 83.5% with a specificity of 86.2%, PPV of 96.4%, and NPV of 54.3%.ConclusionsSelf-reported influenza immunization status is sensitive and specific in patients with IBD. Accuracy for pneumococcal vaccination is slightly lower, but responses were notable for a high PPV. Self-report is an effective way to determine influenza immunization status and provides useful information for receipt of pneumococcal vaccine in patients with IBD.

Immunogenicity, Tolerability, and Clinical Effectiveness of 23-Valent Polysaccharide Pneumococcal Vaccine in Patients with Systemic Lupus Erythematosus

The aim of the work is to study the immunogenicity, tolerability, and clinical efficacy of the 23-valent polysaccharide pneumococcal vaccine (PPV-23) in patients with systemic lupus erythematosus (SLE). Material and methods. The study included 61 patients with a confirmed diagnosis of SLE, including 53 women, 8 men, aged 19 to 68 years. The disease activity at the time of vaccination: in 9 patients — high, in 13 — medium, in 34 — low, in 5 — remission. Therapy outline: 59 patients received glucocorticoids (GC) 5–30 mg/day in terms of prednisolone, 45 — hydroxychloroquine (GC), 33 — cytostatics (CS), 22 — genetically engineered biological drugs (GEBD): 11 — rituximab (RTM), 10 — belimumab (BLM). 23-valent polysaccharide pneumococcal vaccine in an amount of 0.5 ml (1 dose) was injected subcutaneously. Follow-up period: 9 patients — 3 months, 52 — 1 year after the vaccination. Patients were examined before vaccination, as well as in 1, 3, and 12 months after the vaccination. Results and discussion. After a year of observation, the number of «responders» to vaccination was 61.5%, «non-responders» — 38.5%. There was a decreased response to vaccine in patients receiving GEBD compared with patients who did not receive GEBD (40% and 75%, respectively), p=0.02. No differences were found against the background of RTM and BLM therapy. Administering GC in a dose exceeding 10 mg/day did not lead to a more significant decrease in response to vaccine compared to other patients. Standard local vaccination reactions of mild to moderate severity were noted in 50.8% of the patients, general reaction of mild severity — in 1 patient (1.6%), hyperergic Arthus-like reaction — in 1 patient (1.6%), the symptoms of which were relieved in 7 days. During the observation period (1 year), not a single case of exacerbation of SLE, reliably associated with the vaccination, was registered, and no new autoimmune phenomena were identified. Clinically positive dynamics was noted in the form of a decrease in the number of episodes of pneumonia, as well as acute and exacerbated chronic bronchitis, sinusitis. Conclusion. Sufficient immunogenicity, good tolerance, and clinical effectiveness of PPV-23 in patients with SLE, incl. those, who received combined immunosuppressive therapy. Further studies are needed in large groups of patients with long follow-up periods.

Pneumococcal Vaccination Recommendation and Completion Rates Among Inflammatory Bowel Disease Patients Within a Large Academic Health System

Patients with inflammatory bowel disease (IBD) are at increased risk for pneumonia and if hospitalized, have a higher mortality. Based on the Centers for Disease Control (CDC) guidelines published in 2012, vaccination with both the pneumococcal polysaccharide vaccine (PPSV23) and the pneumococcal conjugate vaccine (PCV13) is recommended for IBD patients who are receiving immunosuppressive treatment (steroids, immunomodulators, and/or biologics). Previous studies have shown low pneumococcal vaccination rates among IBD patients, yet few have assessed which specific vaccines are recommended and administered. Thus, we determined the pneumococcal vaccination recommendation and administration rates among IBD patients on immunosuppressive therapy in a large academic health system. We identified a cohort of patients aged ≥ 18 years with an IBD diagnosis based on ICD-9 and 10 codes seen by any gastroenterologist within our health system between 1/1/2014 and 9/4/2019. We performed a retrospective chart review to confirm IBD diagnosis and longitudinal care in a random sample of patients. Data abstraction included patient demographics, provider history, medications and disease characteristics. The primary outcome was the rate of documented vaccination recommendation by providers; the secondary outcome was rate of administration of the vaccines, calculated as the proportion of patients eligible for the vaccines who received the appropriate vaccines. We performed multivariable logistic regression to determine factors associated with receipt of any pneumococcal vaccine in patients on immunosuppressive medications. Our cohort included 253 IBD patients (median age 43 years; 55% female; 70% Caucasian; 83% privately insured) (Table 1). Eighty-seven percent of patients had a primary care physician (PCP) and 78% were on immunosuppressive medications at any time during the study period. Of the 197 immunosuppressed patients, 56% had any pneumococcal vaccination recommended and 38% had recommendations for both PPSV23 and PCV13. In addition, 40% received any pneumococcal vaccine and 16% received both vaccines (Image 2). In the multivariable analysis, age [adjusted odds ratio (aOR) 1.03, 95% confidence interval (CI): 1.01-1.05)] and having a PCP (aOR 3.84, 95% CI: 1.12-13.16) were associated with receipt of any pneumococcal vaccine in immunosuppressed patients, after adjusting for gender, race, insurance, disease activity, and time seen in our GI clinics. In our healthcare system, recommendation and receipt of both PPSV23 and PCV13 in IBD patients on immunosuppression is low. Older patients and those with a PCP were more likely to receive any pneumococcal vaccine. Further investigation of physician and patient knowledge of pneumococcal vaccination indications and barriers to receipt of vaccines is necessary to improve vaccination rates.Table-1Demographics of Total Cohort and Multivariable Analysis of Immunosuppressed PatientsMedian (IQR) or n (%)aOR (95% CI)∗Adjusted models for patients on immunosuppression (n = 197) included: age, gender, race, insurance, disease activity, PCP status, time seen in our GI clinicsTotal number of patients253 (100)Age (years)43 (27)1.03 (1.01-1.05)Sex Female139 (55)0.80 (0.42-1.51) Male114 (45)RefBMI (kg/m2)24.8 (5.4)Race White176 (69.6)Ref Asian12 (4.7)0.60 (0.28-1.28)ˆNon-White vs. White race Black3 (1.2) Other45 (17.8) Unknown17 (6.7)Primary insurance type Private210 (83)Ref Medicare29 (11.5)1.23 (0.46-3.31)¥Medicare/Medicaid/Other vs. Private insurance Medi-Cal/Medicaid4 (1.5) Other3 (1.2) No insurance or unknown7 (2.8)0.59 (0.06-5.62)¶No insurance vs. Private insuranceUrban residence251 (99.2)ASA physical status ASA 137 (14.6) ASA 2181 (71.5) ASA 322 (8.7) ASA 41 (0.4) Unknown12 (4.7)Provider historyTime seen in our GI clinics (years)3 (4)0.97 (0.90-1.05)Primary care provider219 (86.6)3.84 (1.12-13.16)†Ref: No PCPPrimary care provider at our institution129 (51)Disease characteristicsType of IBD Crohn’s disease115 (45.5) Ulcerative colitis138 (54.6)Duration of disease (years)11 (13)Active disease at last GI visit85 (33.6)0.96 (0.49-1.88)€Ref: Inactive diseaseOn immunosuppressive medication(s) at any time197 (77.9)On immunosuppressive medication(s) at last GI visit139 (55)Abbreviations aOR = Adjusted odds ratio, CI = Confidence interval, IQR = Interquartile range, BMI = Body mass index, ASA = American Society of Anesthesiologists, IBD = Inflammatory bowel disease, GI = Gastroenterology, PCP = Primary care physician, Ref = Reference group∗ Adjusted models for patients on immunosuppression (n = 197) included: age, gender, race, insurance, disease activity, PCP status, time seen in our GI clinicsˆ Non-White vs. White race¥ Medicare/Medicaid/Other vs. Private insurance¶ No insurance vs. Private insurance† Ref: No PCP€ Ref: Inactive disease Open table in a new tab Abbreviations aOR = Adjusted odds ratio, CI = Confidence interval, IQR = Interquartile range, BMI = Body mass index, ASA = American Society of Anesthesiologists, IBD = Inflammatory bowel disease, GI = Gastroenterology, PCP = Primary care physician, Ref = Reference group

Clinical efficacy of pneumococcal vaccination in multiple myeloma patients on novel agents: Results of a prospective clinical study

IntroductionAmong the high risk groups, patients with multiple myeloma (MM) have one of the highest incidence of invasive pneumococcal disease, mainly pneumonias. Recent changes in MM treatment have now led to an increase of survival, while the infection-related mortality remains high. The question of efficacy of pneumococcal vaccination in patients receiving novel target agents has not been clinically investigated before. Patients and methodsWe have introduced the 3-dose vaccination regimen by 13-valent pneumococcal conjugate (PCV13) vaccine between the treatment courses with novel target agents (bortezomib, lenalidomide, ixazomib) with a minimum of 1 month interval. The incidence of pneumonias during the one-year observation period was taken as a primary outcome in this registered clinical trial. ResultsFrom 2017 to 2020, we have prospectively included 18 adult patients who were vaccinated by PCV13 along with 18 patients of a control matched group. No adverse effects of vaccination were registered in the study. We have observed an independent effect of PCV13 vaccination on the incidence of pneumonias. The absolute risk reduction of pneumonias in patients received PCV13 vaccination was 33.3%. Number needed to treat for PCV13 vaccination in multiple myeloma patients receiving novel agents was 3.0; (95% CI 1.61–22.1; p = 0.0571). ConclusionTherefore, we have shown the clinical effectiveness of PCV13 vaccination schedule based on 3 doses given with a minimum 1 month interval between the courses of novel agents in multiple myeloma patients, despite the expected decrease in immunological response to vaccination during target and immunotherapy. ClinicalTrials.gov Identifier: NCT03619252.

Analysis of the impact of vaccination of pneumococcal infection in patients with chronic obstructive pulmonary disease in combination with diabetes

The article presents data on the evaluation of the clinical efficacy of using a conjugated pneumococcal vaccine in patients with COPD in combination with 2-type diabetes during a 3-year follow - up period. The study included 309 patients with an isolated course of COPD and in combination with diabetes. The main parameters for evaluating the effectiveness were: the dynamics of clinical symptoms - shortness of breath on the mMRC scale, CAT test, FEV1, the number of exacerbations, hospitalizations, the number of pneumonia, the state of carbohydrate metabolism (HbA1c) and the lipid profile. For vaccine prevention 13-valent conjugated pneumococcal vaccine Prevenar-13 was used. The use of PСV13 helps to reduce the severity of respiratory symptoms, reduce the number and duration of exacerbations of COPD, reduce the number of pneumonia. Both in isolated course of COPD and in combination with diabetes. Vaccination PCV13 in patients with comorbid course contributes to the compensation of carbohydrate metabolism and improve the lipid profile.

2904 Influenza and Pneumococcal Vaccination in Patients With Inflammatory Bowel Disease: Findings From a Large Safety Net Hospital

INTRODUCTION: Inflammatory Bowel Disease (IBD) inherently predisposes to infections due to a lack of appropriate innate and adaptive immune responses to infectious agents. Immunomodulators and biological therapies further increase the risk of infections in IBD patients by dampening the immune response of an already dysregulated intestinal immunity. Many of these infections are preventable with vaccinations. Advisory committee on immunization practices recommends pneumococcal conjugate vaccine (PCV13), pneumococcal polysaccharide vaccine (PPSV23) and annual influenza vaccine for all IBD patients. Despite these recommendations, vaccination rates continue to be suboptimal. We present our findings on the vaccination rate at a large safety net hospital. METHODS: We hypothesized that vaccination rate are low at most outpatient centers. In order to test this, we retrieved electronic medical records (EMR) from one of the outpatient departments of a large safety net hospital between November 2017 and March 2018. Patients with a diagnosis of IBD were identified and EMR were reviewed. Data regarding influenza vaccine, PCV13, PPSV23, immunosuppressive medications and comorbidities were obtained. Microsoft Excel and SPSS software version 21 were used for data management and analyses. Two-sided P-value < 0.05 was considered statistically significant. RESULTS: 181 patients were included in the study, 51.9% female and 48.1% male. Majority were African American (86.7%). The mean age was 45 years with 56.9% of patients being ≤49 years, 38.7% were between 50-69 years and 4.4% were over 70 years. 59.1% of patients were on immunosuppressive therapy. Overall, only 54.1% received an annual influenza vaccine. 24.9%, received PPSV23 alone, 4.4% received PCV13 alone and 13.8% patients received both P13 and PPSV23. Patients within the ages of 50-69 years were more likely to receive influenza vaccine (r = 0.358, P < 0.001). 43.1% of our patient populations were uninsured and 53.5% were unemployed. CONCLUSION: Our study revealed suboptimal implementation of national recommendation on influenza and pneumococcal vaccination among IBD patients at the selected institution, consistent with previous studies. We also found that older age predicts vaccination uptake. We propose that continuous education on the vaccination guidelines should be consistently provided to physicians involved in the care of IBD patients. Incorporating reminder alerts and patient education materials on vaccination guidelines in the EMR might improve its uptake and rate.

Pneumococcal Vaccine in Patients with Systemic Juvenile Idiopathic Arthritis Receiving Biologic Therapy: International Practice Review

International practice of immunization against pneumococcus in patients with systemic juvenile idiopathic arthritis (SJIA) receiving biological therapy is generalized in this review. High efficiency and safety of pneumococcal vaccines in children with SJIA is presented. Numerous researches show the adequate immune response after vaccination as well as alongside with genetically engineered biologic drugs therapy. Prevention of pneumococcal disease in patients with SJIA reduces the risk of development of pneumococcal diseases severe complications.

Immunogenicity and Safety of Pneumococcal Vaccination in Patients Treated With Immune Checkpoint Inhibitors

Immunogenicity and Safety of Pneumococcal Vaccination in Patients Treated With Immune Checkpoint Inhibitors

Interventions to Increase the Rate of Influenza and Pneumococcal Vaccination in Patients with Chronic Obstructive Pulmonary Disease: A Scoping Review.

Background and Objective: Current evidence suggests that patients with chronic obstructive pulmonary disease (COPD) should receive influenza and pneumococcal vaccinations. Despite international guidelines recommending vaccination in patients with COPD, many patients remain unvaccinated. Reasons for vaccine non-acceptance are multifaceted and are likely to be influenced by multiple psychosocial factors and pre-existing health beliefs. The aim of this review was to identify interventions which have been shown to effectively increase vaccination rates in patients with COPD. Materials and Methods: A structured search of PubMed returned 491 titles. Following title and abstract screening, seven full-text articles reporting on 6 unique interventional studies were extracted for narrative synthesis. A variety of interventions were investigated which, for the purposes of this review, were grouped into patient-focussed, clinician-focussed and mixed interventions. Results: Three papers reported findings from clinical trials (2 unique studies) and 4 papers reported findings from before-after studies. Two studies were conducted in the primary care setting, the remaining studies were conducted in secondary and tertiary care. Most studies reported both influenza and pneumococcal vaccination rates. These studies suggest that multimodal interventions, which target multiple aspects of evidence-based care and use both patient-focussed and clinician-focussed techniques, may have the greatest impact on vaccination rates in patients with COPD. Conclusions: Further, adequately powered, high quality studies are needed. It is crucial for individual institutions to monitor their own vaccination rates to determine if there is scope for performance improvement.

PF777 IMMUNOLOGICAL RECONSTITUTION AS A BASIS FOR THE EARLY INITIATION OF PNEUMOCOCCAL VACCINATION AFTER AUTOLOGOUS HEMATOPOIETIC STEM CELL TRANSPLANTATION

Background:In the context of significant advances in the treatment of hematological diseases using the method of autologous hematopoietic stem cell transplantation (auto‐HSCT), the number of patients requiring early vaccination against pneumococcal infection increases worldwide. Current guidelines indicate the early initiation of pneumococcal vaccination starting from 3 months after HSCT. Still, the topical issue is the determination of the earliest optimal dates for the start of vaccination after transplantation, taking into account the dynamics of immunological recovery.Aims:The aim of this study was to determine the optimal timeline for the onset of vaccination with conjugated pneumococcal vaccine in patients with multiple myeloma after auto‐HSCT.Methods:The immune response to the conjugated pneumococcal vaccine is based on the T‐dependent (CD4+) activation of B‐cells, what was taken into account when estimating the timing of immune reconstitution after auto‐HSCT in candidates for vaccination.An immunological study using flow cytometry was performed in 37 adult patients with multiple myeloma prior to the auto‐HSCT procedure, as well as on days +30, +60, +90, +180 after transplantation.Results:After auto‐HSCT, the level of naive B‐cells returns to its original value by the 60th day from transplantation (Kruskal‐Wallis test 41.97; P < 0.001), shown on Fig. 1. At the same time, the level of CD4 + cells did not fall below 200 cells/μl starting from day +30, what indicates the effectiveness of early vaccination with T‐dependent vaccines in this category of patients with immunosuppression. Dendritic cells (DC1 and DC2) are restored in parallel by the 30th day from auto‐HSCT (Kruskal‐Wallis test 25.78; P <0.001 for DC‐1 cells and Kruskal‐Wallis test 11,17; P <0.025, respectively), what confirms the basis for the early vaccination with conjugated pneumococcal vaccines in this category of patients.Summary/Conclusion:The obtained data allows planning the introduction of the first dose of the conjugated pneumococcal vaccine 60 days after autologous HSCT, with the perspective of introducing an individualized vaccination calendar based on immunological parameters. It is also necessary to further implement immunization programs for immunocompromised patients, especially in hematology and cancer setting with the participation of a multidisciplinary team of specialists.image

Immunogenicity and efficiency of a 23-valent pneumococcal vaccine in patients with rheumatoid arthritis: results of a 5-year follow up study

Objective : to study the efficacy, immunogenicity, and safety of a 23-valent pneumococcal polysaccharide vaccine (PPSV-23) in patients with rheumatoid arthritis (RA) receiving disease-modifying antirheumatic drugs (DMARDs) and biologic agents (BAs) during a 5-year follow-up. Patients and methods. The investigation included 79 RA patients with a recent history of ≥2 episodes of lower respiratory tract infections (bronchitis, pneumonia). A single dose (0.5 ml) of PPSV-23 was administered subcutaneously during continued methotrexate/leflunomide therapy or 28–30 days before using TNF-α inhibitors. All the patients were followed up during the first year; 39 patients at 24 months (Visit 5), 13 at 36 months (Visit 6), 23 at 48 months (Visit 7), and 18 at 60 months (Visit 8). Results and discussion . RA patients receiving various therapies were noted to have a marked positive immune response to PPSV-23, which was manifested by a significant increase in the postimmunization response coefficient. Vaccination responses were recorded in 61% of the patients with RA. The level of postvaccination responses tended to decrease at the 4-year follow-up. Only one case of community-acquired pneumonia of unknown etiology was detected at 5 years of follow-up. Conclusion . The data obtained by the authors for the first time in the 5-year prospective study indicate the sufficient and long-term immunogenicity, high efficacy, and safety of PPSV-23 in RA patients treated with DMARDs and BAs. Further clinical trials are needed to clarify the influence of various factors on the efficacy and immunogenicity of PPSV-23 and on the degree of their correlation in patients with RA. Objective: to study the efficacy, immunogenicity, and safety of a 23-valent pneumococcal polysaccharide vaccine (PPSV-23) in patients with rheumatoid arthritis (RA) receiving disease-modifying antirheumatic drugs (DMARDs) and biologic agents (BAs) during a 5-year follow-up.Patients and methods. The investigation included 79 RA patients with a recent history of ≥2 episodes of lower respiratory tract infections (bronchitis, pneumonia). A single dose (0.5 ml) of PPSV-23 was administered subcutaneously during continued methotrexate/leflunomide therapy or 28–30 days before using TNF-α inhibitors. All the patients were followed up during the first year; 39 patients at 24 months (Visit 5), 13 at 36 months (Visit 6), 23 at 48 months (Visit 7), and 18 at 60 months (Visit 8).Results and discussion. RA patients receiving various therapies were noted to have a marked positive immune response to PPSV-23, which was manifested by a significant increase in the postimmunization response coefficient. Vaccination responses were recorded in 61% of the patients with RA. The level of postvaccination responses tended to decrease at the 4-year follow-up. Only one case of community-acquired pneumonia of unknown etiology was detected at 5 years of follow-up.Conclusion. The data obtained by the authors for the first time in the 5-year prospective study indicate the sufficient and long-term immunogenicity, high efficacy, and safety of PPSV-23 in RA patients treated with DMARDs and BAs. Further clinical trials are needed to clarify the influence of various factors on the efficacy and immunogenicity of PPSV-23 and on the degree of their correlation in patients with RA.