Vaccination Of Household Contacts Research Articles

Vaccination of Adults With Cancer: ASCO Guideline.

To guide the vaccination of adults with solid tumors or hematologic malignancies. A systematic literature review identified systematic reviews, randomized controlled trials (RCTs), and nonrandomized studies on the efficacy and safety of vaccines used by adults with cancer or their household contacts. This review builds on a 2013 guideline by the Infectious Disease Society of America. PubMed and the Cochrane Library were searched from January 1, 2013, to February 16, 2023. ASCO convened an Expert Panel to review the evidence and formulate recommendations. A total of 102 publications were included in the systematic review: 24 systematic reviews, 14 RCTs, and 64 nonrandomized studies. The largest body of evidence addressed COVID-19 vaccines. The goal of vaccination is to limit the severity of infection and prevent infection where feasible. Optimizing vaccination status should be considered a key element in the care of patients with cancer. This approach includes the documentation of vaccination status at the time of the first patient visit; timely provision of recommended vaccines; and appropriate revaccination after hematopoietic stem-cell transplantation, chimeric antigen receptor T-cell therapy, or B-cell-depleting therapy. Active interaction and coordination among healthcare providers, including primary care practitioners, pharmacists, and nursing team members, are needed. Vaccination of household contacts will enhance protection for patients with cancer. Some vaccination and revaccination plans for patients with cancer may be affected by the underlying immune status and the anticancer therapy received. As a result, vaccine strategies may differ from the vaccine recommendations for the general healthy adult population vaccine.Additional information is available at www.asco.org/supportive-care-guidelines.

Vaccination Campaign against Hepatitis B Virus in Italy: A History of Successful Achievements.

In Italy, the vaccination campaign against hepatitis B virus has been characterized by two phases. In the first phase (1984-1991), vaccination with plasma-derived vaccines was first recommended for the high-risk group. In the second phase (1991-nowadays), recombinant vaccine targeted, by law, infants 2 months old and teenagers 12 years old (limited to the first 12 years of campaign); screening for HBsAg became compulsory for all pregnant women during the third trimester of pregnancy. Successful achievements have been attained: No acute HBV case has been observed in the age group targeted by vaccination, the pool of chronic HBsAg carriers is strongly reduced, perinatal HBV transmission is under control, and acute delta virus hepatitis cases are nearly eliminated. The key point of this success has been the peculiar vaccination policy adopted. The combined vaccination of teenagers has generated an early immune cohort of youths, who are no longer at risk of acquiring HBV infection by sources of exposure (i.e., drug use and unsafe sex practices) typical of the young adults. Vaccination of household contacts with HBsAg-positive subjects represents an area of improvement; providing migrants and refugees access to healthcare services is also a focal point. In 2020, Italy became the first country in Europe to achieve the WHO's regional hepatitis targets.

Self-Reported Experiences of Adult Hematopoietic Cell Transplantation Survivors with COVID-19 Vaccination and Infection

BACKGROUND Hematopoietic cell transplantation (HCT) survivors are at an increased risk of COVID-19 infection and complications. There are scant data for HCT recipients regarding compliance and experiences with COVID-19 vaccination or uptake of other prevention strategies. COVID infection rate data by vaccination status are also lacking in this population. We surveyed a long-term HCT survivor population to characterize the use of COVID-19 vaccination, other precautionary measures, and COVID-19 outcomes. METHODS As part of Fred Hutchinson Cancer Center's follow up of HCT recipients, we administer an annual survey regarding health status, HCT follow up, and chronic GVHD (cGVHD) status including immunosuppressive treatment. We analyzed surveys sent to adults between 7/1/21 and 5/31/22 that included additional questions about COVID-19 infection, prevention measures, and vaccinations. Comparisons by response and vaccination status were performed using the Chi-square test and Fisher's exact test for categorical variables and the Kruskal-Wallis test for continuous variables. RESULTS Of 4758 survivors who underwent HCT from 1971-2020 and consented to receive annual surveys, 1939 (42%) answered the survey and 1572 (33%) answered the COVID-19 questions. Among 1559 respondents who reported their vaccination status, 1456 (93%) received ≥1 dose of COVID vaccine, the majority of whom (1358/1456, 93%) received only mRNA vaccine. Of 1442 patients who received ≥1 dose of vaccine and who provided vaccination information, 1363 (95%) received 2 doses, 808 (56%) received 3 doses, and 115 (8%) received 4 doses. In univariate analysis, older age (p < 0.001), work status (p = 0.005), and current cancer (p = 0.01) were significantly associated with being vaccinated (Table 1). 1254/1344 (93%) non-Hispanic White patients, 107/108 (99%) non-Hispanic/non-White patients, and 31/37 (84%) of Hispanic/Latino patients reported receipt of ≥1 dose of vaccine. Presence of cGVHD, chronic medical conditions, autologous vs. allogeneic transplant, sex, and time since transplant were not associated with vaccination status. Severe adverse effects after vaccination were reported by 66 (4%) respondents (Figure 1). Among 108 vaccinated patients with cGVHD, 96 (89%) did not report any changes in their cGVHD symptoms after vaccination; 12 (11%) reported worsening symptoms. The most common reasons for declining vaccination in unvaccinated patients (n = 103) were the rapidity of vaccine development (70%), side effects (70%), and lack of testing in HCT recipients (53%) as the most common reasons for declining vaccination. Among survey respondents, 212/1564 (14%) reported having a COVID infection, with 55% (114/206) reporting moderate or severe symptoms and 10% (21/204) requiring hospitalization; 10% (20/204) reported "long-COVID." Of 142 vaccinated patients who developed a COVID infection and whose vaccination and infection dates were available, 56% (n = 79) received their first doses of COVID vaccine after COVID infection. Vaccinated patients (5% vs. 68%, p < 0.001) and their household members (10% vs. 45%, p < 0.001) were significantly less likely to have contracted COVID. Higher number of vaccination doses was significantly associated with reduced risk of COVID infection (p < 0.001) but not disease severity. Among the patients who had COVID, there were no significant differences in disease severity, duration, or hospitalization between those who were and were not vaccinated prior to COVID infection. Vaccinated patients took significantly more precautions against COVID than unvaccinated patients (n = 103) both during (7/1/21-2/28/22: median of 5 vs. 2, p < 0.001) and after (3/1/22-5/31/22: median of 4 vs. 1, p < 0.001) the CDC mask mandate was in effect. Vaccination of household contacts was more frequently reported by vaccinated than unvaccinated patients (82% vs. 45%, p < 0.001). CONCLUSION The majority of survey respondents received ≥1 dose of COVID vaccine, and most reported minimal to no adverse effects. The majority of patients with cGVHD did not experience any worsening symptoms. COVID infection was reported by 14% of respondents and was more common in unvaccinated recipient households than vaccinated households. Vaccinated patients reported greater use of precautionary measures, including household vaccination. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

SARS-CoV-2 vaccination in solid-organ transplant recipients: What the clinician needs to know.

SummaryIn response to the COVID‐19 pandemic, SARS‐CoV‐2 vaccines have been developed at an unparalleled speed, with 14 SARS‐CoV‐2 vaccines currently authorized. Solid‐organ transplant (SOT) recipients are at risk for developing a higher rate of COVID‐19‐related complications and therefore they are at priority for immunization against SARS‐CoV‐2. Preliminary data suggest that although SARS‐CoV‐2 vaccines are safe in SOT recipients (with similar rate of adverse events than in the general population), the antibody responses are decreased in this population. Risk factors for poor vaccine immunogenicity include older age, shorter time from transplantation, use of mycophenolate and belatacept, and worse allograft function. SOT recipients should continue to be advised to maintain hand hygiene, use of facemasks, and social distancing after SARS‐CoV‐2 vaccine. Vaccination of household contacts should be also prioritized. Although highly encouraged for research purposes, systematic assessment in clinical practice of humoral and cellular immune responses after SARS‐CoV‐2 vaccination is controversial, since correlation between immunological findings and clinical protection from severe COVID‐19, and cutoffs for protection are currently unknown in SOT recipients. Alternative immunization schemes, including a booster dose, higher doses, and modulation of immunosuppression during vaccination, need to be assessed in the context of well‐designed clinical trials.

Varicella vaccination in HIV-positive individuals – a time to act

Purpose of the study Primary varicella infection in the HIV population can have serious sequelae. The HIV non-VZV immune population is at risk of attack rates of up to 90% from infected household contacts, who are predominantly children. Universal childhood varicella vaccination is currently under review in Ireland. New recommendations of the Advisory Committee on Immunisation Practices (MMWR) 2007 include expanding the use of varicella vaccine for HIV-infected adults and adolescents with CD4 >200, with vaccination of household contacts of those with CD4<200. These guidelines prompted us to review our HIV patient cohort, 30% of whom are from sub-Saharan Africa (SSA), reflecting the changing demographics of the Irish population. VZV non-immunity is known to be higher in the SSA population.

Vaccination of household contacts of a sporadic case of meningococcal disease: a cost-effective intervention?

Vaccination of household contacts of a sporadic case of meningococcal disease: a cost-effective intervention?

Vaccinations for Adult Solid Organ Transplant Recipient: Current Recommendations

The need for immunization in solid organ transplant recipient can arise from three factors: immune deficit owing to underlying disease, rejection of the organ graft, and immunosuppressive therapy given after transplantation. As a general rule, primary immunizations should be given as early as possible before transplantation because the immune response to vaccines is decreased in patients with end-stage organ disease. There are three categories of vaccines: Live vaccines—oral polio, vaccinia, bacillus Calmette-Guerin, live oral typhoïd, and intranasal influenza vaccines—are contraindicated in solid organ transplant recipients. The use of varicella vaccine remains controversial. The use of rubella vaccine is recommended in young women of childbearing age. Of the killed vaccines or genetically enginereed vaccines, the following are recommended: pneumococcal vaccine, influenza vaccine, hepatitis A vaccine, hepatitis B vaccine, diphtheria, and tetanus vaccine. Vaccination of household contacts and health care workers in transplant centers is recommended. However, live vaccine (with the exception of varicella vaccine) should be avoided in these contacts.

Feasibility of vaccination in preventing secondary cases of hepatitis A virus infection

Although the secondary transmission of hepatitis A virus (HAV) infection is preventable through vaccination, it is not known whether the vaccination of household contacts is feasible. To this end, we conducted a prospective cohort study among the household contacts, 40 years of age or less, of all persons infected with primary HAV infection (index cases) and admitted to eight hospitals in southern Italy within 7 days of onset. Household contacts were vaccinated, and serum samples were taken at vaccination and after 14 and 45 days. Secondary cases were defined as those with IgM seroconversion occurring at least two weeks after enrolment. Coprimary cases were those assumed to have had the same exposure as the index case. Susceptible cases were those who were negative for both IgG and IgM. A total of 495 household contacts participated (acceptance rate of 65%); 65% were vaccinated within 4 days of admission of the index case and 95% within 7 days. At enrolment, 196 (39.6%) household contacts were immune (IgG-positive serum). During follow-up, 19 (3.8%) were IgM-positive: 13 (2.6%) were coprimary cases and 6 (1.2%; 95% CI: 0.2–3.2) secondary cases (5 identified at 14 days from vaccination and 1 at 45 days). Of the 241 susceptible cases, 192 (79.7%) had developed IgG antibodies at 14 days and only 3 (1.2%) did not develop IgG antibodies at 45 days. The 65% acceptance rate and the finding that 95% of the participating household contacts were vaccinated within 7 days of the index case's hospitalization indicate that timely vaccination is indeed feasible. The necessity of returning for the collection of blood samples probably decreased the acceptance rate.

Primary varicella after transplantation

A 51-year-old white woman 6 months status post cadaveric renal transplant developed a mild case of primary varicella-zoster (VZ). It is hypothesized that the limited nature of her illness was due to infection with vaccine-type VZ virus instead of wild-type VZ. Approximately 1 month prior, she had daily household contact with a child who had developed a rash after immunization with live attenuated varicella vaccine. This case highlights several important questions. Should special precautions be undertaken with renal transplant recipients naive to varicella infection after vaccination of household contacts? Should pretransplant immunization with varicella vaccine be performed routinely in naive patients? Should naive patients transplanted and maintained on immunosuppressive therapy be vaccinated? Until there are clinical trials to answer these questions, it may be instructive to consider the recommendations for pediatric and immunocompromised patients. © 2002 by the National Kidney Foundation, Inc.