A Review of Vaccinations in Adult Patients with Secondary Immunodeficiency

Abstract

Vaccine-preventable diseases and their related complications are associated with increased morbidity and mortality in patients with altered immunocompetence. Optimised immunisation in this patient population is challenging because of limited data from vaccine trials, suboptimal vaccine efficacy and safety concerns. Reliable efficacy data are lacking among patients with altered immunocompetence, and existing recommendations are mainly based on expert consensus and may vary geographically. Inactivated vaccines can be generally used without risks in this group, but their efficacy may be reduced, and immunisation schedules vary according to local guidelines, age, and type and stage of the underlying disease. Live vaccines, if indicated, should be administered with care because of the risk of vaccine-associated disease. We have reviewed the current evidence on vaccination principles and recommendations in adult patients with secondary immunodeficiencies, including asplenia, HIV infection, stem cell and solid organ transplant, haematological malignancies, inflammatory bowel disease and other chronic disorders. Supplementary Information The online version contains supplementary material available at 10.1007/s40121-021-00404-y.

Absent antibody production following COVID19 vaccination with mRNA in patients under immunosuppressive treatments

“…Considering the extent of the SARS-CoV-2 pandemic, such observations on vaccine efficacy in healthy individuals were of utmost importance, but information on efficacy in vulnerable populations has been largely lacking [2] . We wondered whether treatments known to directly reduce B-cell numbers or impair T-lymphocyte function would inhibit vaccine-induced antibody production.…”

Pneumococcal Vaccination in Immunocompromised Hosts: An Update

“…However, as mentioned previously, the immune response generated is T cell independent, inducing an IgM-dominated antibody response without immunological memory. This results in waning of immunity after 2–4 years and in high-risk individuals between the age of 19 and 64 years, the CDC recommends a second dose of PPV23 5 years after the first dose of PPV23 [ 10 , 11 , 13 , 22 ]. Those 65 years and older who received PPV23 should receive a final dose of PPV23 at age 65 or older at least 5 years since the last vaccine [ 10 , 11 ].…”

“…The conjugation of the polysaccharide antigen to a carrier protein induces a T-cell-dependent immune response and is recommended in the UK for people with secondary immunodeficiency if the measured antibody response post-PPV23 is inadequate. This increased immunogenicity is the basis for sequential administration of PCV13 following the PPV23 [ 22 ]. The CDC recommends the PCV13 for individuals 19 years and older who are immunocompromised [ 11 ].…”

COVID-19 Vaccine in Veterans with Multiple Sclerosis: Protect the Vulnerable

“…A fundamental problem for pwMS treated with immunomodulatory or immunosuppressive medications is whether the vaccine will remain safe or be able to solicit an adequate immune response. 20,21 As of the time of publication 2021, there is consensus that mRNA based or inactivated vaccines are also considered safe in pwMS undergoing immunomodulatory or immunosuppressive treatments. [18][19][20] We advise a one-on-one conversation between each veteran with MS and their primary neurologist to understand the importance of the vaccination, the minimal risks associated with it and if any specific treatment modification should be made.…”

“…In addition, on the basis of available literature and the American Academy of Neurology recommendations on the use of vaccines in general, the following recommendations are proposed. [20][21][22][23] Recommendation 1: injections, orals, and natalizumab. Given the risks associated with discontinuation of disease modifying agents, pwMS opting to receive a COVID-19 vaccine should continue taking their medications unless recommended otherwise by their primary neurologist.…”