Critical Appraisal of Immunization Strategies for Prevention of Infection in the Compromised Host

Ambrosino, Donna M.; Molrine, Deborah C.

doi:10.1016/s0889-8588(18)30216-8

Cited by 40 publications

(21 citation statements)

References 87 publications

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“…Patients with immunoglobulin G levels of Ͻ400 mg/dl had poorer survival and were at high risk of tissueinvasive cytomegalovirus infection (42). Waning natural immunity and impaired de novo antibody response may cause impaired seroprotection after solid-organ transplantation the same way that has been described in bone marrow recipients during the late posttransplantation period (5).…”

Section: General Principlesmentioning

confidence: 95%

“…It is usually accepted that, in solid-organ recipients receiving immunosuppression, the immune system will not be able to mount a response as effective as in normal subjects (5). Most immunosuppressive regimens after solid-organ transplant include a combination of steroids and calcineurin inhibitors, such as cyclosporin and tacrolimus (FK506).…”

Section: General Principlesmentioning

confidence: 99%

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Vaccinations for Adult Solid-Organ Transplant Recipients: Current Recommendations and Protocols

Duchini¹,

Goss²,

et al. 2003

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Recipients of solid-organ transplantation are at risk of severe infections due to their life-long immunosuppression. Despite emerging evidence that vaccinations are safe and effective among immunosuppressed patients, most vaccines are still underutilized in these patients. The efficacy, safety, and protocols of several vaccines in this patient population are poorly understood. Timing of vaccination appears to be critical because response to vaccinations is decreased in patients with end-stage organ disease and in the first 6 months after transplantation. For these reasons, the primary immunizations should be given before transplantation, as early as possible during the course of disease. Vaccination strategy should include vaccination of household contacts and health care workers at transplant centers unless contraindicated. No conclusive data are available on the use of immunoadjuvants and screening for protective titers. Most vaccines appear to be safe in solid-organ transplantation recipients, but live vaccines should be avoided until further studies are available. The risk of rejection appears minimal. Recommended vaccines include pneumovax, hepatitis A and B, influenza, and tetanus-diphtheria. We outline specific protocols and recommendations in this particular patient population. Specific contraindications exist for other vaccines, such as yellow fever, oral polio vaccine, bacillus Calmette-Guerin, and vaccinia. We conclude that solid-organ recipients will benefit from consistent immunization practices. Further studies are recommended to improve established protocols in this patient population

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Section: General Principlesmentioning

confidence: 95%

Section: General Principlesmentioning

confidence: 99%

Vaccinations for Adult Solid-Organ Transplant Recipients: Current Recommendations and Protocols

Duchini¹,

Goss²,

et al. 2003

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show abstract

“…The effectiveness of a vaccine, however, depends on the competency of the individual immune system to adequately respond to that vaccine (1,2). For example, patients vaccinated within 2 wk before starting immunosuppressive therapy or while receiving immunosuppressive therapy are considered unvaccinated and are, therefore, advised to be revaccinated at least 3 mo after therapy is discontinued if immune competence has been restored (1). The deterioration in both innate and adaptive immunity associated with aging also leads to reduced responses to vaccines and increases morbidity and mortality from infection (2).…”

mentioning

confidence: 99%

Exposure to Nicotine Adversely Affects the Dendritic Cell System and Compromises Host Response to Vaccination

Nouri-Shirazi

Guinet

2012

The Journal of Immunology

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The magnitude of Th1 cells response to vaccination is a critical factor in determining protection from clinical disease. Our previous in vitro studies suggested that exposure to the nicotine component of cigarette smoke skews the differentiation of both human and mouse dendritic cell (DC) precursors into atypical DCs (DCs differentiated ex vivo in the presence of nicotine) lacking parameters essential for the development of Th1-mediated immunity. In this study, we determined the causal relationship between nicotine-induced DC alterations and host response to vaccines. We show that animals exposed to nicotine failed to develop and maintain Ag-specific effector memory Th1 cells and Ab production to protein-based vaccine formulated with Th1 adjuvants. Accordingly, both prophylactic and therapeutic vaccines failed to protect and cure the nicotine-exposed mice from disease. More importantly, we demonstrate the nicotine-induced defects in the biological activities of in vivo DCs as an underlying mechanism. Indeed, i.v. administration of DCs differentiated in the presence of nicotine preferentially promoted the development of Ag-specific IL-4–producing effector cells in the challenged mice. In addition, DC subsets isolated from mice exposed to nicotine produced significantly less cytokines in response to Th1 adjuvants and inadequately supported the development of Ag-specific Th1 cells. Collectively, our studies suggest that nicotine-induced defects in the DC system compromises vaccine efficacy in smokers.

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“…A fter solid-organ transplantation, the recipients are usually unable to mount an adequate immune response as effectively as the normal subjects because of the immunosuppressive agents (1). Under these regimens of steroids and calcineurin inhibitors, both T-and B-cell responses are impaired.…”

mentioning

confidence: 99%

Response to Booster Hepatitis B Vaccines in Liver-Transplanted Children Primarily Vaccinated in Infancy

Ho²,

Wu³

et al. 2008

Transplantation

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Critical Appraisal of Immunization Strategies for Prevention of Infection in the Compromised Host

Cited by 40 publications

References 87 publications

Vaccinations for Adult Solid-Organ Transplant Recipients: Current Recommendations and Protocols

Vaccinations for Adult Solid-Organ Transplant Recipients: Current Recommendations and Protocols

Exposure to Nicotine Adversely Affects the Dendritic Cell System and Compromises Host Response to Vaccination

Response to Booster Hepatitis B Vaccines in Liver-Transplanted Children Primarily Vaccinated in Infancy

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