Immunization of Adults

Gardner, Pierce; Schaffner, William

doi:10.1056/nejm199304293281708

Cited by 132 publications

(8 citation statements)

References 18 publications

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“…For ethical reasons, we did not have a control group who could be given a placebo injection. Additionally, we decided not to compare PCV13 with PPSV23, as several authors have reported a less than adequate response to vaccination with PPSV23 in patients with renal failure and immunocompromised patients (17,18). Finally, our study did not assess clinical pneumococcal disease.…”

Section: Discussionmentioning

confidence: 99%

Immunogenicity of 13-Valent Conjugate Pneumococcal Vaccine in Patients 50 Years and Older with End-Stage Renal Disease and on Dialysis

Mitra

Stein

Bhupalam

et al. 2016

Clin Vaccine Immunol

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Patients with end-stage renal disease (ESRD) and on dialysis are at increased risk of pneumococcal disease. We evaluated the immunogenicity of the 13-valent pneumococcal conjugate vaccine (PCV13) in this population. Eligible patients with ESRD and on dialysis were given a single dose of PCV13. The concentrations of serum antibodies against 13 pneumococcal capsular polysaccharides were measured at the baseline and at 2 and 12 months postvaccination. A response to the vaccine was defined as a >2-fold increase in antibody concentration from that at the baseline and an absolute postvaccination value of at least 1 g/ml. Seventeen patients completed the study. Increases in the concentrations of antibodies to the vaccine serotype were demonstrated 2 months after vaccination. The geometric mean antibody concentrations at 12 months postvaccination declined by 38% to 72% compared to those measured at 2 months postvaccination. A response to at least 1 serotype in the vaccine was seen in all patients at both 2 and 12 months postvaccination. The overall rate of the response to each individual vaccine serotype varied between 23.5% and 94.1% at 2 months postvaccination and 23.5% and 65% at 12 months postvaccination. Pain at the injection site was the most common local reaction. Vaccination with PCV13 induces antibody responses to vaccine serotypes in patients with ESRD and on dialysis at 2 months postvaccination. However, the decline in antibody concentrations at 12 months postvaccination with a conjugate pneumococcal vaccine requires further study. (This study has been registered at ClinicalTrials.gov under registration no. NCT01974817.) P atients with end-stage renal disease (ESRD) and on dialysis are predisposed to infections with Streptococcus pneumoniae (1). Mortality rates from pneumonia in dialysis patients are about 10 to 16 times higher than those in the general population (2, 3). Furthermore, the emergence of multiple-antibiotic-resistant pneumococcal strains has added to this therapeutic challenge. This has led to an increased focus on vaccination for the prevention of pneumococcal diseases in this subset of patients.End-stage renal disease is associated with disorders of the adaptive immune system, which result in decreases in antigenpresenting function, the T-cell-mediated immune response, and immunological memory (4, 5). These patients are thus at risk of vaccine hyporesponsiveness. There is evidence of a decreased immunologic response to the 23-valent pneumococcal polysaccharide vaccine (PPSV23) in patients undergoing dialysis compared to that in the general population (6, 7). Moreover, a rapid decline in anti-pneumococcal IgG levels is observed in patients with ESRD within 1 year after vaccination with PPSV23 (8).PPSV23 predominantly induces a T-cell-independent immune response, and hence, immunologic memory is not achieved (9, 10). Conjugate polysaccharide vaccines, which incorporate a protein carrier (diphtheria toxin cross-reactive material 197 [CRM 197 ]) to the purified capsular saccharides of S. pneumoni...

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Section: Discussionmentioning

confidence: 99%

Immunogenicity of 13-Valent Conjugate Pneumococcal Vaccine in Patients 50 Years and Older with End-Stage Renal Disease and on Dialysis

Mitra

Stein

Bhupalam

et al. 2016

Clin Vaccine Immunol

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“…3 The current 23-valent pneumococcal polysaccharide vaccine (23-PPV) covers 23 of the more than 90 pneumococcal serotypes that are responsible for 88% of bacteremia infections and has been recommended for the elderly population to prevent invasive pneumococcal disease (IPD) for years. 4,5 A recent systemic review strongly supported the efficacy of the 23-PPV vaccine in the prevention of IPD. 6 A program called the Healthy People 2010 was proposed by the United States Public Health Service with the aim of immunizing 90% of the elderly over the age of 65 y and 60% of younger high-risk individuals against pneumococcal diseases.…”

Section: Introductionmentioning

confidence: 99%

Factors associated with pneumococcal vaccination among an urban elderly population in China

Liu

et al. 2014

Human Vaccines & Immunotherapeutics

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Objectives: To investigate the coverage of the 23-valent pneumococcal polysaccharide vaccine (23-PPV) in the Chinese urban elderly population and to understand the attitudes, knowledge and beliefs of this population toward the 23-PPV vaccination. Methods: A cross-sectional approach was employed to survey the willingness of this population to receive the 23-PPV vaccination. Two thousand 9 hundred 2 six subjects over the age of 60 y were enrolled via a multistage random sampling method from the urban community population in Hangzhou, China. The relationships between the variables and the willingness to receive the 23-PPV vaccination were computed as odds ratios (ORs) by multivariate analysis. Results Of the participants, 21.77% were willing to undergo 23-PPV vaccination, and 61.65% of the subjects agreed that pneumonia is a serious disease among elderly people. The rate of reasonable perceptions about vaccination, including the perception about vaccine efficacy and safety, among the subjects was below 50%. Only 1.23% of subjects had been vaccinated with 23-PPV, and a similarly low rate was observed for the seasonal influenza vaccine (4.17%). The factors that were independently related to the willingness to receive the 23-PPV vaccine included consensus with the hazards of pneumonia (OR D 1.67, 95% CI: 1.28 -2.17), the safety of vaccination (OR D 2.00, 95% CI: 1.54 -2.59), advice about the 23-PPV vaccination from family members (OR D 2.37, 95% CI: 1.39 -4.40), influenza vaccination history (OR D 2.57, 95% CI: 1.66 -3.98) and pneumococcal vaccination history (OR D 7.48, 95% CI: 2.4-22.92). Conclusion: The administration of the 23-PPV vaccine among the urban elderly population is not optimistic in China. Emphasis on persuasion from families and the improvement of knowledge about vaccination might encourage elderly people to get the 23-PPV vaccination. Suggestions from physicians did not affect the participants' willingness to get the 23-PPV vaccination in multivariate analysis, but elderly people typically visited the Community Health Center (CHC) in their residential districts, and thus, systematic encouragement from healthcare physicians might be the key to increasing 23-PPV vaccination.

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“…The reason for this low response is unclear, and it has been speculated that adults’ immune response to this vaccine may be attenuated by aging [10]or that geographical or ethnic factors might have played a role in this varied response, as reported for children in another study [21]. Due to the benign nature of the disease, healthy adults are not routinely immunized by H. influenzae type b vaccine; hence, it is hard to evaluate the effect of age on the antibody response to the vaccine.…”

Section: Discussionmentioning

confidence: 99%

“…Due to the benign nature of the disease, healthy adults are not routinely immunized by H. influenzae type b vaccine; hence, it is hard to evaluate the effect of age on the antibody response to the vaccine. To our knowledge, there are no studies available considering the efficacy of this intervention in adults [10]. …”

Section: Discussionmentioning

confidence: 99%

“…Following influenza vaccination, some studies have suggested that these patients may have been effectively immunized [6, 7], while others have reported significantly reduced antibody responses as compared with those of healthy subjects [8, 9]. Regarding H. influenzae vaccination, the issue is even more controversial, because there are limited numbers of studies examining the efficacy of this vaccine in immunosuppressed patients [10]. Moreover, the antibody responses to H. influenzae type b vaccine in patients having different immunosuppressive regimens have not been determined yet.…”

Section: Introductionmentioning

confidence: 99%

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Immune Response to <i>Haemophilus influenzae</i> Type b Vaccination inRenal Transplant Recipients with Well-Functioning Allografts

Sever¹,

Yildiz²,

Eraksoy

et al. 1999

Nephron

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Background: Haemophilus influenzae infection is a mild and self-limited disease in the healthy population. However, it may show an aggressive course in the immunocompromised state which underlines the importance of vaccination against this agent. On the other hand, posttranplant immunosuppression may impair immune responses and thus the efficacy of the vaccination. Methods: Forty-three renal transplant recipients with well-functioning allografts were immunized with H. influenzae type b vaccine in order to investigate the immune response. The patients received a double or a triple immunosuppressive protocol. Seven healthy members of the dialysis unit served as controls. After obtaining basal serum samples, the patients and the control subjects were immunized with H. influenzae type b conjugate vaccine. After 6 and 12 weeks, serum samples obtained again to determine H. influenzae type b antibody titers. Results: The antibody titers 6 and 12 weeks after vaccination were significantly higher as compared with the basal values, similar to those of the control subjects. These titers did not show statistically significant differences between the double and triple immunosuppressive therapy groups. After 12 weeks of vaccination, the antibody titers did not show a statistically significant difference as compared with those obtained after 6 weeks. Conclusion: H. influenzae type b vaccination is safe and effective in patients with well-functioning renal allografts and should be recommended to renal transplant recipients who may have the risk of invasive disease on the basis of the immunosuppressive state.

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Immunization of Adults

Cited by 132 publications

References 18 publications

Immunogenicity of 13-Valent Conjugate Pneumococcal Vaccine in Patients 50 Years and Older with End-Stage Renal Disease and on Dialysis

Immunogenicity of 13-Valent Conjugate Pneumococcal Vaccine in Patients 50 Years and Older with End-Stage Renal Disease and on Dialysis

Factors associated with pneumococcal vaccination among an urban elderly population in China

Immune Response to <i>Haemophilus influenzae</i> Type b Vaccination inRenal Transplant Recipients with Well-Functioning Allografts

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