Pneumococcal polysaccharide vaccination in adults undergoing immunosuppressive treatment for inflammatory diseases – a longitudinal study

Abstract

IntroductionPatients undergoing immunosuppressive therapy are at increased risk of infection. Community-acquired pneumonia and invasive pneumococcal disease account for substantial morbidity and mortality in this population and may be prevented by vaccination. Ideally, immunization to pneumococcal antigens should take place before the start of immunosuppressive treatment. Often, however, the treatment cannot be delayed. Little is known about the efficacy of pneumococcal vaccines during immunosuppressive treatment. The objectives of this study were to determine the percentage of vaccine-naïve, immunosuppressed adults with inflammatory diseases seroprotected against Streptococcus pneumoniae and to assess factors associated with the immunogenicity, clinical impact and safety of 23-valent pneumococcal polysaccharide vaccine (PPV) in seronegative subjects.MethodsThis observational study included patients 18 years of age and older who were receiving prednisone ≥20 mg/day or other immunosuppressive drugs. Exclusion criteria were PPV administration in the previous 5 years, intravenous immunoglobulins and pregnancy. Serum immunoglobulin G (IgG) antibody levels against six pneumococcal serotypes were measured. Seropositivity was defined as IgG of 0.5 μg/ml or greater for at least four of six serotypes. Seronegative patients received PPV, and seropositive patients were included as a comparison group. Vaccine response and tolerance were assessed after 4–8 weeks. Disease activity was evaluated on the basis of the Physician Global Assessment scores. Serology was repeated after 1 year, and information on any kind of infection needing medical attention was collected. Outcomes were the proportion of seropositivity and infections between vaccinated and unvaccinated patients.ResultsOf 201 included patients, 35 received high-dose corticosteroids and 181 were given immunosuppressive drugs. Baseline seronegativity in 60 (30 %) patients was associated with corticotherapy and lower total IgG. After PPV, disease activity remained unchanged or decreased in 81 % of patients, and 87 % became seropositive. After 1 year, 67 % of vaccinated compared with 90 % of observed patients were seropositive (p < 0.001), whereas the rate of infections did not differ between groups. Those still taking prednisone ≥10 mg/day tended to have poorer serological responses and had significantly more infections.ConclusionsPPV was safe and moderately effective based on serological response. Seropositivity to pneumococcal antigens significantly reduced the risk of infections. Sustained high-dose corticosteroids were associated with poor vaccine response and more infections.

Efficacy, immunogenicity and safety of vaccination in adult patients with autoimmune inflammatory rheumatic diseases: a systematic literature review for the 2019 update of EULAR recommendations

“…In this cohort, a direct correlation was shown between the postvaccination levels of antipneumococcal antibodies and the risk of pneumococcal infections: more robust antibody responses after vaccination with PCV7 were associated with lower risk of serious pneumococcal infections 123. The humoral immunogenicity and safety of PPSV23 were demonstrated in RA,76 81 109 112 113 119 124 SLE,116 125 134 and, to a limited extent, in SpA and other rheumatic diseases 115. The long-term immunogenicity of PPSV23 was evaluated in two studies in patients with RA, treated with MTX121 and biologics 130.…”

“…From the previous recommendations and up to August 2018, 34 studies53 76 81 83 84 105–133 and two meta-analyses45 77 have been published on the efficacy, immunogenicity and safety of PPSV23 and the conjugated vaccines PCV7 and PCV13, including evaluation of a combined strategy (tables 7 and 8). 106 128 133…”

2019 update of EULAR recommendations for vaccination in adult patients with autoimmune inflammatory rheumatic diseases

“…On the other hand, a retrospective study on the long-term effect of PPSV23 in RA patients treated with MTX showed a relative risk of 9.7 to develop pneumonia in non-vaccinated patients 124. The humoral immunogenicity and safety of the PPSV23 has been demonstrated in RA,64 87 125–129 SLE,130–132 and to a limited extent in SpA and others 133. The long-term immunogenicity of PPSV23 has been evaluated in two studies, in RA patients treated with MTX124 and biologics, respectively 134.…”

Duration and tension of postvaccinal pneumococcal immunity in HIV-positive patients

“…Примечательно, что в отличие от имму нокомпрометированных лиц (длительно и часто болеющих детей) [9] Анализ значений СГТА у ВИЧ позитивных пациентов в зависимости от стадии инфекции выявил достоверные отличия в продолжитель ности поствакцинального иммунитета. У па циентов с 3 й и 4А стадиями ВИЧ инфекции до проведения иммунизации отсутствовали ста тистически достоверные различия в показате лях СГТА, содержание IgG антител к СП S. рneu moniaе составило 49,8 ± 2,3 и 45,8 ± 1,2 УЕ/мл соответственно (см.…”

“…Полученные ре зультаты подтверждают мнение зарубежных авторов о вакцинации ВИЧ позитивных па циентов от различных патогенных агентов, где указывается, что при прогрессировании инфекции концентрация поствакцинальных антител значительно снижается, т.е. исчезает поствакцинальный иммунитет [9,10]. Также имеются работы, в которых отмечается сни жение эффекта от иммунизации, если паци ент с ВИЧ инфекцией злоупотребляет алко голем или никотином [11].…”