Update: Vaccines in primary immunodeficiency

Abstract

Vaccines were originally developed to prevent or ameliorate infectious disease. As knowledge of immune function and appreciation of immunodeficiency has developed, researchers have used vaccine responses as a tool to characterize the phenotypes of patients exhibiting various syndromes. Thus it has become possible for a clinician to evaluate individual responses to vaccines to interrogate the immunocompetence of their patients. Although there have been many advances in these areas, we still have much to learn about the quantity and quality of humoral and cellular vaccine responses in healthy and immunodeficient subjects and how that knowledge can then be extrapolated to diagnostic purposes. Adverse effects of vaccines have been recognized for many years, especially the occurrence of infections caused by viable vaccine organisms in immunodeficient hosts. Nevertheless, vaccines are essential for disease prevention in immunodeficient patients, just as they are for healthy subjects. Clinicians must understand the appropriate and safe use of vaccines in patients with immunodeficiency. This review highlights some recent advances and ongoing challenges in application of vaccines for the diagnosis and treatment of immunodeficiencies.

Measuring quantity and function of pneumococcal antibodies in immunoglobulin products

“…Pneumococcal antibody levels can be measured with a standardized ELISA (“WHO ELISA”) but this assay is cumbersome to perform for multiple serotypes. Numerous different multiplex bead array (Luminex) assays have been developed to improve the efficiency of pneumococcal antibody measurement; however, results are difficult to interpret because different assays can produce different results . More recently, OPA has been standardized and MOPA has made OPA a practical and useful assay in vaccine studies.…”

“…Numerous different multiplex bead array (Luminex) assays have been developed to improve the efficiency of pneumococcal antibody measurement; however, results are difficult to interpret because different assays can produce different results. 33,61,62 More recently, OPA has been standardized and MOPA has made OPA a practical and useful assay in vaccine studies. MOPA holds promise for the evaluation of immunoglobulin products.…”

Viral ecosystem: An epidemiological hypothesis

“…Hence, we should consider the potential of vaccination strategies in evolutionary process and changes of viral traits . Nevertheless, vaccines are crucial to prevent diseases in immunodeficient patients, such as transplantation recipients . We do not intend to ignore the benefits of vaccine in human health, but sometimes in accordance with this manipulation of the viral ecosystem, it is questioned that producing vaccine and using thereof should be performed with more precaution for lower virulence virus, and there might be no need for immunization against viruses that do not have serious consequences, since their presence is useful in the cycle of the viral ecosystem and might not be so necessary to disrupt this natural cycle of viral ecosystems.…”

Influenza immunization in patients with common variable immunodeficiency

“…Inactivated influenza virus vaccines are an exception to this rule and are indicated in patients whose cellular immunity is preserved, including all predominant antibody deficiency syndromes. [2][3][4] This indication for yearly influenza immunization is justified because human IgG preparations might not contain antibodies to the latest variants of the influenza virus. Furthermore, influenza vaccines can trigger cellular immunity, generating influenza-specific CD4 and CD8 T lymphocytes in patients unable to generate anti-influenza IgG antibodies.…”

“…Similarly, no recommendations can be made regarding immunization of CVID-like patients with different known molecular abnormalities. 8 Furthermore, no evidence for the superiority of 2 doses given 1 month apart instead of 1 dose, as presently recommended, 4 is presented in the study by Gardulf et al 5 The number of vaccine doses given on a yearly basis needs to be evaluated considering limited evidence that annual influenza vaccination might hamper the development of virus-specific CD8 T-cell responses. 9 Patients with CVID in whom a disease causing genetic abnormality was already identified were excluded from the study by Gardulf et al 5 This important variable that can influence the ability to develop specific antibody-mediated or cellular immunity against the influenza virus was not analyzed.…”