Vacinação contra febre amarela em pacientes com diagnósticos de doenças reumáticas, em uso de imunossupressores

Abstract

A febre amarela é uma doença viral, infecciosa não-contagiosa, endêmica em regiões da África e da América do Sul. É transmitida pela picada de insetos hematófagos da família Culicidae, em especial dos gêneros Aedes e Haemagogus 22 . Vacinação contra febre amarela em pacientes com diagnósticos de doenças reumáticas, em uso de imunossupressores ABSTRACTYellow fever is endemic in some countries. The anti-yellow fever vaccine is the only effective means of protection but is contraindicated for immunocompromised patients. The aim of this paper was to report on a case series of rheumatological patients who were using immunosuppressors and were vaccinated against this disease. This was a retrospective study by means of a questionnaire applied to these patients, who were vaccinated 60 days before the investigation. Seventy patients of mean age 46 years were evaluated. Most of them were female (90%). There were cases of rheumatoid arthritis (54), systemic lupus erythematosus (11), spondyloarthropathy (5) and systemic sclerosis (2). The therapeutic schemes included methotrexate (42), corticosteroids (22), sulfasalazine (26), leflunomide (18), cyclophosphamide (3) and immunobiological agents (9). Sixteen patients (22.5%) reported some minor adverse effect. Among the eight patients using immunobiological agents, only one presented a mild adverse effect. Among these patients using immunosuppressors, adverse reactions were no more frequent than among immunocompetent individuals. This is the first study on this topic. A suscetibilidade é geral e irrestrita, não havendo distinção de raça, idade ou gênero. As manifestações clínicas variam desde um quadro febril leve à infecção grave, acarretando falência renal e hepática, dano cardíaco, hemorragia e choque 23 . Estima-se que apenas 10% sejam formas graves, associadas à elevada letalidade, variando de 20-50% dos casos 1 22 . Não há tratamento específico para a doença. Key

Planned Yellow Fever Primary Vaccination Is Safe and Immunogenic in Patients With Autoimmune Diseases: A Prospective Non-interventional Study

“…Also, immunosuppressive drugs can increase the risk of AE ( 9 , 10 ). We did not observe any severe AE; however, we recorded frequent mild AE (34%), which was similar in the control group and to reports from a previous study ( 41 ). We did not explore the risks associated with medication, because all patients were under low level immunosuppression.…”

The Safety of Yellow Fever Vaccine 17D or 17DD in Children, Pregnant Women, HIV+ Individuals, and Older Persons: Systematic Review

“…We identified one study of patients taking immunosuppressants 45 that studied 70 consecutive patients in Brazil with rheumatological diseases who were taking immunosuppressant medications. Surveillance was partly active (questionnaires that enquired about the effect of YFV) but primarily passive in that patients with rheumatological symptoms were not being seen in any clinic; additionally, the rheumatological patients who did not consult between specific dates were excluded.…”

Occurrence of Autoimmune Diseases Related to the Vaccine against Yellow Fever

“…Our group identified 70 patients with rheumatic diseases who were inadvertently vaccinated against yellow fever [25]. In this study, only mild adverse effects were observed (mild skin rash, headache, myalgia, and transient elevation of liver enzymes) at a frequency similar to that reported in the population without a diagnosis of autoimmune diseases.…”