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

Fischer L, Gerstel PF, Poncet A, Siegrist CA, Laffitte E, Gabay C, Seebach JD, Ribi C - Arthritis Res. Ther. (2015)

Bottom Line: 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.After PPV, disease activity remained unchanged or decreased in 81% of patients, and 87% became seropositive.PPV was safe and moderately effective based on serological response.

View Article: PubMed Central - PubMed

Affiliation: Division of Clinical Immunology and Allergy, Department of Medical Specialties, University Hospital and Faculty of Medicine, Geneva, Switzerland. lara.fischer@chuv.ch.

ABSTRACT

Introduction: Patients 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.

Methods: This 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.

Results: Of 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.

Conclusions: PPV 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.

No MeSH data available.


Related in: MedlinePlus

Evolution of serology to vaccine serotypes 14, 19 and 23F in 49 patients immunized with the 23-valent polysaccharide pneumococcal vaccine compared with 135 patients observed after 4–8 weeks and after 1 year. Reverse cumulative distribution curves of specific serum immunoglobulin G (IgG) against serotypes 14, 19 and 23F in patients immunized 4–8 weeks after vaccine (thin blue lines) and after 1 year (bold blue lines) compared with patients observed after 1 year (dotted red lines). Reverse cumulative distribution function takes into account censored values obtained by real-time enzyme-linked immunosorbent assay [28]. Median (95 % confidence interval) specific IgG titers to pneumococcal serotype 14 decreased from 2.5 (1.2–4.1) μg/ml 4–8 weeks after immunization to 1.1 (0.8–3.0) μg/ml after 1 year (p = 0.001 by from paired Prentice–Wilcoxon test for censored paired data), to serotype 19 from 2.3 (1.7–3.3) to 1.5 (1.2–2.1) μg/ml (p = 0.009) and to serotype 23F from 0.7 (0.5–1.1) to 0.5 (0.4–0.7) μg/ml (p = 0.005). In patients observed, median (95 % confidence interval) IgG values after 1 year were 2.5 (2.1–3.4) μg/ml to serotype 14, 3.1 (2.5–4.2) μg/ml to serotype 19 and 0.8 (0.6–1.0) to serotype 23F
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Fig3: Evolution of serology to vaccine serotypes 14, 19 and 23F in 49 patients immunized with the 23-valent polysaccharide pneumococcal vaccine compared with 135 patients observed after 4–8 weeks and after 1 year. Reverse cumulative distribution curves of specific serum immunoglobulin G (IgG) against serotypes 14, 19 and 23F in patients immunized 4–8 weeks after vaccine (thin blue lines) and after 1 year (bold blue lines) compared with patients observed after 1 year (dotted red lines). Reverse cumulative distribution function takes into account censored values obtained by real-time enzyme-linked immunosorbent assay [28]. Median (95 % confidence interval) specific IgG titers to pneumococcal serotype 14 decreased from 2.5 (1.2–4.1) μg/ml 4–8 weeks after immunization to 1.1 (0.8–3.0) μg/ml after 1 year (p = 0.001 by from paired Prentice–Wilcoxon test for censored paired data), to serotype 19 from 2.3 (1.7–3.3) to 1.5 (1.2–2.1) μg/ml (p = 0.009) and to serotype 23F from 0.7 (0.5–1.1) to 0.5 (0.4–0.7) μg/ml (p = 0.005). In patients observed, median (95 % confidence interval) IgG values after 1 year were 2.5 (2.1–3.4) μg/ml to serotype 14, 3.1 (2.5–4.2) μg/ml to serotype 19 and 0.8 (0.6–1.0) to serotype 23F

Mentions: Disease activity according to PGA score decreased from 1.12±0.77 at baseline to 0.93±0.76 (p = 0.004) in the observation group and from 1.2±0.56 to 0.91±0.88 (p = 0.025) in the vaccination group. Follow-up serology was performed within a median (IQR) of 383 (364–421) days in patients observed and 369 (342–392) days in patients vaccinated. Within the observation group, 13 (10 %) of 135 had become seronegative to S. pneumoniae compared with 16 (33 %) of 49 immunized patients (p < 0.001). Of the 42 patients seropositive after PPV, 9 (21 %) had become seronegative. The decline in antibody titers to serotypes 14, 19 and 23F after 1 year in vaccinated patients compared with those observed is shown in Fig. 3. Of the 16 seronegative patients 1 year after PPV, 12 (75 %) were still taking corticosteroids. Four of them had prednisone doses ≥10 mg/day both at inclusion and at the end of follow-up. In comparison, 16 (53 %) of the seropositive patients were treated with corticosteroids, with 2 having prednisone doses ≥10 mg/day at both study start and end (p = 0.086). There was no difference regarding the type of immunosuppressant used.Fig. 3


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

Fischer L, Gerstel PF, Poncet A, Siegrist CA, Laffitte E, Gabay C, Seebach JD, Ribi C - Arthritis Res. Ther. (2015)

Evolution of serology to vaccine serotypes 14, 19 and 23F in 49 patients immunized with the 23-valent polysaccharide pneumococcal vaccine compared with 135 patients observed after 4–8 weeks and after 1 year. Reverse cumulative distribution curves of specific serum immunoglobulin G (IgG) against serotypes 14, 19 and 23F in patients immunized 4–8 weeks after vaccine (thin blue lines) and after 1 year (bold blue lines) compared with patients observed after 1 year (dotted red lines). Reverse cumulative distribution function takes into account censored values obtained by real-time enzyme-linked immunosorbent assay [28]. Median (95 % confidence interval) specific IgG titers to pneumococcal serotype 14 decreased from 2.5 (1.2–4.1) μg/ml 4–8 weeks after immunization to 1.1 (0.8–3.0) μg/ml after 1 year (p = 0.001 by from paired Prentice–Wilcoxon test for censored paired data), to serotype 19 from 2.3 (1.7–3.3) to 1.5 (1.2–2.1) μg/ml (p = 0.009) and to serotype 23F from 0.7 (0.5–1.1) to 0.5 (0.4–0.7) μg/ml (p = 0.005). In patients observed, median (95 % confidence interval) IgG values after 1 year were 2.5 (2.1–3.4) μg/ml to serotype 14, 3.1 (2.5–4.2) μg/ml to serotype 19 and 0.8 (0.6–1.0) to serotype 23F
© Copyright Policy - open-access
Related In: Results  -  Collection

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Show All Figures
getmorefigures.php?uid=PMC4481118&req=5

Fig3: Evolution of serology to vaccine serotypes 14, 19 and 23F in 49 patients immunized with the 23-valent polysaccharide pneumococcal vaccine compared with 135 patients observed after 4–8 weeks and after 1 year. Reverse cumulative distribution curves of specific serum immunoglobulin G (IgG) against serotypes 14, 19 and 23F in patients immunized 4–8 weeks after vaccine (thin blue lines) and after 1 year (bold blue lines) compared with patients observed after 1 year (dotted red lines). Reverse cumulative distribution function takes into account censored values obtained by real-time enzyme-linked immunosorbent assay [28]. Median (95 % confidence interval) specific IgG titers to pneumococcal serotype 14 decreased from 2.5 (1.2–4.1) μg/ml 4–8 weeks after immunization to 1.1 (0.8–3.0) μg/ml after 1 year (p = 0.001 by from paired Prentice–Wilcoxon test for censored paired data), to serotype 19 from 2.3 (1.7–3.3) to 1.5 (1.2–2.1) μg/ml (p = 0.009) and to serotype 23F from 0.7 (0.5–1.1) to 0.5 (0.4–0.7) μg/ml (p = 0.005). In patients observed, median (95 % confidence interval) IgG values after 1 year were 2.5 (2.1–3.4) μg/ml to serotype 14, 3.1 (2.5–4.2) μg/ml to serotype 19 and 0.8 (0.6–1.0) to serotype 23F
Mentions: Disease activity according to PGA score decreased from 1.12±0.77 at baseline to 0.93±0.76 (p = 0.004) in the observation group and from 1.2±0.56 to 0.91±0.88 (p = 0.025) in the vaccination group. Follow-up serology was performed within a median (IQR) of 383 (364–421) days in patients observed and 369 (342–392) days in patients vaccinated. Within the observation group, 13 (10 %) of 135 had become seronegative to S. pneumoniae compared with 16 (33 %) of 49 immunized patients (p < 0.001). Of the 42 patients seropositive after PPV, 9 (21 %) had become seronegative. The decline in antibody titers to serotypes 14, 19 and 23F after 1 year in vaccinated patients compared with those observed is shown in Fig. 3. Of the 16 seronegative patients 1 year after PPV, 12 (75 %) were still taking corticosteroids. Four of them had prednisone doses ≥10 mg/day both at inclusion and at the end of follow-up. In comparison, 16 (53 %) of the seropositive patients were treated with corticosteroids, with 2 having prednisone doses ≥10 mg/day at both study start and end (p = 0.086). There was no difference regarding the type of immunosuppressant used.Fig. 3

Bottom Line: 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.After PPV, disease activity remained unchanged or decreased in 81% of patients, and 87% became seropositive.PPV was safe and moderately effective based on serological response.

View Article: PubMed Central - PubMed

Affiliation: Division of Clinical Immunology and Allergy, Department of Medical Specialties, University Hospital and Faculty of Medicine, Geneva, Switzerland. lara.fischer@chuv.ch.

ABSTRACT

Introduction: Patients 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.

Methods: This 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.

Results: Of 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.

Conclusions: PPV 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.

No MeSH data available.


Related in: MedlinePlus