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Ez-Zaoui S, Rkain H, Kronbi F, Benzine N, Farih S, Tahiri L, Abouqal R, Hassouni K, Hajjaj-Hassouni N, Allali F. Assessing the Vaccination Status and Barriers to Influenza, Pneumococcal, and COVID-19 Vaccination Among Moroccan Patients With Chronic Inflammatory Rheumatic Disease. Cureus 2024; 16:e61676. [PMID: 38835556 PMCID: PMC11149921 DOI: 10.7759/cureus.61676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2024] [Indexed: 06/06/2024] Open
Abstract
OBJECTIVE To evaluate the vaccination coverage of patients with chronic inflammatory rheumatic disease (CIRD) against influenza, pneumococcus, and COVID-19 and to determine, per the patients' point of view, the possible factors related to vaccination hesitation and/or refusal. METHODS A cross-sectional study carried out by the vaccination working group of the Moroccan Society of Rheumatology, including patients with CIRD in Morocco. Information about vaccination coverage and reasons for non-vaccination against influenza, pneumococcal infection, and COVID-19 was collected. RESULTS This survey included 230 patients (mean age of 46.9 +/-13.89 years; 68.7% females) affected by CIRD (rheumatoid arthritis 53%, spondyloarthritis 39.6%, psoriatic arthritis 7%). The study shows a significant lack of influenza and pneumococcal vaccination in CIRD patients, with vaccination coverage against influenza, pneumococcal infection, and COVID-19 at 2.2%, 0.4%, and 80.9%, respectively. The main reason for non-vaccination against influenza and pneumococcus was related to the absence of recommendations by their doctors (77%, 87%, p = 0.04). Additionally, the primary reason for non-vaccination against COVID-19 was the fear of the vaccine's side effects (51%, p = 0.0001), mainly a flare-up of CIRD (44%, p = 0.001). CONCLUSION This survey shows a lack of influenza, pneumococcal, and COVID-19 vaccination in CIRD patients. The principal actions to improve vaccination should aim to educate patients and encourage rheumatologists to vaccinate their patients.
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Affiliation(s)
- Samya Ez-Zaoui
- Rheumatology, Ayachi Hospital, Ibn Sina Hospital Center, Rabat, MAR
- Rheumatology, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, MAR
| | - Hanan Rkain
- Rheumatology, Ayachi Hospital, Ibn Sina Hospital Center, Rabat, MAR
- Exercise Physiology and Autonomous Nervous System, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, MAR
| | - Fatine Kronbi
- Rheumatology, Ayachi Hospital, Ibn Sina Hospital Center, Rabat, MAR
- Rheumatology, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, MAR
| | - Nada Benzine
- Rheumatology, Ayachi Hospital, Ibn Sina Hospital Center, Rabat, MAR
- Rheumatology, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, MAR
| | - Sara Farih
- Rheumatology, Ayachi Hospital, Ibn Sina Hospital Center, Rabat, MAR
- Rheumatology, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, MAR
| | - Latifa Tahiri
- Rheumatology, Ayachi Hospital, Ibn Sina Hospital Center, Rabat, MAR
- Rheumatology, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, MAR
| | - Redouane Abouqal
- Biostatistics, Clinical and Epidemiological Research, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, MAR
| | - Kenza Hassouni
- Social Sciences, International School of Public Health, Mohammed VI University of Health Sciences, Casablanca, MAR
| | - Najia Hajjaj-Hassouni
- Rheumatology, Faculty of Medicine, Research Center of Health Sciences, International University of Rabat, Rabat, MAR
| | - Fadoua Allali
- Rheumatology, Ayachi Hospital, Ibn Sina Hospital Center, Rabat, MAR
- Rheumatology, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, MAR
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Miyake H, Sada RM, Tsugihashi Y, Hatta K. Single-centre, cross-sectional study on the factors and reasons for non-vaccination among patients with rheumatoid arthritis. Mod Rheumatol 2023; 34:79-86. [PMID: 36702156 DOI: 10.1093/mr/road003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 12/21/2022] [Accepted: 12/28/2022] [Indexed: 01/28/2023]
Abstract
OBJECTIVES We aimed to investigate the vaccination coverage and the factors associated with non-vaccination for vaccine-preventable diseases among patients with rheumatoid arthritis. METHODS This single-centre, cross-sectional study was conducted in a 715-bed regional tertiary-care teaching hospital in Japan from 1 September to 30 November 2020. Vaccination status and the factors and reasons for not receiving the influenza vaccine, 23-valent pneumococcal polysaccharide vaccine (PPSV23), 13-valent pneumococcal conjugate vaccine (PCV13), and varicella vaccine live (VVL) were investigated. RESULTS Among 991 patients, the vaccination coverage for the influenza vaccine, PPSV23, PCV13, and VVL was 62%, 46%, 14%, and 3%, respectively. The most common reasons for vaccine hesitancy were efficacy concerns for the influenza vaccine, safety concerns for the PPSV23 and PCV13, and both efficacy and safety concerns for the VVL. Younger age, no use of biologics or other hospital visits, and public assistance were factors significantly associated with non-vaccination for the influenza vaccine; younger age, short disease duration, and no visits to other hospitals for PPSV23; younger age, no hospitalisation, more experienced doctor, and no medical immunodeficiency for PCV13. CONCLUSIONS We found that the factors associated with non-vaccination varied by vaccine type; therefore, vaccinations should be promoted with individualised strategies.
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Affiliation(s)
- Hirofumi Miyake
- Department of General Internal Medicine, Tenri Hospital, Nara, Japan
| | - Ryuichi Minoda Sada
- Department of General Internal Medicine, Tenri Hospital, Nara, Japan
- Department of Infection Control, Graduate School of Medicine, Osaka University, Osaka, Japan
- Department of Transformative Protection to Infectious Disease, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Yukio Tsugihashi
- Medical Home Care Centre, Tenri Hospital Shirakawa Branch, Nara, Japan
| | - Kazuhiro Hatta
- Department of General Internal Medicine, Tenri Hospital, Nara, Japan
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Wroński J, Palej K, Stańczyk S, Łosoś M, Werońska-Tatara J, Stasiek M, Wysmołek M, Olech A, Felis-Giemza A. Do Not Leave Your Patients in the Dark-Using American College of Rheumatology and European Alliance of Associations for Rheumatology Recommendations for Vaccination in Polish Adult Patients with Autoimmune Inflammatory Rheumatic Diseases. Vaccines (Basel) 2023; 11:1854. [PMID: 38140256 PMCID: PMC10748174 DOI: 10.3390/vaccines11121854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 12/12/2023] [Accepted: 12/12/2023] [Indexed: 12/24/2023] Open
Abstract
(1) Introduction: Patients with autoimmune inflammatory rheumatic diseases (AIIRD) face a higher infectious risk compared to the general population. As per the ACR and EULAR recommendations, vaccinations against influenza, COVID-19, pneumococci, and tetanus are recommended for most patients with AIIRD. (2) Objectives: This study aimed to assess vaccination coverage among Polish AIIRD patients and identify factors influencing it. (3) Patients and Methods: This study was conducted at the reference rheumatological center in Poland between May 2023 and October 2023. The study participants completed a questionnaire covering their knowledge of vaccination recommendations, actual vaccination status, factors affecting their decision to vaccinate, and their perspectives on immunization. (4) Results: This study involved 300 AIIRD patients and 60 controls. Both groups exhibited comparably low vaccination rates for all diseases (the highest for COVID-19-52% in both groups and the lowest for pneumococci-7.7% and 10%, respectively). Knowledge about recommended vaccinations was limited among patients in both groups. AIIRD patients were also not aware that they should avoid live vaccines. The primary motivators for vaccination among AIIRD patients were fear of infection (up to 75%) and medical advice (up to 74.6%). Conversely, the predominant reasons for non-vaccination were a lack of knowledge that vaccination is recommended (up to 74.7%) and concerns about potential adverse effects (up to 48.6%). Many patients reported not receiving vaccination recommendations from either primary care physicians or rheumatologists. (5) Conclusions: To enhance vaccination coverage among AIIRD patients in Poland, it is essential to educate them about vaccinations during routine medical consultations, emphasizing the increased risk of infection, informing them about recommended vaccinations, and clarifying doubts about adverse effects.
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Affiliation(s)
- Jakub Wroński
- Department of Rheumatology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Spartańska 1, 02-637 Warsaw, Poland;
| | - Karolina Palej
- Biologic Therapy Center, National Institute of Geriatrics, Rheumatology and Rehabilitation, 02-637 Warsaw, Poland; (K.P.); (S.S.); (M.Ł.); (J.W.-T.); (M.S.); (M.W.); (A.F.-G.)
| | - Sandra Stańczyk
- Biologic Therapy Center, National Institute of Geriatrics, Rheumatology and Rehabilitation, 02-637 Warsaw, Poland; (K.P.); (S.S.); (M.Ł.); (J.W.-T.); (M.S.); (M.W.); (A.F.-G.)
| | - Marta Łosoś
- Biologic Therapy Center, National Institute of Geriatrics, Rheumatology and Rehabilitation, 02-637 Warsaw, Poland; (K.P.); (S.S.); (M.Ł.); (J.W.-T.); (M.S.); (M.W.); (A.F.-G.)
| | - Joanna Werońska-Tatara
- Biologic Therapy Center, National Institute of Geriatrics, Rheumatology and Rehabilitation, 02-637 Warsaw, Poland; (K.P.); (S.S.); (M.Ł.); (J.W.-T.); (M.S.); (M.W.); (A.F.-G.)
| | - Małgorzata Stasiek
- Biologic Therapy Center, National Institute of Geriatrics, Rheumatology and Rehabilitation, 02-637 Warsaw, Poland; (K.P.); (S.S.); (M.Ł.); (J.W.-T.); (M.S.); (M.W.); (A.F.-G.)
| | - Marta Wysmołek
- Biologic Therapy Center, National Institute of Geriatrics, Rheumatology and Rehabilitation, 02-637 Warsaw, Poland; (K.P.); (S.S.); (M.Ł.); (J.W.-T.); (M.S.); (M.W.); (A.F.-G.)
| | - Agnieszka Olech
- Department of Rheumatology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Spartańska 1, 02-637 Warsaw, Poland;
| | - Anna Felis-Giemza
- Biologic Therapy Center, National Institute of Geriatrics, Rheumatology and Rehabilitation, 02-637 Warsaw, Poland; (K.P.); (S.S.); (M.Ł.); (J.W.-T.); (M.S.); (M.W.); (A.F.-G.)
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4
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Miyake H, Minoda Sada R, Manabe A, Tsugihashi Y, Hatta K. Factors and Reasons for Non-vaccination among Patients with Systemic Lupus Erythematosus: A Single-centre, Cross-sectional Study. Intern Med 2023; 62:2483-2491. [PMID: 36575017 PMCID: PMC10518547 DOI: 10.2169/internalmedicine.1067-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 11/20/2022] [Indexed: 12/28/2022] Open
Abstract
Objective This study aimed to clarify the vaccination coverage of vaccine-preventable diseases and the factors and reasons for non-vaccination among patients with systemic lupus erythematosus (SLE). Methods This single-centre, cross-sectional study was conducted from 1 September to 30 November 2020 in a 715-bed regional tertiary-care teaching hospital in Japan. A questionnaire survey was undertaken to investigate the vaccination status of patients with SLE, and the factors and reasons for not receiving the influenza vaccine, 23-valent-pneumococcal-polysaccharide vaccine (PPSV23), 13-valent pneumococcal conjugate vaccine (PCV13), varicella vaccine live (VVL), and recombinant zoster vaccine (RZV). Results The vaccination coverage for the influenza vaccine, PPSV23, PCV13, VVL, and RZV was 61%, 22%, 19%, 3.4%, and 0%, respectively, among 261 patients. The most common reason for vaccine hesitancy was 'efficacy concerns about vaccines' for the influenza vaccine and 'cost' for PPSV23 and PCV13. The factors significantly associated with non-vaccination were prescription of high-dose glucocorticoids and no history of visits to other internal medicine clinics for the influenza vaccine; a younger age and prescription of high-dose glucocorticoids for PPSV23; and a younger age, no medication with hydroxychloroquine, no history of hospitalisation in internal medicine, and extensive clinical experience of the doctor for PCV13. Conclusion These findings, which demonstrated that the factors and reasons for non-vaccination varied by vaccine type, suggest that individualised strategies should be used to promote vaccination in this population.
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Affiliation(s)
- Hirofumi Miyake
- Department of General Internal Medicine, Tenri Hospital, Japan
| | - Ryuichi Minoda Sada
- Department of General Internal Medicine, Tenri Hospital, Japan
- Department of Infection Control, Graduate School of Medicine, Osaka University, Japan
- Department of Transformative Protection to Infectious Disease, Graduate School of Medicine, Osaka University, Japan
| | - Atsushi Manabe
- Department of General Internal Medicine, Tenri Hospital, Japan
- Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University, Japan
| | - Yukio Tsugihashi
- Medical Home Care Centre, Tenri Hospital Shirakawa Branch, Japan
| | - Kazuhiro Hatta
- Department of General Internal Medicine, Tenri Hospital, Japan
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Varjú C, Pauling JD, Saketkoo LA. Multi-Organ System Screening, Care, and Patient Support in Systemic Sclerosis. Rheum Dis Clin North Am 2023; 49:211-248. [PMID: 37028832 DOI: 10.1016/j.rdc.2023.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2023]
Abstract
Systemic sclerosis (SSc) is a heterogenous systemic autoimmune disease of complex multi-organ manifestations with a disease-specific mortality of >50%. The patient journey is fraught with severe, diverse, and diffuse physical impairment, psychological burden, and diminishing health-related quality of life. SSc remains unfamiliar to many clinicians. Delayed/misdiagnosis, inadequate screening, and attention for common complications with potentially preventable disability/death contribute to patients feeling isolated and unsupported. We present actionable standards including screening, anticipatory guidance, and counseling in patient-centered SSc-care emphasizing psycho-social health as the central goal, whereas robust vigilance and efforts to improve biophysical health and survival are imperatives that support this goal.
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Affiliation(s)
- Cecília Varjú
- Department of Rheumatology and Immunology, Medical School, University of Pécs, Pécs, Hungary
| | - John D Pauling
- Department of Rheumatology, North Bristol NHS Trust, Bristol, UK; Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Lesley Ann Saketkoo
- New Orleans Scleroderma and Sarcoidosis Patient Care and Research Center, New Orleans, LA 70112, USA; University Medical Center - Comprehensive Pulmonary Hypertension Center and Interstitial Lung Disease Clinic Programs, New Orleans, LA, USA; Section of Pulmonary Medicine, Louisiana State University School of Medicine, New Orleans, LA, USA; Tulane University School of Medicine, New Orleans, LA, USA.
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6
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Chevallard M, Adinolfi A, Belloli L, Casu C, Di Cicco M, Destefani C, Di Rosa B, Gentile MG, Filippini DA, Luisi A, Muscarà M, Schito E, Ughi N, Verduci E, Vincenti EM, Zoppini L, Epis OM. Active vaccination campaign to increase seasonal influenza vaccination coverage: a monocenter experience in a cohort of Italian patients with systemic autoimmune diseases. Clin Rheumatol 2023; 42:923-928. [PMID: 36205812 PMCID: PMC9540136 DOI: 10.1007/s10067-022-06380-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 09/13/2022] [Accepted: 09/14/2022] [Indexed: 11/03/2022]
Abstract
Seasonal influenza is a frequent cause of hospitalization and mortality among patients with systemic autoimmune diseases. Despite this evidence, vaccination coverage is generally much lower than the minimum 75% target proposed by the WHO. Therefore, an active campaign was implemented in the years 2019/2020 and 2020/2021 within the Rheumatology Department of the Niguarda Hospital (Milan, Italy) to improve the vaccination coverage in patients with inflammatory arthritis. This study aims to evaluate the vaccination coverage in the 2019/2020 and 2020/2021 (active campaigns) seasons and to compare these results with the 2018/2019 season. A monocenter observational study was conducted among adult patients with rheumatoid arthritis, spondylarthritis, or psoriatic arthropathy, who were referred to the Rheumatology Department of the Niguarda Hospital. Patients were given a questionnaire to investigate previous years' vaccination coverage and to propose an influenza vaccine for the 2020/2021 season. Compared with 2018/2019, a trend for increase in vaccination coverage was reported in 2019/2020 season (+ 10.7%, p = 0.055; 45.5% of coverage) and a statistically significant increase was reported in 2020/2021 (+ 31.2%, p < 0.001; 65.9% of coverage). The increase was also significant when comparing the 2020/2021 and 2019/2020 seasons (+ 20.5%, p < 0.001). The greatest increase in vaccination coverage was observed among under-65-year-old patients. Obtained results support the implementation of active vaccination campaigns to increase vaccination coverage among patients with systemic autoimmune diseases and highlight the importance of external factors (such as the COVID-19 pandemic) in directing the patient to adopt preventive measures to avoid infections and related complications.
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Affiliation(s)
- Michel Chevallard
- Internal Medicine Unit, Department of Medicine, Ospedale Salvini Garbagnate Milanese, ASST Rhodense, Milan, Italy.
| | - Antonella Adinolfi
- Division of Rheumatology, Multispecialist Medical Department, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Laura Belloli
- Division of Rheumatology, Multispecialist Medical Department, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Cinzia Casu
- Division of Rheumatology, Multispecialist Medical Department, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Maria Di Cicco
- Division of Rheumatology, Multispecialist Medical Department, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Chiara Destefani
- Division of Rheumatology, Multispecialist Medical Department, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Bartolomeo Di Rosa
- Division of Rheumatology, Multispecialist Medical Department, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Maria Giovanna Gentile
- Division of Rheumatology, Multispecialist Medical Department, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Davide Antonio Filippini
- Division of Rheumatology, Multispecialist Medical Department, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Angela Luisi
- Division of Rheumatology, Multispecialist Medical Department, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Marina Muscarà
- Division of Rheumatology, Multispecialist Medical Department, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Emanuela Schito
- Internal Medicine Unit, Department of Medicine, Ospedale Salvini Garbagnate Milanese, ASST Rhodense, Milan, Italy
| | - Nicola Ughi
- Division of Rheumatology, Multispecialist Medical Department, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Elisa Verduci
- Division of Rheumatology, Multispecialist Medical Department, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Emanuela Marta Vincenti
- Division of Rheumatology, Multispecialist Medical Department, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Laura Zoppini
- Division of Rheumatology, Multispecialist Medical Department, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Oscar Massimiliano Epis
- Division of Rheumatology, Multispecialist Medical Department, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
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7
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Nasreen S, Gebretekle GB, Lynch M, Kurdina A, Thomas M, Fadel S, Houle SKD, Waite NM, Crowcroft NS, Allin S. Understanding predictors of pneumococcal vaccine uptake in older adults aged 65 years and older in high-income countries across the globe: A scoping review. Vaccine 2022; 40:4380-4393. [PMID: 35781171 DOI: 10.1016/j.vaccine.2022.06.056] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 05/31/2022] [Accepted: 06/20/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND Pneumococcal disease causes substantial morbidity and mortality in older adults. Pneumococcal polysaccharide vaccine (PPV23) is routinely recommended to reduce the disease burden in this population. However, the vaccination coverage in older adults remains suboptimal in high-income countries. OBJECTIVES We sought to understand the current landscape of published literature on the predictors of pneumococcal vaccine uptake in older adults aged 65 years and older in high-income countries, and to identify the gaps in literature to inform future research. METHODS We conducted a scoping review employing the Arksey and O'Malley framework and Joanna Briggs Methods. We searched Medline, EMBASE, CINAHL, PsycInfo and Cochrane databases. We included quantitative and qualitative studies on predictors of pneumococcal vaccination in older adults that reported older adult- and pneumococcal vaccine-specific results, conducted in high-income settings, and published in English between January 2015 and April 2020. We excluded studies assessing interventions to improve vaccine uptake. We followed the Strategic Advisory Group of Experts on Immunization Working Group Vaccine Hesitancy Determinants Matrix to map the predictors within contextual, individual and social group, and vaccine and vaccination-specific influence determinants. Studies on providers and institutions were also included and results summarized separately. RESULTS We included 52 publications in our review. Most of the predictors in 39 quantitative studies belonged to the individual and social group influences (n = 12), followed by contextual influences (n = 11) and vaccine and vaccination-specific issues (n = 3). Few qualitative studies explored the barriers to pneumococcal vaccination. Only five studies examined predictors from the healthcare providers' perspective. Three studies examined the institutional characteristics as the predictors of pneumococcal vaccination in older adults. CONCLUSIONS We identified enablers and barriers of pneumococcal vaccination among older adults in high-income settings. We also identified gaps in the literature and provide recommendations for future research to address the gaps.
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Affiliation(s)
- Sharifa Nasreen
- Centre for Vaccine Preventable Diseases, University of Toronto, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Ontario, Canada.
| | - Gebremedhin B Gebretekle
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, Ontario, Canada
| | - Meghan Lynch
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Anna Kurdina
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Madeleine Thomas
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Shaza Fadel
- Centre for Vaccine Preventable Diseases, University of Toronto, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
| | | | - Nancy M Waite
- School of Pharmacy, University of Waterloo, Waterloo, Ontario, Canada
| | - Natasha S Crowcroft
- Centre for Vaccine Preventable Diseases, University of Toronto, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
| | - Sara Allin
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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8
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Magliulo D, Wade SD, Kyttaris VC. Immunogenicity of SARS-CoV-2 vaccination in rituximab-treated patients: Effect of timing and immunologic parameters. Clin Immunol 2021; 234:108897. [PMID: 34848357 PMCID: PMC8627008 DOI: 10.1016/j.clim.2021.108897] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 11/24/2021] [Accepted: 11/24/2021] [Indexed: 12/12/2022]
Abstract
Rituximab (RTX), an important therapeutic option for patients with rheumatic diseases, has been shown to reduce immune responses to various vaccines. We asked whether following SARS-CoV-2 vaccination, response rates in RTX treated patients are reduced and whether specific patient characteristics influence the responses. We recruited patients on chronic RTX therapy undergoing anti-SARS-CoV2 vaccination and measured the post-vaccination anti-spike IgG antibody levels. The median time from pre-vaccination RTX infusion to vaccination and from vaccination to the post-vaccination RTX infusion was 20.5 weeks and 7.2 weeks respectively. Only 36.5% of patients developed measurable titers of IgG anti-SARS-CoV-2 spike antibody after vaccination. Hypogammaglobulinemia (IgG and/or IgM) but not timing of vaccination, B cell numbers, or concomitant immune suppressive medications, correlated with sero-negativity (p = 0.004). Our results underscore the fact that even after B cell reconstitution, RTX induced chronic hypogammaglobulinemia significantly impairs the ability of the immune system to respond to SARS-CoV-2 vaccination.
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Affiliation(s)
- Daniel Magliulo
- Division of Rheumatology, Beth Israel Deaconess Medical Center, Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America
| | - Stefanie D Wade
- Division of Rheumatology, Beth Israel Deaconess Medical Center, Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America
| | - Vasileios C Kyttaris
- Division of Rheumatology, Beth Israel Deaconess Medical Center, Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America.
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9
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Rosamilia F, Noberasco G, Olobardi D, Orsi A, Icardi G, Lantieri F, Murdaca G. Flu and Pneumococcal Vaccine Coverage in Scleroderma Patients Still Need to Be Prompted: A Systematic Review. Vaccines (Basel) 2021; 9:1330. [PMID: 34835261 PMCID: PMC8617735 DOI: 10.3390/vaccines9111330] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 11/02/2021] [Accepted: 11/04/2021] [Indexed: 01/14/2023] Open
Abstract
Systemic sclerosis (scleroderma, SSc) is an autoimmune connective tissue disease characterized by excessive production of collagen and multiorgan involvement. Scleroderma patients are at increased risk of influenza complications and pneumonia; thus, vaccinations are recommended. This systematic review evaluated the influenza and pneumococcus vaccination coverage for SSc patients. We included all studies from Pubmed reporting on influenza and pneumococcal vaccination rate in Scleroderma patients up to May 2021. The 14 studies thus selected identified a suboptimal vaccination rate in autoimmune and SSc patients, ranging from 28 to 59% for the flu vaccine, and from 11 to 58% for the pneumo vaccine in absence of specific vaccination campaigns, variously considering also other variables such as age, gender, vaccination settings, and possible vaccination campaigns. We also considered the reasons for low coverage and the approaches that might increase the vaccination rates. A lack of knowledge about the importance of vaccination in these patients and their doctors underlined the need to increase the awareness for vaccination in this patients' category. Current guidelines recommend vaccination in elderly people and people affected by particular conditions that widely overlap with SSc, yet autoimmune diseases are not always clearly mentioned. Improving this suboptimal vaccination rate with clear guidelines is crucial for SSc patients and for clinicians to immunize these categories based principally on the pathology, prior to the age. Recommendations by the immunologist and the direct link to the vaccine providers can highly improve the vaccine coverage.
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Affiliation(s)
- Francesca Rosamilia
- Biostatistics Unit, Health Science Department (DISSAL), University of Genova, Via Pastore 1, 16132 Genova, Italy; (F.R.); (F.L.)
| | - Giovanni Noberasco
- Vaccines and Clinical Trials Unit, Department of Health Sciences, University of Genova, 16132 Genova, Italy; (G.N.); (D.O.); (A.O.); (G.I.)
| | - Dario Olobardi
- Vaccines and Clinical Trials Unit, Department of Health Sciences, University of Genova, 16132 Genova, Italy; (G.N.); (D.O.); (A.O.); (G.I.)
| | - Andrea Orsi
- Vaccines and Clinical Trials Unit, Department of Health Sciences, University of Genova, 16132 Genova, Italy; (G.N.); (D.O.); (A.O.); (G.I.)
- Hygiene Unit, Ospedale Policlinico San Martino IRCCS, 16132 Genova, Italy
| | - Giancarlo Icardi
- Vaccines and Clinical Trials Unit, Department of Health Sciences, University of Genova, 16132 Genova, Italy; (G.N.); (D.O.); (A.O.); (G.I.)
- Hygiene Unit, Ospedale Policlinico San Martino IRCCS, 16132 Genova, Italy
| | - Francesca Lantieri
- Biostatistics Unit, Health Science Department (DISSAL), University of Genova, Via Pastore 1, 16132 Genova, Italy; (F.R.); (F.L.)
| | - Giuseppe Murdaca
- Departments of Internal Medicine, University of Genova, 16132 Genova, Italy
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10
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Chiganer EH, Ochi BC, Lessa CF. Influenza and pneumococcal vaccination coverage in Latin American patients with systemic lupus erythematosus: a cross-sectional and comparative study. Adv Rheumatol 2021; 61:46. [PMID: 34238387 DOI: 10.1186/s42358-021-00197-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 06/16/2021] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Infections are a major cause of morbidity and mortality in systemic lupus (SLE). Vaccination would be an effective method to reduce infection rate. Coverage for influenza and pneumococcus appears to be low in Latin America. The objective of this study was to evaluate vaccination coverage for influenza and pneumococcus in Latin America, causes of non-vaccination and to compare it with European patients. METHODS A survey was conducted through social networks targeting Latin American lupus patients. A self-report was used to assess the demographics, risk factors for pneumonia, vaccination status, and causes of non-vaccination. The same method was used for European patients. We used binary logistic regression to identify factors associated with pneumococcal and influenza vaccination. RESULTS There were 1130 participants from Latin America. Among them, 97% were women with an average of 37.9 years (SD: 11.3) and 46.5% had more than 7 years of disease duration. Two or more risk factors for pneumonia were found in 64.9%. Coverage for influenza and pneumococcal was 42.7 and 25% respectively, being lower than in Europe. Tetanus coverage was the most important predictor for receiving influenza and pneumococcal vaccination. Lack of prescription was the most common cause of non-application (64.6%). CONCLUSIONS Vaccination coverage for influenza and pneumonia is low in Latin America, especially compared to Europe. It is necessary to make specialists aware of their role in vaccine control and to implement measures to improve coordination between them and general practitioners.
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Affiliation(s)
- Edson Hernán Chiganer
- Department of Immunology and Histocompatibility Unity, Carlos G Durand Hospital, Díaz Vélez Avenue, 5044, C1405DCS, Buenos Aires, Argentina.
| | - Bruno Camargo Ochi
- Department of Immunology and Histocompatibility Unity, Carlos G Durand Hospital, Díaz Vélez Avenue, 5044, C1405DCS, Buenos Aires, Argentina
| | - Carmen Flora Lessa
- Department of Immunology and Histocompatibility Unity, Carlos G Durand Hospital, Díaz Vélez Avenue, 5044, C1405DCS, Buenos Aires, Argentina
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11
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Wade SD, Kyttaris VC. Rituximab-associated hypogammaglobulinemia in autoimmune rheumatic diseases: a single-center retrospective cohort study. Rheumatol Int 2021; 41:1115-1124. [PMID: 33811499 PMCID: PMC8019084 DOI: 10.1007/s00296-021-04847-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 03/22/2021] [Indexed: 12/22/2022]
Abstract
B-cell targeted therapies, such as rituximab (RTX), are used widely in autoimmune rheumatic diseases (AIRD). RTX can cause hypogammaglobulinemia and predispose patients to infections. Herein, we asked whether the underlying diagnosis influences the risk for hypogammaglobulinemia in patients treated with RTX. All patients who received RTX infusions and carried a diagnosis of rheumatoid arthritis (RA), ANCA-associated vasculitis (AAV), or connective tissue disease (CTD) were included in this single-center retrospective cohort study. We used STATA® for analysis: Chi-square test was used for comparing categorical variables. Based on distribution, continuous variables were compared using the t test/ANOVA or the Wilcoxon/Kruskal-Wallis tests. Of the 163 patients who received RTX for an AIRD, 60 with pre- and post- RTX immunoglobulins were analyzed. A higher incidence of post-treatment hypogammaglobulinemia was seen in AAV (45%) compared to RA (22%) and CTD (9.1%) groups (p = 0.03). Glucocorticoid exposure of 10 mg or more was identified as a significant risk factor for hypogammaglobulinemia. Finally, we observed a higher number of clinically significant infections per person in the AAV group than in the RA and CTD groups. We observed an increased incidence of hypogammaglobulinemia in the RTX-treated AAV group, with almost half of patients developing post-RTX hypogammaglobulinemia. The rate of infections per person was highest in the AAV group. Screening immunoglobulins were not consistently measured pre- and post-RTX. Results highlight a need for increased awareness of the role of immunoglobulin measurement before maintenance doses of RTX, especially in patients with AAV and steroid exposure.
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Affiliation(s)
- Stefanie D Wade
- Division of Rheumatology and Clinical Immunology, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Vasileios C Kyttaris
- Division of Rheumatology and Clinical Immunology, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA.
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12
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van Aalst M, Garcia Garrido HM, van der Leun J, Meek B, van Leeuwen EMM, Löwenberg M, D'Haens GR, Ponsioen CYI, Grobusch MP, Goorhuis A. Immunogenicity of the Currently Recommended Pneumococcal Vaccination Schedule in Patients With Inflammatory Bowel Disease. Clin Infect Dis 2021; 70:595-604. [PMID: 30899961 DOI: 10.1093/cid/ciz226] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 04/23/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Patients with inflammatory bowel disease (IBD) are at increased risk of invasive pneumococcal infections. Therefore, vaccination with the 13-valent pneumococcal conjugate vaccine (PCV13) followed by 23-valent pneumococcal polysaccharide vaccine (PPSV23) 2 months later is recommended. However, the level of immunogenicity induced by this vaccination schedule in IBD patients with and without immunosuppressive medication remains unclear. METHODS We prospectively assessed the immunogenicity of PCV13 followed by PPSV23 in IBD patients by measuring serotype-specific pneumococcal immunoglobulin G antibody concentrations at baseline and 4-8 weeks postvaccination. Response to vaccination was defined as a postvaccination antibody concentration ≥1.3 μg/mL for 70% of the measured serotypes. We analyzed the immunogenic effect of 4 different medication regimens: (1) conventional immunomodulators (ie, oral prednisolone >10 mg/day, thiopurines, methotrexate); (2) anti-tumor necrosis factor agents; (3) combination therapy; and (4) no treatment with immunosuppressive agents (control group). RESULTS One hundred forty-one IBD patients were included, of whom 37 were controls. Adequate response to vaccination was 59% (61/104) in patients using immunosuppressive agents (groups 1-3) vs 81% (30/37) in controls (odds ratio, 0.33 [95% confidence interval, .13-.82]). A combination of different immunosuppressive drugs most severely impaired the immune response to pneumococcal vaccination (response, 52% [15/29]). CONCLUSIONS Although the sequential vaccination schedule of PCV13 followed by PPSV23 is safe, immunogenic, and thus beneficial in the majority of IBD patients, those receiving immunosuppressive agents, and especially those receiving combination therapy, have an impaired immune response compared to controls. Therefore, preferably, vaccinations should be administered before the initiation of immunosuppressive therapy. CLINICAL TRIALS REGISTRATION Dutch trial register #6315.
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Affiliation(s)
- Mariëlle van Aalst
- Centre of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam University Medical Centres, Nieuwegein
| | - Hannah M Garcia Garrido
- Centre of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam University Medical Centres, Nieuwegein
| | - Josephine van der Leun
- Centre of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam University Medical Centres, Nieuwegein
| | - Bob Meek
- Department of Medical Microbiology and Immunology, St Antonius Hospital, Nieuwegein
| | - Ester M M van Leeuwen
- Department of Experimental Immunology, Amsterdam University Medical Centres, University of Amsterdam, The Netherlands
| | - Mark Löwenberg
- Department of Gastroenterology, Amsterdam University Medical Centres, University of Amsterdam, The Netherlands
| | - Geert R D'Haens
- Department of Gastroenterology, Amsterdam University Medical Centres, University of Amsterdam, The Netherlands
| | - Cyriel Y I Ponsioen
- Department of Gastroenterology, Amsterdam University Medical Centres, University of Amsterdam, The Netherlands
| | - Martin P Grobusch
- Centre of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam University Medical Centres, Nieuwegein.,Institute of Tropical Medicine, University of Tübingen, Germany
| | - Abraham Goorhuis
- Centre of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam University Medical Centres, Nieuwegein
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13
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Aberumand B, Dyck BA, Towheed T. Identifying perceptions and barriers regarding vaccination in patients with rheumatoid arthritis: A Canadian perspective. Int J Rheum Dis 2020; 23:1526-1533. [PMID: 32965794 DOI: 10.1111/1756-185x.13971] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 08/20/2020] [Accepted: 08/29/2020] [Indexed: 12/15/2022]
Abstract
AIM Canadian guidelines recommend that patients with rheumatoid arthritis (RA) receive pneumococcal, influenza and shingles vaccinations. The aim of this study was to identify and understand vaccination rates in Canadian patients with RA. METHODS We conducted an observational study to evaluate uptake of herpes zoster (HZ), influenza and pneumonia vaccination in a cross-section of patients with RA in Kingston, Ontario, Canada. Data were collected using a self-administered questionnaire in patients attending at an academic rheumatology clinic. If vaccination was not received, the reason was established. RESULTS Ninety-eight out of a total of 103 patients surveyed met the inclusion criteria and were evaluated: 72.4% had received the influenza vaccination in the past year encompassing a period of 2017-2019. Of the 27.6% who did not, the most common chosen reason was personal preference not to get vaccinated (55.6%). Regarding HZ, 18.4% had received vaccination. Of the 2 available types of vaccines, more participants received Zostavax (66.7%) as compared to Shringrix (33.3%). For those not vaccinated (81.6%), "Other" was the most chosen option (37.5%) with the reasons subsequently specified as cost, concern over interaction with treatment and waiting until age ≥65 years. In terms of pneumococcal vaccination, 36.7% were vaccinated, with the majority being vaccinated with Pneumovax-23 (63.9%) compared to Prevnar-13 (16.7%) or both (19.4%). Of the 63.3% of the participants who did not receive vaccination, the most cited reason was they did not know they should receive pneumococcal vaccination (48.4%). CONCLUSIONS Vaccination rates among Canadian patients with RA are suboptimal.
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Affiliation(s)
- Babak Aberumand
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Bailey A Dyck
- Division of Rheumatology, Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Tanveer Towheed
- Division of Rheumatology, Department of Medicine, Queen's University, Kingston, Ontario, Canada
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14
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Garcia Garrido HM, Veurink AM, Leeflang M, Spijker R, Goorhuis A, Grobusch MP. Hepatitis A vaccine immunogenicity in patients using immunosuppressive drugs: A systematic review and meta-analysis. Travel Med Infect Dis 2019; 32:101479. [PMID: 31521804 DOI: 10.1016/j.tmaid.2019.101479] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 09/02/2019] [Accepted: 09/09/2019] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Inactivated hepatitis A (HepA) vaccines are very immunogenic in healthy individuals; however, it remains unclear how different immunosuppressive regimens affect HepA vaccine immunogenicity. Our objective was to summarise the current evidence on immunogenicity of HepA vaccination in patients using immunosuppressive drugs. METHODS We systematically searched the literature for studies on immunogenicity of inactivated HepA vaccines in adults using immunosuppressive drugs. Studies reporting seroconversion rates (SCR) 4-8 weeks after 1 and 2 doses of HepA vaccine in organ transplant recipients and patients with chronic inflammatory conditions were included in a meta-analysis. RESULTS We included 17 studies, comprising 1,332 individuals. In healthy controls (2 studies), SCRs were 90-94% after the first dose and 100% after the second dose. In organ transplant recipients, SCRs ranged from 0 to 67% after the first dose of vaccine and 0-97% after the second dose. In patients with chronic inflammatory conditions, SCRs ranged from 6% to 100% after the first dose and from 48 to 100% after the second dose of vaccine. Patients using a TNF-alpha inhibitor versus conventional immune-modulators (e.g. methotrexate, azathioprine, corticosteroids) were more likely to seroconvert after the first dose of vaccine (OR12.1 [2.14-68.2]) but not after the second dose of vaccine (OR 0.78 [0.21-2.92]) in a meta-analysis. CONCLUSION Studies evaluating HepA vaccine immunogenicity in immunosuppressive agents are heterogeneous. Overall, there is an impaired immune response following HepA vaccination in patients using immunosuppressive drugs, especially after only one dose of vaccine and in organ transplant recipients. HepA vaccination should therefore be considered before immunosuppressive therapy. Future research should focus on alternative vaccination regimens and long-term immunogenicity. PROSPERO ID CRD42018102607.
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Affiliation(s)
- Hannah M Garcia Garrido
- Amsterdam UMC, University of Amsterdam, Centre of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Meibergdreef 9, Amsterdam, the Netherlands.
| | - Ati M Veurink
- Amsterdam UMC, University of Amsterdam, Centre of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Meibergdreef 9, Amsterdam, the Netherlands
| | - Mariska Leeflang
- Amsterdam UMC, University of Amsterdam, Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam Public Health, Meibergdreef 9, Amsterdam, the Netherlands
| | - René Spijker
- Amsterdam UMC, University of Amsterdam, Medical Library, Amsterdam Public Health, Meibergdreef 9, Amsterdam, the Netherlands; Cochrane Netherlands, Julius Center for Health Sciences and Primary Care, UMC Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Abraham Goorhuis
- Amsterdam UMC, University of Amsterdam, Centre of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Meibergdreef 9, Amsterdam, the Netherlands
| | - Martin P Grobusch
- Amsterdam UMC, University of Amsterdam, Centre of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Meibergdreef 9, Amsterdam, the Netherlands
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15
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Qendro T, de la Torre ML, Panopalis P, Hazel E, Ward BJ, Colmegna I, Hudson M. Suboptimal Immunization Coverage among Canadian Rheumatology Patients in Routine Clinical Care. J Rheumatol 2019; 47:770-778. [PMID: 31308211 DOI: 10.3899/jrheum.181376] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2019] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To assess vaccination coverage and predictors of vaccination among a Canadian population of rheumatology patients in routine clinical care. METHODS In this cross-sectional study, consecutive adult patients presenting to a tertiary rheumatology clinic at the McGill University Health Center between May and September 2015 were asked to fill a survey on vaccination. Patients self-identified as having rheumatoid arthritis (RA), systemic autoimmune rheumatic diseases (SARD), spondyloarthropathies (SpA), or other diseases (OD). Multivariate logistical regression analyses were performed to evaluate patient and physician factors associated with various vaccinations [for influenza, pneumococcus, and hepatitis B virus (HBV)]. Published Quebec general population influenza and pneumococcal vaccination rates in those aged ≥ 65 years were used as comparative baseline rates. RESULTS Three hundred fifty-two patients were included in the analysis (RA: 136, SARD: 113, SpA: 47, OD: 56). Vaccination rates were reported as follows: (1) influenza: RA 48.5%, SARD 42.0%, SpA 31.9%, OD 88.9%, Quebec general population 58.5%; (2) pneumococcal: RA 42.0%, SARD 37.8%, SpA 29.7%, OD 33.3%, Quebec general population 53.2%; (3) HBV: RA 33.6%, SARD 55.6%, SpA 73.5%, OD 36.8%; and (4) herpes zoster: RA 5.6%, SARD 28.6%, SpA 25.0%, OD 16.7%. Physician recommendation was the strongest independent predictor of vaccination across all vaccine types (influenza: OR 8.56, 95% CI 2.80-26.2, p < 0.001; pneumococcal: OR 314, 95% CI 73.0-1353, p < 0.001; HBV: OR 12.8, 95% CI 5.27-31.1, p < 0.001). Disease group, disease duration, comorbidities, treatment type, and being followed by a primary care physician were not significantly associated with vaccination. CONCLUSION There is suboptimal immunization coverage among ambulatory rheumatology patients. An important role for patient and physician education is highlighted in our study, especially because physician recommendation of vaccination was strongly predictive of vaccine uptake.
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Affiliation(s)
- Tedi Qendro
- From the Department of Medicine, McGill University, Montreal; Division of Rheumatology, McGill University Health Center, Montreal; Infectious Diseases and Immunity in Global Health Program, Research Institute of the McGill University Health Center, Montreal; Division of Rheumatology and Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada; Internal Medicine, Rheumatology and Immunology, Centro de Educacion Medica e Investigaciones Clinicas Norberto Quirno, Buenos Aires, Argentina.,T. Qendro, MSc, Department of Medicine, McGill University; M.L. de la Torre, MD, Internal medicine, Rheumatology and Immunology, Centro de Educacion Medica e Investigaciones Clinicas Norberto Quirno; P. Panopalis, MD, Division of Rheumatology, McGill University Health Center; E. Hazel, MD, Division of Rheumatology, McGill University Health Center; B.J. Ward, MD, DTM&H, Infectious Diseases and Immunity in Global Health Program, Research Institute of the McGill University Health Center; I. Colmegna, MD, Division of Rheumatology, McGill University Health Center; M. Hudson, MD, MPH, FRCPC, Division of Rheumatology and Lady Davis Institute for Medical Research, Jewish General Hospital
| | - María Laura de la Torre
- From the Department of Medicine, McGill University, Montreal; Division of Rheumatology, McGill University Health Center, Montreal; Infectious Diseases and Immunity in Global Health Program, Research Institute of the McGill University Health Center, Montreal; Division of Rheumatology and Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada; Internal Medicine, Rheumatology and Immunology, Centro de Educacion Medica e Investigaciones Clinicas Norberto Quirno, Buenos Aires, Argentina.,T. Qendro, MSc, Department of Medicine, McGill University; M.L. de la Torre, MD, Internal medicine, Rheumatology and Immunology, Centro de Educacion Medica e Investigaciones Clinicas Norberto Quirno; P. Panopalis, MD, Division of Rheumatology, McGill University Health Center; E. Hazel, MD, Division of Rheumatology, McGill University Health Center; B.J. Ward, MD, DTM&H, Infectious Diseases and Immunity in Global Health Program, Research Institute of the McGill University Health Center; I. Colmegna, MD, Division of Rheumatology, McGill University Health Center; M. Hudson, MD, MPH, FRCPC, Division of Rheumatology and Lady Davis Institute for Medical Research, Jewish General Hospital
| | - Pantelis Panopalis
- From the Department of Medicine, McGill University, Montreal; Division of Rheumatology, McGill University Health Center, Montreal; Infectious Diseases and Immunity in Global Health Program, Research Institute of the McGill University Health Center, Montreal; Division of Rheumatology and Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada; Internal Medicine, Rheumatology and Immunology, Centro de Educacion Medica e Investigaciones Clinicas Norberto Quirno, Buenos Aires, Argentina.,T. Qendro, MSc, Department of Medicine, McGill University; M.L. de la Torre, MD, Internal medicine, Rheumatology and Immunology, Centro de Educacion Medica e Investigaciones Clinicas Norberto Quirno; P. Panopalis, MD, Division of Rheumatology, McGill University Health Center; E. Hazel, MD, Division of Rheumatology, McGill University Health Center; B.J. Ward, MD, DTM&H, Infectious Diseases and Immunity in Global Health Program, Research Institute of the McGill University Health Center; I. Colmegna, MD, Division of Rheumatology, McGill University Health Center; M. Hudson, MD, MPH, FRCPC, Division of Rheumatology and Lady Davis Institute for Medical Research, Jewish General Hospital
| | - Elizabeth Hazel
- From the Department of Medicine, McGill University, Montreal; Division of Rheumatology, McGill University Health Center, Montreal; Infectious Diseases and Immunity in Global Health Program, Research Institute of the McGill University Health Center, Montreal; Division of Rheumatology and Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada; Internal Medicine, Rheumatology and Immunology, Centro de Educacion Medica e Investigaciones Clinicas Norberto Quirno, Buenos Aires, Argentina.,T. Qendro, MSc, Department of Medicine, McGill University; M.L. de la Torre, MD, Internal medicine, Rheumatology and Immunology, Centro de Educacion Medica e Investigaciones Clinicas Norberto Quirno; P. Panopalis, MD, Division of Rheumatology, McGill University Health Center; E. Hazel, MD, Division of Rheumatology, McGill University Health Center; B.J. Ward, MD, DTM&H, Infectious Diseases and Immunity in Global Health Program, Research Institute of the McGill University Health Center; I. Colmegna, MD, Division of Rheumatology, McGill University Health Center; M. Hudson, MD, MPH, FRCPC, Division of Rheumatology and Lady Davis Institute for Medical Research, Jewish General Hospital
| | - Brian J Ward
- From the Department of Medicine, McGill University, Montreal; Division of Rheumatology, McGill University Health Center, Montreal; Infectious Diseases and Immunity in Global Health Program, Research Institute of the McGill University Health Center, Montreal; Division of Rheumatology and Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada; Internal Medicine, Rheumatology and Immunology, Centro de Educacion Medica e Investigaciones Clinicas Norberto Quirno, Buenos Aires, Argentina.,T. Qendro, MSc, Department of Medicine, McGill University; M.L. de la Torre, MD, Internal medicine, Rheumatology and Immunology, Centro de Educacion Medica e Investigaciones Clinicas Norberto Quirno; P. Panopalis, MD, Division of Rheumatology, McGill University Health Center; E. Hazel, MD, Division of Rheumatology, McGill University Health Center; B.J. Ward, MD, DTM&H, Infectious Diseases and Immunity in Global Health Program, Research Institute of the McGill University Health Center; I. Colmegna, MD, Division of Rheumatology, McGill University Health Center; M. Hudson, MD, MPH, FRCPC, Division of Rheumatology and Lady Davis Institute for Medical Research, Jewish General Hospital
| | - Inés Colmegna
- From the Department of Medicine, McGill University, Montreal; Division of Rheumatology, McGill University Health Center, Montreal; Infectious Diseases and Immunity in Global Health Program, Research Institute of the McGill University Health Center, Montreal; Division of Rheumatology and Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada; Internal Medicine, Rheumatology and Immunology, Centro de Educacion Medica e Investigaciones Clinicas Norberto Quirno, Buenos Aires, Argentina.,T. Qendro, MSc, Department of Medicine, McGill University; M.L. de la Torre, MD, Internal medicine, Rheumatology and Immunology, Centro de Educacion Medica e Investigaciones Clinicas Norberto Quirno; P. Panopalis, MD, Division of Rheumatology, McGill University Health Center; E. Hazel, MD, Division of Rheumatology, McGill University Health Center; B.J. Ward, MD, DTM&H, Infectious Diseases and Immunity in Global Health Program, Research Institute of the McGill University Health Center; I. Colmegna, MD, Division of Rheumatology, McGill University Health Center; M. Hudson, MD, MPH, FRCPC, Division of Rheumatology and Lady Davis Institute for Medical Research, Jewish General Hospital
| | - Marie Hudson
- From the Department of Medicine, McGill University, Montreal; Division of Rheumatology, McGill University Health Center, Montreal; Infectious Diseases and Immunity in Global Health Program, Research Institute of the McGill University Health Center, Montreal; Division of Rheumatology and Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada; Internal Medicine, Rheumatology and Immunology, Centro de Educacion Medica e Investigaciones Clinicas Norberto Quirno, Buenos Aires, Argentina. .,T. Qendro, MSc, Department of Medicine, McGill University; M.L. de la Torre, MD, Internal medicine, Rheumatology and Immunology, Centro de Educacion Medica e Investigaciones Clinicas Norberto Quirno; P. Panopalis, MD, Division of Rheumatology, McGill University Health Center; E. Hazel, MD, Division of Rheumatology, McGill University Health Center; B.J. Ward, MD, DTM&H, Infectious Diseases and Immunity in Global Health Program, Research Institute of the McGill University Health Center; I. Colmegna, MD, Division of Rheumatology, McGill University Health Center; M. Hudson, MD, MPH, FRCPC, Division of Rheumatology and Lady Davis Institute for Medical Research, Jewish General Hospital.
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16
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Papp KA, Haraoui B, Kumar D, Marshall JK, Bissonnette R, Bitton A, Bressler B, Gooderham M, Ho V, Jamal S, Pope JE, Steinhart AH, Vinh DC, Wade J. Vaccination Guidelines for Patients with Immune-mediated Disorders Taking Immunosuppressive Therapies: Executive Summary. J Rheumatol 2019; 46:751-754. [PMID: 30709945 DOI: 10.3899/jrheum.180784] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2018] [Indexed: 11/22/2022]
Abstract
The use of immunosuppressive therapies for immune-mediated disease is associated with an elevated risk of infections and related comorbidities. While many infectious diseases can generally be prevented by vaccines, immunization rates in this specific patient population remain suboptimal, due in part to uncertainty about their efficacy or safety under these clinical situations. To address this concern, a multidisciplinary group of Canadian physicians with expertise in dermatology, gastroenterology, infectious diseases, and rheumatology developed evidence-based clinical guidelines on vaccinations featuring 13 statements that are aimed at reducing the risk of preventable infections in individuals exposed to immunosuppressive and immunomodulatory agents.
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Affiliation(s)
- Kim A Papp
- From K. Papp Clinical Research; Probity Medical Research, Waterloo; University Health Network; Faculty of Medicine, University of Toronto; Mount Sinai Hospital, Toronto; Department of Medicine and Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton; Faculty of Medicine, Queen's University, Kingston; Faculty of Medicine, University of Western Ontario; St. Joseph's Health Care, London, Ontario; Centre Hospitalier de l'Université de Montréal; Innovaderm Research Inc.; McGill University Health Centre; Research Institute - McGill University Health Centre, Montreal, Quebec; Faculty of Medicine, University of British Columbia; St. Paul's Hospital; Vancouver Coastal Health; Vancouver General Hospital, Vancouver, British Columbia, Canada. .,K.A. Papp, MD, PhD, FRCPC, K. Papp Clinical Research, and Probity Medical Research; B. Haraoui, MD, FRCPC, Centre Hospitalier de l'Université de Montréal; D. Kumar, MD, MSc, FRCPC, University Health Network, and Faculty of Medicine, University of Toronto; J.K. Marshall, MD, MSc, FRCPC, AGAF, Department of Medicine and Farncombe Family Digestive Health Research Institute, McMaster University; R. Bissonnette, MD, Innovaderm Research Inc.; A. Bitton, MD, FRCP, McGill University Health Centre; B. Bressler, MD, MS, FRCPC, Faculty of Medicine, University of British Columbia, and St. Paul's Hospital; M. Gooderham, MSc, MD, FRCPC, Probity Medical Research, and Faculty of Medicine, Queen's University; V. Ho, MD, FRCPC, Faculty of Medicine, University of British Columbia; S. Jamal, MD, FRCPC, MSc, Vancouver Coastal Health; J.E. Pope, MD, MPH, FRCPC, Faculty of Medicine, University of Western Ontario, and St. Joseph's Health Care; A.H. Steinhart, MD, FRCP(C), Faculty of Medicine, University of Toronto, and Mount Sinai Hospital; D.C. Vinh, MD, McGill University Health Centre, and Research Institute - McGill University Health Centre; J. Wade, MD, FRCP(C), Faculty of Medicine, University of British Columbia, and Vancouver General Hospital.
| | - Boulos Haraoui
- From K. Papp Clinical Research; Probity Medical Research, Waterloo; University Health Network; Faculty of Medicine, University of Toronto; Mount Sinai Hospital, Toronto; Department of Medicine and Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton; Faculty of Medicine, Queen's University, Kingston; Faculty of Medicine, University of Western Ontario; St. Joseph's Health Care, London, Ontario; Centre Hospitalier de l'Université de Montréal; Innovaderm Research Inc.; McGill University Health Centre; Research Institute - McGill University Health Centre, Montreal, Quebec; Faculty of Medicine, University of British Columbia; St. Paul's Hospital; Vancouver Coastal Health; Vancouver General Hospital, Vancouver, British Columbia, Canada.,K.A. Papp, MD, PhD, FRCPC, K. Papp Clinical Research, and Probity Medical Research; B. Haraoui, MD, FRCPC, Centre Hospitalier de l'Université de Montréal; D. Kumar, MD, MSc, FRCPC, University Health Network, and Faculty of Medicine, University of Toronto; J.K. Marshall, MD, MSc, FRCPC, AGAF, Department of Medicine and Farncombe Family Digestive Health Research Institute, McMaster University; R. Bissonnette, MD, Innovaderm Research Inc.; A. Bitton, MD, FRCP, McGill University Health Centre; B. Bressler, MD, MS, FRCPC, Faculty of Medicine, University of British Columbia, and St. Paul's Hospital; M. Gooderham, MSc, MD, FRCPC, Probity Medical Research, and Faculty of Medicine, Queen's University; V. Ho, MD, FRCPC, Faculty of Medicine, University of British Columbia; S. Jamal, MD, FRCPC, MSc, Vancouver Coastal Health; J.E. Pope, MD, MPH, FRCPC, Faculty of Medicine, University of Western Ontario, and St. Joseph's Health Care; A.H. Steinhart, MD, FRCP(C), Faculty of Medicine, University of Toronto, and Mount Sinai Hospital; D.C. Vinh, MD, McGill University Health Centre, and Research Institute - McGill University Health Centre; J. Wade, MD, FRCP(C), Faculty of Medicine, University of British Columbia, and Vancouver General Hospital
| | - Deepali Kumar
- From K. Papp Clinical Research; Probity Medical Research, Waterloo; University Health Network; Faculty of Medicine, University of Toronto; Mount Sinai Hospital, Toronto; Department of Medicine and Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton; Faculty of Medicine, Queen's University, Kingston; Faculty of Medicine, University of Western Ontario; St. Joseph's Health Care, London, Ontario; Centre Hospitalier de l'Université de Montréal; Innovaderm Research Inc.; McGill University Health Centre; Research Institute - McGill University Health Centre, Montreal, Quebec; Faculty of Medicine, University of British Columbia; St. Paul's Hospital; Vancouver Coastal Health; Vancouver General Hospital, Vancouver, British Columbia, Canada.,K.A. Papp, MD, PhD, FRCPC, K. Papp Clinical Research, and Probity Medical Research; B. Haraoui, MD, FRCPC, Centre Hospitalier de l'Université de Montréal; D. Kumar, MD, MSc, FRCPC, University Health Network, and Faculty of Medicine, University of Toronto; J.K. Marshall, MD, MSc, FRCPC, AGAF, Department of Medicine and Farncombe Family Digestive Health Research Institute, McMaster University; R. Bissonnette, MD, Innovaderm Research Inc.; A. Bitton, MD, FRCP, McGill University Health Centre; B. Bressler, MD, MS, FRCPC, Faculty of Medicine, University of British Columbia, and St. Paul's Hospital; M. Gooderham, MSc, MD, FRCPC, Probity Medical Research, and Faculty of Medicine, Queen's University; V. Ho, MD, FRCPC, Faculty of Medicine, University of British Columbia; S. Jamal, MD, FRCPC, MSc, Vancouver Coastal Health; J.E. Pope, MD, MPH, FRCPC, Faculty of Medicine, University of Western Ontario, and St. Joseph's Health Care; A.H. Steinhart, MD, FRCP(C), Faculty of Medicine, University of Toronto, and Mount Sinai Hospital; D.C. Vinh, MD, McGill University Health Centre, and Research Institute - McGill University Health Centre; J. Wade, MD, FRCP(C), Faculty of Medicine, University of British Columbia, and Vancouver General Hospital
| | - John K Marshall
- From K. Papp Clinical Research; Probity Medical Research, Waterloo; University Health Network; Faculty of Medicine, University of Toronto; Mount Sinai Hospital, Toronto; Department of Medicine and Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton; Faculty of Medicine, Queen's University, Kingston; Faculty of Medicine, University of Western Ontario; St. Joseph's Health Care, London, Ontario; Centre Hospitalier de l'Université de Montréal; Innovaderm Research Inc.; McGill University Health Centre; Research Institute - McGill University Health Centre, Montreal, Quebec; Faculty of Medicine, University of British Columbia; St. Paul's Hospital; Vancouver Coastal Health; Vancouver General Hospital, Vancouver, British Columbia, Canada.,K.A. Papp, MD, PhD, FRCPC, K. Papp Clinical Research, and Probity Medical Research; B. Haraoui, MD, FRCPC, Centre Hospitalier de l'Université de Montréal; D. Kumar, MD, MSc, FRCPC, University Health Network, and Faculty of Medicine, University of Toronto; J.K. Marshall, MD, MSc, FRCPC, AGAF, Department of Medicine and Farncombe Family Digestive Health Research Institute, McMaster University; R. Bissonnette, MD, Innovaderm Research Inc.; A. Bitton, MD, FRCP, McGill University Health Centre; B. Bressler, MD, MS, FRCPC, Faculty of Medicine, University of British Columbia, and St. Paul's Hospital; M. Gooderham, MSc, MD, FRCPC, Probity Medical Research, and Faculty of Medicine, Queen's University; V. Ho, MD, FRCPC, Faculty of Medicine, University of British Columbia; S. Jamal, MD, FRCPC, MSc, Vancouver Coastal Health; J.E. Pope, MD, MPH, FRCPC, Faculty of Medicine, University of Western Ontario, and St. Joseph's Health Care; A.H. Steinhart, MD, FRCP(C), Faculty of Medicine, University of Toronto, and Mount Sinai Hospital; D.C. Vinh, MD, McGill University Health Centre, and Research Institute - McGill University Health Centre; J. Wade, MD, FRCP(C), Faculty of Medicine, University of British Columbia, and Vancouver General Hospital
| | - Robert Bissonnette
- From K. Papp Clinical Research; Probity Medical Research, Waterloo; University Health Network; Faculty of Medicine, University of Toronto; Mount Sinai Hospital, Toronto; Department of Medicine and Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton; Faculty of Medicine, Queen's University, Kingston; Faculty of Medicine, University of Western Ontario; St. Joseph's Health Care, London, Ontario; Centre Hospitalier de l'Université de Montréal; Innovaderm Research Inc.; McGill University Health Centre; Research Institute - McGill University Health Centre, Montreal, Quebec; Faculty of Medicine, University of British Columbia; St. Paul's Hospital; Vancouver Coastal Health; Vancouver General Hospital, Vancouver, British Columbia, Canada.,K.A. Papp, MD, PhD, FRCPC, K. Papp Clinical Research, and Probity Medical Research; B. Haraoui, MD, FRCPC, Centre Hospitalier de l'Université de Montréal; D. Kumar, MD, MSc, FRCPC, University Health Network, and Faculty of Medicine, University of Toronto; J.K. Marshall, MD, MSc, FRCPC, AGAF, Department of Medicine and Farncombe Family Digestive Health Research Institute, McMaster University; R. Bissonnette, MD, Innovaderm Research Inc.; A. Bitton, MD, FRCP, McGill University Health Centre; B. Bressler, MD, MS, FRCPC, Faculty of Medicine, University of British Columbia, and St. Paul's Hospital; M. Gooderham, MSc, MD, FRCPC, Probity Medical Research, and Faculty of Medicine, Queen's University; V. Ho, MD, FRCPC, Faculty of Medicine, University of British Columbia; S. Jamal, MD, FRCPC, MSc, Vancouver Coastal Health; J.E. Pope, MD, MPH, FRCPC, Faculty of Medicine, University of Western Ontario, and St. Joseph's Health Care; A.H. Steinhart, MD, FRCP(C), Faculty of Medicine, University of Toronto, and Mount Sinai Hospital; D.C. Vinh, MD, McGill University Health Centre, and Research Institute - McGill University Health Centre; J. Wade, MD, FRCP(C), Faculty of Medicine, University of British Columbia, and Vancouver General Hospital
| | - Alain Bitton
- From K. Papp Clinical Research; Probity Medical Research, Waterloo; University Health Network; Faculty of Medicine, University of Toronto; Mount Sinai Hospital, Toronto; Department of Medicine and Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton; Faculty of Medicine, Queen's University, Kingston; Faculty of Medicine, University of Western Ontario; St. Joseph's Health Care, London, Ontario; Centre Hospitalier de l'Université de Montréal; Innovaderm Research Inc.; McGill University Health Centre; Research Institute - McGill University Health Centre, Montreal, Quebec; Faculty of Medicine, University of British Columbia; St. Paul's Hospital; Vancouver Coastal Health; Vancouver General Hospital, Vancouver, British Columbia, Canada.,K.A. Papp, MD, PhD, FRCPC, K. Papp Clinical Research, and Probity Medical Research; B. Haraoui, MD, FRCPC, Centre Hospitalier de l'Université de Montréal; D. Kumar, MD, MSc, FRCPC, University Health Network, and Faculty of Medicine, University of Toronto; J.K. Marshall, MD, MSc, FRCPC, AGAF, Department of Medicine and Farncombe Family Digestive Health Research Institute, McMaster University; R. Bissonnette, MD, Innovaderm Research Inc.; A. Bitton, MD, FRCP, McGill University Health Centre; B. Bressler, MD, MS, FRCPC, Faculty of Medicine, University of British Columbia, and St. Paul's Hospital; M. Gooderham, MSc, MD, FRCPC, Probity Medical Research, and Faculty of Medicine, Queen's University; V. Ho, MD, FRCPC, Faculty of Medicine, University of British Columbia; S. Jamal, MD, FRCPC, MSc, Vancouver Coastal Health; J.E. Pope, MD, MPH, FRCPC, Faculty of Medicine, University of Western Ontario, and St. Joseph's Health Care; A.H. Steinhart, MD, FRCP(C), Faculty of Medicine, University of Toronto, and Mount Sinai Hospital; D.C. Vinh, MD, McGill University Health Centre, and Research Institute - McGill University Health Centre; J. Wade, MD, FRCP(C), Faculty of Medicine, University of British Columbia, and Vancouver General Hospital
| | - Brian Bressler
- From K. Papp Clinical Research; Probity Medical Research, Waterloo; University Health Network; Faculty of Medicine, University of Toronto; Mount Sinai Hospital, Toronto; Department of Medicine and Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton; Faculty of Medicine, Queen's University, Kingston; Faculty of Medicine, University of Western Ontario; St. Joseph's Health Care, London, Ontario; Centre Hospitalier de l'Université de Montréal; Innovaderm Research Inc.; McGill University Health Centre; Research Institute - McGill University Health Centre, Montreal, Quebec; Faculty of Medicine, University of British Columbia; St. Paul's Hospital; Vancouver Coastal Health; Vancouver General Hospital, Vancouver, British Columbia, Canada.,K.A. Papp, MD, PhD, FRCPC, K. Papp Clinical Research, and Probity Medical Research; B. Haraoui, MD, FRCPC, Centre Hospitalier de l'Université de Montréal; D. Kumar, MD, MSc, FRCPC, University Health Network, and Faculty of Medicine, University of Toronto; J.K. Marshall, MD, MSc, FRCPC, AGAF, Department of Medicine and Farncombe Family Digestive Health Research Institute, McMaster University; R. Bissonnette, MD, Innovaderm Research Inc.; A. Bitton, MD, FRCP, McGill University Health Centre; B. Bressler, MD, MS, FRCPC, Faculty of Medicine, University of British Columbia, and St. Paul's Hospital; M. Gooderham, MSc, MD, FRCPC, Probity Medical Research, and Faculty of Medicine, Queen's University; V. Ho, MD, FRCPC, Faculty of Medicine, University of British Columbia; S. Jamal, MD, FRCPC, MSc, Vancouver Coastal Health; J.E. Pope, MD, MPH, FRCPC, Faculty of Medicine, University of Western Ontario, and St. Joseph's Health Care; A.H. Steinhart, MD, FRCP(C), Faculty of Medicine, University of Toronto, and Mount Sinai Hospital; D.C. Vinh, MD, McGill University Health Centre, and Research Institute - McGill University Health Centre; J. Wade, MD, FRCP(C), Faculty of Medicine, University of British Columbia, and Vancouver General Hospital
| | - Melinda Gooderham
- From K. Papp Clinical Research; Probity Medical Research, Waterloo; University Health Network; Faculty of Medicine, University of Toronto; Mount Sinai Hospital, Toronto; Department of Medicine and Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton; Faculty of Medicine, Queen's University, Kingston; Faculty of Medicine, University of Western Ontario; St. Joseph's Health Care, London, Ontario; Centre Hospitalier de l'Université de Montréal; Innovaderm Research Inc.; McGill University Health Centre; Research Institute - McGill University Health Centre, Montreal, Quebec; Faculty of Medicine, University of British Columbia; St. Paul's Hospital; Vancouver Coastal Health; Vancouver General Hospital, Vancouver, British Columbia, Canada.,K.A. Papp, MD, PhD, FRCPC, K. Papp Clinical Research, and Probity Medical Research; B. Haraoui, MD, FRCPC, Centre Hospitalier de l'Université de Montréal; D. Kumar, MD, MSc, FRCPC, University Health Network, and Faculty of Medicine, University of Toronto; J.K. Marshall, MD, MSc, FRCPC, AGAF, Department of Medicine and Farncombe Family Digestive Health Research Institute, McMaster University; R. Bissonnette, MD, Innovaderm Research Inc.; A. Bitton, MD, FRCP, McGill University Health Centre; B. Bressler, MD, MS, FRCPC, Faculty of Medicine, University of British Columbia, and St. Paul's Hospital; M. Gooderham, MSc, MD, FRCPC, Probity Medical Research, and Faculty of Medicine, Queen's University; V. Ho, MD, FRCPC, Faculty of Medicine, University of British Columbia; S. Jamal, MD, FRCPC, MSc, Vancouver Coastal Health; J.E. Pope, MD, MPH, FRCPC, Faculty of Medicine, University of Western Ontario, and St. Joseph's Health Care; A.H. Steinhart, MD, FRCP(C), Faculty of Medicine, University of Toronto, and Mount Sinai Hospital; D.C. Vinh, MD, McGill University Health Centre, and Research Institute - McGill University Health Centre; J. Wade, MD, FRCP(C), Faculty of Medicine, University of British Columbia, and Vancouver General Hospital
| | - Vincent Ho
- From K. Papp Clinical Research; Probity Medical Research, Waterloo; University Health Network; Faculty of Medicine, University of Toronto; Mount Sinai Hospital, Toronto; Department of Medicine and Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton; Faculty of Medicine, Queen's University, Kingston; Faculty of Medicine, University of Western Ontario; St. Joseph's Health Care, London, Ontario; Centre Hospitalier de l'Université de Montréal; Innovaderm Research Inc.; McGill University Health Centre; Research Institute - McGill University Health Centre, Montreal, Quebec; Faculty of Medicine, University of British Columbia; St. Paul's Hospital; Vancouver Coastal Health; Vancouver General Hospital, Vancouver, British Columbia, Canada.,K.A. Papp, MD, PhD, FRCPC, K. Papp Clinical Research, and Probity Medical Research; B. Haraoui, MD, FRCPC, Centre Hospitalier de l'Université de Montréal; D. Kumar, MD, MSc, FRCPC, University Health Network, and Faculty of Medicine, University of Toronto; J.K. Marshall, MD, MSc, FRCPC, AGAF, Department of Medicine and Farncombe Family Digestive Health Research Institute, McMaster University; R. Bissonnette, MD, Innovaderm Research Inc.; A. Bitton, MD, FRCP, McGill University Health Centre; B. Bressler, MD, MS, FRCPC, Faculty of Medicine, University of British Columbia, and St. Paul's Hospital; M. Gooderham, MSc, MD, FRCPC, Probity Medical Research, and Faculty of Medicine, Queen's University; V. Ho, MD, FRCPC, Faculty of Medicine, University of British Columbia; S. Jamal, MD, FRCPC, MSc, Vancouver Coastal Health; J.E. Pope, MD, MPH, FRCPC, Faculty of Medicine, University of Western Ontario, and St. Joseph's Health Care; A.H. Steinhart, MD, FRCP(C), Faculty of Medicine, University of Toronto, and Mount Sinai Hospital; D.C. Vinh, MD, McGill University Health Centre, and Research Institute - McGill University Health Centre; J. Wade, MD, FRCP(C), Faculty of Medicine, University of British Columbia, and Vancouver General Hospital
| | - Shahin Jamal
- From K. Papp Clinical Research; Probity Medical Research, Waterloo; University Health Network; Faculty of Medicine, University of Toronto; Mount Sinai Hospital, Toronto; Department of Medicine and Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton; Faculty of Medicine, Queen's University, Kingston; Faculty of Medicine, University of Western Ontario; St. Joseph's Health Care, London, Ontario; Centre Hospitalier de l'Université de Montréal; Innovaderm Research Inc.; McGill University Health Centre; Research Institute - McGill University Health Centre, Montreal, Quebec; Faculty of Medicine, University of British Columbia; St. Paul's Hospital; Vancouver Coastal Health; Vancouver General Hospital, Vancouver, British Columbia, Canada.,K.A. Papp, MD, PhD, FRCPC, K. Papp Clinical Research, and Probity Medical Research; B. Haraoui, MD, FRCPC, Centre Hospitalier de l'Université de Montréal; D. Kumar, MD, MSc, FRCPC, University Health Network, and Faculty of Medicine, University of Toronto; J.K. Marshall, MD, MSc, FRCPC, AGAF, Department of Medicine and Farncombe Family Digestive Health Research Institute, McMaster University; R. Bissonnette, MD, Innovaderm Research Inc.; A. Bitton, MD, FRCP, McGill University Health Centre; B. Bressler, MD, MS, FRCPC, Faculty of Medicine, University of British Columbia, and St. Paul's Hospital; M. Gooderham, MSc, MD, FRCPC, Probity Medical Research, and Faculty of Medicine, Queen's University; V. Ho, MD, FRCPC, Faculty of Medicine, University of British Columbia; S. Jamal, MD, FRCPC, MSc, Vancouver Coastal Health; J.E. Pope, MD, MPH, FRCPC, Faculty of Medicine, University of Western Ontario, and St. Joseph's Health Care; A.H. Steinhart, MD, FRCP(C), Faculty of Medicine, University of Toronto, and Mount Sinai Hospital; D.C. Vinh, MD, McGill University Health Centre, and Research Institute - McGill University Health Centre; J. Wade, MD, FRCP(C), Faculty of Medicine, University of British Columbia, and Vancouver General Hospital
| | - Janet E Pope
- From K. Papp Clinical Research; Probity Medical Research, Waterloo; University Health Network; Faculty of Medicine, University of Toronto; Mount Sinai Hospital, Toronto; Department of Medicine and Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton; Faculty of Medicine, Queen's University, Kingston; Faculty of Medicine, University of Western Ontario; St. Joseph's Health Care, London, Ontario; Centre Hospitalier de l'Université de Montréal; Innovaderm Research Inc.; McGill University Health Centre; Research Institute - McGill University Health Centre, Montreal, Quebec; Faculty of Medicine, University of British Columbia; St. Paul's Hospital; Vancouver Coastal Health; Vancouver General Hospital, Vancouver, British Columbia, Canada.,K.A. Papp, MD, PhD, FRCPC, K. Papp Clinical Research, and Probity Medical Research; B. Haraoui, MD, FRCPC, Centre Hospitalier de l'Université de Montréal; D. Kumar, MD, MSc, FRCPC, University Health Network, and Faculty of Medicine, University of Toronto; J.K. Marshall, MD, MSc, FRCPC, AGAF, Department of Medicine and Farncombe Family Digestive Health Research Institute, McMaster University; R. Bissonnette, MD, Innovaderm Research Inc.; A. Bitton, MD, FRCP, McGill University Health Centre; B. Bressler, MD, MS, FRCPC, Faculty of Medicine, University of British Columbia, and St. Paul's Hospital; M. Gooderham, MSc, MD, FRCPC, Probity Medical Research, and Faculty of Medicine, Queen's University; V. Ho, MD, FRCPC, Faculty of Medicine, University of British Columbia; S. Jamal, MD, FRCPC, MSc, Vancouver Coastal Health; J.E. Pope, MD, MPH, FRCPC, Faculty of Medicine, University of Western Ontario, and St. Joseph's Health Care; A.H. Steinhart, MD, FRCP(C), Faculty of Medicine, University of Toronto, and Mount Sinai Hospital; D.C. Vinh, MD, McGill University Health Centre, and Research Institute - McGill University Health Centre; J. Wade, MD, FRCP(C), Faculty of Medicine, University of British Columbia, and Vancouver General Hospital
| | - A Hillary Steinhart
- From K. Papp Clinical Research; Probity Medical Research, Waterloo; University Health Network; Faculty of Medicine, University of Toronto; Mount Sinai Hospital, Toronto; Department of Medicine and Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton; Faculty of Medicine, Queen's University, Kingston; Faculty of Medicine, University of Western Ontario; St. Joseph's Health Care, London, Ontario; Centre Hospitalier de l'Université de Montréal; Innovaderm Research Inc.; McGill University Health Centre; Research Institute - McGill University Health Centre, Montreal, Quebec; Faculty of Medicine, University of British Columbia; St. Paul's Hospital; Vancouver Coastal Health; Vancouver General Hospital, Vancouver, British Columbia, Canada.,K.A. Papp, MD, PhD, FRCPC, K. Papp Clinical Research, and Probity Medical Research; B. Haraoui, MD, FRCPC, Centre Hospitalier de l'Université de Montréal; D. Kumar, MD, MSc, FRCPC, University Health Network, and Faculty of Medicine, University of Toronto; J.K. Marshall, MD, MSc, FRCPC, AGAF, Department of Medicine and Farncombe Family Digestive Health Research Institute, McMaster University; R. Bissonnette, MD, Innovaderm Research Inc.; A. Bitton, MD, FRCP, McGill University Health Centre; B. Bressler, MD, MS, FRCPC, Faculty of Medicine, University of British Columbia, and St. Paul's Hospital; M. Gooderham, MSc, MD, FRCPC, Probity Medical Research, and Faculty of Medicine, Queen's University; V. Ho, MD, FRCPC, Faculty of Medicine, University of British Columbia; S. Jamal, MD, FRCPC, MSc, Vancouver Coastal Health; J.E. Pope, MD, MPH, FRCPC, Faculty of Medicine, University of Western Ontario, and St. Joseph's Health Care; A.H. Steinhart, MD, FRCP(C), Faculty of Medicine, University of Toronto, and Mount Sinai Hospital; D.C. Vinh, MD, McGill University Health Centre, and Research Institute - McGill University Health Centre; J. Wade, MD, FRCP(C), Faculty of Medicine, University of British Columbia, and Vancouver General Hospital
| | - Donald C Vinh
- From K. Papp Clinical Research; Probity Medical Research, Waterloo; University Health Network; Faculty of Medicine, University of Toronto; Mount Sinai Hospital, Toronto; Department of Medicine and Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton; Faculty of Medicine, Queen's University, Kingston; Faculty of Medicine, University of Western Ontario; St. Joseph's Health Care, London, Ontario; Centre Hospitalier de l'Université de Montréal; Innovaderm Research Inc.; McGill University Health Centre; Research Institute - McGill University Health Centre, Montreal, Quebec; Faculty of Medicine, University of British Columbia; St. Paul's Hospital; Vancouver Coastal Health; Vancouver General Hospital, Vancouver, British Columbia, Canada.,K.A. Papp, MD, PhD, FRCPC, K. Papp Clinical Research, and Probity Medical Research; B. Haraoui, MD, FRCPC, Centre Hospitalier de l'Université de Montréal; D. Kumar, MD, MSc, FRCPC, University Health Network, and Faculty of Medicine, University of Toronto; J.K. Marshall, MD, MSc, FRCPC, AGAF, Department of Medicine and Farncombe Family Digestive Health Research Institute, McMaster University; R. Bissonnette, MD, Innovaderm Research Inc.; A. Bitton, MD, FRCP, McGill University Health Centre; B. Bressler, MD, MS, FRCPC, Faculty of Medicine, University of British Columbia, and St. Paul's Hospital; M. Gooderham, MSc, MD, FRCPC, Probity Medical Research, and Faculty of Medicine, Queen's University; V. Ho, MD, FRCPC, Faculty of Medicine, University of British Columbia; S. Jamal, MD, FRCPC, MSc, Vancouver Coastal Health; J.E. Pope, MD, MPH, FRCPC, Faculty of Medicine, University of Western Ontario, and St. Joseph's Health Care; A.H. Steinhart, MD, FRCP(C), Faculty of Medicine, University of Toronto, and Mount Sinai Hospital; D.C. Vinh, MD, McGill University Health Centre, and Research Institute - McGill University Health Centre; J. Wade, MD, FRCP(C), Faculty of Medicine, University of British Columbia, and Vancouver General Hospital
| | - John Wade
- From K. Papp Clinical Research; Probity Medical Research, Waterloo; University Health Network; Faculty of Medicine, University of Toronto; Mount Sinai Hospital, Toronto; Department of Medicine and Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton; Faculty of Medicine, Queen's University, Kingston; Faculty of Medicine, University of Western Ontario; St. Joseph's Health Care, London, Ontario; Centre Hospitalier de l'Université de Montréal; Innovaderm Research Inc.; McGill University Health Centre; Research Institute - McGill University Health Centre, Montreal, Quebec; Faculty of Medicine, University of British Columbia; St. Paul's Hospital; Vancouver Coastal Health; Vancouver General Hospital, Vancouver, British Columbia, Canada.,K.A. Papp, MD, PhD, FRCPC, K. Papp Clinical Research, and Probity Medical Research; B. Haraoui, MD, FRCPC, Centre Hospitalier de l'Université de Montréal; D. Kumar, MD, MSc, FRCPC, University Health Network, and Faculty of Medicine, University of Toronto; J.K. Marshall, MD, MSc, FRCPC, AGAF, Department of Medicine and Farncombe Family Digestive Health Research Institute, McMaster University; R. Bissonnette, MD, Innovaderm Research Inc.; A. Bitton, MD, FRCP, McGill University Health Centre; B. Bressler, MD, MS, FRCPC, Faculty of Medicine, University of British Columbia, and St. Paul's Hospital; M. Gooderham, MSc, MD, FRCPC, Probity Medical Research, and Faculty of Medicine, Queen's University; V. Ho, MD, FRCPC, Faculty of Medicine, University of British Columbia; S. Jamal, MD, FRCPC, MSc, Vancouver Coastal Health; J.E. Pope, MD, MPH, FRCPC, Faculty of Medicine, University of Western Ontario, and St. Joseph's Health Care; A.H. Steinhart, MD, FRCP(C), Faculty of Medicine, University of Toronto, and Mount Sinai Hospital; D.C. Vinh, MD, McGill University Health Centre, and Research Institute - McGill University Health Centre; J. Wade, MD, FRCP(C), Faculty of Medicine, University of British Columbia, and Vancouver General Hospital
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Papp KA, Haraoui B, Kumar D, Marshall JK, Bissonnette R, Bitton A, Bressler B, Gooderham M, Ho V, Jamal S, Pope JE, Steinhart AH, Vinh DC, Wade J. Vaccination Guidelines for Patients with Immune-Mediated Disorders on Immunosuppressive Therapies-Executive Summary. J Can Assoc Gastroenterol 2019; 2:149-152. [PMID: 31616855 PMCID: PMC6785689 DOI: 10.1093/jcag/gwy069] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 12/12/2018] [Indexed: 12/24/2022] Open
Abstract
The use of immunosuppressive therapies for immune-mediated disease (IMD) is associated with an elevated risk of infections and related comorbidities. While many infectious diseases can generally be prevented by vaccines, immunization rates in this specific patient population remain suboptimal, due in part to uncertainty about their efficacy or safety under these clinical situations. To address this concern, a multidisciplinary group of Canadian physicians with expertise in dermatology, gastroenterology, infectious diseases and rheumatology developed evidence-based clinical guidelines on vaccinations featuring 13 statements that are aimed at reducing the risk of preventable infections in individuals exposed to immunosuppressive agents.
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Affiliation(s)
- Kim A Papp
- Clinical Research, Waterloo, Ontario, Canada.,Probity Medical Research, Waterloo, Ontario, Canada
| | - Boulos Haraoui
- Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Deepali Kumar
- University Health Network, Toronto, Ontario, Canada.,Faculty of Medicine, University of Toronto, Ontario, Canada
| | - John K Marshall
- Department of Medicine and Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | | | - Alain Bitton
- McGill University Health Centre, Montréal, Québec, Canada
| | - Brian Bressler
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Melinda Gooderham
- Probity Medical Research, Waterloo, Ontario, Canada.,Faculty of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Vincent Ho
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Shahin Jamal
- Vancouver Coastal Health, Vancouver, British Columbia, Canada
| | - Janet E Pope
- Faculty of Medicine, University of Western Ontario, London, Ontario, Canada.,St. Joseph's Health Care, London, Ontario, Canada
| | - A Hillary Steinhart
- Faculty of Medicine, University of Toronto, Ontario, Canada.,Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Donald C Vinh
- McGill University Health Centre, Montréal, Québec, Canada.,Research Institute, McGill University Health Centre, Montréal, Québec, Canada
| | - John Wade
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Vancouver General Hospital, Vancouver, British Columbia, Canada
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Fayet F, Savel C, Rodere M, Soubrier M, Mathieu S. Obstacles and motivations to influenza and pneumococcal vaccination in patients with rheumatoid arthritis. A qualitative study. Comment on: “Pneumococcal and influenza vaccination rates in patients treated with corticosteroids and/or immunosuppressive therapies for systemic auto-immune diseases: A cross-sectional study” by Assala et al., Joint Bone Spine 2017;84:365–6. Joint Bone Spine 2019; 86:117-118. [DOI: 10.1016/j.jbspin.2018.06.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 06/27/2018] [Indexed: 12/11/2022]
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Papp KA, Haraoui B, Kumar D, Marshall JK, Bissonnette R, Bitton A, Bressler B, Gooderham M, Ho V, Jamal S, Pope JE, Steinhart AH, Vinh DC, Wade J. Vaccination Guidelines for Patients With Immune-Mediated Disorders on Immunosuppressive Therapies. J Cutan Med Surg 2018; 23:50-74. [PMID: 30463418 PMCID: PMC6330697 DOI: 10.1177/1203475418811335] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND: Patients with immune-mediated diseases on immunosuppressive therapies have more infectious episodes than healthy individuals, yet vaccination practices by physicians for this patient population remain suboptimal. OBJECTIVES: To evaluate the safety and efficacy of vaccines in individuals exposed to immunosuppressive therapies and provide evidence-based clinical practice recommendations. METHODS: A literature search for vaccination safety and efficacy in patients on immunosuppressive therapies (2009-2017) was conducted. Results were assessed using the Grading of Recommendation, Assessment, Development, and Evaluation system. RESULTS: Several immunosuppressive therapies attenuate vaccine response. Thus, vaccines should be administered before treatment whenever feasible. Inactivated vaccines can be administered without treatment discontinuation. Similarly, evidence suggests that the live zoster vaccine is safe and effective while on select immunosuppressive therapy, although use of the subunit vaccine is preferred. Caution regarding other live vaccines is warranted. Drug pharmacokinetics, duration of vaccine-induced viremia, and immune response kinetics should be considered to determine appropriate timing of vaccination and treatment (re)initiation. Infants exposed to immunosuppressive therapies through breastmilk can usually be immunized according to local guidelines. Intrauterine exposure to immunosuppressive agents is not a contraindication for inactivated vaccines. Live attenuated vaccines scheduled for infants and children ⩾12 months of age, including measles, mumps, rubella, and varicella, can be safely administered as sufficient time has elapsed for drug clearance. CONCLUSIONS: Immunosuppressive agents may attenuate vaccine responses, but protective benefit is generally maintained. While these recommendations are evidence based, they do not replace clinical judgment, and decisions regarding vaccination must carefully assess the risks, benefits, and circumstances of individual patients.
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Affiliation(s)
- Kim A Papp
- 1 K Papp Clinical Research, Waterloo, ON, Canada.,2 Probity Medical Research, Waterloo, ON, Canada
| | - Boulos Haraoui
- 3 Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Deepali Kumar
- 4 University Health Network, Toronto, ON, Canada.,5 Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - John K Marshall
- 6 Department of Medicine and Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, ON, Canada
| | | | - Alain Bitton
- 8 McGill University Health Centre, Montreal, QC, Canada
| | - Brian Bressler
- 9 Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.,10 St Paul's Hospital, Vancouver, BC, Canada
| | - Melinda Gooderham
- 2 Probity Medical Research, Waterloo, ON, Canada.,11 Faculty of Medicine, Queen's University, Kingston, ON, Canada
| | - Vincent Ho
- 9 Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Shahin Jamal
- 12 Vancouver Coastal Health, Vancouver, BC, Canada
| | - Janet E Pope
- 13 Faculty of Medicine, University of Western Ontario, London, ON, Canada.,14 St Joseph's Health Care, London, ON, Canada
| | - A Hillary Steinhart
- 5 Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,15 Mount Sinai Hospital, Toronto, ON, Canada
| | - Donald C Vinh
- 8 McGill University Health Centre, Montreal, QC, Canada.,16 Research Institute, McGill University Health Centre, Montreal, QC, Canada
| | - John Wade
- 9 Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.,17 Vancouver General Hospital, Vancouver, BC, Canada
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Nguyen M, Lindegaard H, Hendricks O, Friis-Møller N. Factors associated with influenza and pneumococcal vaccine uptake among rheumatoid arthritis patients in Denmark invited to participate in a pneumococcal vaccine trial (Immunovax_RA). Scand J Rheumatol 2017; 46:446-453. [PMID: 28145151 DOI: 10.1080/03009742.2016.1242774] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE This study investigates predictors of influenza and pneumococcal vaccine coverage among rheumatoid arthritis (RA) patients, and explores possible differences according to type of RA therapy. METHOD RA patients from two clinics in the region of Southern Denmark were informed about the survey during scheduled follow-up visits. The questionnaire included questions concerning previous influenza and pneumococcal vaccine uptake, attitudes about vaccination, and socio-demographic factors. Factors associated with recalled vaccine uptake were assessed by multivariate logistic regression. RESULTS A total of 192 RA patients completed the survey, 134 (70%) of whom were women and 90 (47%) were aged ≥ 65 years. Sixty-seven patients (35%) received conventional disease-modifying anti-rheumatic drugs (cDMARDs) and 125 (65%) combination therapy with biological disease-modifying anti-rheumatic drugs (bDMARDs). Self-reported uptake of vaccination against seasonal influenza ever was 59% overall; 57% among patients receiving cDMARDs and 61% in patients receiving bDMARDs. Self-reported vaccine uptake against pneumococcal diseases was only 6% overall. Older age, educational level, and information and recommendation by a specialist or general physician were positively associated with influenza vaccine uptake, while there was no significant difference in vaccine uptake according to RA treatment type. Reasons for not being vaccinated included fear of adverse effects, lack of information and recommendation, and perception of good health. CONCLUSION We observed a low prevalence of influenza and in particular of pneumococcal vaccinations among RA patients receiving immunosuppressive drugs, with no difference in coverage according to type of RA therapy. More population-specific evidence to support recommendations is required to increase awareness among patients and physicians.
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Affiliation(s)
- Mtt Nguyen
- a Department of Infectious Diseases , Odense University Hospital , Odense , Denmark.,b Institute of Clinical Research , University of Southern Denmark , Odense , Denmark.,c OPEN, Odense Patient data Explorative Network , Odense University Hospital , Odense , Denmark
| | - H Lindegaard
- d Department of Rheumatology , Odense University Hospital , Odense , Denmark
| | - O Hendricks
- e Department of Rheumatology , King Christian 10th Hospital for Rheumatic Diseases , Graasten , Denmark.,f Institute of Regional Research , University of Southern Denmark , Odense , Denmark
| | - N Friis-Møller
- a Department of Infectious Diseases , Odense University Hospital , Odense , Denmark
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