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Boekel L. Protecting patients with SLE against herpes zoster: time for early proactive vaccine counselling. THE LANCET. RHEUMATOLOGY 2024; 6:e331-e333. [PMID: 38710193 DOI: 10.1016/s2665-9913(24)00115-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Accepted: 04/18/2024] [Indexed: 05/08/2024]
Affiliation(s)
- Laura Boekel
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Reade, 1056 AB, Amsterdam, Netherlands.
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Harris JG, Jones JT, Favier L, Fox E, Holland MJ, Ivy A, Hoffart CM, Ibarra M, Cooper AM. Improving Pneumococcal Vaccination Rates in Immunosuppressed Pediatric Patients with Rheumatic Disease. Pediatr Qual Saf 2024; 9:e725. [PMID: 38751894 PMCID: PMC11093563 DOI: 10.1097/pq9.0000000000000725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 03/10/2024] [Indexed: 05/18/2024] Open
Abstract
Background Patients with rheumatic diseases are at a high risk of invasive pneumococcal disease due to immunosuppression. We conducted a quality improvement project, and the first aim was to increase the percentage of patients with systemic lupus erythematosus and mixed connective tissue disease that is up to date on pneumococcal vaccinations from 9.6% to 80% within one year. Subsequently, the second aim was to increase the percentage of patients on immunosuppression with systemic lupus erythematosus, mixed connective tissue disease, juvenile dermatomyositis and systemic vasculitis that is up to date on pneumococcal vaccinations from 62.6% to 80% within one year. Methods Two process measures were up-to-date vaccination status on (1) 13-valent pneumococcal conjugated vaccine (PCV13) and (2) 23-valent pneumococcal polysaccharide vaccine (PPSV23). Our outcome measure was being fully up to date on both pneumococcal vaccinations. Interventions included an immunization algorithm, reporting of eligible patients, education, reminders, and pre-visit planning. Results There were shifts in the centerline for all quality measures in both phases of this project. The combined pneumococcal vaccination rate for Phase 1 increased from 9.6% to 91.1%, and this centerline was sustained. Pneumococcal vaccination rates also significantly increased for Phase 2: 68.8% to 93.4% for PCV13, 65.2% to 88.5% for PPSV23, and 62.6% to 86.5% for the combined pneumococcal vaccination rate. Conclusions Quality improvement methodology significantly increased and sustained pneumococcal vaccination rates in our high-risk, immunosuppressed patients. We continue to prioritize this important initiative to mitigate the risk of invasive pneumococcal disease.
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Affiliation(s)
- Julia G. Harris
- From the Department of Pediatrics, Children’s Mercy Kansas City, Kansas City, Mo
- University of Missouri-Kansas City School of Medicine, Kansas City, Mo. 2401 Gillham Road Kansas City, MO 64108
| | - Jordan T. Jones
- From the Department of Pediatrics, Children’s Mercy Kansas City, Kansas City, Mo
- University of Missouri-Kansas City School of Medicine, Kansas City, Mo. 2401 Gillham Road Kansas City, MO 64108
| | - Leslie Favier
- From the Department of Pediatrics, Children’s Mercy Kansas City, Kansas City, Mo
- University of Missouri-Kansas City School of Medicine, Kansas City, Mo. 2401 Gillham Road Kansas City, MO 64108
| | - Emily Fox
- From the Department of Pediatrics, Children’s Mercy Kansas City, Kansas City, Mo
- University of Missouri-Kansas City School of Medicine, Kansas City, Mo. 2401 Gillham Road Kansas City, MO 64108
| | - Michael J. Holland
- From the Department of Pediatrics, Children’s Mercy Kansas City, Kansas City, Mo
- University of Missouri-Kansas City School of Medicine, Kansas City, Mo. 2401 Gillham Road Kansas City, MO 64108
| | - Amy Ivy
- From the Department of Pediatrics, Children’s Mercy Kansas City, Kansas City, Mo
| | - Cara M. Hoffart
- From the Department of Pediatrics, Children’s Mercy Kansas City, Kansas City, Mo
- University of Missouri-Kansas City School of Medicine, Kansas City, Mo. 2401 Gillham Road Kansas City, MO 64108
| | - Maria Ibarra
- From the Department of Pediatrics, Children’s Mercy Kansas City, Kansas City, Mo
- University of Missouri-Kansas City School of Medicine, Kansas City, Mo. 2401 Gillham Road Kansas City, MO 64108
| | - Ashley M. Cooper
- From the Department of Pediatrics, Children’s Mercy Kansas City, Kansas City, Mo
- University of Missouri-Kansas City School of Medicine, Kansas City, Mo. 2401 Gillham Road Kansas City, MO 64108
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Furer V, Weil C, Chodik G, Slav SA, Blonder SN, Fisher-Shoval Y, Barak M, Elkayam O. Real-World Coverage With Influenza, Pneumococcal, and Herpes Zoster Vaccines Among Patients With Rheumatic Diseases in a Nationwide Healthcare Plan. J Rheumatol 2024; 51:505-516. [PMID: 38302167 DOI: 10.3899/jrheum.2023-0867] [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] [Accepted: 01/23/2024] [Indexed: 02/03/2024]
Abstract
OBJECTIVE Vaccination against preventable infections is important for the management of rheumatic diseases (RDs). This study assessed the vaccination coverage and predictors among patients with RDs using real-world data from Israel. METHODS This retrospective cross-sectional study, based on a Maccabi Healthcare Services database, included adult patients diagnosed with rheumatoid arthritis (RA), psoriatic arthritis (PsA), and systemic lupus erythematosus (SLE), as of April 30, 2019. Age-specific vaccination coverage for influenza (past year), pneumococcal (23-valent pneumococcal polysaccharide vaccine [PPSV23] and/or 13-valent pneumococcal conjugate vaccine [PCV13]), and live-attenuated herpes zoster (HZ) vaccines (past 5 years) was reported. Logistic regression was used to investigate predictors of vaccination. RESULTS The study included 14,528 patients (RA: n = 6932; PsA: n = 4395; SLE: n = 1951; > 1 condition: n = 1250). Influenza vaccine coverage among patients with RA, PsA, and SLE was 45.1%, 36.2%, and 33.7%, respectively. For PPSV23, corresponding rates were 19.6%, 16.2%, and 12.6%, respectively. In the elderly population (≥ 65 years), 63.2% had influenza vaccine in the past year and 83.4% had a PPSV23 vaccine in the past 5 years or at age ≥ 65. For PCV13 and HZ, coverage in the overall study population was low at 4.8% and 3.6%, respectively. Central residence and treatment with corticosteroids and biologic or targeted synthetic disease-modifying antirheumatic drugs within the past 5 years were significant predictors of vaccination coverage across all vaccines (P < 0.05). Other predictors varied by vaccine, including female sex (influenza, PPSV23, PCV13), age (influenza, PPSV23), chronic comorbidities (influenza, PPSV23, PCV13), shorter disease duration (PCV13), and high socioeconomic status (PCV13, HZ). CONCLUSION This study demonstrated suboptimal coverage of influenza, pneumococcal, and HZ vaccination in patients with RA, PsA, and SLE, in particular among younger adults in Israel.
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Affiliation(s)
- Victoria Furer
- V. Furer, MD, O. Elkayam, MD, Department of Rheumatology, Tel Aviv Sourasky Medical Center, and Faculty of Medicine, Tel Aviv University, Tel Aviv;
| | - Clara Weil
- C. Weil, MSc, Maccabi Institute for Research and Innovation, Maccabi Healthcare Services, Tel Aviv
| | - Gabriel Chodik
- G. Chodik, MD, Faculty of Medicine, Tel Aviv University, and Maccabi Institute for Research and Innovation, Maccabi Healthcare Services, Tel Aviv
| | - Shera Ann Slav
- S.A. Slav, DMD, S.N. Blonder, PhD, Y. Fisher-Shoval, PhD, M. Barak, MD, AbbVie Inc., Hod HaSharon, Israel
| | - Shiran Naftelberg Blonder
- S.A. Slav, DMD, S.N. Blonder, PhD, Y. Fisher-Shoval, PhD, M. Barak, MD, AbbVie Inc., Hod HaSharon, Israel
| | - Yonit Fisher-Shoval
- S.A. Slav, DMD, S.N. Blonder, PhD, Y. Fisher-Shoval, PhD, M. Barak, MD, AbbVie Inc., Hod HaSharon, Israel
| | - Moran Barak
- S.A. Slav, DMD, S.N. Blonder, PhD, Y. Fisher-Shoval, PhD, M. Barak, MD, AbbVie Inc., Hod HaSharon, Israel
| | - Ori Elkayam
- V. Furer, MD, O. Elkayam, MD, Department of Rheumatology, Tel Aviv Sourasky Medical Center, and Faculty of Medicine, Tel Aviv University, Tel Aviv
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Frodlund M, Nived P, Chatzidionysiou K, Södergren A, Klingberg E, Hansson M, Ohlsson S, Pin E, Bengtsson A, Klareskog L, Kapetanovic M. The serological immunogenicity of the third and fourth doses of COVID-19 vaccine in patients with inflammatory rheumatic diseases on different biologic or targeted DMARDs: a Swedish nationwide study (COVID-19-REUMA). Microbiol Spectr 2024; 12:e0298123. [PMID: 38441463 PMCID: PMC10986619 DOI: 10.1128/spectrum.02981-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 12/05/2023] [Indexed: 04/06/2024] Open
Abstract
Studies investigating the immunogenicity of additional COVID-19 vaccine doses in immunosuppressed patients with inflammatory rheumatic diseases (IRD) are still limited. The objective was to explore the antibody response including response to omicron virus subvariants (sBA.1 and sBS.2) after third and fourth COVID-19 vaccine doses in Swedish IRD patients treated with immunomodulating drugs compared to controls. Antibody levels to spike wild-type antigens (full-length protein and S1) and the omicron variants sBA.1 and sBA.2 (full-length proteins) were measured. A positive response was defined as having antibody levels over cut-off or ≥fourfold increase in post-vaccination levels for both antigens. Patients with arthritis, vasculitis, and other autoimmune diseases (n = 414), and controls (n = 61) receiving biologic/targeted synthetic disease-modifying anti-rheumatic drugs (DMARDs) with or without conventional synthetic DMARDs participated. Of these, blood samples were available for 370 patients and 52 controls after three doses, and 65 patients and 15 controls after four doses. Treatment groups after three vaccine doses were rituximab (n = 133), abatacept (n = 22), IL6r inhibitors (n = 71), JAnus Kinase inhibitors (JAK-inhibitors) (n = 56), tumor necrosis factor inhibitor (TNF-inhibitors) (n = 61), IL12/23/17 inhibitors (n = 27), and controls (n = 52). The percentage of responders after three and four vaccine doses was lower in rituximab-treated patients (59% and 57%) compared to controls (100%) (P < 0.001). After three doses, the percentage of responders in all other groups was 100%, including response to omicron sBA.1 and sBA.2. In rituximab-treated patients, higher baseline immunoglobulin G (IgG) and longer time-period between rituximab and vaccination predicted better response. In this Swedish nationwide study including IRD patients three and four COVID-19 vaccine doses were immunogenic in patients treated with IL6r inhibitors, TNF-inhibitors, JAK-inhibitors, and IL12/23/17-inhibitors but not in rituximab. As >50% of rituximab patients responded to vaccines including omicron subvariants, these patients should be prioritized for additional vaccine doses. IMPORTANCE Results from this study provide further evidence that additional doses of COVID-19 vaccines are immunogenic and result in satisfactory antibody response in a majority of patients with inflammatory rheumatic diseases (IRD) receiving potent immunomodulating treatments such as biological or targeted disease-modifying anti-rheumatic drugs (DMARDs) given as monotherapy or combined with traditional DMARDs. We observed that rituximab treatment, both as monotherapy and combined with csDMARDs, impaired antibody response, and only roughly 50% of patients developed a satisfactory antibody response including response to omicron subvariants after the third vaccine. In addition, higher IgG levels at the last rituximab course before the third vaccine dose and a longer time after the last rituximab treatment increased the chance of a satisfactory antibody response. These results indicate that rituximab-treated patients should be prioritized for additional vaccine doses. CLINICAL TRIALS EudraCT (European Union Drug Regulating Authorities Clinical Trials Database) with number 2021-000880-63.
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Affiliation(s)
- Martina Frodlund
- Department of Biomedical and Clinical Sciences, Division of Inflammation and Infection/Rheumatology, Linköping University, Linköping, Sweden
| | - Per Nived
- Department of Clinical Sciences, Section for Rheumatology, Lund University, Lund and Skåne University Hospital, Lund, Lund, , Sweden
| | - Katerina Chatzidionysiou
- Department of Medicine, Rheumatology Unit, Karolinska University Hospital and Karolinska Institutet, Stockholm, Solna, Sweden
| | - Anna Södergren
- Department of Public Health and Clinical Medicine/Rheumatology, Umeå University, Umeå, Sweden
| | - Eva Klingberg
- Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Monica Hansson
- Department of Medicine, Rheumatology Unit, Karolinska University Hospital and Karolinska Institutet, Stockholm, Solna, Sweden
| | - Sophie Ohlsson
- Department of Clinical Sciences, Section for Nephrology, Lund University, Lund and Skåne University Hospital, Lund, Lund, , Sweden
| | - Elisa Pin
- Department of Protein Science, SciLifeLab, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Anders Bengtsson
- Department of Clinical Sciences, Section for Rheumatology, Lund University, Lund and Skåne University Hospital, Lund, Lund, , Sweden
| | - Lars Klareskog
- Department of Medicine, Rheumatology Unit, Karolinska University Hospital and Karolinska Institutet, Stockholm, Solna, Sweden
| | - Meliha Kapetanovic
- Department of Clinical Sciences, Section for Rheumatology, Lund University, Lund and Skåne University Hospital, Lund, Lund, , Sweden
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Eviatar T, Furer V, Polachek A, Zisman D, Peleg H, Elalouf O, Levartovsky D, Kaufman I, Broyde A, Haddad A, Feld J, Aassi M, Quebe-Fehling E, Alarcon I, Pel S, Paran D, Elkayam O. Effect of Secukinumab and Tumor Necrosis Factor Inhibitors on Humoral Response to BNT162b2 mRNA Vaccine in Patients With Spondyloarthritis Compared to Immunocompetent Controls. J Rheumatol 2024; 51:415-422. [PMID: 37914221 DOI: 10.3899/jrheum.2023-0357] [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] [Accepted: 10/06/2023] [Indexed: 11/03/2023]
Abstract
OBJECTIVE To assess the humoral response to the BNT162b2 mRNA vaccine among patients with spondyloarthritis (SpA) receiving secukinumab (SEC) compared to those receiving tumor necrosis factor inhibitors (TNFi) and immunocompetent controls. METHODS Consecutive patients with psoriatic arthritis or axial SpA receiving SEC (n = 37) or TNFi (monotherapy, n = 109; + methotrexate [MTX], n = 16), immunocompetent controls (n = 122), and patients with rheumatoid arthritis (RA) receiving TNFi therapy (controls, n = 50) were vaccinated with 2 or 3 doses of the BNT162b2 vaccine. We evaluated humoral response, adverse events, and disease activity, and monitored for breakthrough coronavirus disease 2019 (COVID-19) postvaccination. RESULTS The 2-dose vaccine regimen induced a comparable seropositive response in all study groups. S1/S2 antibody titers (in binding antibody units/mL; mean [SD]) were higher in the SEC group vs the TNFi + MTX-SpA and TNFi-RA groups (192.5 [68.4] vs 104.6 [46.9], P < 0.001, and 143.1 [81.9], P = 0.004). After 6 months, 96.3%, 96.6%, and 80.9% of the SEC, immunocompetent, and TNFi monotherapy-SpA groups (P = 0.10), respectively; 66.7% of the TNFi + MTX-SpA group (P = 0.03); and 63% of the TNFi-RA group (P = 0.004) remained seropositive. S1/S2 antibody titer decline was steeper in the TNFi groups than the SEC group. After the third dose, 100% of the SpA and immunocompetent and 88.9% of the TNFi-RA (P = 0.25) groups were seropositive. Rate of breakthrough COVID-19 infection was higher in the TNFi groups than in the SEC group (36-37.5% vs 10.8%). No significant between-group differences were observed for postvaccination disease activity and adverse events. CONCLUSION SEC did not interfere with the immunogenic response to BNT162b2 vaccine in patients with SpA; however, TNFi therapy was associated with lower S1/S2-antibody titers, faster decline, and higher rate of breakthrough infections.
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Affiliation(s)
- Tali Eviatar
- T. Eviatar, MD, V. Furer, MD, A. Polachek, MD, O. Elalouf, MD, D. Levartovsky, MD, I. Kaufman, MD, A. Broyde, MD, S. Pel, MPH, D. Paran, MD, O. Elkayam, MD, Rheumatology Department, Tel Aviv Sourasky Medical Center and Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel;
| | - Victoria Furer
- T. Eviatar, MD, V. Furer, MD, A. Polachek, MD, O. Elalouf, MD, D. Levartovsky, MD, I. Kaufman, MD, A. Broyde, MD, S. Pel, MPH, D. Paran, MD, O. Elkayam, MD, Rheumatology Department, Tel Aviv Sourasky Medical Center and Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ari Polachek
- T. Eviatar, MD, V. Furer, MD, A. Polachek, MD, O. Elalouf, MD, D. Levartovsky, MD, I. Kaufman, MD, A. Broyde, MD, S. Pel, MPH, D. Paran, MD, O. Elkayam, MD, Rheumatology Department, Tel Aviv Sourasky Medical Center and Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Devy Zisman
- D. Zisman, MD, A. Haddad, MD, J. Feld, MD, Rheumatology Unit, Carmel Hospital, and Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel
| | - Hagit Peleg
- H. Peleg, MD, Rheumatology Unit, Hadassah University Hospital, and the Hebrew University of Jerusalem Faculty of Medicine, Jerusalem, Jerusalem, Israel
| | - Ofir Elalouf
- T. Eviatar, MD, V. Furer, MD, A. Polachek, MD, O. Elalouf, MD, D. Levartovsky, MD, I. Kaufman, MD, A. Broyde, MD, S. Pel, MPH, D. Paran, MD, O. Elkayam, MD, Rheumatology Department, Tel Aviv Sourasky Medical Center and Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - David Levartovsky
- T. Eviatar, MD, V. Furer, MD, A. Polachek, MD, O. Elalouf, MD, D. Levartovsky, MD, I. Kaufman, MD, A. Broyde, MD, S. Pel, MPH, D. Paran, MD, O. Elkayam, MD, Rheumatology Department, Tel Aviv Sourasky Medical Center and Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ilana Kaufman
- T. Eviatar, MD, V. Furer, MD, A. Polachek, MD, O. Elalouf, MD, D. Levartovsky, MD, I. Kaufman, MD, A. Broyde, MD, S. Pel, MPH, D. Paran, MD, O. Elkayam, MD, Rheumatology Department, Tel Aviv Sourasky Medical Center and Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Adi Broyde
- T. Eviatar, MD, V. Furer, MD, A. Polachek, MD, O. Elalouf, MD, D. Levartovsky, MD, I. Kaufman, MD, A. Broyde, MD, S. Pel, MPH, D. Paran, MD, O. Elkayam, MD, Rheumatology Department, Tel Aviv Sourasky Medical Center and Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amir Haddad
- D. Zisman, MD, A. Haddad, MD, J. Feld, MD, Rheumatology Unit, Carmel Hospital, and Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel
| | - Joy Feld
- D. Zisman, MD, A. Haddad, MD, J. Feld, MD, Rheumatology Unit, Carmel Hospital, and Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel
| | - Maher Aassi
- M. Aassi, MD, E. Quebe-Fehling, PhD, I. Alarcon, MD, Novartis Pharma AG, Medical Affairs, Basel, Switzerland
| | - Erhard Quebe-Fehling
- M. Aassi, MD, E. Quebe-Fehling, PhD, I. Alarcon, MD, Novartis Pharma AG, Medical Affairs, Basel, Switzerland
| | - Ivette Alarcon
- M. Aassi, MD, E. Quebe-Fehling, PhD, I. Alarcon, MD, Novartis Pharma AG, Medical Affairs, Basel, Switzerland
| | - Sara Pel
- T. Eviatar, MD, V. Furer, MD, A. Polachek, MD, O. Elalouf, MD, D. Levartovsky, MD, I. Kaufman, MD, A. Broyde, MD, S. Pel, MPH, D. Paran, MD, O. Elkayam, MD, Rheumatology Department, Tel Aviv Sourasky Medical Center and Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Daphna Paran
- T. Eviatar, MD, V. Furer, MD, A. Polachek, MD, O. Elalouf, MD, D. Levartovsky, MD, I. Kaufman, MD, A. Broyde, MD, S. Pel, MPH, D. Paran, MD, O. Elkayam, MD, Rheumatology Department, Tel Aviv Sourasky Medical Center and Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ori Elkayam
- T. Eviatar, MD, V. Furer, MD, A. Polachek, MD, O. Elalouf, MD, D. Levartovsky, MD, I. Kaufman, MD, A. Broyde, MD, S. Pel, MPH, D. Paran, MD, O. Elkayam, MD, Rheumatology Department, Tel Aviv Sourasky Medical Center and Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Pier M, Wolbink G, Boekel L. Time to talk to adults with rheumatic diseases about herpes zoster vaccination. THE LANCET. RHEUMATOLOGY 2024; 6:e247-e251. [PMID: 38373432 DOI: 10.1016/s2665-9913(24)00019-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Revised: 01/07/2024] [Accepted: 01/16/2024] [Indexed: 02/21/2024]
Abstract
The 2019 European Alliance of Associations for Rheumatology (EULAR) recommendations on herpes zoster vaccination for adult patients with rheumatic immune-mediated inflammatory diseases stated that these patients are at increased risk of herpes zoster compared with the general population. However, these recommendations lack clarity and specificity and are cautiously phrased, which might cause physicians to underestimate the importance of herpes zoster vaccination for these patients, potentially resulting in suboptimal protection. Since the formulation of the 2019 EULAR guidelines, new data on herpes zoster in patients with immune-mediated inflammatory diseases have been published. Moreover, a recombinant herpes zoster vaccine (Shingrix) has become available that can be given to these patients in a more accessible manner than the original live-attenuated vaccine (Zostavax). Here, we evaluate existing evidence on risk factors for herpes zoster and the safety and efficacy of the recombinant vaccine in patients with rheumatic immune-mediated inflammatory diseases and discuss the necessity of herpes zoster vaccination for these patients.
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Affiliation(s)
- Mischa Pier
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Amsterdam, Netherlands
| | - Gertjan Wolbink
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Amsterdam, Netherlands; Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam University Medical Center, Amsterdam, Netherlands
| | - Laura Boekel
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Amsterdam, Netherlands.
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de Almeida ALB, Guimarães MFBR, da Costa Pinto MR, Pereira LR, Reis APMG, Bonfiglioli KR, Louzada-Junior P, Giorgi RDN, de Castro GRW, Radominski SC, Brenol CV, Pugliesi A, da Mota LMH, da Rocha Castelar-Pinheiro G. Predictors of serious infections in rheumatoid arthritis-a prospective Brazilian cohort. Adv Rheumatol 2024; 64:23. [PMID: 38553751 DOI: 10.1186/s42358-024-00363-1] [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: 07/17/2023] [Accepted: 03/19/2024] [Indexed: 04/02/2024] Open
Abstract
BACKGROUND Infections increase mortality and morbidity and often limit immunosuppressive treatment in rheumatoid arthritis patients. OBJECTIVE To analyze the occurrence of serious infections and the associated factors in a cohort of rheumatoid arthritis patients under real-life conditions. METHODS We analyzed data from the REAL, a prospective observational study, that evaluated Brazilian RA patients, with clinical and laboratory data collected over a year. Univariate and multivariate analyses were performed from the adjustment of the logistic regression model Generalized Estimating Equations (GEE), with the primary outcome being the occurrence of serious infection, defined as need for hospitalization or use of intravenous antibiotics for its treatment. RESULTS 841 patients were included with an average follow-up time of 11.2 months (SD 2.4). Eighty-nine serious infections occurred, corresponding to 13 infections per 100 patient-years. Pulmonary fibrosis, chronic kidney disease (CKD) and central nervous system disease increased the chances of serious infection by 3.2 times (95% CI: 1.5-6.9), 3.6 times (95% CI: 1.2-10.4) and 2.4 times (95% CI: 1.2-5.0), respectively. The use of corticosteroids in moderate doses increased the chances by 5.4 times (95% CI: 2.3-12.4), and for each increase of 1 unit in the health assessment questionnaire (HAQ), the chance increased 60% (95% CI: 20-120%). CONCLUSION The use of corticosteroids at moderate doses increased the risk of serious infection in RA patients. Reduced functionality assessed by the HAQ and comorbidities were other important factors associated with serious infection in this cohort.
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Affiliation(s)
| | | | | | - Leticia Rocha Pereira
- Departamento de Reumatologia, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Karina Rossi Bonfiglioli
- Departamento de Reumatologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | | | | | | | | | - Claiton Viegas Brenol
- Departamento de Reumatologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Alisson Pugliesi
- Departamento de Reumatologia, Universidade Estadual de Campinas, Campinas, SP, Brazil
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Kwiatkowska B, Krajewska-Włodarczyk M, Batko B, Maślińska M, Stajszczyk M, Świerkot J, Wiland P, Żuber Z, Tomasiewicz K. COVID-19 prophylaxis, diagnostics, and treatment in patients with rheumatic diseases. The Polish experts panel opinion. Reumatologia 2024; 62:4-17. [PMID: 38558893 PMCID: PMC10979375 DOI: 10.5114/reum/183469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Accepted: 01/30/2024] [Indexed: 04/04/2024] Open
Abstract
As severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) evolves, infection management in vulnerable populations requires formalized guidance. Although low-virulence variants of SARS-CoV-2 remain predominant, they pose an increased risk of severe illness in adults with rheumatic and musculoskeletal diseases (RMDs). Several disease-specific (chronic long-grade inflammation, concomitant immunosuppression) and individual (advanced age, multimorbidity, pregnancy, vaccination status) factors contribute to excess risk in RMD populations. Various post-COVID-19 manifestations are also increasingly reported and appear more commonly than in the general population. At a pathogenetic level, complex interplay involving innate and acquired immune dysregulation, viral persistence, and genetic predisposition shapes a unique susceptibility profile. Moreover, incident cases of SARS-CoV-2 infection as a trigger factor for the development of autoimmune conditions have been reported. Vaccination remains a key preventive strategy, and encouraging active education and awareness will be crucial for rheumatologists in the upcoming years. In patients with RMDs, COVID-19 vaccines' benefits outweigh the risks. Derivation of specialized diagnostic and therapeutic protocols within a comprehensive COVID-19 care plan represents an ideal scenario for healthcare system organization. Vigilance for symptoms of infection and rapid diagnosis are key for introducing antiviral treatment in patients with RMDs in a timely manner. This review provides updated guidance on optimal immunization, diagnosis, and antiviral treatment strategies.
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Affiliation(s)
- Brygida Kwiatkowska
- Early Arthritis Clinic, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
| | | | - Bogdan Batko
- Department of Rheumatology and Immunology, Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski University, Krakow, Poland
| | - Maria Maślińska
- Early Arthritis Clinic, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
| | - Marcin Stajszczyk
- Department of Rheumatology and Autoimmune Diseases, Silesian Center for Rheumatology, Orthopedics and Rehabilitation, Ustron, Poland
| | - Jerzy Świerkot
- Department of Rheumatology and Internal Medicine, Wroclaw Medical University, Poland
| | - Piotr Wiland
- Department of Rheumatology and Internal Medicine, Wroclaw Medical University, Poland
| | - Zbigniew Żuber
- Department of Rheumatology, St. Louis Voivodeship Specialist Children’s Hospital, Krakow, Poland
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9
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Clemente D, Cuadros EN, Lovillo MC, Hernández JC, Martín SG, Silveira LF, Cruz MJL, Tagarro A, Rueda RMA, López López A, Aritziturri MS, Calvo C. Position statement on infection screening, prophylaxis, and vaccination of pediatric patients with rheumatic diseases and immunosuppressive therapies, part 3: precautions in situations of surgery, fever, and opportunistic infections. Eur J Pediatr 2024; 183:915-927. [PMID: 38047962 PMCID: PMC10912362 DOI: 10.1007/s00431-023-05295-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 10/16/2023] [Accepted: 10/17/2023] [Indexed: 12/05/2023]
Abstract
The objective of this study is to provide practical recommendations on the management of pediatric patients with immune-mediated rheumatic diseases receiving immunosuppressive therapies. The recommendations specifically address the cases of surgery, fever, and opportunistic infections (varicella, herpes-zoster, tuberculosis, invasive fungal disease). A qualitative approach was applied. A narrative literature review was performed via Medline. Primary searches were conducted using MeSH terms and free text to identify publications on infections and vaccinations in pediatric patients with immune-mediated rheumatic diseases receiving immunosuppressive therapies. The results were presented and discussed in a nominal group meeting, comprising a committee of 12 pediatric rheumatologists from the Infection Prevention and Treatment Working Group of the Spanish Society of Pediatric Rheumatology. Several recommendations were generated. A consensus procedure was implemented via a Delphi process; this was extended to members of the Spanish Society of Pediatric Rheumatology and Spanish Society of Pediatric Infectious Disease of the Spanish Association of Pediatrics. Participants produced a score ranging from 0 (totally disagree) to 10 (totally agree). Agreement was defined as a vote ≥ 7 by at least 70% of participants. The literature review included more than 400 articles. Overall, 63 recommendations (19 on surgery, fever, and opportunistic infections) were generated and voted by 59 pediatric rheumatologists and other pediatric specialists. Agreement was reached for all 63 recommendations. The recommendations on special situations cover management in cases of surgery, fever, and opportunistic infections (varicella, herpes-zoster, tuberculosis, and invasive fungal disease). Conclusions: Hereby, we provided consensus and updated of recommendations about the management of special situations such as surgery, fever, and opportunistic in children with immune-mediated rheumatic diseases receiving immunosuppressive therapies. Several of the recommendations depend largely on clinical judgement and specific balance between risk and benefit for each individual and situation. To assess this risk, the clinician should have knowledge of the drugs, the patient's previous situation as well as the current infectious disease, in addition to experience. What is Known: • Infectious diseases and related complications are a major cause of morbidity and mortality in patients with immune-mediated rheumatic diseases. • Information on how to manage the treatment in situations of fever, opportunistic infections, and surgery in children is limited, and guidelines for action are often extrapolated from adults. What is New: • In the absence of strong evidence, a literature review and a Delphi survey were conducted to establish a series of expert recommendations that could support the clinical practice, providing a practical and simple day-to-day approach to be used by pediatric rheumatologists.
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Affiliation(s)
- Daniel Clemente
- Pediatric Rheumatology Unit, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Esmeralda Núñez Cuadros
- Pediatric Rheumatology Unit, UGC Pediatría, Hospital Regional Universitario de Málaga, Instituto de investigación biomédica de Málaga (IBIMA), Málaga, Spain
| | - Marisol Camacho Lovillo
- Servicio de Inmunología, Hospital Universitario Virgen del Rocío, Reumatología e Infectología pediátricas, Seville, Spain
| | - Joan Calzada Hernández
- Unitat de Reumatologia Pediàtrica, Servei de Pediatria, Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
| | - Sara Guillén Martín
- Department of Pediatrics, Hospital Universitario de Getafe, CIBERINFEC ISCIII, Carretera de Toledo Km 12, 500, 28905, Getafe, Madrid, Spain.
| | - Laura Fernández Silveira
- Servicio de Inmunología, Hospital Universitario Virgen del Rocío/Instituto de Biomedicina de Sevilla (IBIS), Reumatología e Infectología pediátricas, Seville, Spain
| | | | - Alfredo Tagarro
- Pediatrics Department. Hospital Universitario Infanta Sofía, Instituto de Investigación 12 de Octubre (imas12), Universidad Europea, Madrid, Spain
| | | | - Agustín López López
- Department of Paediatrics, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | | | - Cristina Calvo
- Department of Pediatrics, Infectious and Tropical Diseases, Hospital Universitario La Paz, La Paz Research Institute (IdiPaz), Translational Research Network of Pediatric Infectious Diseases (RITIP), CIBERINFEC ISCIII, Madrid, Spain
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10
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Gazitt T, Hayat N, Stein N, Haddad A, Feldhamer I, Cohen AD, Saliba W, Zisman D. The Risk of Herpes Zoster Events in Patients with Spondyloarthritis and the Effect of BNT162b2 mRNA COVID-19 Vaccine. Vaccines (Basel) 2024; 12:85. [PMID: 38250898 PMCID: PMC10821079 DOI: 10.3390/vaccines12010085] [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: 01/07/2024] [Accepted: 01/10/2024] [Indexed: 01/23/2024] Open
Abstract
The data on the risk of herpes zoster (HZ) in spondyloarthropathy (SpA) patients are sparse, especially regarding its association with the novel mRNA COVID-19 vaccines and immunosuppressants. We aimed to evaluate whether SpA diagnosis and/or immunosuppressant use affect HZ risk and the influence of mRNA COVID-19 vaccination. We assessed the association between SpA (psoriatic arthritis (PsA) and ankylosing spondylitis (AS)) diagnoses and HZ in a large population database with patients matched by age and sex to controls. We also assessed the association between the COVID-19 vaccine and new-onset HZ using two nested case-control studies, identifying all new HZ cases diagnosed from 1 January-31 December 2021 within the SpA and general population cohorts, matched randomly by sex, age and HZ index date to controls without HZ. Exposure to mRNA COVID-19 vaccination was ascertained in the 6 weeks prior to the index date both in cases and controls. In our results, the incidence rate of HZ was higher in PsA patients vs. the general population, at 1.03 vs. 0.64 per 100 person-years, respectively (adjusted HR = 1.55; 95%CI, 1.19-2.02). Within the SpA group, Jak-I treatment was associated with a higher risk of developing new-onset HZ (adjusted OR = 3.79; 1.15-12.5). Multivariable conditional logistic regression models we used showed no association between COVID-19 vaccination and new-onset HZ among the SpA patients (OR = 1.46; 0.68-3.14).
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Affiliation(s)
- Tal Gazitt
- Rheumatology Unit, Carmel Medical Center, Haifa 3436212, Israel; (A.H.); (D.Z.)
- Division of Rheumatology, University of Washington Medical Center, Seattle, WA 98195-6428, USA
| | - Noa Hayat
- Department of Internal Medicine, Carmel Medical Center, Haifa 3436212, Israel;
| | - Nili Stein
- Department of Community Medicine and Epidemiology, Carmel Medical Center, Haifa 3436212, Israel (W.S.)
| | - Amir Haddad
- Rheumatology Unit, Carmel Medical Center, Haifa 3436212, Israel; (A.H.); (D.Z.)
| | - Ilan Feldhamer
- Chief Physician’s Office, Central Headquarters, Clalit Health Services, Tel Aviv 67754, Israel
| | - Arnon Dov Cohen
- Chief Physician’s Office, Central Headquarters, Clalit Health Services, Tel Aviv 67754, Israel
- Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 84105, Israel
| | - Walid Saliba
- Department of Community Medicine and Epidemiology, Carmel Medical Center, Haifa 3436212, Israel (W.S.)
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa 31096, Israel
| | - Devy Zisman
- Rheumatology Unit, Carmel Medical Center, Haifa 3436212, Israel; (A.H.); (D.Z.)
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa 31096, Israel
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11
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Holladay EE, Mudano AS, Xie F, Stewart P, Jackson LE, Danila MI, Gavigan K, Nowell WB, Venkatachalam S, Curtis JR. COVID-19 Vaccine Uptake, Hesitancy, and Flare in a Large Rheumatology Practice Network. Arthritis Care Res (Hoboken) 2024; 76:111-119. [PMID: 37750035 DOI: 10.1002/acr.25241] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 09/13/2023] [Accepted: 09/18/2023] [Indexed: 09/27/2023]
Abstract
OBJECTIVE The goal of this study was to ascertain COVID-19 vaccine uptake, reasons for hesitancy, and self-reported flare in a large rheumatology practice-based network. METHODS A tablet-based survey was deployed by 108 rheumatology practices from December 2021 to December 2022. Patients were asked about COVID-19 vaccine status and why they might not receive a vaccine or booster. We used descriptive statistics to explore the differences between vaccination status and vaccine and booster hesitancy, comparing patients with and without autoimmune and inflammatory rheumatic diseases (AIIRDs). We used multivariable logistic regression to examine the association between vaccine uptake and AIIRD status and self-reported flare and AIIRD status. We reported adjusted odds ratios (aORs). RESULTS Of the 61,158 patients, 89% reported at least one dose of vaccine; of the vaccinated, 68% reported at least one booster. Vaccinated patients were less likely to have AIIRDs (44% vs 56%). A greater proportion of patients with AIIRDs were vaccine hesitant (14% vs 10%) and booster hesitant (21% vs 16%) compared to patients without AIIRDs. Safety concerns (28%) and side effects (23%) were the main reasons for vaccine hesitancy, whereas a lack of recommendation from the physician was the primary factor for booster hesitancy (23%). Patients with AIIRD did not have increased odds of self-reported flare or worsening disease compared to patients without with AIIRD (aOR 0.99, 95% confidence interval [CI] 0.94-1.05). Among the patients who were vaccine hesitant and booster hesitant, 12% and 39% later reported receiving a respective dose. Patients with AIIRD were 32% less likely to receive a vaccine (aOR 0.68, 95% CI 0.65-0.72) versus patients without AIIRD. CONCLUSION Some patients who are vaccine and booster hesitant eventually receive a vaccine dose, and future interventions tailored to patients with AIIRD may be fruitful.
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Affiliation(s)
| | | | | | | | | | - Maria I Danila
- University of Alabama at Birmingham and Birmingham Department of Veterans Affairs Medical Center, Birmingham, Alabama
| | - Kelly Gavigan
- Global Healthy Living Foundation, Upper Nyack, New York
| | | | | | - Jeffrey R Curtis
- University of Alabama at Birmingham and Illumination Health, Hoover, Alabama
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12
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Moraliyska R, Georgiev T, Bogdanova-Petrova S, Shivacheva T. Adoption rates of recommended vaccines and influencing factors among patients with inflammatory arthritis: a patient survey. Rheumatol Int 2024; 44:165-172. [PMID: 37837450 DOI: 10.1007/s00296-023-05476-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Accepted: 09/19/2023] [Indexed: 10/16/2023]
Abstract
To determine the scope of recommended vaccination uptake among patients with inflammatory arthritis (IA) receiving biologic and targeted synthetic disease-modifying antirheumatic agents (bDMARDs and tsDMARDs, respectively) and to determine factors, which influence their decision and are subject to modification. A single-center, cross-sectional study was conducted including patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA), or ankylosing spondylitis (AS) on bDMARDs or tsDMARDs. Demographic, anthropometric, and clinical parameters were analyzed. Disease activity was determined using the validated indices DAS28-CRP and CDAI for RA and peripheral PsA, whereas BASDAI and ASDAS for AS and axial PsA. Patients completed a questionnaire with predefined response options assessing their vaccination status and attitudes about receiving a COVID-19 vaccination. A total of 201 patients with inflammatory joint diseases were included in the study, with a mean age of 54.6 (± 8.6) years and a disease duration of 11 (± 14.4) years. More than one-third of the study group had received full vaccination against SARS-CoV-2, with the majority (68.1%) receiving the BNT162b2 vaccine. The proportion of patients who had received recommended pneumococcal and influenza vaccinations and regular reimmunizations against diphtheria and tetanus was low, with only 13.9% (n = 28), 1.5% (n = 3), and 44.8% (n = 90), respectively. Patients who had a preceding discussions with a rheumatologist were more likely to get vaccinated. Considering the suboptimal vaccination rates and the prevalent uncertainty among individuals with IA in Bulgaria, there is an urgent need to devise novel strategies to promote vaccination uptake and enhance patient awareness. These strategies aim to educate patients about their autoimmune condition, as well as emphasize the safety and efficacy of vaccines.
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Affiliation(s)
- Rosina Moraliyska
- Clinic of Rheumatology, University Hospital St. Marina, 9010, Varna, Bulgaria
- Department of Clinical Medical Sciences, Faculty of Dentistry, Medical University-Varna, 9002, Varna, Bulgaria
| | - Tsvetoslav Georgiev
- Clinic of Rheumatology, University Hospital St. Marina, 9010, Varna, Bulgaria.
- First Department of Internal Medicine, Faculty of Medicine, Medical University-Varna, 9002, Varna, Bulgaria.
| | - Simona Bogdanova-Petrova
- Clinic of Rheumatology, University Hospital St. Marina, 9010, Varna, Bulgaria
- First Department of Internal Medicine, Faculty of Medicine, Medical University-Varna, 9002, Varna, Bulgaria
| | - Tanya Shivacheva
- Clinic of Rheumatology, University Hospital St. Marina, 9010, Varna, Bulgaria
- First Department of Internal Medicine, Faculty of Medicine, Medical University-Varna, 9002, Varna, Bulgaria
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13
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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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14
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Ezeh N, Sirek G, Ulysse SN, Williams JN, Chandler MT, Ojikutu BO, York M, Crespo-Bosque M, Jean-Jacques M, Roberson T, Mancera-Cuevas K, Milaeger H, Losina E, Dhand A, Son MB, Ramsey-Goldman R, Feldman CH. Understanding Stakeholders' Perspectives to Increase COVID-19 Vaccine and Booster Uptake Among Black Individuals With Rheumatic Conditions. Arthritis Care Res (Hoboken) 2023; 75:2508-2518. [PMID: 37309724 PMCID: PMC10716359 DOI: 10.1002/acr.25172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 05/09/2023] [Accepted: 06/08/2023] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Disparities in COVID-19 vaccine and booster uptake persist. This study aimed to obtain perspectives from community and physician stakeholders on COVID-19 vaccine and booster hesitancy and strategies to promote vaccine uptake among Black individuals with rheumatic and musculoskeletal conditions. METHODS We invited community leaders and physicians in greater Boston and Chicago to participate in semi-structured interviews using a moderator guide developed a priori. Participants were queried about how to best address vaccine hesitancy, strategies to target high-risk populations, and factors to identify future community leaders. Interviews were audio recorded, transcribed verbatim, and analyzed thematically using Dedoose. RESULTS A total of 8 physicians and 12 community leaders participated in this study between November 2021 and October 2022. Qualitative analyses revealed misinformation/mixed messaging and mistrust, with subthemes including conspiracy theories, concerns regarding vaccine development and function, racism and historical injustices, and general mistrust of health care systems as the top cited reasons for COVID-19 vaccine hesitancy. Participants also shared demographic-specific differences, such as race, ethnicity, age, and gender that influenced the identified themes, with emphasis on COVID-19 vaccine access and apathy. Strategies for community-based vaccine-related information dissemination included personal storytelling with an iterative and empathetic approach, while recognizing the importance of protecting community leader well-being. CONCLUSION To increase vaccine uptake among Black individuals with rheumatic conditions, strategies should acknowledge and respond to racial/ethnic and socioeconomic injustices that engender vaccine hesitancy. Messaging should be compassionate, individually tailored, and recognize heterogeneity in experiences and opinions. Results from these analyses will inform a planned community-based intervention in Boston and Chicago.
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Affiliation(s)
- Nnenna Ezeh
- Department of Dermatology, Brigham and Women’s Hospital, Boston, MA
- Division of Rheumatology, Inflammation and Immunity, Department of Medicine, Brigham and Women’s Hospital, Boston, MA
| | - Greta Sirek
- Division of Rheumatology, Inflammation and Immunity, Department of Medicine, Brigham and Women’s Hospital, Boston, MA
| | - Sciaska N. Ulysse
- Division of Rheumatology, Inflammation and Immunity, Department of Medicine, Brigham and Women’s Hospital, Boston, MA
| | - Jessica N. Williams
- Division of Rheumatology, Department of Medicine, Emory School of Medicine, Atlanta, GA
| | - Mia T. Chandler
- The Rheumatology Program, Boston Children’s Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Bisola O. Ojikutu
- Harvard Medical School, Boston, MA
- Boston Public Health Commission, Boston, MA
- Division of Global Health Equity, Brigham and Women’s Hospital, Boston, MA
| | - Michael York
- Department of Rheumatology, Boston Medical Center, Boston, MA
| | | | | | - Tonya Roberson
- College of Health and Human Services, Governors State University, University Park, IL
| | | | - Holly Milaeger
- Division of Rheumatology, Department of Medicine Northwestern Medicine/Feinberg School of Medicine, Chicago, IL
| | - Elena Losina
- Harvard Medical School, Boston, MA
- The Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopedics, Brigham and Women’s Hospital, Boston, MA
| | - Amar Dhand
- Division of Neurology, Brigham and Women’s Hospital, Boston, MA
| | - Mary Beth Son
- The Rheumatology Program, Boston Children’s Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Rosalind Ramsey-Goldman
- Division of Rheumatology, Department of Medicine Northwestern Medicine/Feinberg School of Medicine, Chicago, IL
| | - Candace H. Feldman
- Division of Rheumatology, Inflammation and Immunity, Department of Medicine, Brigham and Women’s Hospital, Boston, MA
- Harvard Medical School, Boston, MA
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15
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Wee LE, Conceicao EP, Tan JY, Thumboo J, Venkatachalam I. Correspondence on 'Impact of the COVID-19 pandemic on morbidity and mortality in patients with inflammatory joint diseases and in the general population: a nationwide Swedish cohort study'. Ann Rheum Dis 2023; 82:e224. [PMID: 33837047 DOI: 10.1136/annrheumdis-2021-220462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 03/31/2021] [Indexed: 11/04/2022]
Affiliation(s)
- Liang En Wee
- Infectious Diseases, Singapore General Hospital, Singapore
| | | | - Jing Yuan Tan
- Internal Medicine, Singapore General Hospital, Singapore
| | - Julian Thumboo
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore
| | - Indumathi Venkatachalam
- Infectious Diseases, Singapore General Hospital, Singapore
- Infection Prevention and Epidemiology, Singapore General Hospital, Singapore
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16
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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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17
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Morel J. Infection prevention and vaccination in the rheumatic diseases. Joint Bone Spine 2023; 90:105568. [PMID: 36990142 DOI: 10.1016/j.jbspin.2023.105568] [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] [Accepted: 07/05/2022] [Indexed: 03/29/2023]
Abstract
Patients with chronic inflammatory rheumatisms (CIR) have a higher risk of infections compared to healthy subjects. Viral and bacterial pneumonia are the most frequent infections observed in CIR with targeted disease modifying anti-rheumatic drugs (DMARDs). Moreover, drugs used to treat CIR (especially biologic and synthetic targeted DMARDs) increase the risk of infection and expose CIR patients to opportunistic infections such as tuberculosis reactivation. To limit the risk of infection, the risk-benefit ratio should be evaluated for each patient based on their characteristics and comorbidities. To prevent infections, an initial pre-treatment work-up must be performed, especially before the initiation of conventional synthetic DMARDs or biological and synthetic targeted DMARDs. This pre-treatment assessment includes the case history, laboratory and radiology findings as well. The physician must make sure a patient's vaccinations are up-to-date. The vaccines recommended for patients with CIR being treated with conventional synthetic DMARDs, bDMARDs, tsDMARDs and/or steroids should be given. Patient education is also very important. During workshops, they learn how to manage their drug treatments in at-risk situations and learn which symptoms require treatment discontinuation.
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Affiliation(s)
- Jacques Morel
- Rheumatology Department, CHU and University of Montpellier, PhyMedExp, Inserm, CNRS, Montpellier, France.
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18
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Wroński J, Ciechomska M, Kuca-Warnawin E. Impact of methotrexate treatment on vaccines immunogenicity in adult rheumatological patients - Lessons learned from the COVID-19 pandemic. Biomed Pharmacother 2023; 165:115254. [PMID: 37542854 DOI: 10.1016/j.biopha.2023.115254] [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: 06/16/2023] [Revised: 07/26/2023] [Accepted: 07/28/2023] [Indexed: 08/07/2023] Open
Abstract
Despite the development of new biological and synthetic targeted therapies, methotrexate remains one of the most commonly used immunomodulatory drugs in rheumatology. However, its effect on the immunogenicity of vaccines has been studied only to a limited extent until recently, resulting in the lack of clear guidelines on the use of methotrexate during vaccination. Significant progress was made during the COVID-19 pandemic due to the dynamic development of research on vaccines, including patients with autoimmune inflammatory rheumatic diseases. In the following literature review, we present a summary of what we know so far on the impact of methotrexate on post-vaccination response in adult rheumatology patients, taking into account the lessons learned from the COVID-19 pandemic. Studies on the effect of methotrexate on the immunogenicity of influenza, pneumococcal, herpes zoster, tetanus/diphtheria/pertussis, hepatitis A, yellow fever, and COVID-19 vaccines are described in detail, including the effect of methotrexate on the humoral and cellular response of individual vaccines. The available evidence for recommendations for withholding methotrexate in the post-vaccination period is presented. Lastly, an overview of potential immunological mechanisms through which MTX modulates the immunogenicity of vaccinations is also provided.
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Affiliation(s)
- Jakub Wroński
- Department of Rheumatology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Spartańska 1, 02-637 Warsaw, Poland.
| | - Marzena Ciechomska
- Department of Pathophysiology and Immunology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Spartańska 1, 02-637 Warsaw, Poland
| | - Ewa Kuca-Warnawin
- Department of Pathophysiology and Immunology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Spartańska 1, 02-637 Warsaw, Poland
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19
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Ohm M, van Straalen JW, de Joode-Smink G, van Montfrans J, Bartels M, van Wildenbeest JG, Lindemans CA, Wennink RA, de Boer JH, Sanders EA, Verduyn-Lunel FM, Berbers GA, Wulffraat NM, Jansen MHA. Meningococcal ACWY conjugate vaccine immunogenicity in adolescents with primary or secondary immune deficiencies, a prospective observational cohort study. Pediatr Rheumatol Online J 2023; 21:73. [PMID: 37475057 PMCID: PMC10360259 DOI: 10.1186/s12969-023-00846-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 06/16/2023] [Indexed: 07/22/2023] Open
Abstract
BACKGROUND Immunization with meningococcal ACWY conjugate vaccine induces protective antibodies against invasive meningococcal disease (IMD) caused by serogroups A, C, W and Y. We studied MenACWY-TT vaccine immunogenicity in adolescents with a heterogenous group of primary and secondary immune deficiency including patients with systemic lupus erythematosus, mixed connective tissue disease, vasculitis, uveitis, 22Q11 syndrome, sickle cell disease, and patients who underwent stem cell transplantation for bone marrow failure. FINDINGS We enrolled 69 individuals aged 14-18 years diagnosed with a primary or secondary immune deficiency in a prospective observational cohort study. All patients received a single dose of MenACWY-TT vaccine during the catch-up campaign 2018-19 because of the IMD-W outbreak in the Netherlands. Capsular polysaccharide-specific (PS) IgG concentrations against MenACWY were measured before and 3-6, 12, and 24 months after vaccination. Overall, geometric mean concentrations (GMCs) of MenACWY-PS-specific IgG were lower in patients compared to data from healthy, aged-matched controls (n = 75) reaching significance at 12 months postvaccination for serogroup A and W (adjusted GMC ratios 0.26 [95% CI: 0.15-0.47] and 0.22 [95% CI: 0.10-0.49], respectively). No serious adverse events were reported by study participants. CONCLUSIONS The MenACWY conjugate vaccine was less immunogenic in adolescent patients with primary or secondary immunodeficiency compared to healthy controls, urging the need for further surveillance of these patients and supporting considerations for booster MenACWY conjugate vaccinations in these patient groups.
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Affiliation(s)
- Milou Ohm
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Joeri W van Straalen
- Department of Pediatric Immunology and Rheumatology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Gerrie de Joode-Smink
- Department of Pediatric Immunology and Rheumatology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Joris van Montfrans
- Department of Pediatric Immunology and Rheumatology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, the Netherlands
- Department of Pediatric Infectious Diseases, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Marije Bartels
- Department of Pediatric Hematology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Joanne G van Wildenbeest
- Department of Pediatric Infectious Diseases, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Caroline A Lindemans
- Department of Pediatric Immunology and Rheumatology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, the Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Roos Aw Wennink
- Department of Ophthalmology, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Joke H de Boer
- Department of Ophthalmology, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Elisabeth Am Sanders
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Frans M Verduyn-Lunel
- Department of Medical Microbiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Guy Am Berbers
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Nico M Wulffraat
- Department of Pediatric Immunology and Rheumatology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Marc H A Jansen
- Department of Pediatric Immunology and Rheumatology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, the Netherlands.
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20
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Song YJ, Cho SK, Kim H, Kim HW, Nam E, Jeon JY, Yoo HJ, Choi CB, Kim TH, Jun JB, Bae SC, Yoo DH, Sung YK. Increased risk of herpes zoster with tofacitinib treatment in Korean patients with rheumatoid arthritis: a single-center prospective study. Sci Rep 2023; 13:7877. [PMID: 37188765 DOI: 10.1038/s41598-023-33718-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 04/18/2023] [Indexed: 05/17/2023] Open
Abstract
We aimed to determine the risk of herpes zoster (HZ) in Korean rheumatoid arthritis (RA) patients on tofacitinib compared with tumor necrosis factor inhibitor (TNFi) treatment. From the prospective cohorts of RA patients who started tofacitinib or TNFi in an academic referral hospital in Korea, patients who started tofacitinib between March 2017 and May 2021 and those who started TNFi between July 2011 and May 2021 were included. Baseline characteristics of tofacitinib and TNFi users were balanced through inverse probability of treatment weighting (IPTW) using the propensity score including age, disease activity of RA and medication use. The incidence rate of HZ in each group and incidence rate ratio (IRR) were calculated. A total of 912 patients were included: 200 tofacitinib and 712 TNFi users. There were 20 cases of HZ among tofacitinib users and 36 among TNFi users during observation period of 331.4 person-years (PYs) and 1950.7 PYs, respectively. In IPTW analysis with a balanced sample, IRR of HZ was 8.33 (95% confidence interval 3.05-22.76). Tofacitinib use increased the risk of HZ compared with TNFi in Korean patients with RA, but the rate of serious HZ or permanent discontinuation of tofacitinib due to HZ event was low.
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Affiliation(s)
- Yeo-Jin Song
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, 222-1 Wangsimni-ro, Seongdong-gu, Seoul, 04763, Republic of Korea
- Hanyang University Institute for Rheumatology Research, Seoul, Republic of Korea
| | - Soo-Kyung Cho
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, 222-1 Wangsimni-ro, Seongdong-gu, Seoul, 04763, Republic of Korea
- Hanyang University Institute for Rheumatology Research, Seoul, Republic of Korea
| | - Hyoungyoung Kim
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, 222-1 Wangsimni-ro, Seongdong-gu, Seoul, 04763, Republic of Korea
- Hanyang University Institute for Rheumatology Research, Seoul, Republic of Korea
| | - Hye Won Kim
- Hanyang University Institute for Rheumatology Research, Seoul, Republic of Korea
| | - Eunwoo Nam
- Hanyang University Institute for Rheumatology Research, Seoul, Republic of Korea
| | - Ja-Young Jeon
- Pfizer Pharmaceuticals Korea Ltd., Seoul, Republic of Korea
| | - Hyun-Jeong Yoo
- Pfizer Pharmaceuticals Korea Ltd., Seoul, Republic of Korea
| | - Chan-Bum Choi
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, 222-1 Wangsimni-ro, Seongdong-gu, Seoul, 04763, Republic of Korea
- Hanyang University Institute for Rheumatology Research, Seoul, Republic of Korea
| | - Tae-Hwan Kim
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, 222-1 Wangsimni-ro, Seongdong-gu, Seoul, 04763, Republic of Korea
- Hanyang University Institute for Rheumatology Research, Seoul, Republic of Korea
| | - Jae-Bum Jun
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, 222-1 Wangsimni-ro, Seongdong-gu, Seoul, 04763, Republic of Korea
- Hanyang University Institute for Rheumatology Research, Seoul, Republic of Korea
| | - Sang-Cheol Bae
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, 222-1 Wangsimni-ro, Seongdong-gu, Seoul, 04763, Republic of Korea
- Hanyang University Institute for Rheumatology Research, Seoul, Republic of Korea
| | - Dae Hyun Yoo
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, 222-1 Wangsimni-ro, Seongdong-gu, Seoul, 04763, Republic of Korea
- Hanyang University Institute for Rheumatology Research, Seoul, Republic of Korea
| | - Yoon-Kyoung Sung
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, 222-1 Wangsimni-ro, Seongdong-gu, Seoul, 04763, Republic of Korea.
- Hanyang University Institute for Rheumatology Research, Seoul, Republic of Korea.
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21
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The impact of immunomodulating treatment on the immunogenicity of COVID-19 vaccines in patients with immune-mediated inflammatory rheumatic diseases compared to healthy controls. A Swedish nationwide study (COVID19-REUMA). Vaccine 2023; 41:3247-3257. [PMID: 37076360 PMCID: PMC10070777 DOI: 10.1016/j.vaccine.2023.03.065] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 03/10/2023] [Accepted: 03/29/2023] [Indexed: 04/07/2023]
Abstract
Objectives To elucidate antibody responses after the second and third dose of COVID-19 vaccine in patients with inflammatory rheumatic diseases (IRD) treated with biologic/targeted disease modifying anti-rheumatic drugs (b/ts DMARDs). Methods Antibody levels to antigens representing spike full length protein and spike S1 were measured before vaccination, 2-12 weeks after the second dose, before and after the third dose using multiplex bead-based serology assay. Positive antibody response was defined as antibody levels over cut off (seropositivity) in seronegative individuals or ≥4-fold increase in antibodies in individuals seropositive for both spike proteins. Results Patients (n=414) receiving b/ts DMARDs (283 had arthritis, 75 systemic vasculitis and 56 other autoimmune diseases) and controls (n=61) from five Swedish regions participated. Treatments groups were: rituximab (n=145); abatacept (n=22); Interleukin 6 receptor inhibitors [IL6i (n=79)]; JAnus Kinase Inhibitors [JAKi (n=58)], Tumour Necrosis Factor inhibitor [TNFi (n=68)] and Interleukin12/23/17 inhibitors [IL12/23/17i (n=42)]. Percentage of patients with positive antibody response after two doses was significantly lower in rituximab (33,8%) and abatacept (40,9%) (p<0,001) but not in IL12/23/17i, TNFi or JAKi groups compared to controls (80,3%). Higher age, rituximab treatment and shorter time between last rituximab course and vaccination predicted impaired antibody response. Antibody levels collected 21-40 weeks after second dose decreased significantly (IL6i: p=0,02; other groups: p<0,001) compared to levels at 2-12 week but most participants remained seropositive. Proportion of patients with positive antibody response increased after third dose but was still significantly lower in rituximab (p<0,001). Conclusions Older individuals and patients on maintenance rituximab have an impaired response after two doses of COVID-19 vaccine which improves if the time between last rituximab course and vaccination extends and also after an additional vaccine dose. Rituximab patients should be prioritized for booster vaccine doses. TNFi, JAKi and IL12/23/17i does not diminished humoral response to primary and an additional vaccination.
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22
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Moon KW. Vaccination of patients with autoimmune inflammatory rheumatic disease: physicians' perspectives. JOURNAL OF RHEUMATIC DISEASES 2023; 30:69-71. [PMID: 37483482 PMCID: PMC10324938 DOI: 10.4078/jrd.2023.0017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 03/10/2023] [Indexed: 07/25/2023]
Affiliation(s)
- Ki Won Moon
- Division of Rheumatology, Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Korea
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23
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Mori S, Ueki Y, Ishiwada N. Impact of Janus kinase inhibitors on antibody response to 13-valent pneumococcal conjugate vaccine in patients with rheumatoid arthritis. Mod Rheumatol 2023; 33:312-317. [PMID: 35348759 DOI: 10.1093/mr/roac029] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 03/02/2022] [Accepted: 03/11/2022] [Indexed: 11/13/2022]
Abstract
OBJECTIVES To evaluate the antibody response to 13-valent pneumococcal conjugate vaccine (PCV13) in patients with rheumatoid arthritis receiving Janus kinase inhibitors (JAKIs). METHODS Fifty-three patients receiving methotrexate (MTX; n = 10), JAKI (n = 20), or MTX + JAKI (n = 23) were vaccinated with PCV13. Serum concentrations of immunoglobulin G (IgG) antibodies to 13 pneumococcal serotype capsular polysaccharides were quantified before and 4-6 weeks after vaccination. Positive antibody response was defined as a 2-fold or more increase in IgG concentrations from prevaccination levels. RESULTS After vaccination, IgG concentrations significantly increased in all treatment groups (P <0.001), but fold increases (postvaccination to prevaccination ratios) were different among treatment groups (9.30 for MTX, 6.36 for JAKI, and 3.46 for combination therapy). Positive antibody response rates were comparable between the MTX group (90%) and the JAKI group (95%) but lower in the MTX + JAKI group (52.2%). In a multivariable logistic regression analysis, the combination therapy was the only factor associated with a reduced antibody response to PCV13. No severe adverse events were observed in any treatment group. CONCLUSION Although JAKIs do not impair PCV13 immunogenicity in rheumatoid arthritis patients, the combination of MTX with JAKI can reduce the antibody response in this patient population.
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Affiliation(s)
- Shunsuke Mori
- Department of Rheumatology, Clinical Research Center for Rheumatic Diseases, National Hospital Organization Kumamoto Saishun Medical Center, Kohshi, Kumamoto, Japan
| | - Yukitaka Ueki
- Rheumatic and Collagen Disease Center, Sasebo Chuo Hospital, Sasebo, Nagasaki, Japan
| | - Naruhiko Ishiwada
- Department of Infectious Diseases, Medical Mycology Research Center, Chiba University, Chiba, Japan
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24
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Curtis JR, Johnson SR, Anthony DD, Arasaratnam RJ, Baden LR, Bass AR, Calabrese C, Gravallese EM, Harpaz R, Kroger A, Sadun RE, Turner AS, Williams EA, Mikuls TR. American College of Rheumatology Guidance for COVID-19 Vaccination in Patients With Rheumatic and Musculoskeletal Diseases: Version 5. Arthritis Rheumatol 2023; 75:E1-E16. [PMID: 36345691 PMCID: PMC9878068 DOI: 10.1002/art.42372] [Citation(s) in RCA: 41] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 03/02/2022] [Accepted: 09/22/2022] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To provide guidance to rheumatology providers on the use of COVID-19 vaccines for patients with rheumatic and musculoskeletal diseases (RMDs). METHODS A task force was assembled that included 9 rheumatologists/immunologists, 2 infectious diseases specialists, and 2 public health physicians. After agreeing on scoping questions, an evidence report was created that summarized the published literature and publicly available data regarding COVID-19 vaccine efficacy and safety, as well as literature for other vaccines in RMD patients. Task force members rated their agreement with draft consensus statements on a 9-point numerical scoring system, using a modified Delphi process and the RAND/University of California Los Angeles Appropriateness Method, with refinement and iteration over 2 sessions. Consensus was determined based on the distribution of ratings. RESULTS Despite a paucity of direct evidence, statements were developed by the task force and agreed upon with consensus to provide guidance for use of the COVID-19 vaccines, including supplemental/booster dosing, in RMD patients and to offer recommendations regarding the use and timing of immunomodulatory therapies around the time of vaccination. CONCLUSION These guidance statements are intended to provide direction to rheumatology health care providers on how to best use COVID-19 vaccines and to facilitate implementation of vaccination strategies for RMD patients.
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Affiliation(s)
| | - Sindhu R. Johnson
- Toronto Western HospitalMount Sinai Hospital, and University of TorontoTorontoOntarioCanada
| | - Donald D. Anthony
- Louis Stokes Cleveland VA Medical CenterMetroHealth Medical Center, and Case Western Reserve UniversityClevelandOhio
| | - Reuben J. Arasaratnam
- VA North Texas Health Care System and University of Texas Southwestern Medical CenterDallas
| | | | - Anne R. Bass
- Hospital for Special Surgery and Weill Cornell MedicineNew YorkNew York
| | | | | | | | | | | | | | | | - Ted R. Mikuls
- University of Nebraska Medical Center and VA Nebraska–Western Iowa Health Care SystemOmaha
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25
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Siegel CH, Choi JM, D'Angelo D, Christos P, Lally L, Navarro-Millan I, Cooke J, Goyal P, Mandl LA, Barbhaiya M. Outcomes of COVID-19 and Factors Associated With Its Severity Among Hospitalized Patients With and Without Systemic Rheumatic Disease During the First Wave of the Pandemic in New York City. J Clin Rheumatol 2023; 29:7-15. [PMID: 35905465 PMCID: PMC9803346 DOI: 10.1097/rhu.0000000000001891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND/OBJECTIVE Conflicting data exist regarding whether patients with systemic rheumatic disease (SRD) experience more severe outcomes related to COVID-19. Using data from adult patients hospitalized with COVID-19 in New York City during the first wave of the pandemic, we evaluated whether patients with SRD were at an increased risk for severe outcomes. METHODS We conducted a medical records review study including patients aged ≥18 years with confirmed SARS-CoV-2 infection hospitalized at 3 NewYork-Presbyterian sites, March 3-May 15, 2020. Inverse probability of treatment weighting was applied to a multivariable logistic regression model to assess the association between SRD status and the composite of mechanical ventilation, intensive care unit admission, or death. RESULTS Of 3710 patients hospitalized with COVID-19 (mean [SD] age, 63.7 [17.0] years; 41% female, 29% White, and 34% Hispanic/Latinx), 92 (2.5%) had SRD. Patients with SRD had similar age and body mass index but were more likely to be female, ever smokers, and White or Black, compared with those without SRD. A higher proportion of patients with versus without SRD had hypertension and pulmonary disease, and used hydroxychloroquine, corticosteroids, and immunomodulatory/immunosuppressive medications before admission. In the weighted multivariable analysis, patients with SRD had an odds ratio of 1.24 (95% confidence interval, 1.10-1.41; p < 0.01) for the composite of mechanical ventilation, intensive care unit admission, or death, compared with patients without SRD. CONCLUSIONS During the initial peak of the pandemic in New York City, patients with versus without SRD hospitalized with COVID-19 had a 24% increased likelihood of having severe COVID-19 after multivariable adjustment.
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Affiliation(s)
- Caroline H. Siegel
- From the Division of Rheumatology, Hospital for Special Surgery
- Department of Medicine, Weill Cornell Medicine
| | - Jacky M. Choi
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY
| | - Debra D'Angelo
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY
| | - Paul Christos
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY
| | - Lindsay Lally
- From the Division of Rheumatology, Hospital for Special Surgery
- Department of Medicine, Weill Cornell Medicine
| | - Iris Navarro-Millan
- From the Division of Rheumatology, Hospital for Special Surgery
- Department of Medicine, Weill Cornell Medicine
| | - Joseph Cooke
- Department of Medicine, Weill Cornell Medicine
- Department of Medicine, NewYork-Presbyterian/Queens, Queens, NY
| | - Parag Goyal
- Department of Medicine, Weill Cornell Medicine
| | - Lisa A. Mandl
- From the Division of Rheumatology, Hospital for Special Surgery
- Department of Medicine, Weill Cornell Medicine
| | - Medha Barbhaiya
- From the Division of Rheumatology, Hospital for Special Surgery
- Department of Medicine, Weill Cornell Medicine
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY
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26
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Chen Y, Chen B, Shen X, Zhou A, Liang Y, Wang Y, Chen H. A survey of systemic lupus erythematosus patients' attitudes toward influenza and pneumococcal vaccination in Southwest China. Front Public Health 2022; 10:1018899. [PMID: 36605245 PMCID: PMC9807807 DOI: 10.3389/fpubh.2022.1018899] [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: 09/09/2022] [Accepted: 11/08/2022] [Indexed: 12/24/2022] Open
Abstract
Introduction Vaccination is the most effective measure for prevention against infectious diseases in patients with systemic lupus erythematosus (SLE). Therefore, it is important to know SLE patients' attitudes toward influenza and pneumococcal vaccination. This study aimed to investigate the attitude toward influenza and pneumococcal vaccination among SLE patients in Southwest China and its influencing factors. Methods A web-based questionnaire was conducted to collect data regarding SLE patients' demographics, history of infections, medications, comorbidities, attitudes toward infection and vaccination, rates of influenza and pneumococcal vaccination, and role of health professionals in promoting vaccination. Univariate and multivariate logistic regression analyses were conducted to assess the vaccination willingness-associated factors. Results A total of 251 patients participated in the survey and 240 questionnaires were completed and statistically analyzed. The influenza and pneumococcal vaccination rates were 8.3 and 1.7%, respectively. The top three reasons for non-vaccination were worrying about the SLE exacerbation or flare resulting from the vaccine or its adjuvants, being concerned about adverse events, and the lack of awareness of vaccine availability. More than half of the participants were willing to be vaccinated against influenza (56.2%) and pneumococcus (52.9%). Factors associated to the willingness to receive the influenza vaccine and pneumococcal vaccine were being afraid of infection, believing in the efficacy of influenza vaccination, lower family income, less perceived care from family members, perceived susceptibility to pneumococcal infection, and perceiving influenza and pneumococcal vaccination as beneficial for health. Conclusions The influenza and pneumococcal vaccination rates are low among SLE patients in Southwest China. The positive perspective of vaccination on health represented the most impacting factor on their willingness to undergo influenza and pneumococcal vaccination. Non-vaccinated patients were mainly concerned about exacerbation of the disease or adverse events caused by vaccines. It is important to improve the compliance with the guideline-recommended roles of health professionals and to promote the collaboration between rheumatology and primary care teams.
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Affiliation(s)
- Yanling Chen
- West China School of Nursing, Department of Rheumatology and Immunology, West China Hospital, Sichuan University, Chengdu, China
| | - Bo Chen
- Department of Rheumatology and Immunology, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaolin Shen
- West China School of Nursing, Department of Rheumatology and Immunology, West China Hospital, Sichuan University, Chengdu, China
| | - Aiping Zhou
- West China School of Nursing, Department of Rheumatology and Immunology, West China Hospital, Sichuan University, Chengdu, China
| | - Yan Liang
- West China School of Nursing, Department of Rheumatology and Immunology, West China Hospital, Sichuan University, Chengdu, China
| | - Ying Wang
- West China School of Nursing, Department of Rheumatology and Immunology, West China Hospital, Sichuan University, Chengdu, China
| | - Hong Chen
- West China School of Nursing, West China Hospital, Sichuan University, Chengdu, China,*Correspondence: Hong Chen
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27
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Roseti L, Grigolo B. COVID-19 and rheumatic diseases: A mini-review. Front Med (Lausanne) 2022; 9:997876. [PMID: 36226148 PMCID: PMC9548696 DOI: 10.3389/fmed.2022.997876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 09/12/2022] [Indexed: 11/13/2022] Open
Abstract
Joint pain and arthralgia can be manifestations of COVID-19, and studies evaluating long COVID symptoms identified the persistence of these disorders. Moreover, some case reports highlighted the development of new inflammatory arthritis in patients with COVID-19, suggesting a possible relation. Viral infections and rheumatic diseases share a documented relationship; they have been associated with genetic and environmental risk factors responsible for some of them. There is crosstalk between viruses and the immune system during the development of several rheumatic diseases. Moreover, infections may participate in the pathogenesis of autoimmune rheumatic diseases and contribute to patient mortality. Therefore, it is crucial to provide a clearer insight into the interaction between viral infections and rheumatic diseases. Here, we provide a mini-review of the current literature with the aim of shedding light on the relationship between COVID-19 and rheumatic or musculoskeletal diseases, which is still unclear. Specifically, we examined several aspects: risk for the rheumatic population of acquiring the virus or developing severe symptoms, similarities of COVID-19 and arthritis, the possible rheumatic consequence of COVID-19, of rheumatic drugs and vaccines, and COVID-19 prevention in rheumatic patients through vaccination.
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28
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Chevet B, Figueroa-Parra G, Yang JX, Hocaoglu M, Osei-Onomah SA, Hulshizer CA, Gunderson TM, Cornec D, Barbour KE, Greenlund KJ, Crowson CS, Duarte-García A. Utilization of preventive services in a systemic lupus erythematosus population-based cohort: a Lupus Midwest Network (LUMEN) study. Arthritis Res Ther 2022; 24:211. [PMID: 36050780 PMCID: PMC9434086 DOI: 10.1186/s13075-022-02878-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 07/24/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Systemic lupus erythematosus (SLE) is a disease that can lead to damage of multiple organs and, along with certain treatments, increase the risk of developing cancer, cardiovascular disease, diabetes, osteoporosis, and infections. Preventive services are particularly important in patients with SLE to mitigate the aforementioned risks. We aimed to evaluate the trends of preventive services utilization in patients with systemic lupus erythematosus, compared with non-SLE population. METHODS All ≥19-year-old patients in the Lupus Midwest Network (LUMEN) registry, a population-based cohort, with SLE on January 1, 2015, were included and matched (1:1) by sex, age, race, and county to non-SLE comparators. Among both groups, we compared the rates of screenings for breast and cervical cancer, hypertension, hyperlipidemia, diabetes mellitus, and osteoporosis as well as immunizations. RESULTS We included 440 SLE patients and 430 non-SLE comparators. The probability of breast cancer screening among women with SLE was similar to comparators (hazard ratio [HR] 1.09, 95% CI 0.85-1.39), while cervical cancer screening was lower (HR 0.75, 95% CI 0.58-0.96). Hypertension screening was higher among patients with SLE (HR 1.35, 95% CI 1.13-1.62); however, hyperlipidemia screening was similar to comparators (HR 1.16, 95% CI 0.96-1.41). Diabetes and osteoporosis screenings were more likely to be performed for SLE patients than for comparators (HR 2.46, 95% CI 2.11-2.87; and HR 3.19, 95% CI 2.31-4.41; respectively). Influenza and pneumococcal immunizations were higher among SLE patients (HR 1.31, 95% CI 1.12-1.54; and HR 2.06, 95% CI 1.38-3.09; respectively), while zoster vaccination was similar (HR 1.17, 95% CI 0.81-1.69). CONCLUSIONS The trends of utilization of preventive services by SLE patients vary according to screening or vaccine compared with the general population. Considering these differences, we demonstrate an opportunity for improvement, particularly in cervical cancer, hyperlipidemia, and osteoporosis screenings and vaccinations.
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Affiliation(s)
- Baptiste Chevet
- Division of Rheumatology, Mayo Clinic, Rochester, 200 First Street SW, MN, 55905, USA
- Division of Rheumatology, Brest Teaching Hospital; LBAI, UMR1227, Univ Brest, Inserm, CHU de Brest, Brest, France
| | | | - Jeffrey X Yang
- Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Mehmet Hocaoglu
- Division of Rheumatology, Mayo Clinic, Rochester, 200 First Street SW, MN, 55905, USA
| | | | | | - Tina M Gunderson
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Divi Cornec
- Division of Rheumatology, Brest Teaching Hospital; LBAI, UMR1227, Univ Brest, Inserm, CHU de Brest, Brest, France
| | - Kamil E Barbour
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kurt J Greenlund
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Cynthia S Crowson
- Division of Rheumatology, Mayo Clinic, Rochester, 200 First Street SW, MN, 55905, USA
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Alí Duarte-García
- Division of Rheumatology, Mayo Clinic, Rochester, 200 First Street SW, MN, 55905, USA.
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA.
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He N, Leng X, Zeng X. Systemic lupus erythematosus following human papillomavirus vaccination: A case-based review. Int J Rheum Dis 2022; 25:1208-1212. [PMID: 35948863 DOI: 10.1111/1756-185x.14404] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 07/09/2022] [Accepted: 07/16/2022] [Indexed: 01/03/2023]
Abstract
Systemic lupus erythematosus (SLE) is a heterogeneous systemic autoimmune diseases (AIDs) with many pathogenic factors, ranging from genetic to epigenetic to environmental. The human papillomavirus (HPV), a viral infectious agent, is a common contributor to the onset and exacerbation of SLE. HPV infections are more prevalent among SLE patients than healthy individuals, bringing about a substantial need for treatment. While HPV recombinant gene vaccines are accepted as a universal method for infection prevention, they pose a risk for adverse events such as fever, joint pain, and rashes. In rare cases, they might even trigger AIDs such as SLE, especially in patients with a personal or family history of such diseases. In this article, we provide a report of a case of SLE onset following HPV vaccination and a review of 11 similar cases. An analysis of 12 patients revealed that 7 cases of SLE developed between 3 weeks and 2 months post-vaccination. Symptoms of SLE generally manifest as fatigue, fever, joint pain, and myalgia. Two patients had lupus nephritis, 2 showed central nervous system involvement, including abnormal behavior and epileptic seizures, and 1 had intestinal pseudo-obstruction. All patients showed rapid remission with glucocorticoid and immunosuppressive therapy and remained stable during several months of follow-up.
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Affiliation(s)
- Nan He
- The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Xiaomei Leng
- Peking Union Medical College Hospital, Beijing, China
| | - Xiaofeng Zeng
- Peking Union Medical College Hospital, Beijing, China
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Barbhaiya M, Frey MB, Levine J, Vitone G, Lally L, Lockshin MD, Bykerk V, Feldman CH, Mandl LA. Modification of immunomodulatory medications by rheumatology patients during the peak of the COVID-19 pandemic in New York City. Clin Rheumatol 2022; 41:2597-2599. [PMID: 35596096 PMCID: PMC9122542 DOI: 10.1007/s10067-022-06203-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 04/27/2022] [Accepted: 05/05/2022] [Indexed: 11/25/2022]
Affiliation(s)
- Medha Barbhaiya
- Division of Rheumatology, Hospital for Special Surgery, New York, NY USA
- Department of Medicine, Weill Cornell Medicine, New York, NY USA
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY USA
| | | | | | | | - Lindsay Lally
- Division of Rheumatology, Hospital for Special Surgery, New York, NY USA
- Department of Medicine, Weill Cornell Medicine, New York, NY USA
| | - Michael D. Lockshin
- Division of Rheumatology, Hospital for Special Surgery, New York, NY USA
- Department of Medicine, Weill Cornell Medicine, New York, NY USA
| | - Vivian Bykerk
- Division of Rheumatology, Hospital for Special Surgery, New York, NY USA
- Department of Medicine, Weill Cornell Medicine, New York, NY USA
| | - Candace H. Feldman
- Division of Rheumatology, Inflammation, and Immunity, Department of Medicine, Brigham and Women’s Hospital, Boston, MA USA
| | - Lisa A. Mandl
- Division of Rheumatology, Hospital for Special Surgery, New York, NY USA
- Department of Medicine, Weill Cornell Medicine, New York, NY USA
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY USA
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31
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Apaydin H, Erden A, Güven SC, Armağan B, Konak HE, Polat B, Afşin Y, Kaygisiz M, Omma A, Kucuksahin O. Effects of anti‐SARS‐CoV‐2 vaccination on safety and disease exacerbation in patients with Behçet syndrome in a monocentric cohort. Int J Rheum Dis 2022; 25:1068-1077. [PMID: 35851753 PMCID: PMC9349705 DOI: 10.1111/1756-185x.14387] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 06/21/2022] [Accepted: 06/29/2022] [Indexed: 01/05/2023]
Abstract
Aim Vaccination represents a cornerstone in mastering the coronavirus disease 2019 (COVID‐19) pandemic. There is a paucity of data regarding the safety of COVID‐19 vaccines in patients with rheumatic diseases such as Behçet syndrome (BS). The present study aimed to investigate the side‐effects and post‐vaccine disease exacerbation rates of COVID‐19 vaccines in a BS cohort. Methods We retrospectively evaluated 450 BS patients followed in our clinic who met the criteria of the International Study Group. COVID‐19 vaccination status, type of vaccine received (Pfizer‐BioNTech vs CoronaVac), post‐vaccine side‐effects and exacerbations were evaluated by interviewing patients over the phone or face to face. Behçet's Disease Current Activity Form (BDCAF) scores were calculated for BS symptoms before and after vaccination. Results In all, 287 patients received at least one dose of the COVID‐19 vaccine. Of the total number of COVID‐19 vaccines (n = 639), 379 (59%) were Pfizer‐BioNTech vaccines and 257 (41%) were CoronaVac vaccines. The number of side‐effects after first, second, third and fourth vaccine doses were 151 (52.6%), 135 (49.4%), 29 (42.6%), and 3 (30%), respectively. BS exacerbation after first, second, third, and fourth vaccine doses were 151 (52.6%), 135 (49.4%), 16 (23.5%), and 3 (30%), respectively. Injection site pain/swelling was the most common side‐effect at all vaccine doses followed by fatigue and arthralgia. Conclusion COVID‐19 vaccines are well tolerated in patients with BS, and more side‐effects develop after mRNA vaccines. Regardless of the vaccine type, exacerbations after the COVID‐19 vaccine are common, predominantly mucocutaneous and articular involvement, and exacerbations in the form of other organ involvement are rare.
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Affiliation(s)
- Hakan Apaydin
- Clinical Rheumatology Ankara City Hospital Cankaya Turkey
| | - Abdulsamet Erden
- Division of Rheumatology, Department of Internal Medicine Yıldırım Beyazıt University, Ankara City Hospital Ankara Türkiye
| | | | - Berkan Armağan
- Clinical Rheumatology Ankara City Hospital Cankaya Turkey
| | | | - Bünyamin Polat
- Clinical Rheumatology Ankara City Hospital Cankaya Turkey
| | - Yağnur Afşin
- Internal Medicine Ankara City Hospital Ankara Türkiye
| | | | - Ahmet Omma
- Clinical Rheumatology University of Health Sciences Ankara Türkiye
| | - Orhan Kucuksahin
- Division of Rheumatology, Department of Internal Medicine Yıldırım Beyazıt University, Ankara City Hospital Ankara Türkiye
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Rúa-Figueroa Fernández de Larrinoa Í, Carreira PE, Brito García N, Díaz Del Campo Fontecha P, Pego Reigosa JM, Gómez Puerta JA, Ortega-Castro R, Tejera Segura B, Aguado García JM, Torre-Cisneros J, Valencia-Martín JL, Pereda CA, Nishishinya-Aquino MB, Otón Sánchez MT, Silva Fernández L, Maese Manzano J, Chamizo Carmona E, Correyero Plaza M. Recommendations for prevention of infection in systemic autoimmune rheumatic diseases. REUMATOLOGIA CLINICA 2022; 18:317-330. [PMID: 34607782 DOI: 10.1016/j.reumae.2021.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 04/11/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To develop recommendations for the prevention of infection in adult patients with systemic autoimmune rheumatic diseases (SARD). METHODS Clinical research questions relevant to the objective of the document were identified by a panel of experts selected based on their experience in the field. Systematic reviews of the available evidence were conducted, and evidence was graded according to the Scottish Intercollegiate Guidelines Network criteria. Specific recommendations were made. RESULTS Five questions were selected, referring to prevention of infection by Pneumocystis jirovecii with trimethoprim/sulfamethoxazole, primary and secondary prophylactic measures against hepatitis B virus, vaccination against human papillomavirus, vaccination against Streptococcus pneumoniae and vaccination against influenza virus, making a total of 18 recommendations, structured by question, based on the evidence found for the different SARD and/or expert consensus. CONCLUSIONS There is enough evidence on the safety and efficacy of vaccinations and other prophylactic measures against the microorganisms reviewed in this document to specifically recommend them for patients with SARD.
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Affiliation(s)
| | - Patricia E Carreira
- Servicio de Reumatología, Hospital Universitario 12 de octubre, Madrid, Spain
| | - Noé Brito García
- Unidad de Investigación, Sociedad Española de Reumatología, Madrid, Spain.
| | | | - José María Pego Reigosa
- Servicio de Reumatología, Complexo Hospitalario Universitario de Vigo, Grupo IRIDIS-VIGO (Investigation in Rheumatology and Immune-Mediated Diseases), Instituto de Investigación Sanitaria Galicia Sur (IISGS), Vigo, Spain
| | | | - Rafaela Ortega-Castro
- Unidad de Gestión Clínica de Reumatologia, Hospital Universitario Reina Sofía, Universidad de Córdoba, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
| | | | - José María Aguado García
- Unidad de Enfermedades Infecciosas, Hospital Universitario 12 de Octubre. Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Universidad Complutense Madrid, Madrid, Spain
| | - Julián Torre-Cisneros
- Servicio de Enfermedades Infecciosas, Hospital Universitario Reina Sofía, Instituto Maimónides de Investigación Biomédica (IMIBIC), Departamento de Ciencias Médicas y Quirúrgicas, Universidad de Córdoba, Córdoba, Spain
| | - José L Valencia-Martín
- Servicio de Medicina Preventiva y Salud Pública, Hospital Universitario Ramón y Cajal, Madrid, Spain
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Curtis JR, Johnson SR, Anthony DD, Arasaratnam RJ, Baden LR, Bass AR, Calabrese C, Gravallese EM, Harpaz R, Kroger A, Sadun RE, Turner AS, Williams EA, Mikuls TR. American College of Rheumatology Guidance for COVID-19 Vaccination in Patients With Rheumatic and Musculoskeletal Diseases: Version 4. Arthritis Rheumatol 2022; 74:e21-e36. [PMID: 35474640 PMCID: PMC9082483 DOI: 10.1002/art.42109] [Citation(s) in RCA: 42] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 03/02/2022] [Accepted: 03/02/2022] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To provide guidance to rheumatology providers on the use of COVID-19 vaccines for patients with rheumatic and musculoskeletal diseases (RMDs). METHODS A task force was assembled that included 9 rheumatologists/immunologists, 2 infectious disease specialists, and 2 public health physicians. After agreeing on scoping questions, an evidence report was created that summarized the published literature and publicly available data regarding COVID-19 vaccine efficacy and safety, as well as literature for other vaccines in RMD patients. Task force members rated their agreement with draft consensus statements on a 9-point numerical scoring system, using a modified Delphi process and the RAND/University of California Los Angeles Appropriateness Method, with refinement and iteration over 2 sessions. Consensus was determined based on the distribution of ratings. RESULTS Despite a paucity of direct evidence, statements were developed by the task force and agreed upon with consensus to provide guidance for use of the COVID-19 vaccines, including supplemental/booster dosing, in RMD patients and to offer recommendations regarding the use and timing of immunomodulatory therapies around the time of vaccination. CONCLUSION These guidance statements are intended to provide direction to rheumatology health care providers on how to best use COVID-19 vaccines and to facilitate implementation of vaccination strategies for RMD patients.
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Affiliation(s)
| | - Sindhu R Johnson
- Toronto Western Hospital, Mount Sinai Hospital, and University of Toronto, Toronto, Ontario, Canada
| | - Donald D Anthony
- Louis Stokes Cleveland VA Medical Center, MetroHealth Medical Center, and Case Western Reserve University, Cleveland, Ohio
| | - Reuben J Arasaratnam
- VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas
| | | | - Anne R Bass
- Hospital for Special Surgery and Weill Cornell Medicine, New York, New York
| | | | | | | | | | | | - Amy S Turner
- American College of Rheumatology, Atlanta, Georgia
| | | | - Ted R Mikuls
- University of Nebraska Medical Center and VA Nebraska-Western, Iowa Health Care System, Omaha
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Tedeschi SK, Jin Y, Vine S, Lee H, Pethoe-Schramm A, Yau V, Kim SC. Giant cell arteritis treatment patterns and rates of serious infections. Clin Exp Rheumatol 2022; 40:826-833. [PMID: 34905480 PMCID: PMC10475312 DOI: 10.55563/clinexprheumatol/uonz1p] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 10/04/2021] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Giant cell arteritis (GCA) afflicts older adults who may have age- and comorbidity-related risks for infection and is treated with immunosuppressants that increase risk of infection. We examined GCA treatment patterns and rates of serious infections in two real-world cohorts in the U.S. METHODS We identified two GCA cohorts using two U.S. health insurance databases, Medicare (public, 2007-2017) and MarketScan (commercial, 2015-2019), by applying a validated claims-based algorithm with positive predictive value 79.0% for GCA. We required age ≥50 years and assessed baseline comorbidities, dispensing of immunosuppressants and prophylactic antibiotics, and vaccine administration. We calculated incidence rates (IR) of serious infections, defined as bacterial or viral infections requiring hospitalisation based on primary inpatient diagnosis code. Multivariable Cox proportional hazards models estimated hazard ratios for risk of serious infection for prespecified covariates. RESULTS The Medicare cohort included 734 patients, 28% male, mean age 77.1; the MarketScan cohort included 1022 patients, 30% male, mean age 68.4. More than 85% used prednisone ≥60mg daily at index date and <10% used tocilizumab. Serious infections developed in 27.9% of Medicare and 7.2% of MarketScan patients: IR per 100 person-years = 10.7 (95% CI 9.3, 12.2) in Medicare and 6.3 (95% CI 5.0, 7.9) in MarketScan. Older age and higher frailty score were significantly associated with increased risk for serious infection. CONCLUSIONS In these two U.S. GCA cohorts, high-dose glucocorticoids were the most common initial treatment, and over 25% of Medicare and 7% of MarketScan patients developed serious infection during follow-up. Older age and higher frailty score were associated with higher risk of serious infections, though maximum daily prednisone dose was not. Pneumocystis jiroveci pneumonia was rare in two GCA cohorts despite infrequent use of prophylactic antibiotics.
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Affiliation(s)
- Sara K Tedeschi
- Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
| | - Yinzhu Jin
- Division of Pharmacoepidemiology & Pharmacoeconomics, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Seanna Vine
- Division of Pharmacoepidemiology & Pharmacoeconomics, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Hemin Lee
- Division of Pharmacoepidemiology & Pharmacoeconomics, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | | | | | - Seoyoung C Kim
- Division of Rheumatology, Inflammation and Immunity and Division of Pharmacoepidemiology & Pharmacoeconomics, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
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Szebeni GJ, Gémes N, Honfi D, Szabó E, Neuperger P, Balog JÁ, Nagy LI, Szekanecz Z, Puskás LG, Toldi G, Balog A. Humoral and Cellular Immunogenicity and Safety of Five Different SARS-CoV-2 Vaccines in Patients With Autoimmune Rheumatic and Musculoskeletal Diseases in Remission or With Low Disease Activity and in Healthy Controls: A Single Center Study. Front Immunol 2022; 13:846248. [PMID: 35432314 PMCID: PMC9008200 DOI: 10.3389/fimmu.2022.846248] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 03/04/2022] [Indexed: 12/25/2022] Open
Abstract
Background Vaccine-induced immunity is essential for controlling the COVID-19 pandemic. Data on humoral and cellular immunogenicity and safety of different SARS-CoV-2 vaccines in patients with autoimmune rheumatic and musculoskeletal diseases (RMDs) are limited. Methods A single center observational study evaluated the immunogenicity and safety of the two-dose regimen of the BBIBP-CorV inactivated, Gam-COVID-Vac and AZD1222 adenovirus-based, and BNT162b2 and mRNA-1273 mRNA-based vaccines in patients with RMDs (n = 89) compared with healthy controls (n = 74). Neutralizing anti-RBD (receptor binding domain) specific antibodies and SARS-CoV-2 specific T-cell response were measured one and four months after the second vaccine dose in parallel with vaccination efficacy and safety. Results Disease-specific comparison showed that antibody response at four months was higher in spondylarthropathies compared to rheumatoid arthritis and autoimmune RMDs. Risk factors for reduced immunogenicity included longer disease duration, positive immunoserological profile and anti-CD20 therapy of patients. The rate of positive anti-RBD antibody response for healthy controls versus patients after 4 months post vaccination was 69% vs. 55% for the inactivated viral vaccine BBIBP-CorV, 97% vs. 53% for the pooled data of adenovirus vector-based vaccines Gam-COVID-Vac and AZD1222, or 100% vs. 81% for the pooled data of mRNA vaccines BNT162b2 and mRNA-1273, respectively. Patients who received the Gam-COVID-Vac or mRNA-1273 vaccines had a higher proportion of TNF-α producing CD4+ T-cells upon SARS-CoV-2 antigen stimulation compared to the inactivated viral vaccine. Conclusion All five investigated vaccines were immunogenic in the majority of patients and healthy controls with variable antibody and T-cell response and an acceptable safety profile.
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Affiliation(s)
- Gábor J. Szebeni
- Biological Research Centre, Laboratory of Functional Genomics, Szeged, Hungary
- Department of Physiology, Anatomy and Neuroscience, Faculty of Science and Informatics, University of Szeged, Szeged, Hungary
- CS-Smartlab Devices, Kozarmisleny, Hungary
| | - Nikolett Gémes
- Biological Research Centre, Laboratory of Functional Genomics, Szeged, Hungary
- Doctoral School in Biology, Faculty of Science and Informatics, University of Szeged, Szeged, Hungary
| | - Dániel Honfi
- Department of Rheumatology and Immunology, Faculty of Medicine, Albert Szent-Gyorgyi Health Centre, University of Szeged, Szeged, Hungary
| | - Enikő Szabó
- Biological Research Centre, Laboratory of Functional Genomics, Szeged, Hungary
| | - Patrícia Neuperger
- Biological Research Centre, Laboratory of Functional Genomics, Szeged, Hungary
- Doctoral School in Biology, Faculty of Science and Informatics, University of Szeged, Szeged, Hungary
| | - József Á. Balog
- Biological Research Centre, Laboratory of Functional Genomics, Szeged, Hungary
- Doctoral School in Biology, Faculty of Science and Informatics, University of Szeged, Szeged, Hungary
| | | | - Zoltán Szekanecz
- Division of Rheumatology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - László G. Puskás
- Biological Research Centre, Laboratory of Functional Genomics, Szeged, Hungary
- Avidin Ltd., Szeged, Hungary
| | - Gergely Toldi
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Attila Balog
- Department of Rheumatology and Immunology, Faculty of Medicine, Albert Szent-Gyorgyi Health Centre, University of Szeged, Szeged, Hungary
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Bower H, Frisell T, Di Giuseppe D, Delcoigne B, Askling J. Influenza outcomes in patients with inflammatory joint diseases and DMARDs: how do they compare to those of COVID-19? Ann Rheum Dis 2022; 81:433-439. [PMID: 34810197 PMCID: PMC8610614 DOI: 10.1136/annrheumdis-2021-221461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 10/22/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To estimate absolute and relative risks for seasonal influenza outcomes in patients with inflammatory joint diseases (IJDs) and disease-modifying antirheumatic drugs (DMARDs). To contextualise recent findings on corresponding COVID-19 risks. METHODS Using Swedish nationwide registers for this cohort study, we followed 116 989 patients with IJD and matched population comparators across four influenza seasons (2015-2019). We quantified absolute risks of hospitalisation and death due to influenza, and compared IJD to comparators via Cox regression. We identified 71 556 patients with IJD on active treatment with conventional synthetic DMARDs and biological disease-modifying antirheumatic drugs (bDMARDs)/targeted synthetic disease-modifying antirheumatic drug (tsDMARDs) at the start of each influenza season, estimated risks for the same outcomes and compared these risks across DMARDs via Cox regression. RESULTS Per season, average risks for hospitalisation listing influenza were 0.25% in IJD and 0.1% in the general population, corresponding to a crude HR of 2.38 (95% CI 2.21 to 2.56) that decreased to 1.44 (95% CI 1.33 to 1.56) following adjustments for comorbidities. For death listing influenza, the corresponding numbers were 0.015% and 0.006% (HR=2.63, 95% CI 1.93 to 3.58, and HR=1.46, 95% CI 1.07 to 2.01). Absolute risks for influenza outcomes were half (hospitalisation) and one-tenth (death) of those for COVID-19, but relative estimates comparing IJD to the general population were similar. CONCLUSIONS In absolute terms, COVID-19 in IJD outnumbers that of average seasonal influenza, but IJD entails a 50%-100% increase in risk for hospitalisation and death for both types of infections, which is largely dependent on associated comorbidities. Overall, bDMARDs/tsDMARDs do not seem to confer additional risk for hospitalisation or death related to seasonal influenza.
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Affiliation(s)
- Hannah Bower
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Thomas Frisell
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Daniela Di Giuseppe
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Bénédicte Delcoigne
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Johan Askling
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
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Sim JJL, Lim CC. Influenza Vaccination in Systemic Lupus Erythematosus: Efficacy, Effectiveness, Safety, Utilization, and Barriers. Am J Med 2022; 135:286-296.e9. [PMID: 34563493 DOI: 10.1016/j.amjmed.2021.08.038] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 08/26/2021] [Accepted: 08/27/2021] [Indexed: 12/19/2022]
Abstract
Influenza increases morbidity and mortality in systemic lupus erythematosus (SLE) and lupus nephritis but is preventable through vaccination. This systematic review of PubMed, Embase, CENTRAL, WHO Clinical Trials, and ClinicalTrials.gov publications until August 2021 identified 45 reports (16,596 patients), including 8.5% with renal involvement or lupus nephritis: 9 studies (10,446 patients) on clinical effectiveness, 20 studies (1327 patients) on vaccine efficacy, 22 studies (1116 patients) on vaccine safety, 14 studies (4619 patients) on utilization rates, and 5 studies (3220 patients) on barriers. Pooled seroconversion rates ranged between 46% and 56%, while seroprotection rates ranged from 68% to 73% and were significantly associated with age and disease duration. Influenza infection was lower in vaccinated patients with systemic lupus erythematosus compared with unvaccinated patients. Disease activity scores did not change significantly after vaccination and reported flares were mild to moderate. Pooled current vaccination rate was 40.0% (95% confidence interval [CI]: 33.7%-46.5%) with significant heterogeneity and associated with the gross domestic product (P = .002) and disease duration (P = .001). Barriers to vaccination were the lack of doctor recommendation (57.4%) and concerns over the safety or efficacy of the vaccine (12.7%).
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Affiliation(s)
- Jackie Jia Lin Sim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Cynthia Ciwei Lim
- Department of Renal Medicine, Singapore General Hospital, Singapore.
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Sim J, Lee TL, Lim CC. COVID-19 vaccination in anti-neutrophil cytoplasmic antibody-associated vasculitis: lessons from influenza vaccination? Clin Kidney J 2022; 15:1015-1016. [PMID: 35498902 PMCID: PMC9050532 DOI: 10.1093/ckj/sfac053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Indexed: 11/12/2022] Open
Affiliation(s)
- Jackie Sim
- Yong Loo Lin School of Medicine, National University of Singapore
| | - Tung Lin Lee
- Department of Renal Medicine, Singapore General Hospital, Singapore
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39
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Voignier A, Skopinski S, Duffau P, Ribeiro E, Biscay P, Constans J, Mercié P. Descriptive study of pneumococcal vaccination in cases of inflammatory disease: analysis of practices. Infect Dis Now 2022; 52:154-159. [DOI: 10.1016/j.idnow.2022.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 11/09/2021] [Accepted: 01/31/2022] [Indexed: 11/29/2022]
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40
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Valerio V, Hudson M, Wang M, Bernatsky S, Hazel EM, Ward B, Colmegna I. Influenza Vaccine Hesitancy and Its Determinants Among Rheumatology Patients. ACR Open Rheumatol 2022; 4:352-362. [PMID: 35049149 PMCID: PMC8992470 DOI: 10.1002/acr2.11408] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 10/22/2021] [Accepted: 12/02/2021] [Indexed: 01/18/2023] Open
Abstract
Objective Patients with rheumatic disease (RD) have an increased risk of influenza and its complications. Despite inactivated influenza vaccine (IIV) recommendations, IIV uptake in patients with RD is suboptimal, a problem of increasing importance in the COVID‐19 era. We estimated the frequency of IIV hesitancy and associated factors among Canadian patients with RD. Methods A cross‐sectional vaccine hesitancy survey was completed by rheumatology clinic patients (November 2019 to January 2020). Patients rated their likelihood of receiving the influenza vaccine (scale of 0‐10). We categorized these as follows: likely to refuse (scale of 0‐2), uncertain (scale of 3‐7), or likely to accept (scale of 8‐10). Multivariate logistical regression was used to evaluate factors associated with vaccine hesitancy. Results A total of 282 patients (63.5% of those approached) completed the survey, with 165 (58.5%) being likely to accept, 67 (23.8%) being likely to refuse, and 50 (17.7%) uncertain. Uncertain patients were younger and more likely to be employed than those in the other two groups. No previous influenza vaccination (odds ratio [OR] 36.6, 95% confidence interval [CI] 5.3‐252.9), belief that vaccination should not be mandatory (OR 0.1, 95% CI 0.0‐0.7), unwillingness to take time off work to be vaccinated (OR 6.8, 95% CI 1.5‐30.6), and distrust in pharmaceutical companies (OR 41.0, 95% CI 5.6‐301.5) predicted likeliness to refuse. Reluctance to pay for vaccination (OR 2.8, 95% CI 1.1‐7.5) and no previous influenza vaccination (OR 18.9, 95% CI 3.3‐109.7) predicted uncertainty. Conclusion More than 40% of rheumatology patients are either likely to refuse or uncertain about receiving IIV. This contributes to suboptimal vaccine coverage in this population. Interventions addressing these concerns are needed, particularly in the COVID‐19 era.
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Affiliation(s)
- Valeria Valerio
- The Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Marie Hudson
- Lady Davis Institute, Jewish General Hospital, Montreal, Quebec, Canada
| | - Mianbo Wang
- Lady Davis Institute, Montreal, Quebec, Canada
| | - Sasha Bernatsky
- The Research Institute of the McGill University Health Centre and McGill University, Montreal, Quebec, Canada
| | | | - Brian Ward
- The Research Institute of the McGill University Health Centre and McGill University, Montreal, Quebec, Canada
| | - Inés Colmegna
- The Research Institute of the McGill University Health Centre and McGill University, Montreal, Quebec, Canada
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Cuadros EN, Calzada-Hernández J, Clemente D, Martín SG, Silveira LF, Lirola-Cruz MJ, Tagarro A, Lovillo MC, Rueda RMA, López AL, Aritziturri MS, Calvo C. Position statement of the Spanish Society of Pediatric Rheumatology on infection screening, prophylaxis, and vaccination of pediatric patients with rheumatic diseases and immunosuppressive therapies: Part 1 (screening). Eur J Pediatr 2022; 181:2343-2354. [PMID: 35258699 PMCID: PMC9110499 DOI: 10.1007/s00431-022-04418-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 01/31/2022] [Accepted: 02/13/2022] [Indexed: 02/02/2023]
Abstract
This study provides practical recommendations on infection screening in pediatric patients with immune-mediated rheumatic diseases and immunosuppressive therapies. For this reason, a qualitative approach was applied. A narrative literature review was performed via Medline. Primary searches were conducted using Mesh and free texts to identify articles that analyzed data on infections and vaccinations in pediatric patients with immune-mediated rheumatic diseases and immunosuppressive therapies. The results were presented and discussed in a nominal group meeting, comprising a committee of 12 pediatric rheumatologists from the infections prevention and treatment working group of the Spanish Society of Pediatric Rheumatology. Several recommendations were generated. A consensus procedure was implemented via a Delphi process that was extended to members of the Spanish Society of Pediatric Rheumatology and Vaccine Advisory Committee of the Spanish Association of Pediatrics. Participants to the process produced a score ranging from 0 = totally disagree to 10 = totally agree. Agreement was considered if at least 70% of participants voted ≥ 7. The literature review included more than 400 articles. Overall, 63 recommendations were generated (21 on infection screening) voted by 59 pediatric rheumatologists and other pediatric specialists, all of them achieving the pre-established agreement level. The recommendations on screening cover all the procedures (serology, assessment of risk factors, and other clinical activities) connected with the screening for infections including tuberculosis; hepatitis A, B, and C viruses; measles; mumps; rubella; diphtheria; and other infections. Conclusion: Screening for infections is an essential part of risk management in pediatric patients with immune-mediated rheumatic diseases and immunosuppressive therapies. What is Known: • Infectious diseases and related complications are a major cause of morbidity and mortality in patients with immune-mediated rheumatic diseases. • At present, practical information on infectious prophylaxis in children with rheumatic diseases is limited, and often extrapolated from children with cancer. What is New: • In the absence of evidence, a literature review and a Delphi survey were conducted to establish a series of expert recommendations that would be useful in clinical practice, providing a practical and simple day-to-day approach to be used by pediatric rheumatologists.
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Affiliation(s)
- Esmeralda Núñez Cuadros
- Pediatric Rheumatology Unit, UGC Pediatría, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Av. Arroyo de los Ángeles, s/n 29011, Málaga, Spain.
| | - Joan Calzada-Hernández
- Unitat de Reumatologia Pediàtrica, Servei de Pediatria, Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
| | - Daniel Clemente
- Pediatric Rheumatology Unit, Hospital Infantil Universitario, Niño Jesús, Madrid, Spain
| | - Sara Guillén Martín
- Department of Paediatrics, Hospital Universitario de Getafe, CIBERINFEC ISCIII, Getafe, Madrid, Spain
| | - Laura Fernández Silveira
- Servicio de Inmunología, Reumatología e Infectología Pediátricas, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - María José Lirola-Cruz
- Department of Paediatríc Rheumatology, Instituto Hispalense de Pediatría, Seville, Spain
| | - Alfredo Tagarro
- Pediatrics Department, Instituto de Investigación 12 de Octubre (imas12), Hospital Universitario Infanta Sofía, Universidad Europea, Madrid, Spain
| | - Marisol Camacho Lovillo
- Servicio de Inmunología, Reumatología e Infectología Pediátricas, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | | | - Agustín López López
- Department of Paediatrics, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | | | - Cristina Calvo
- Department of Pediatrics, Infectious and Tropical Diseases, Hospital Universitario La Paz, and La Paz Research Institute (IdiPaz). CIBERINFEC. ISCIII, Madrid, Spain ,Translational Research Network of Pediatric Infectious Diseases (RITIP), Madrid, Spain
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42
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Prevalence of high-risk human papilloma virus infection and cervical cytological abnormalities in female Turkish patients with rheumatologic disease. JOURNAL OF SURGERY AND MEDICINE 2022. [DOI: 10.28982/josam.1057510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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43
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Welzel T, Kuemmerle-Deschner J, Sluka C, Carlomagno R, Cannizzaro Schneider E, Kaiser D, Hofer M, Hentgen V, Woerner A. Vaccination completeness in children with rheumatic diseases: A longitudinal, observational multicenter cohort study in Switzerland. Front Pediatr 2022; 10:993811. [PMID: 36160778 PMCID: PMC9493270 DOI: 10.3389/fped.2022.993811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 08/08/2022] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Children with pediatric inflammatory rheumatic diseases (PRD) have an increased infection risk. Vaccinations are effective to avoid vaccine-preventable diseases. This study aimed to assess the vaccination completeness in Swiss PRD patients stratified by immunosuppressive treatment (IST). MATERIALS AND METHODS This multicenter observational cohort study of PRD patients was performed in Basel, Geneva, Lucerne, Lausanne, and Zurich in PRD patients aged < 18 years included in the Juvenile Inflammatory Rheumatism Cohort. Completeness was assessed for i) the overall vaccination status (Swiss national immunization program (NIP) and specific additional PRD-recommended vaccinations), ii) for all and each vaccination of the NIP at PRD diagnosis and reference date (RefD) and iii) all and each specific additional PRD-recommended vaccination at RefD. Completeness was assessed over the disease course and stratified by IST. RESULTS Of 616 eligible patients, 234 children were analyzed. Of these, 147 (63%) were girls. Median age at PRD diagnosis was 6.5 years (IQR 2.9-10.3) and 10.9 years at RefD (6.9-14.3). The median follow-up since PRD diagnosis was 3 years (1.1-5.5). 120/234 children received IST. At RefD, overall vaccination completeness was 3.8% (9/234 children), completeness for the NIP vaccinations was 70.1% (164/234 children; IST 65%, no IST: 75.4%) and for all specific additional PRD-recommended vaccinations was 3.8% (9/234 children; IST 2.5%; no IST 5.3%). Vaccination completeness against pneumococcal disease, hepatitis B virus, and human papilloma virus (HPV) was 50.4, 20, 37.9%, respectively. In 25/35 children with negative varicella zoster virus history vaccination status was complete (IST: 94.4%, no IST: 47%). Annual non-live influenza vaccination was complete in 24.2% of children during IST; adherence decreased over the disease course. DISCUSSION This study identified a low overall vaccination completeness in children with PRD. Particularly, the completeness of specific additional PRD-recommended vaccinations was low. If not performed early after PRD diagnosis, vaccination status remained frequently incomplete. Close collaboration between pediatrician and rheumatologist to improve vaccination completeness is essential. Exchange of vaccination records, standardized assessment of specific PRD-recommended vaccinations and those of the NIP, and annual reminder for influenza vaccination are crucial to improve vaccination completeness in this vulnerable pediatric population.
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Affiliation(s)
- Tatjana Welzel
- Pediatric Rheumatology, University Children's Hospital Basel, University of Basel, Basel, Switzerland
| | - Jasmin Kuemmerle-Deschner
- Department of Pediatrics, Division of Pediatric Rheumatology, Autoinflammation Reference Center Tuebingen (arcT), University Hospital Tuebingen, Tuebingen, Germany.,European Reference Network for Rare and Low Prevalence Complex Diseases, Network Immunodeficiency, Autoinflammatory and Autoimmune Diseases (ERN RITA), Tuebingen, Germany
| | - Constantin Sluka
- Department of Clinical Research, University of Basel and University Hospital Basel, Basel, Switzerland
| | - Raffaella Carlomagno
- Pediatric Rheumatology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.,Pediatric Rheumatology, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | | | - Daniela Kaiser
- Pediatric Rheumatology, Children's Hospital Lucerne, Lucerne, Switzerland
| | - Michael Hofer
- Pediatric Rheumatology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.,Pediatric Rheumatology, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Veronique Hentgen
- Reference Center for Autoinflammatory Diseases CeRéMAIA, Versailles Hospital, Versailles, France
| | - Andreas Woerner
- Pediatric Rheumatology, University Children's Hospital Basel, University of Basel, Basel, Switzerland
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Shenoy P, Umesh R, Paul A, Shenoy V, Ahmed S, Cherian S, Prasad A. Humoral responses to SARS-CoV-2 vaccination in rituximab-treated patients depend on peripheral B cell re-population rather than the timings of the dosing. INDIAN JOURNAL OF RHEUMATOLOGY 2022. [DOI: 10.4103/injr.injr_215_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Tedeschi SK, Ellrodt J, Stratton J, Santacroce L, Chandler PD, Gravallese EM, Solomon DH. Acceptability of Vaccines Against Preventable Infections Including Coronavirus Disease 2019 Among Patients With Rheumatic Disease. ACR Open Rheumatol 2022; 4:3-7. [PMID: 34613668 PMCID: PMC8652709 DOI: 10.1002/acr2.11351] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 08/24/2021] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE Vaccination against preventable infections is widely recommended for patients with systemic rheumatic disease. The coronavirus disease 2019 (COVID-19) pandemic has highlighted variability in attitudes toward vaccination, particularly with the use of novel vaccine platforms. We studied attitudes toward vaccination against COVID-19 and other preventable infections among patients with systemic rheumatic disease and compared these against the general population. METHODS We surveyed patients treated at Brigham and Women's Hospital for systemic rheumatic disease using a secure web-based survey or paper survey in English or Spanish, from December 2020 to April 2021. We included survey questions used in the nationwide Harris Poll (October 2020 and February 2021), allowing the comparison of responses with those from the general population. Response frequencies were estimated and compared using descriptive statistics. RESULTS Of 243 participants (25% response rate), the mean age was 56 years, 82% were women, and 33% were nonwhite. Rheumatoid arthritis (50%) and systemic lupus erythematosus (28%) were the most common diagnoses. Thirty percent had been hospitalized previously for any infection. Seventy-six percent worried a lot or somewhat about contracting COVID-19. Attitudes toward vaccination were very favorable, with 92% having received a flu shot in the past year and 84% desiring a COVID-19 vaccine as soon as possible compared with 30% to 40% of Harris Poll respondents (P < 0.001). Physician recommendation to receive a vaccine and desire to avoid infection were the most common reasons for desiring vaccinations. CONCLUSION Vaccine acceptability, including toward COVID-19 vaccines, was high among this population of patients with systemic rheumatic disease seen at an academic medical center cohort. Physician recommendation is a key factor for vaccine uptake.
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Stefanski AL, Rincon-Arevalo H, Schrezenmeier E, Karberg K, Szelinski F, Ritter J, Jahrsdörfer B, Schrezenmeier H, Ludwig C, Sattler A, Kotsch K, Chen Y, Claußnitzer A, Haibel H, Proft F, Guerra G, Durek P, Heinrich F, Ferreira-Gomes M, Burmester GR, Radbruch A, Mashreghi MF, Lino AC, Dörner T. B cell numbers predict humoral and cellular response upon SARS-CoV-2 vaccination among patients treated with rituximab. Arthritis Rheumatol 2021; 74:934-947. [PMID: 34962360 PMCID: PMC9011692 DOI: 10.1002/art.42060] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 10/25/2021] [Accepted: 12/22/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Patients with autoimmune inflammatory rheumatic diseases receiving rituximab (RTX) therapy are at higher risk for poor COVID-19 outcomes and show substantially impaired humoral anti-SARS-CoV-2 vaccine responses. However, the complex relationship between antigen-specific B and T cells and the level of B cell repopulation necessary to achieve anti-vaccine responses remain largely unknown. METHODS Antibody responses to SARS-CoV-2 vaccines and induction of antigen-specific B and CD4/CD8 T cell subsets were studied in 19 rheumatoid arthritis (RA) and ANCA-associated vasculitis (AAV) patients receiving RTX, 12 RA patients on other therapies and 30 healthy controls after SARS-CoV-2 vaccination with either mRNA or vector based vaccines. RESULTS A minimum of 10 B cells/μL (0,4% of lymphocytes) in the peripheral circulation appeared to be required in RTX patients to mount seroconversion to anti-S1 IgG upon SARS-CoV-2 vaccination. RTX patients lacking IgG seroconversion showed reduced RBD+ B cells, lower frequency of TfH-like cells as well as less activated CD4 and CD8 T cells compared to IgG seroconverted RTX patients. Functionally relevant B cell depletion resulted in impaired IFNγ secretion by spike-specific CD4 T cells. In contrast, antigen-specific CD8 T cells were reduced in patients, independently of IgG formation. CONCLUSIONS In patients receiving RTX, a minimum of 10 B cells/μl in the peripheral circulation candidates as biomarker for a high likelihood of an appropriate cellular and humoral response after SARS-CoV-2 vaccination. Mechanistically, the data emphasize the crucial role of co-stimulatory B cell functions for the proper induction of CD4 responses propagating vaccine-specific B and plasma cell differentiation.
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Affiliation(s)
- Ana L Stefanski
- Department of Rheumatology and Clinical Immunology, Charité Universitätsmedizin Berlin; Berlin, Germany.,Deutsches Rheumaforschungszentrum (DRFZ), Berlin, Germany
| | - Hector Rincon-Arevalo
- Department of Rheumatology and Clinical Immunology, Charité Universitätsmedizin Berlin; Berlin, Germany.,Deutsches Rheumaforschungszentrum (DRFZ), Berlin, Germany.,Department of Nephrology and Medical Intensive Care, Charité Universitätsmedizin Berlin, Berlin, Germany.,Grupo de Inmunología Celular e Inmunogenética, Facultad de Medicina, Instituto de Investigaciones Médicas, Universidad de Antioquia UdeA, Medellín, Colombia
| | - Eva Schrezenmeier
- Deutsches Rheumaforschungszentrum (DRFZ), Berlin, Germany.,Department of Nephrology and Medical Intensive Care, Charité Universitätsmedizin Berlin, Berlin, Germany.,Berlin Institute of Health Charité Universitätsmedizin Berlin, BIH Academy, Berlin, Germany
| | - Kirsten Karberg
- Rheumatology outpatient office RheumaPraxis Steglitz, Berlin, Germany
| | - Franziska Szelinski
- Department of Rheumatology and Clinical Immunology, Charité Universitätsmedizin Berlin; Berlin, Germany.,Deutsches Rheumaforschungszentrum (DRFZ), Berlin, Germany
| | - Jacob Ritter
- Department of Rheumatology and Clinical Immunology, Charité Universitätsmedizin Berlin; Berlin, Germany.,Berlin Institute of Health Charité Universitätsmedizin Berlin, BIH Academy, Berlin, Germany
| | - Bernd Jahrsdörfer
- Institute of Transfusion Medicine, Ulm University, Ulm, Germany and Institute for Clinical Transfusion Medicine and Immunogenetics, German Red Cross Blood Transfusion Service Baden-Württemberg - Hessen and University Hospital Ulm, Ulm, Germany
| | - Hubert Schrezenmeier
- Institute of Transfusion Medicine, Ulm University, Ulm, Germany and Institute for Clinical Transfusion Medicine and Immunogenetics, German Red Cross Blood Transfusion Service Baden-Württemberg - Hessen and University Hospital Ulm, Ulm, Germany
| | - Carolin Ludwig
- Institute of Transfusion Medicine, Ulm University, Ulm, Germany and Institute for Clinical Transfusion Medicine and Immunogenetics, German Red Cross Blood Transfusion Service Baden-Württemberg - Hessen and University Hospital Ulm, Ulm, Germany
| | - Arne Sattler
- Department for General, Visceral and Vascular Surgery, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Katja Kotsch
- Department for General, Visceral and Vascular Surgery, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Yidan Chen
- Department of Rheumatology and Clinical Immunology, Charité Universitätsmedizin Berlin; Berlin, Germany.,Deutsches Rheumaforschungszentrum (DRFZ), Berlin, Germany
| | - Anne Claußnitzer
- Department of Rheumatology and Clinical Immunology, Charité Universitätsmedizin Berlin; Berlin, Germany
| | - Hildrun Haibel
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Fabian Proft
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charité Universitätsmedizin Berlin, Berlin, Germany
| | | | - Pawel Durek
- Deutsches Rheumaforschungszentrum (DRFZ), Berlin, Germany
| | | | | | - Gerd R Burmester
- Department of Rheumatology and Clinical Immunology, Charité Universitätsmedizin Berlin; Berlin, Germany.,Deutsches Rheumaforschungszentrum (DRFZ), Berlin, Germany
| | | | | | - Andreia C Lino
- Deutsches Rheumaforschungszentrum (DRFZ), Berlin, Germany
| | - Thomas Dörner
- Department of Rheumatology and Clinical Immunology, Charité Universitätsmedizin Berlin; Berlin, Germany.,Deutsches Rheumaforschungszentrum (DRFZ), Berlin, Germany
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Current Take on Systemic Sclerosis Patients' Vaccination Recommendations. Vaccines (Basel) 2021; 9:vaccines9121426. [PMID: 34960174 PMCID: PMC8708328 DOI: 10.3390/vaccines9121426] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 11/26/2021] [Accepted: 11/30/2021] [Indexed: 12/14/2022] Open
Abstract
Systemic sclerosis (SSc) is a rare autoimmune inflammatory rheumatic disease. The prevalence of SSc ranges from 7 to 700 cases per million worldwide. Due to multiple organ involvement and constant inflammatory state, this group of patients presents an increased risk of infectious diseases. This paper aimed to gather the up-to-date evidence on vaccination strategies for patients with SSc and to be a useful tool for the prevention and management of infectious diseases. The authors conducted a scoping review in which each paragraph presents data on a specific vaccine’s safety, immunogenicity, and efficacy. The work deals with the following topics: SARS-CoV-2, seasonal influenza, S. pneumoniae, HAV, HBV, HZV, N. meningitidis, H. influenzae, HPV, and diphtheria-tetanus-pertussis.
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48
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Toscano S, Chisari CG, Patti F. Multiple Sclerosis, COVID-19 and Vaccines: Making the Point. Neurol Ther 2021; 10:627-649. [PMID: 34625925 PMCID: PMC8500471 DOI: 10.1007/s40120-021-00288-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 09/22/2021] [Indexed: 12/15/2022] Open
Abstract
On 11 March 2020, the World Health Organization declared the coronavirus disease 19 (COVID-19) outbreak a pandemic. In this context, several studies and clinical trials have been conducted since then, and many are currently ongoing, leading to the development of several COVID-19 vaccines with different mechanisms of action. People affected by multiple sclerosis (MS) have been considered high-risk subjects in most countries and prioritized for COVID-19 vaccination. However, the management of MS during the COVID-19 pandemic has represented a new challenge for MS specialists, particularly because of the initial lack of guidelines and differing recommendations. Despite an initial hesitation in prescribing disease-modifying drugs (DMDs) in naïve and already treated patients with MS, most national neurology associations and organizations agree on not stopping treatment. However, care is needed especially for patients treated with immune-depleting drugs, which also require some attentions in programming vaccine administration. Many discoveries and new research results have accumulated in a short time on COVID-19, resulting in a need for summarizing the existing evidence on this topic. In this review, we describe the latest research results on the immunological aspects of SARS-CoV-2 infection speculating about their impact on COVID-19 vaccines' mechanisms of action and focused on the management of MS during the COVID pandemic according to the most recent guidelines and recommendations. Finally, the efficacy of COVID-19 and other well-known vaccines against infectious disease in patients with MS on DMDs is discussed.
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Affiliation(s)
- Simona Toscano
- Department G. F. Ingrassia, Section of Neurosciences, University of Catania, Via Santa Sofia 78, 95123, Catania, Italy
| | - Clara G Chisari
- Department G. F. Ingrassia, Section of Neurosciences, University of Catania, Via Santa Sofia 78, 95123, Catania, Italy
| | - Francesco Patti
- Department G. F. Ingrassia, Section of Neurosciences, University of Catania, Via Santa Sofia 78, 95123, Catania, Italy.
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49
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Maranini B, Ciancio G, Cultrera R, Govoni M. Herpes zoster infection following mRNA COVID-19 vaccine in a patient with ankylosing spondylitis. Reumatismo 2021; 73. [PMID: 34814659 DOI: 10.4081/reumatismo.2021.1445] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 09/16/2021] [Indexed: 11/23/2022] Open
Abstract
Since the severe acute respiratory syndrome-related coronavirus 2 (SARS-CoV-2) pandemic outbreak, vaccines gained a growing role. Possible vaccine-related side effects range from minor local events to more prominent systemic manifestations up to anaphylactic reactions. A heterogeneous spectrum of cutaneous reactions has been reported, ranging from local injection site reactions to urticarial and morbilliform eruptions, pernio/chilblains and zoster flares. Here, we describe a case of varicella zoster virus reactivation following mRNA coronavirus 2019 vaccine and discuss the available literature upon the topic published so far.
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Affiliation(s)
- B Maranini
- Rheumatology Unit, Department of Medical Sciences, University of Ferrara.
| | - G Ciancio
- Rheumatology Unit, Department of Medical Sciences, University of Ferrara.
| | - R Cultrera
- Infectious Diseases, Department of Translational Medicine, University of Ferrara.
| | - M Govoni
- Rheumatology Unit, Department of Medical Sciences, University of Ferrara.
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50
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Dos Reis BS, Staub FC, Koishi A, Zanluca C, Dos Santos CND, Skare TL, Kahlow BS. Seroconversion of rheumatoid arthritis patients after yellow fever vaccination. Clin Rheumatol 2021; 41:705-708. [PMID: 34674083 DOI: 10.1007/s10067-021-05962-7] [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: 09/02/2021] [Revised: 10/06/2021] [Accepted: 10/07/2021] [Indexed: 11/28/2022]
Abstract
Vaccination is a current strategy used to prevent infections in patients with immune-mediated rheumatic diseases. However, the use of live-attenuated vaccines prepared from living microorganisms in these patients should be avoided due to the risk of acquiring infections. The present study aimed to investigate the effect of the yellow fever (YF) vaccine (a live-attenuated vaccine) in 12 patients with rheumatoid arthritis (RA). The sample comprised 12 patients (9 females and 3 males; mean age 52.2 ± 6.5 years) with RA, who inadvertently received fractionated 17D yellow fever vaccination during an outbreak of this disease. In this cohort, 10 were administered leflunomide; 7 were administered methotrexate; 6 were administered prednisone (median dose of 5.0 mg/day); 6 took biologic drugs; and 1 took tofacitinib. All but one patient (used rituximab, prednisone, and methotrexate) seroconverted. None of them developed clinical signs of infection after the procedure. The fractionated dose of the YF vaccine is effective and safe in the observed sample. Key Points • Patients with autoimmune inflammatory rheumatic diseases (AIIRD) are at a high risk of acquiring infections • The fractionated dose of the YF vaccine is effective and safe in the observed sample • Vaccination against YF should be avoided in patients with AIIRD under immunosuppression owing to the risks of inducing YF infection.
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Affiliation(s)
| | - Felipe Cintra Staub
- Pontifícia Universidade Católica do Paraná - PUCPR, Curitiba, Paraná, Brazil
| | - Andrea Koishi
- Laboratório de Virologia Molecular, Instituto Carlos Chagas/Fiocruz PR, Curitiba, , Paraná, Brazil
| | - Camila Zanluca
- Laboratório de Virologia Molecular, Instituto Carlos Chagas/Fiocruz PR, Curitiba, , Paraná, Brazil
| | | | - Thelma L Skare
- Rheumatology Unit, Hospital Evangélico Mackenzie, Professor Ulisses Vieira, 145 ap 54 - Vila Izabel, Curitiba, Paraná, CEP 80320-090, Brazil
| | - Bárbara Stadler Kahlow
- Pontifícia Universidade Católica do Paraná - PUCPR, Curitiba, Paraná, Brazil. .,Rheumatology Unit, Hospital Evangélico Mackenzie, Professor Ulisses Vieira, 145 ap 54 - Vila Izabel, Curitiba, Paraná, CEP 80320-090, Brazil.
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