A comprehensive overview of pneumococcal vaccination recommendations for adults in South Africa, 2022

Vaccination Strategies for a Liver Transplant Recipient

Patients with cirrhosis and liver transplant recipients are at increased risk of infections. Malnutrition, multiple hospital admissions, immune dysfunction related to cirrhosis, and immunosuppressive agents used for liver transplantation predispose the recipient to various life-threatening infections. Some of these infections are preventable with vaccines. With the COVID-19 pandemic, there has been an accelerated research in vaccination technology and platforms, which in turn may also improve awareness of physicians regarding this healthy and often ignored aspect of management of patients with cirrhosis and transplant recipients. The organ transplant candidates should complete the recommended vaccination schedule as early as possible (especially patients with compensated cirrhosis) or at least during their pretransplant work-up so as to prevent or reduce the severity of various infections.

Analysis of COPD: Distinguishing Characteristics and Management of Smoking vs Never Smoking Patients

Background

Chronic obstructive pulmonary disease (COPD) is a significant public health issue characterized by gradually worsening airflow limitation. It is a leading cause of mortality and morbidity worldwide, yet research on COPD patients who have never smoked is limited. This study aims to document the demographic, symptomatic, and therapeutic characteristics of COPD patients receiving outpatient pulmonary care in Hungary, focusing on smoking history, and evaluate their distribution according to the GOLD A/B/E classification.

Methods

The study recorded demographic data, symptom severity, occurrence of severe and moderate exacerbations, treatment, comorbidities, quality of life, and COVID-19 vaccination status among COPD patients from November 2021 to January 2023. A total of 6974 patients were categorized into current smokers, former smokers, and never smokers.

Results

Patients had an average age of 67.2±8.9 years, with 48.2% male and 51.8% female. Of participants, 86.1% had a smoking history, while 13.9% had never smoked. COPD patients who had never smoked showed significantly better quality of life (CAT: 15.2±7.6 vs 15.8±6.9; p=0.006), oxygen saturation (SpO2%: 96.7±2.3 vs 95.8±2.4; p<0.001), higher body mass index (BMI: 29.4±5.9 vs 27.1±6.3; p<0.001), and better lung function (FEV1ref%: 67.9±20.7 vs 58.9±18.1; p<0.001) compared to smokers. However, non-smoking COPD patients had a higher frequency of comorbidities (3.5±2.2 vs 2.9±2.1; p<0.05). These differences may arise from complex genetic and environmental interactions.

Conclusion

COPD patients who have never smoked exhibited better quality of life, nutritional status, and lung function compared to smokers, indicating the need for tailored treatment approaches. Further long-term studies are essential to validate these differences in quality of life and lung function between smoking and non-smoking COPD patients.

Vaccine uptake, associated factors and reasons for vaccination status among the South African elderly; findings and next steps

OBJECTIVES

The elderly are particularly prone to complications from a number of vaccine-preventable diseases. However, there are limited data on vaccine uptake for this vulnerable population in South Africa. Consequently, this study investigated influenza, pneumococcal and shingles vaccine uptake among elderly people in South Africa; reasons for their vaccination status; and factors associated with their uptake.

METHODS

Cross-sectional study using an interviewer-administered questionnaire to survey 985 consenting adults aged ≥65 years in 2018. Participants were recruited from across South Africa. Bivariate analysis was used to identify socio-demographic variables associated with vaccine uptake, with multivariate logistic regression analysis used to identify key factors associated with vaccine uptake.

RESULTS

Influenza vaccine uptake was 32.3% (318/985), with uptake highest in those aged 85-90 years. Pneumococcal and shingles vaccine uptake was 3.8% (37/985) and 0.4% (4/985) respectively, being highest among those aged >90 years. The strongest statistically significant predictors for influenza vaccination were previous influenza vaccination (OR: 8.42 [5.61-12.64]); identifying as 'Coloured' (OR: 8.39 [3.98-17.69]); and residing in Gauteng Province (OR: 5.44 [3.30-9.02]). The strongest statistically significant predictors of receiving pneumococcal vaccination included receiving influenza vaccination (OR = 10.67 [3.27-37.83]); residing in the Western Cape Province (OR: 7.34 [1.49-36.22]); identifying as 'Indian' (OR: 5.85 [2.53-13.55]); and having a university education (OR: 5.56 [1.25-24.77]). Statistically significant barriers to receiving influenza vaccination included following the Traditional African religion (OR: 0.08 [0.01-0.62]) and residing in Limpopo Province (OR: 0.16 [0.04-0.71]). The main reasons for non-vaccination were considering influenza as a mild illness (36.6%; 242/661), and lack of knowledge about the pneumococcal (93.4%; 886/948) and shingles (95.2%; 934/981) vaccines.

CONCLUSION

Vaccine uptake for all vaccines was sub-optimal, with multiple non-modifiable factors predicting vaccine uptake. These pre-COVID-19 data provide a baseline for measuring the effectiveness of future interventions to increase vaccine uptake and safeguard the health of the elderly.

Long-term effect of pneumococcal conjugate vaccines on invasive pneumococcal disease incidence among people of all ages from national, active, laboratory-based surveillance in South Africa, 2005-19: a cohort observational study

BACKGROUND

In South Africa, 7-valent pneumococcal conjugate vaccine (PCV7) was introduced in 2009 and 13-valent PCV (PCV13) was introduced in 2011, both in a two plus one schedule. We evaluated the ongoing effects of PCV on the prevention of invasive pneumococcal disease (IPD) over 15 years of sustained surveillance in South Africa before the COVID-19 pandemic.

METHODS

We conducted national, active, laboratory-based surveillance for IPD among all ages in South Africa, including isolate serotyping and susceptibility testing. We fitted linear regression models with vaccine covariates to imputed IPD case counts each year by serotype and age to compare expected and actual IPD cases in 2019, which was the main outcome. Vaccine effects were set to zero to identify expected incidence after the introduction of PCV7 and PCV13.

FINDINGS

From Jan 1, 2005, to Dec 31, 2019, surveillance identified 52 957 IPD cases. Among the 50 705 individuals with age data available, 9398 (18·5%) were infants aged younger than 2 years. Compared with expected case numbers (no vaccination) predicted using all available data, overall IPD rates among children younger than 2 years declined by 76·0% (percentage risk difference; 95% CI -79·0 to -72·8%) in 2019; notably, PCV7 and additional PCV13 serotype IPD rates declined by 95·5% (-97·0 to -93·4%) and 93·8% (-96·2 to-90·5%), respectively, whereas non-vaccine serotypes (NVTs) did not change significantly. Among adults aged 25-44 years, overall IPD declined by 50·4% (-54·2 to -46·3%), and PCV7 and additional PCV13 serotype IPD rates declined by 86·1% (-88·7 to -83·1%) and 77·2% (-80·9 to -73·0%), respectively, whereas NVTs increased by 78·5% (56·8 to 103·4%). Individuals aged older than 64 years also benefited from declines in IPD (-30·2%; -41·9 to -16·2%), but NVTs increased (234·9%; 138·1 to 379·4%).

INTERPRETATION

We documented sustained direct and indirect benefits of PCV across age groups, and NVT increases in adults older than 24 years. Higher valency PCVs would have the added benefit of preventing this residual disease.

FUNDING

National Institute for Communicable Diseases of the National Health Laboratory Service (South Africa) and US Agency for International Development Antimicrobial Resistance Initiative, US Centers for Disease Control and Prevention.

Value of diagnostic vaccination in diagnosis of humoral inborn errors of immunity

Inborn errors of immunity (IEIs) or primary immunodeficiency diseases, are disorders caused by genetic defects affecting immune function. Clinically, IEI presents mainly as recurrent or severe infections, immune dysregulation (autoimmunity or autoinflammatory disorders), and lymphoproliferation with or without dysmorphic features. Humoral IEIs are the largest subgroup of IEI, with a wide spectrum of quantitative and qualitative antibody defects. These disorders are normally diagnosed based on immunological evaluation; diagnostic vaccination is part of this evaluation. This review examines the importance and relevance of diagnostic vaccination in the diagnosis of humoral IEIs and different technologies which can be utilised in diagnosis.