Anti-polysaccharide and anti-diphtheria protective antibodies after 13-valent pneumococcal conjugate vaccination in rheumatoid arthritis patients under immunosuppressive therapy

Immunogenicity of 13-valent pneumococcal polysaccharide (PnPS) conjugate vaccine (PCV13) was evaluated in 38 rheumatoid arthritis patients under immunosuppressive treatment and 20 healthy controls (HC). Antibodies to all PnPS and diphtheria-toxin analogue conjugate protein were measured pre- (T0), 1 (T1), 6 (T2), 12 (T3) months post-immunization. Patients and HC had similar response to individual PnPS. Mean antibody levels to all PnPS but one doubled at T1 compared with T0, with T3 persistence for only 8-7/13 PnPS. Baseline antibody levels was inversely associated with the rate of responders at T1 (T1/T0≥2) to 11/13 PnPS. Few subjects reached protective IgG levels against some serotypes frequently isolated in Italian patients with invasive pneumococcal disease. Antibody response was not influenced by therapy, except the one to PS7F, which was reduced by tumor necrosis factor-α-inhibitors. Vaccination increased also anti-diphtheria IgG. Despite this study substantially confirmed the PCV13 immunogenicity in immunocompromised patients, it also revealed some limitations.

[HPV vaccination: active offer in an Italian region]

Human Papillomavirus is responsible for 4.8% of cancers, and is the main cause of cervical cancer. Cervical cancer can be reduced by mean of secondary prevention (PAP-test, HPV-DNA test), while through primary prevention (anti-HPV vaccine) the incidence of other HPV-attributable cancers can also be reduced. In Italy, anti-HPV vaccination is part of the immunization schedule in girls since 2008, and in 2017 it was extended to boys. However, vaccine coverage is decreasing nationwide. This study aims to examine anti-HPV vaccination practices in Health care services of Lazio Region, Italy. Questionnaires were sent or administered directly to those in charge of vaccinations. Data, collected from 11/12 (92%) Lazio Local Health Units and from 116 vaccination centers, show a remarkable diversity in the offer: 41% of the centers open only 1-2 days/week, 42% only in the morning, and only 7% are open on Saturday. Vaccination is available by reservation only in 62% of the centers, while vaccines are not administered to ≥18 years subjects in 33%; 93% of the centers call actively the girls in the target cohort, while 70% and 94% recall the patients who had not received the first or the second dose of vaccine, respectively. Collaboration with family physicians and/or pediatricians was declared by 80% of the centers. Vaccine coverage could probably be improved by addressing the highlighted critical issues and applying best practices widely.

[Contraindications and adverse events of immunizations at workplace. Multidisciplinary management in workers for 2005-2010]

We have studied 790 workers working abroad, for 2005-2010, divided into 3 main groups for recommended and mandatory vaccination schemes, specific for geographic areas, in co-administration. After the standardized prevaccine screening, 780 (98.7%) workers were eligible for vaccination, 10 (1.2%) workers showed temporary contraindications and personal precautions need. The post vaccination evaluation has shown that a percentage from 9 to 20% of workers had local adverse effects, mild injection site.

[Health management of Italian workers abroad]

In the last 20 years traveling workers abroad have increased markedly. This resulted in the need for standardized preventive tools available to protect workers-travelers in geographic areas with related additional risk factors. Health surveillance of these workers require a company organization that involves the components of the process prior: the occupational physician, safety service, administrative areas, travel clinic. The application phases of medical surveillance must be differentiated into two main phases: 1. pre-travel, in which successive stages also encoded by the SIMLII guidelines; 2. the return journey, where the paths are different for asymptomatic and symptomatic workers. The evaluation of fitness to perform the job abroad is based on general criteria that allow to correlate the health of the worker with respect to the destination area. The application methods actually available allow modulations of the health surveillance for companies of different dimension.

A comparison of populations vaccinated in a public service and in a private hospital setting in the same area

Background

Improving immunisation rates in risk groups is one of the main objectives in vaccination strategies. However, achieving high vaccination rates in children with chronic conditions is difficult. Different types of vaccine providers may differently attract high risk children.

Aim

To describe the characteristics of two populations of children who attended a private and a public immunisation provider in the same area. Secondarily, to determine if prevalence of patients with underlying diseases by type of provider differs and to study if the choice of different providers influences timeliness in immunisation.

Methods

We performed a cross-sectional study on parents of children 2 – 36 months of age who attended a private hospital immunisation service or a public immunisation office serving the same metropolitan area of Rome, Italy. Data on personal characteristics and immunisation history were collected through a face to face interview with parents of vaccinees, and compared by type of provider. Prevalence of underlying conditions was compared in the two populations. Timeliness in immunisation and its determinants were analysed through a logistic regression model.

Results

A total of 202 parents of children 2–36 months of age were interviewed; 104 were in the public office, and 98 in the hospital practice. Children immunised in the hospital were more frequently firstborn female children, breast fed for a longer period, with a lower birthweight, and more frequently with a previous hospitalisation. The prevalence of high risk children immunised in the hospital was 9.2 vs 0% in the public service (P = 0.001). Immunisation delay for due vaccines was higher in the hospital practice than in the public service (DTP, polio, HBV, and Hib: 39.8% vs 22.1%; P = 0.005). Anyway multivariate analyses did not reveal differences in timeliness between the public and private hospital settings.

Conclusion

Children with underlying diseases or a low birthweight were more frequently immunised in the hospital. This finding suggests that offering immunisations in a hospital setting may facilitate vaccination uptake in high risk groups. An integration between public and hospital practices and an effort to improve communication on vaccines to parents, may significantly increase immunisation rates in high risk groups and in the general population, and prevent immunisation delays.