Vaccination in Immunocompromised Host (ICH)

2021 ◽  
Author(s):  
Igor Stoma
Keyword(s):  
Passive Immunization ◽  
Immunocompromised Host ◽  
Individual Risk ◽  
Post Exposure Prophylaxis ◽  
Immune Functions ◽  
Varicella Zoster ◽  
Organ Rejection ◽  
Comprehensive Management ◽  
Vaccination History ◽  
Exposure Prophylaxis

Infectious disease (ID) are a major cause of morbidity and fatality in the ICH and moreover IDs may trigger underlying diseases or graft versus host disease (GVHD) and organ rejection. To reduce risk, management of ID in ICH requires a comprehensive management from day 1, with (1) reduction of exposures: fewer social contacts; cocooning (vaccination of any close contacts); appropriate “low pathogen-diet”; avoiding environmental exposures (dust); (2) Detection of pre-existing risks (latent infections, vaccination history); (3) bearing in mind “expected IDs” by type and severity of immunosuppression. Inactivated vaccines have similar reactogenicity and safety profiles in the ICH and health subjects; however due to reduced immunogenicity, efficacy may be reduced. Live vaccines are usually contraindicated as they may cause harm in severely immunocompromised patients; however, they can be considered based on an individual risk-benefit assessment with remaining immune functions in mind. In some instances, post-exposure prophylaxis with immunoglobulins is effective, (“passive immunization”) specifically against measles and the varicella-zoster-virus. For the latter, antivirals can be used as an alternative.

Post-exposure Prophylaxis against Varicella Zoster Virus in Hospitalized Children after Inadvertent Exposure

2016 ◽  
Vol 23 (3) ◽  
pp. 180
Author(s):  
Song I Yang ◽  
Ji Hee Lim ◽  
Eun Jin Kim ◽  
Ji Young Park ◽  
Ki Wook Yun ◽  
...  
Keyword(s):  
Varicella Zoster Virus ◽  
Post Exposure Prophylaxis ◽  
Hospitalized Children ◽  
Varicella Zoster ◽  
Post Exposure ◽  
Exposure Prophylaxis

Vaccine-Preventable Disease

2020 ◽  
pp. 123-136
Author(s):  
Loren G. Yamamoto
Keyword(s):  
Respiratory Syncytial Virus ◽  
Hepatitis B ◽  
Post Exposure Prophylaxis ◽  
Vaccine Preventable Disease ◽  
Varicella Zoster ◽  
Vaccine Preventable Diseases ◽  
Disease Entities ◽  
Syncytial Virus ◽  
Rabies Exposure ◽  
Exposure Prophylaxis

This chapter discusses disease entities that are vaccine preventable. Diseases not likely to be seen by physicians because of near eradication include diphtheria, tetanus, polio, and rabies. However, suspected rabies exposure is common, and initiating post-exposure prophylaxis is essential to preventing rabies. Clearly, other diseases that vaccines have reduced but not eliminated, such as pertussis, hepatitis A, hepatitis B, rotavirus, varicella/zoster, pneumococcal disease, meningococcal disease, influenza, respiratory syncytial virus, and tuberculosis, will be encountered. Haemophilus influenzae type b disease may also rarely be seen. There is great potential for physicians to never see a case of measles, mumps, and rubella, but because clusters of parents have chosen to not vaccinate their children, sporadic outbreaks will continue to occur.

Challenges facing human rabies control: the Lebanese experience

2013 ◽  
Vol 142 (7) ◽  
pp. 1486-1494 ◽  
Author(s):  
A. BIZRI ◽  
A. ALAWIEH ◽  
N. GHOSN ◽  
A. BERRY ◽  
U. MUSHARRAFIEH
Keyword(s):  
Regional Cooperation ◽  
Public Awareness ◽  
Passive Immunization ◽  
Human Rabies ◽  
Post Exposure Prophylaxis ◽  
Post Exposure ◽  
Zoonotic Infections ◽  
Rabies Control ◽  
Animal Bites ◽  
Exposure Prophylaxis

SUMMARYRabies is one of the most important zoonotic infections worldwide. The burden of the disease continues to be significant in countries in the Middle East where the most important vector is stray dogs. Control efforts are hindered by lack of awareness and incomplete post-exposure prophylaxis. The aim of this article is to re-assess the situation of rabies in Lebanon and compare it to other Middle Eastern countries. Eight cases of rabies and 5280 incidents of animal bites to humans were reported to the Lebanese Ministry of Public Health between 2001 and 2012. Dogs were the only vector of infection and were responsible for most reported animal bites to humans. An average of 3·2 doses of vaccine per bite was administered as post-exposure prophylaxis. The status of human and canine rabies control, the risks associated with children's behaviour and the hazards of secondary wild reservoirs are discussed. Our data illustrates the importance of prevention through vector control, public awareness and education, and timely administration of active and passive immunization, as well as the significance of regional cooperation and monitoring the circulation of viral variants in wild animals.

scholarly journals Isolation and Characterization of Cross-Reactive Human Monoclonal Antibodies that Potently Neutralize Australian Bat Lyssavirus Variants and Other Phylogroup 1 Lyssaviruses

2021 ◽  
Author(s):  
Dawn Weir ◽  
Si'Ana Coggins ◽  
Bang Vu ◽  
Jessica Coertse ◽  
Lianying Yan ◽  
...  
Keyword(s):  
Monoclonal Antibodies ◽  
G Protein ◽  
Passive Immunization ◽  
Diagnostic Tools ◽  
Post Exposure Prophylaxis ◽  
Human Monoclonal Antibodies ◽  
Isolation And Characterization ◽  
Glycoprotein G ◽  
Exposure Prophylaxis ◽  
Australian Bat Lyssavirus

Australian bat lyssavirus (ABLV) is a rhabdovirus that circulates in four species of pteropid bats (ABLVp) and the yellow-bellied sheath-tailed bat (ABLVs) in mainland Australia. In the three confirmed human cases of ABLV, rabies illness preceded fatality. As with rabies virus (RABV), post-exposure prophylaxis (PEP) for potential ABLV infections consists of wound cleansing, ad-ministration of the rabies vaccine and injection of rabies immunoglobulin (RIG) proximal to the wound. Despite the efficacy of PEP, the inaccessibility of human RIG (HRIG) in the developing world and the high immunogenicity of equine RIG (ERIG) has led to consideration of human monoclonal antibodies (hmAbs) as a passive immunization option that offers enhanced safety and specificity. Using a recombinant vesicular stomatitis virus (rVSV) expressing the glycoprotein (G) protein of ABLVs and phage display, we identified two hmAbs, A6 and F11, which completely neutralize ABLVs/ABLVp, and RABV at concentrations ranging from 0.19-3.12 µg/mL and 0.39-6.25 µg/mL respectively. A6 and F11 recognize overlapping epitopes in the lyssavirus G protein, ef-fectively neutralizing phylogroup 1 lyssaviruses, while having little effect on phylogroup 2 and non-grouped diverse lyssaviruses. These results suggest A6 and F11 could be effective therapeutic and diagnostic tools for phylogroup 1 lyssavirus infections.

#30: Patterns of Post-Exposure Prophylaxis for Varicella-Zoster Virus in Pediatric Patients

2021 ◽  
Vol 10 (Supplement_1) ◽  
pp. S3-S3
Author(s):  
Shan Sun ◽  
Sameer Patel ◽  
Ravi Jhaveri
Keyword(s):  
High Risk ◽  
Varicella Zoster Virus ◽  
Risk Groups ◽  
Severe Illness ◽  
Post Exposure Prophylaxis ◽  
Annual Data ◽  
Varicella Zoster ◽  
Post Exposure ◽  
Exposure Prophylaxis ◽  
Over Time

Abstract Background Varicella-Zoster virus (VZV) is still a significant threat for severe illness for patients in high-risk groups. These patients are candidates for post-exposure prophylaxis (PEP), but among adult providers there is significant variation on what agents are used for PEP. There are little data on PEP practices among pediatric providers. Objective We sought to define patterns of PEP for VZV exposure across children’s hospitals. Methods Using the Pediatric Health Information Systems database, we analyzed claims data for the relevant ICD-9/10 codes for VZV exposure from 2009 to 2018. We evaluated patients for subsequent VZV disease, and we also evaluated how frequently PEP was given, how many days after the exposure or admission, and what agent was used for PEP. We analyzed annual data and institutional-level data over the study period and looked for trends over time. We performed Kruskal–Willis testing when comparing more than two independent samples of equal or different sample sizes. Results Over the 10 years, we identified 1726 children with VZV exposure, 1622 of them with only one exposure. Of these 1662 children, 683 (42.1%) were prescribed some form of PEP after VZV exposure, while 75 (4.6%) ultimately developed some form of symptomatic VZV. Among the agents used for VZV PEP, acyclovir along was the most frequently used overall, but its use declined over time (45% in 2009 to 30% in 2018). Immunoglobulin was the second most used option (26–43%), while a consistent percentage (4–19%) of children also received the combination of acyclovir and IG. Varicella-specific immune globulin (VariZIG) was used sparingly before 2013, but its use was more frequent from 2015 to 2018 (23–27%). Most children receiving VZV PEP had some form of malignancy, with various newborn populations comprising most of the rest of PEP recipients. Efficacy in preventing VZV was significantly different: 27/218 (12.4%) of children with acyclovir PEP ultimately had a VZV-diagnosis code, compared with 1/148 (0.7%) and 1/112 (0.9%) treated, respectively, with either IG or VariZIG (P < 0.0001). Conclusions Increasing use of VariZIG likely corresponded to widespread US availability after a long market absence. Nonetheless, the management of VZV PEP in children with high-risk conditions varied considerably across institutions. As the CDC and AAP Red Book list VariZIG as the primary option for PEP, there is considerable room to optimize PEP practice and reduce breakthrough VZV infections.

scholarly journals Awareness, Utilization, and Preferences for Traditional and Contemporary HIV Prevention Strategies Among Facebook and Instagram-Using MSM in the United States

2021 ◽  
Vol 20 ◽  
pp. 232595822110247
Author(s):  
Akshay Sharma ◽  
Ariana Paredes-Vincent ◽  
Erin M. Kahle
Keyword(s):  
Hiv Prevention ◽  
The United States ◽  
Easy Access ◽  
Individual Risk ◽  
Post Exposure Prophylaxis ◽  
Prevention Strategies ◽  
Hiv Prevention Strategies ◽  
And Bisexual ◽  
Sex With Men ◽  
Exposure Prophylaxis

HIV prevention research among men who have sex with men (MSM) has traditionally focused on individual risk reduction strategies. Our study evaluated awareness, utilization, and preferences for 10 complementary HIV prevention strategies among 1,286 MSM recruited via Facebook and Instagram from June-August 2018. Ages ranged from 18-85 years, and the majority were non-Hispanic white (n = 1,019, 79.24%), college-educated (n = 819, 63.69%), gay-identifying (n = 1,074, 83.51%), and partnered (n = 808, 62.83%). Post-exposure prophylaxis was the least familiar option, and engaging in sexual activities other than anal sex was the most utilized option. Progressively older and bisexual-identifying MSM were less likely, but those with higher educational levels and easy access to local HIV resources were more likely to be aware of and to be utilizing a greater number of strategies. Additionally, Hispanic MSM were less likely to be aware of, and those in a “closed” relationship were less likely to be utilizing a greater number of strategies. In a subset of 775 multiple strategy users, pre-exposure prophylaxis, regularly testing for HIV, and limiting the number of sex partners emerged as the most preferred options. Combination intervention packages for MSM should be tailored to personal circumstances, including sexual orientation, relationship characteristics and access to local HIV resources.

A Decade of Varicella Screening Within a Paediatric Inflammatory Bowel Disease Population

2019 ◽  
Vol 14 (5) ◽  
pp. 608-616 ◽  
Author(s):  
Rachel E Harris ◽  
Lee Curtis ◽  
Vikas Hegde ◽  
Vikki Garrick ◽  
Lisa Gervais ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Hospital Admissions ◽  
Immunisation Programme ◽  
Post Exposure Prophylaxis ◽  
Varicella Zoster ◽  
Post Exposure ◽  
Increased Risk ◽  
Inflammatory Bowel ◽  
Exposure Prophylaxis

Abstract Introduction Increased risk of opportunistic infection—e.g., varicella zoster infection—secondary to therapies is a cause of morbidity in inflammatory bowel disease [IBD] patients. The UK vaccination schedule does not include varicella immunisation. We aimed to evaluate the varicella screening and immunisation programme in a paediatric IBD population. Methods Data regarding IBD diagnosis, varicella status, and consequent immunisations/treatment interventions were collected retrospectively from the records of patients diagnosed with IBD over a 10-year period [2009–2018]. Results In all, 520 IBD patients were diagnosed; 505/520 [97%] had varicella testing; 46/505 [9%] were naïve. Of 501 patients, 391[78%] were tested before or within 7 days of diagnosis; this increased in the second 5-year period compared with the first (229/268 [85%] versus 162/233 [70%]; p <0.00001). Median diagnosis age of naïve patients was lower [8.3 years versus 12.8 years; p <0.00001]. Where vaccination was feasible, 21/31 [68%] had two and 7/31 [23%] one immunisation. Prednisolone induction led to lower rates of vaccination (5/13 [39%] versus 23/33 [70%] for other induction therapies; p =0.02). Of 28 vaccinated patients, 5 [18%] had suspected breakthrough varicella; and 6/18 [33%] unimmunised patients required post-exposure prophylaxis or treatment for varicella. Immunisation was associated with a decrease in patients requiring post-exposure prophylaxis (0/28 [0%] versus 5/18 [28%]; p =0.0006) and varicella-related hospital admission (1/28 [4%] versus 4/18 [22%]; p =0.01). Conclusions High rates of varicella screening and immunisation within a PIBD population are possible, resulting in a reduction in hospital admissions for varicella treatment. Varicella immunisation may be of increasing importance within the PIBD population with the emergence of novel therapeutic strategies.

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