scholarly journals Vaccination in rheumatology: present and prospects

2020 ◽  
Vol 2 (37) ◽  
pp. 44-49
Author(s):  
B. S. Belov ◽  
G. M. Tarasova ◽  
D. V. Bukhanova ◽  
N. V. Muravyeva

In rheumatology in recent years, the importance of comorbid infections has increased significantly, especially in connection with the introduction of genetic engineering biological drugs into clinical practice. One way to solve this problem is to study and actively use various vaccines. This review provides an updated version of the recommendations for vaccinating adult patients with autoimmune inflammatory rheumatic diseases, proposed in 2019 by experts from the European Anti-Rheumatic League (EULAR). Issues regarding the use of influenza vaccines, infections caused by Pneumococci, Hepatitis B viruses, herpes and human papillomaviruses in rheumatological patients are considered. The main directions of future research on this issue are outlined.

RMD Open ◽  
2019 ◽  
Vol 5 (2) ◽  
pp. e001041 ◽  
Author(s):  
Victoria Furer ◽  
Christien Rondaan ◽  
Marloes Heijstek ◽  
Sander van Assen ◽  
Marc Bijl ◽  
...  

ObjectivesThe aims of this study were to update the evidence on the incidence and prevalence rates of vaccine preventable infections (VPI) in patients with autoimmune inflammatory rheumatic diseases (AIIRD) and compare the data to the general population when available.MethodsA literature search was performed using Medline, Embase and Cochrane library (October 2009 to August 2018). The primary outcome was the incidence or prevalence of VPI in the adult AIIRD population. Meta-analysis was performed when appropriate.ResultsSixty-three publications out of 3876 identified records met the inclusion criteria: influenza (n=4), pneumococcal disease (n=7), hepatitis B (n=10), herpes zoster (HZ) (n=29), human papillomavirus (HPV) infection (n=13). An increased incidence of influenza and pneumococcal disease was reported in patients with AIIRD. HZ infection-pooled incidence rate ratio (IRR) was 2.9 (95% CI 2.4 to 3.3) in patients with AIIRD versus general population. Among AIIRD, inflammatory myositis conferred the highest incidence rate (IR) of HZ (pooled IRR 5.1, 95% CI 4.3 to 5.9), followed by systemic lupus erythematosus (SLE) (pooled IRR 4.0, 95% CI 2.3 to 5.7) and rheumatoid arthritis (pooled IRR 2.3, 95% CI 2.1 to 2.6). HPV infection-pooled prevalence ratio was 1.6, 95% CI 0.7 to 3.4 versus general population, based on studies mainly conducted in the SLE population in Latin America and Asia. Pooled prevalence of hepatitis B surface antigen and hepatitis B core antibody in patients with AIIRD was similar to the general population, 3%, 95% CI 1% to 5% and 15%, 95% CI 7% to 26%, respectively.ConclusionCurrent evidence shows an increased risk of VPI in patients with AIIRD, emphasising that prevention of infections is essential in these patients.


2020 ◽  
Vol 65 (1-2) ◽  
pp. 61-67
Author(s):  
B. S. Belov ◽  
G. M. Tarasova ◽  
N. V. Muravyova

Comorbid infections have a significant effect on morbidity and mortality in modern rheumatology, especially in immune-mediated inflammatory rheumatic diseases (IMIRD). In this regard, vaccination is becoming increasingly important in the prevention of infections in IMIRD. The article analyzes an updated version of the recommendations for vaccination of adult patients with IMIRD, proposed by experts of the European League Against Rheumatism at the end of 2019. The safety and immunogenicity of vaccination associated with the prevention of various infections in patients with IMIRD are discussed. The main directions of future research on this issue are outlined.


2021 ◽  
pp. 177-187
Author(s):  
B. S. Belov ◽  
N. V. Muravyeva ◽  
M. M. Baranova

The problem of comorbid infections in rheumatology seems to be very relevant in connection with the active introduction into clinical practice of innovative disease-modifying anti-rheumatic drugs (DMARDs), the so-called targeted DMARDs (tDMARDs), as well as genetically engineered biological drugs (biologics), the action of which is directed at specific links in the pathogenesis of immuno-inflammatory rheumatic diseases. With the accumulation of global clinical experience, the association of the use of these drugs with an increasing risk of developing comorbid infections of various nature and localization has become clearly traced. The real way out of this situation seems to be the creation, improvement and introduction into clinical practice of various vaccines. At the same time, a number of anti-rheumatic drugs may have a certain negative effect on the immunogenicity of some vaccines, which may lead to a decrease in the preventive effectiveness of the latter. This review presents the latest data on the effect of various anti-rheumatic drugs on the immunogenicity of vaccines against influenza, pneumococcal and herpes virus infections, viral hepatitis B, yellow fever and COVID-19 used in rheumatological patients. It has been shown that the anti-B-cell drug ritux imab has a significant negative effect on the immunogenicity of vaccines, which increases with a shortening of the time between immunization and the use of the drug. Methotrexate also negatively affects the immunogenicity of most vaccines, but to a lesser extent. Abatacept probably reduces the immunogenicity of vaccines, although studies were performed in the absence of adequate control groups. Tumor necrosis factor inhibitors-α and tDMARDs (janus kinase inhibitors) reduce the absolute values of antibody concentrations for many vaccines, but apparently do not have a significant effect on the frequency of patients who have achieved seroprotection. Inhibitors of interleukin (IL) -6, IL-12 / IL-23 and IL-17 practically do not affect the immunogenicity of vaccines. The accumulated data on the effect of the above drugs on the immunogenicity of the vaccine against SARS-CoV-2, apparently, are similar to those obtained in studies on vaccination against other infections in patients with immuno-inflammatory rheu matic diseases. Further clinical studies are needed to assess the effect of immunosuppressive therapy on the vaccine response and to develop methods for its optimization.


2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 909.1-909
Author(s):  
M. Viola ◽  
A. Benitez ◽  
C. Garbarino ◽  
G. Rodriguez ◽  
F. Benavidez ◽  
...  

Background:Infectious diseases are increased in patients with rheumatic disorders; vaccination improves morbidity and mortalityObjectives:The aim of this study was to describe the frequency of vaccination in patients with rheumatic disorders and to compare the results with those obtained in 2009 and 2013 in a similar population. We also identified factors leading to lack of vaccination and patients beliefs on vaccines.Methods:Multicentric cross sectional study in patients with autoinmune diseases from external rheumatology offices. Evaluation of vaccination status and patients´ knowledge about vaccines were studied. A comparative analysis was carried out with the series registered in 2009 and 2013 in a similar population.Results:179 patients (158 female, 88.3% and 21 male, 11.7%) were evaluated. Median age was 52 years. Main pathologies were: Rheumatoid Arthritis 65.9% (n:118), Systemic Lupus Erythematosus 11.7% (n:21), Systemic Sclerosis 3.9% (7), Sjogren Syndrome n = 3.4% (n:6), other diseases 15% (n: 27). Median disease duration: 8.87 years. Ninety three percent of patients (n:167) were taking inmunomodulators and 36.8% (n: 66) were using oral corticosteroids (20mg/day or less); 26,8% patients (n: 48) were receiving biological therapies. Vaccination frequency in the population was: Influenza 82% (147); 13-valent conjugate pneumococcal 69.3% (124), 23-valent pneumococcal 64.2% (115) and hepatitis B 62% (111). Comparative with 2009 and 2013 series there was an increase in the rate of vaccinated patients: influenza (82% vs. 39,1% and 74,2% respectively), antineumococcal (64% vs. 17% and 29%) and hepatitis B (62% vs. 6,7% and 26,7%).Reasons for non-vaccination were absence of medical indication (41% of patients for hepatitis B; 32% for 23-valent pneumococcal; 38% for 13-valent pneumococcal and 34% for influenza).139 patients (77, 7%) knew the benefits of vaccines, 164 (91, 6%) thought vaccines are useful; 134 (74,9%) reported that vaccines may decrease dying probability, 155 (86,5%) thought that vaccines are effective to prevent diseases and 149 patients (83,2%) believed that they prevent serious infections. 71 patients (39%) believed that vaccines can lead to serious consequences and 99 (55,3%) that they are more likely to acquire infections than the rest of the population.Conclusion:Frequency of vaccination has increased since 2009 but there is still misinformation regarding vaccines risks and benefits. Promotion and information is essential to improve adherence.References:[1]2019 update of EULAR recommendations for vaccination in adult patients with autoimmune inflammatory rheumatic diseases. Furer V, et al. Ann Rheum Dis 2020;79:39–52[2] Vaccines and Disease-Modifying Antirheumatic Drugs: Practical Implications for the Rheumatologist. Friedman MA et al. Rheum Dis Clin North Am. 2017 Feb; 43 (1):1-13.[3] Recommendations and barriers to vaccination in systemic lupus erythematosus. Garg M et al. Autoimmun Rev. 2018 Oct; 17 (10):990-1001.[4] Comparison of national clinical practice guidelines and recommendations on vaccination of adult patients with autoimmune rheumatic diseases. Papadopoulou D. et al. Rheumatol Int. 2014 Feb;34 (2):151-63.[5] Guías de recomendaciones de prevención de infecciones en pacientes que reciben modificadores de la respuesta biológica. Jordán R. Et al. Rev Arg Reumatol. 2014; 25 (2): 08-26.Disclosure of Interests:Malena Viola: None declared, Alejandro Benitez: None declared, Cecilia Garbarino: None declared, Gonzalo Rodriguez: None declared, Federico Benavidez: None declared, Claudia Peon: None declared, Eliana Soledad Blanco: None declared, Hernan Molina: None declared, Gimena Gómez: None declared, griselda redondo: None declared, Maria DeLaVega: None declared, Dario Mata: None declared, Augusto Riopedre: None declared, Osvaldo Messina Speakers bureau: Amgen; Americas Health Foundation; Pfizer


2020 ◽  
Vol 8 (11) ◽  
pp. 1792
Author(s):  
Marco Canzoni ◽  
Massimo Marignani ◽  
Maria Laura Sorgi ◽  
Paola Begini ◽  
Michela Ileen Biondo ◽  
...  

Chronic hepatitis B virus (HBV) infection may be reactivated by immunosuppressive drugs in patients with autoimmune inflammatory rheumatic diseases. This study evaluates HBV serum markers’ prevalence in rheumatic outpatients belonging to Spondyloarthritis, Chronic Arthritis and Connective Tissue Disease diagnostic groups in Italy. The study enrolled 302 subjects, sex ratio (M/F) 0.6, mean age ± standard deviation 57 ± 15 years, 167 (55%) of whom were candidates for immunosuppressive therapy. The Spondyloarthritis group included 146 subjects, Chronic Arthritis 75 and Connective Tissue Disease 83 (two patients had two rheumatic diseases; thus, the sum is 304 instead of 302). Ten subjects (3%) reported previous anti-HBV vaccination and tested positive for anti-HBs alone with a titer still protective (>10 IU/mL). Among the remaining 292 subjects, the prevalence of positivity for HBsAg, isolated anti-HBc, anti-HBc/anti-HBs, and any HBV marker was 2%, 4%, 18%, and 24%, respectively. A total of 26/302 (9%) patients with γ-globulin levels ≤0.7 g/dL were more frequently (p = 0.03455) prescribed immunosuppressive therapy, suggesting a more severe rheumatic disease. A not negligible percentage of rheumatic patients in Italy are at potential risk of HBV reactivation related to immunosuppressive therapy. Before starting treatment, subjects should be tested for HBV markers. Those resulting positive should receive treatment or prophylaxis with Nucleos (t) ides analogue (NUCs) at high barrier of resistance, or pre-emptive therapy, according to the pattern of positive markers. HB vaccination is recommended for those who were never exposed to the virus.


2021 ◽  
pp. annrheumdis-2021-220647
Author(s):  
Victoria Furer ◽  
Tali Eviatar ◽  
Devy Zisman ◽  
Hagit Peleg ◽  
Daphna Paran ◽  
...  

IntroductionVaccination represents a cornerstone in mastering the COVID-19 pandemic. Data on immunogenicity and safety of messenger RNA (mRNA) vaccines in patients with autoimmune inflammatory rheumatic diseases (AIIRD) are limited.MethodsA multicentre observational study evaluated the immunogenicity and safety of the two-dose regimen BNT162b2 mRNA vaccine in adult patients with AIIRD (n=686) compared with the general population (n=121). Serum IgG antibody levels against SARS-CoV-2 spike S1/S2 proteins were measured 2–6 weeks after the second vaccine dose. Seropositivity was defined as IgG ≥15 binding antibody units (BAU)/mL. Vaccination efficacy, safety, and disease activity were assessed within 6 weeks after the second vaccine dose.ResultsFollowing vaccination, the seropositivity rate and S1/S2 IgG levels were significantly lower among patients with AIIRD versus controls (86% (n=590) vs 100%, p<0.0001 and 132.9±91.7 vs 218.6±82.06 BAU/mL, p<0.0001, respectively). Risk factors for reduced immunogenicity included older age and treatment with glucocorticoids, rituximab, mycophenolate mofetil (MMF), and abatacept. Rituximab was the main cause of a seronegative response (39% seropositivity). There were no postvaccination symptomatic cases of COVID-19 among patients with AIIRD and one mild case in the control group. Major adverse events in patients with AIIRD included death (n=2) several weeks after the second vaccine dose, non-disseminated herpes zoster (n=6), uveitis (n=2), and pericarditis (n=1). Postvaccination disease activity remained stable in the majority of patients.ConclusionmRNA BNTb262 vaccine was immunogenic in the majority of patients with AIIRD, with an acceptable safety profile. Treatment with glucocorticoids, rituximab, MMF, and abatacept was associated with a significantly reduced BNT162b2-induced immunogenicity.


Author(s):  
Rebecca Hasseli ◽  
Alexander Pfeil ◽  
Andreas Krause ◽  
Hendrik Schulze-Koops ◽  
Ulf Müller-Ladner ◽  
...  

AbstractThe objective is to evaluate the attitude of rheumatologists regarding the use of COVID-19 vaccination in patients with inflammatory rheumatic diseases (IRDs). From February 2nd until March 15th, 2021, rheumatologists from Germany were asked to participate anonymously in a survey addressing their attitude with respect to COVID-19 vaccinations of IRD patients. The survey was completed by 214 participants (107 men, 103 women, 4 unspecified). More than half of the physicians (61%) were working in rheumatologic private practices and 62% had more than 20 years of experience in rheumatology. 90% reported to be at least confidential in handling issues of COVID-19 vaccination and 99% would recommend COVID-19 vaccination for IRD patients. The majority would not recommend to stop or reduce immunomodulatory drugs for vaccination except for rituximab. More than 70% would prefer vaccination with a mRNA vaccine for their IRD patients. This study shows that almost all rheumatologists in Germany support the COVID-19 vaccination for their IRD patients without reducing or terminating the actual immunomodulatory medication to potentially improve the response to the vaccine. This attitude is in accordance with the current recommendations of the German Society of Rheumatology regarding COVID-19 vaccination in IRD patients, and indicates that these have been well accepted and work in everyday clinical practice.


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