Immunisation in the current management of cystic fibrosis patients

Abstract

Although no special recommendations exist, clearly patients with cystic fibrosis (CF) can benefit from immunisation. We reviewed the literature regarding vaccination in CF and other chronic diseases. CF subjects should follow national immunisation programmes without delay to obtain optimal vaccination coverage. Indeed they may escape normal programmes due to frequent hospital admissions and school absenteeism and may be more at risk to get "vaccine-controlled" diseases at any age. There is no uniform European immunisation schedule for basic infant and childhood vaccines or for vaccines against hepatitis A (HAV) and B (HBV), varicella (VZ) and booster vaccinations. HAV and HBV vaccination is appropriate in CF as recommended in general for patients with chronic liver disease (CLD). Varicella (VZ) vaccination is not recommended in all European countries. There are no recent data about possible worsening of pulmonary status following VZ in CF, but it is known to cause pulmonary damage in non-CF adults and to be potentially fatal post transplantation and during steroid treatment. Therefore it is recommended at least for seronegative adolescents and transplant candidates. Influenza vaccine is recommended annually for CF patients aged > or =6 months. Pneumococcal vaccine is generally indicated for CF patients. RSV infection might play a role in the initial Pseudomonas colonization and the decline in pulmonary function. However no RSV vaccine is available at present. There are no recommendations for palivizumab in CF as an alternative but expensive prophylaxis. Anti-bacterial vaccinations protecting directly against Pseudomonas aeruginosa colonisation are promising for the future, potential candidates are currently being assessed in phase III clinical trials. More studies are needed to complete recommendations especially for CF adults and transplant candidates.

Acinetobacter baumannii : Emergence of a Successful Pathogen

“…Such agents have broad-spectrum activity, including activity against Clostridium difficile spores; however, copper resistance was described when copper was used in animal feed (223). Other innovative therapeutic avenues, which have not yet been tested against A. baumannii but have the potential for efficacy, include the use of bacteriophage treatment (590), improvement in host response via passive or active immunization (63,122,134,350), and modification of bacterial virulence by inhibition of quorum sensing (202,375), other bacterial secretion systems (17), or LPS biosynthesis (118). More broadly, deepening our understanding of the mechanisms of antimicrobial resistance gene transfer and the cellular responses (such as the SOS response) that lead to mutagenesis and eventual resistance (23,92,313) will provide unique targets that, when inhibited, may prevent the emergence and dissemination of resistance.…”

Guidelines on the early management of infants diagnosed with cystic fibrosis following newborn screening

“…These statements should be read in conjunction with the ECFS Vaccination Group document "Immunisation in the current management of cystic fibrosis patients" [13].…”

Kommentar zur Post-RSV-Atemwegserkrankung

“…RSV und andere virale respiratorische Pathogene führen bei Patienten mit CF ("cystic fibrosis") zu signifikanten, klinisch und lungenfunktionsdiagnostisch erfassbaren Verschlechterungen und sind oft Wegbereiter für bakterielle Atemwegserkrankungen, insbesondere durch Pseudomonas aeruginosa [8,9,12,26]. Obwohl es aufgrund fehlender Studiendaten noch keine Empfehlungen zur RSV-Prophylaxe mit Palivizumab bei CF-Patienten gibt [17,23], finden sich in der internationalen Literatur Hinweise für die Sinnhaftigkeit einer solchen Maßnahme [18], da eine chronische Pseudomonasinfektion mit erhöhter Morbidität und Mortalität assoziiert ist. Einige weitere Erkrankungen des Respirationstrakts .…”