Seroconversion of 2009 pandemic influenza A (H1N1) vaccination in kidney transplant patients and the influence of different risk factors

Azevedo, Luiz Sergio; Gerhard, J.; Miraglia, João Luiz; Precioso, Alexander Roberto; Timenetsky, Mcst; Agena, Fabiana; Gamba, C.; Shikanai-Yasuda, Maria Aparecida; David‐Neto, Elias; Pierrotti, Lı́gia Camera

doi:10.1111/tid.12140

Cited by 17 publications

(8 citation statements)

References 30 publications

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“…The finding of positive IgM and IgG antibodies in our second patient with a negative SARS‐CoV‐2 RT‐PCR on diagnosis day 23 illustrated that viral shedding may not be significantly prolonged in a solid organ transplant recipient. This finding is comparable to the average duration of viral shedding in immunocompetent patients as reported by To et al 14 and Xu et al, 25 which were 20 and 17 days from diagnosis, respectively. Notably, both of our patients had continued tacrolimus, which has demonstrated inhibitory effect on SARS‐CoV viral replication in vitro 26 .…”

Section: Discussionsupporting

confidence: 88%

“…MMF may additionally inhibit desirable post‐transplant immune responses such as seroconversion to vaccines. In a study of 94 kidney transplant recipients, the rate of seroconversion to the H1N1 influenza vaccine was lowest in patients treated with MMF 14 . Multiple other studies in the kidney transplant population support the negative association between MMF and seroconversion following different vaccines 15‐17 .…”

Section: Discussionmentioning

confidence: 94%

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Influence of immunosuppression on seroconversion against SARS‐CoV‐2 in two kidney transplant recipients

Wang

Quintero

et al. 2020

Transplant Infectious Dis

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Solid organ transplant recipients are at risk for infectious complications due to chronic immunosuppression. The outbreak of Coronavirus Disease 2019 (COVID‐19) in United States has raised growing concerns for the transplant patient population. We seek to add to the current limited literature on COVID‐19 in transplant recipients by describing the clinical course of two kidney transplant recipients with SARS‐Cov‐2 infection monitored by both RT‐PCR and serology. Through careful adjustment of their immunosuppression regimen, both patients had excellent recovery with intact graft function and development of anti‐SARS‐Cov‐2 antibodies.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 94%

Influence of immunosuppression on seroconversion against SARS‐CoV‐2 in two kidney transplant recipients

Wang

Quintero

et al. 2020

Transplant Infectious Dis

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“…This suggests the difference in medication caused the difference in seroconversion. MMF was reported to reduce the proportion of transplant patients that showed seroconversion after influenza vaccination by strong suppression of antibody production 14,15 …”

Section: Discussionmentioning

confidence: 99%

Efficacy of hepatitis B vaccination in children with rheumatic diseases

Kohagura¹,

Kawabe²,

Abe³

et al. 2021

Pediatrics International

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Background Vaccination to prevent hepatitis B (HB) virus infection is important for children undergoing immunosuppressive treatment. Information on the efficacy of HB vaccination in children with rheumatic diseases undergoing immunosuppressive therapy is scarce. Methods Children with rheumatic diseases administered HB vaccine during immunosuppressive treatment between May 2013 and September 2016 were enrolled. Patients were vaccinated three times (primary series). Those who remained seronegative after the primary series received a secondary series of vaccinations. Patient baseline characteristics and treatment details from the medical records were retrospectively investigated. The proportion of patients that was seropositive for HB virus antibody after primary‐and secondary series of vaccinations was calculated. Associations between immunosuppressants and serostatus were evaluated. Results Fifteen of 26 patients (58%) produced anti‐hepatitis B surface antibody (anti‐HBs) after the primary vaccinations. Eight of 10 patients (80%) taking methotrexate and 3 of 11 (27%) taking mycophenolate mofetil (MMF) were seropositive. Multivariate analysis adjusted for dosage of prednisolone per body weight. Multivariate analysis showed MMF was a factor impeding seroconversion (odds ratio 0.093, 95% confidence interval 0.014–0.615). In six of seven patients (86%) who received a secondary series of vaccinations, anti‐HBs were produced. Conclusions MMF may impede seroconversion after a primary series of HB vaccinations, thus requiring secondary series of vaccinations in pediatric patients with a rheumatic disease undergoing immunosuppressive therapy.

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“…Reduced seroconversion rates observed, [38][39][40] particularly at prednisone-equivalent doses ⩾10 mg/d 38,39 Leflunomide RA, PsA, AS, SLE Reduced humoral response to vaccine compared to healthy controls 46,168 Well tolerated and did not exacerbate disease activity 46,168 Methotrexate RA, SpA Reduced humoral response to the vaccine (mean dose in studies: 16-20 mg/wk) [44][45][46] Well tolerated 43,44,46 Mycophenolate Solid organ transplant Reduced humoral response to the vaccine 166,167,[170][171][172][173][174] Well tolerated without incidence of allograft rejection 166,167,[170][171][172]174 Well tolerated without incidence of allograft rejection 163…”

Section: Slementioning

confidence: 99%

Vaccination Guidelines for Patients With Immune-Mediated Disorders on Immunosuppressive Therapies

et al. 2018

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Background:Patients with immune-mediated diseases on immunosuppressive therapies have more infectious episodes than healthy individuals, yet vaccination practices by physicians for this patient population remain suboptimal.Objectives:To evaluate the safety and efficacy of vaccines in individuals exposed to immunosuppressive therapies and provide evidence-based clinical practice recommendations.Methods:A literature search for vaccination safety and efficacy in patients on immunosuppressive therapies (2009-2017) was conducted. Results were assessed using the Grading of Recommendation, Assessment, Development, and Evaluation system.Results:Several immunosuppressive therapies attenuate vaccine response. Thus, vaccines should be administered before treatment whenever feasible. Inactivated vaccines can be administered without treatment discontinuation. Similarly, evidence suggests that the live zoster vaccine is safe and effective while on select immunosuppressive therapy, although use of the subunit vaccine is preferred. Caution regarding other live vaccines is warranted. Drug pharmacokinetics, duration of vaccine-induced viremia, and immune response kinetics should be considered to determine appropriate timing of vaccination and treatment (re)initiation. Infants exposed to immunosuppressive therapies through breastmilk can usually be immunized according to local guidelines. Intrauterine exposure to immunosuppressive agents is not a contraindication for inactivated vaccines. Live attenuated vaccines scheduled for infants and children ⩾12 months of age, including measles, mumps, rubella, and varicella, can be safely administered as sufficient time has elapsed for drug clearance.Conclusions:Immunosuppressive agents may attenuate vaccine responses, but protective benefit is generally maintained. While these recommendations are evidence based, they do not replace clinical judgment, and decisions regarding vaccination must carefully assess the risks, benefits, and circumstances of individual patients.

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Seroconversion of 2009 pandemic influenza A (H1N1) vaccination in kidney transplant patients and the influence of different risk factors

Abstract: In this study, the monovalent A(H1N1)pdm09 influenza vaccine demonstrated low rates of seroconversion, particularly in patients on MPA, but with potentially higher response rates in patients on sirolimus.

Cited by 17 publications

References 30 publications

Influence of immunosuppression on seroconversion against SARS‐CoV‐2 in two kidney transplant recipients

Influence of immunosuppression on seroconversion against SARS‐CoV‐2 in two kidney transplant recipients

Efficacy of hepatitis B vaccination in children with rheumatic diseases

Vaccination Guidelines for Patients With Immune-Mediated Disorders on Immunosuppressive Therapies

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