Seroprotection After Hepatitis A Vaccination in Patients With Drug‐Induced Immunosuppression

Abstract

Last-minute vaccination in subjects using immunosuppressive medication is not reliable, only 60% of our subjects had a protective antibody level after a single vaccination. When serology was done within 4 weeks after a single vaccination, seroprotection rates were only 50%, after 4 weeks this number rose to 64%. When persons visit a travel clinic in time for a complete vaccination series, satisfactory seroprotection rates can be reached. Seroprotection rate depends on the drug being used, persons using anti-TNF alpha are less protected.

2019 update of EULAR recommendations for vaccination in adult patients with autoimmune inflammatory rheumatic diseases

“…Data on the vaccine efficacy are lacking, but there is a strong correlation between antibody concentrations and seroprotection against infection. It should be emphasised that, as opposed to strong immunogenicity in healthy individuals, a single dose of HAV vaccine does not seem to afford a sufficient protection in RA151 and patients using immunosuppressive drugs 152. Therefore, second HAV vaccination after 6 months and determination of post-vaccination antibody titers is recommended.…”

Travel risk assessment, advice and vaccinations in immunocompromised travellers (HIV, solid organ transplant and haematopoeitic stem cell transplant recipients): A review

“…Successful seroconversion rates are also dependent on higher CD4 counts (>350/ml) and viral suppression [51e53]. Similarly, antibody responses to HAV in those with druginduced immunosuppression are dependent on the type of immunosuppression with poor seroconversion rates after a single HAV dose (w60% overall) [54], but generally >70% response rate is achieved after 2 doses [54,55]. However, durability of this response was very poor in 2-year follow-up [56], and it remains unclear in immunocompromised travellers as to whether successful seroconversion after 2 doses of HAV confers >20 years if not life-time protection as generally accepted in immunocompetent travellers.…”

A practical approach to vaccination of patients with autoimmune inflammatory rheumatic diseases in Australia

“…A study of 53 RA patients treated with a TNFi ( n = 15), TNFi + MTX ( n = 21) or MTX ( n = 17) found that a single dose of vaccine did not reliably result in seroconversion, but two doses of HAV vaccine at a 6‐month interval provided protection . A larger Dutch study of 740 patients on immunosuppression to treat a range of conditions found the overall sero‐protection rate after a single HAV vaccination was only 60%, but increased to 95% after a second vaccination . Those using a TNFi had sero‐protection rates of 46 and 79% after a first and second vaccination respectively.…”

“…Those using a TNFi had sero‐protection rates of 46 and 79% after a first and second vaccination respectively. Corresponding rates for those on csDMARDs were 62 and 98% . Intramuscular Ig may be required in immunocompromised individuals lacking a serological response to vaccination or where there is insufficient time before travel to allow two vaccine doses. Salmonella typhi : Parenteral polysaccharide vaccine is recommended prior to travel to endemic areas.…”