The effect of immunosuppressive agents on immunogenicity of pneumococcal vaccination: A systematic review and meta-analysis

Abstract

The findings of our systematic review indicate that, in patients treated with immunosuppressive medication and compared to controls, the initial serologic response to pneumococcal conjugate vaccine (PCV) and pneumococcal polysaccharide vaccine (PPSV) are impaired. Moreover, this impaired response was more profound after PCV than after PPSV. We hypothesize that the immunosuppressive medication mainly compromises the cellular immunity, explaining the more severely reduced response rate to PCV (which induces a T-cell dependent immune response), compared to PPSV. Treatment with TNFα blocking agents was associated with a more favorable response, compared to patients treated with other immunosuppressive medication. Targeted research applying uniform correlates of protection is needed to bridge the knowledge gap in vaccination immunology in this patient group. PROSPERO registration: CRD42017058364.

The Immune Response to Eastern Equine Encephalitis Virus Acquired Through Organ Transplantation

“…Although the central nervous system is considered an immunoprivileged site, antibody-secreting B cells and virus-specific antibody can be detected in mice with SINV infection (Metcalf and Griffin, 2011;Metcalf et al, 2013). In contrast to patients on rituximab who were infected with EEEV reported in the literature (Berlin et al, 2017;Solomon et al, 2017), our participant developed antibodies to EEEV despite the use of immunosuppression. The nature of the immunosuppressive agents may contribute to this difference; following pneumococcal vaccine challenge, rituximab has a clear association with an impaired antibody response (van Aalst et al, 2018) whereas solid organ transplant recipients on immunosuppression develop antibody levels comparable to healthy controls (Dendle et al, 2018).…”

“…Prior to the cluster of EEEV infections associated with organ transplantation, only two case reports describe EEEV infection among patients receiving immunosuppressive medicine; in both instances, the patients received rituximab prior to developing rapidly fatal EEEV encephalitis without mounting an antibody response (Berlin et al, 2017;Solomon et al, 2017). Evidence from non-human primate and mouse models suggest that antibodies play a role in both protection against disease and clearance of neuroinvasive alphavirus infections, such as EEEV and VEEV in non-human primates and Sindbis virus (SINV) in mice.…”

“…In contrast to patients on rituximab who were infected with EEEV reported in the literature ( Berlin et al, 2017 ; Solomon et al, 2017 ), our participant developed antibodies to EEEV despite the use of immunosuppression. The nature of the immunosuppressive agents may contribute to this difference; following pneumococcal vaccine challenge, rituximab has a clear association with an impaired antibody response ( van Aalst et al, 2018 ) whereas solid organ transplant recipients on immunosuppression develop antibody levels comparable to healthy controls ( Dendle et al, 2018 ). The antibody titers observed in this instance of transplant-associated EEEV infection are in line with those from two individual case reports in immunocompetent hosts, although the IgM titers are lower than those reported in two case series ( Calisher et al, 1986a , b ; Golomb et al, 2001 ; Garlick et al, 2016 ).…”

Hydroxychloroquine in Covid-19: Does the end justify the means?

“…Thus, immunization responses in immunosuppressed patients can be suboptimal. [6,7] In the absence of an effective anti-Covid-19 vaccine, collective immunity, so-called 'herd immunity', has been proposed as a population-level strategy to manage this pandemic. Most countries have imposed lockdowns in an attempt to flatten the pandemic curve, to give health systems time to build capacity, and, ultimately, to allow for a progressive development of herd immunity.…”

A comprehensive review of vaccination in patients with inflammatory bowel diseases: An Indian perspective

“…Available data for pneumococcal vaccination in IBD patients suggest that combination therapy with an immunomodulator and a biologic agent may blunt vaccine responses significantly. Therefore, while all immunosuppressed adults can safely receive the vaccine, it should ideally be administered before initiation of immunosuppression [31,32].…”