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Vaccinations in Primary and Secondary Immunodeficiencies Including Asplenia

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Primary and Secondary Immunodeficiency

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Abstract

Most individuals are able to tolerate vaccinations as per the recommended schedule without incident. However, those with immunodeficiencies are at increased risk of recurrent, severe, and/or recalcitrant infections which may be reduced or prevented with the use of appropriate vaccinations. Determining which vaccines are appropriate for provision of protection against infection requires an understanding of any underlying immune defects as well as resulting infection risk. Furthermore, understanding the mechanism of immunodeficiency can also help to identify those vaccinations which are contraindicated due to risk of infection. Individuals with common variable immunodeficiency (CVID) are at increased risk of infection with encapsulated bacteria and should be given a particular set of vaccinations. Individuals with CVID also may present with autoimmune disorders such as immune thrombocytopenia (ITP). ITP can result in either functional asplenia or in complications requiring surgical splenectomy. Those with asplenia should be vaccinated appropriately in order to protect against encapsulated bacteria similar to those in CVID. However, there are some important differences to note between the indicated and contraindicated vaccines for individuals with CVID and asplenia. Those with CVID who develop the complication of asplenia should be approached carefully when considering the appropriate vaccinations given the combined, although somewhat overlapping, immunodeficiency.

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References

  1. Hannoun C. The evolving history of influenza viruses and influenza vaccines. Expert Rev Vaccines. 2013;12(9):1085–94. https://doi.org/10.1586/14760584.2013.824709.

    Article  CAS  PubMed  Google Scholar 

  2. Ferkol T, Schraufnagel D. The global burden of respiratory disease. Ann Am Thorac Soc. 2014;11(3):404–6. https://doi.org/10.1513/AnnalsATS.201311-405PS.

    Article  PubMed  Google Scholar 

  3. Bonilla FA, Barlan I, Chapel H, Costa-Carvalho BT, Cunningham-Rundles C, de la Morena MT, et al. International consensus document (ICON): common variable immunodeficiency disorders. J Allergy Clin Immunol Pract. 2016;4(1):38–59. https://doi.org/10.1016/j.jaip.2015.07.025.

    Article  PubMed  Google Scholar 

  4. Gregersen S, Aaløkken TM, Mynarek G, Kongerud J, Sukrust P, Froland SS, et al. High resolution computed tomography and pulmonary function in common variable immunodeficiency. Respir Med. 2009;103(6):873–80. https://doi.org/10.1016/j.rmed.2008.12.015.

    Article  PubMed  Google Scholar 

  5. Afonso AFB, João CMP. The production processes and biological effects of intravenous immunoglobulin. Biomol Ther. 2016;6(1). https://doi.org/10.3390/biom6010015.

  6. Chua I, Lagos M, Charalambous BM, Workman S, Chee R, Grimbacher B. Pathogen-specific IgG antibody levels in immunodeficient patients receiving immunoglobulin replacement do not provide additional benefit to therapeutic management over total serum IgG. J Allergy Clin Immunol. 2011;127(6):1410–1. https://doi.org/10.1016/j.jaci.2011.01.035.

    Article  PubMed  Google Scholar 

  7. Cox RJ, Brokstad KA, Ogra P. Influenza virus: immunity and vaccination strategies. Comparison of the immune response to inactivated and live, attenuated influenza vaccines. Scand J Immunol. 2004;59(1):1–15. https://doi.org/10.1111/j.0300-9475.2004.01382.x.

    Article  CAS  PubMed  Google Scholar 

  8. Committee on Infectious Diseases, American Academy of Pediatrics. Redbook: 2012 report of the Committee on Infectious Diseases. Elk Grove Village: American Academy of Pediatrics; 2012.

    Google Scholar 

  9. Kamboj M, Sepkowitz KA. Risk of transmission associated with live attenuated vaccines given to healthy persons caring for or residing with an immunocompromised patient. Infect Control Hosp Epidemiol. 2007;28(6):702–7. https://doi.org/10.1086/517952.

    Article  PubMed  Google Scholar 

  10. Kroger A, Duchin J, Vázquez M. General best practice guidelines for immunization. Best practices guidance of the advisory committee on immunization practices (ACIP). Cdc, Ncird. 2017. https://www.cdc.gov/vaccines/hcp/acip-recs/general-recs/downloads/general-recs.pdf.

  11. Medical Advisory Committee of the Immune Deficiency Foundation, Shearer WT, Fleisher TA, Buckley RH, Ballas Z, Ballow M, et al. Recommendations for live viral and bacterial vaccines in immunodeficient patients and their close contacts. J Allergy Clin Immunol. 2014;133(4):961–6. https://doi.org/10.1016/j.jaci.2013.11.043.

    Article  CAS  Google Scholar 

  12. Farcet MR, Karbiener M, Rabel PO, Schirmer A, Ilk R, Kreil TR. Measles virus neutralizing antibodies in immunoglobulin lots produced from plasma collected in Europe or the United States. Vaccine. 2019;37(24):3151–3. https://doi.org/10.1016/j.vaccine.2019.04.022.

    Article  CAS  PubMed  Google Scholar 

  13. Modrof J, Tille B, Farcet MR, McVey J, Schreiner JA, Borders CM, et al. Measles virus neutralizing antibodies in intravenous immunoglobulins: is an increase by revaccination of plasma donors possible? J Infect Dis. 2017;216(8):977–80. https://doi.org/10.1093/infdis/jix428.

    Article  CAS  PubMed  Google Scholar 

  14. Zhan W, Yue F, Liu J, Lee JK, Ho J, Moir S, et al. Response to influenza immunization in patients with common variable immunodeficiency. Allergy Asthma Clin Immunol. 2011;7(S2). https://doi.org/10.1186/1710-1492-7-s2-a28.

  15. Rubin LG, Schaffner W. Care of the asplenic patient. N Engl J Med. 2014;371(4):349–56. https://doi.org/10.1056/NEJMcp1314291.

    Article  CAS  PubMed  Google Scholar 

  16. Centers for Disease Control and Prevention (CDC), War W, Ii WW, et al. CDC pink book. Epidemiol Prev Vaccine-Preventable Dis. 13th ed. 2015;1302(9):31–44. https://doi.org/10.1016/B978-1-4377-2702-9.00226-9.

    Article  Google Scholar 

  17. Centers for Disease Control and Prevention. Pneumococcal vaccine timing for adults. Centers Dis Control Prev. 2018:11–4. https://www.cdc.gov/vaccines/vpd/pneumo/downloads/pneumo-vaccine-timing.pdf?fbclid=IwAR2fMH6JiqsbZdZy9tnRVmwoMs3OJX1C50N8BfgjRV7hN47lxK2aE7FIdRU (Accessed 8/30/2020).

  18. Cunningham-Rundles C, Bodian C. Common variable immunodeficiency: clinical and immunological features of 248 patients. Clin Immunol. 1999;92(1):34–48. https://doi.org/10.1006/clim.1999.4725.

    Article  CAS  PubMed  Google Scholar 

  19. Feuille EJ, Anooshiravani N, Sullivan KE, Fuleihan RL, Cunningham-Rundles C. Autoimmune cytopenias and associated conditions in CVID: a report from the USIDNET registry. J Clin Immunol. 2018;38(1):28–34. https://doi.org/10.1007/s10875-017-0456-9.

    Article  CAS  PubMed  Google Scholar 

  20. Cunningham-Rundles C. The many faces of common variable immunodeficiency. Hematology Am Soc Hematol Educ Program. 2012;2012:301–5. https://doi.org/10.1182/asheducation.v2012.1.301.3798316.

    Article  PubMed  Google Scholar 

  21. Al-Samkari H, Kuter DJ. Immune thrombocytopenia in adults: modern approaches to diagnosis and treatment. Semin Thromb Hemost. 2019; https://doi.org/10.1055/s-0039-1700512.

  22. Stasi R, Newland A, Thornton P, Pabinger I. Should medical treatment options be exhausted before splenectomy is performed in adult ITP patients? A debate. Ann Hematol. 2010;89(12):1185–95. https://doi.org/10.1007/s00277-010-1066-2.

    Article  PubMed  Google Scholar 

  23. Bussel JB. Therapeutic approaches to secondary immune thrombocytopenic purpura. Semin Hematol. 2009;46(suppl. 2). https://doi.org/10.1053/j.seminhematol.2008.12.003.

  24. Cirasino L, Robino AM, Cattaneo M, Pioltelli PE, Pogliani EM, Terranova L, et al. Appropriate hospital management of adult immune thrombocytopenic purpura patients in major Italian institutions in 2000–2002: a retrospective analysis. Blood Coagul Fibrinolysis. 2010;21(1):77–84. https://doi.org/10.1097/MBC.0b013e328332dbb6.

    Article  PubMed  Google Scholar 

  25. Di Sabatino A, Carsetti R, Corazza GR. Post-splenectomy and hyposplenic states. Lancet. 2011;378(9785):86–97. https://doi.org/10.1016/S0140-6736(10)61493-6.

    Article  PubMed  Google Scholar 

  26. Brousse V, Buffet P, Rees D. The spleen and sickle cell disease: the sick(led) spleen. Br J Haematol. 2014;166(2):165–76. https://doi.org/10.1111/bjh.12950.

    Article  PubMed  Google Scholar 

  27. Cameron PU, Jones P, Gorniak M, Dunster K, Paul E, Lewin S, et al. Splenectomy associated changes in IgM memory B cells in an adult spleen registry cohort. PLoS ONE. 2011;6(8). https://doi.org/10.1371/journal.pone.0023164.

  28. Azar S, Wong TE. Sickle cell disease: a brief update. Med Clin North Am. 2017;101(2):375–93. https://doi.org/10.1016/j.mcna.2016.09.009.

    Article  PubMed  Google Scholar 

  29. Davies JM, Lewis MPN, Wimperis J, Rafi I, Ladhani S, Bolton-Maggs PHB. Review of guidelines for the prevention and treatment of infection in patients with an absent or dysfunctional spleen: prepared on behalf of the British Committee for Standards in Haematology by a working party of the Haemato-Oncology task force. Br J Haematol. 2011;155(3):308–17. https://doi.org/10.1111/j.1365-2141.2011.08843.x.

    Article  CAS  PubMed  Google Scholar 

  30. Bonanni P, Grazzini M, Niccolai G, Paolini D, Varone O, Bartoloni A, et al. Recommended vaccinations for asplenic and hyposplenic adult patients. Hum Vaccin Immunother. 2017;13(2):359–68. https://doi.org/10.1080/21645515.2017.1264797.

    Article  PubMed  Google Scholar 

  31. Bonilla FA. Update: vaccines in primary immunodeficiency. J Allergy Clin Immunol. 2018;141(2):474–81. https://doi.org/10.1016/j.jaci.2017.12.980.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Medicine, VA Medical Center Miami, Miami, FL, USA

    Lauren Fine

  2. Ruth and Bruce Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel

    Nofar Kimchi

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  2. Nofar Kimchi
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Editors and Affiliations

  1. College of Medicine, University of Cincinnati, Cincinnati, OH, USA

    Jonathan A. Bernstein

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Fine, L., Kimchi, N. (2021). Vaccinations in Primary and Secondary Immunodeficiencies Including Asplenia. In: Bernstein, J.A. (eds) Primary and Secondary Immunodeficiency. Springer, Cham. https://doi.org/10.1007/978-3-030-57157-3_23

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