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1.
Facilitators and barriers to successful revaccination after hematopoietic stem cell transplantation among adult survivors: A scoping review
Wickline, M., McErlean, G., Carpenter, P. A., Iribarren, S., Reding, K., Berry, D. L.
Transplantation and cellular therapy. 2023
Abstract
OBJECTIVES Revaccination uptake of childhood vaccines after transplant in adult hematopoietic stem cell transplant (HSCT) survivors is sub-optimal, increasing the risk of infectious morbidity and mortality within this population. We systematically reviewed the literature for factors related to revaccination uptake as well as the barriers and facilitators that affect successful revaccination. METHODS We conducted a scoping review searching PubMed, CINAHL, Embase, and Web of Science in March 2023. Two independent reviewers performed study selection using the complete dual review process. Data were extracted using a standard form. Factors were characterized as demographic, clinical, or social determinants of health that affected revaccination uptake. Barriers and facilitators were categorized using the constructs from the World Health Organization Behavioural and Social Drivers Framework. RESULTS Searches yielded 914 sources, of which 15 publications were included (five original research and ten quality improvement initiatives). More than half of the reports listed factors associated with poorer uptake, with most of these clinical factors, followed by social determinants of health, then demographic factors. Nearly all the reports described barriers to successful revaccination uptake, with most of these falling into the "practical issues" construct. Most of the reports described facilitators, with nearly all related to health care system improvements associated with improved revaccination uptake. CONCLUSIONS While a good starting point for understanding what impedes successful revaccination after HSCT, this review reveals that we lack enough evidence to drive targeted interventions to improve uptake. More research should be done, focusing on the survivor's voice to inform our knowledge of barriers and facilitators to complete revaccination after HSCT, exploring behavioral and social drivers within this population, and focusing on the care delivery models that may complicate vaccine delivery in this population.
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2.
Safety and efficacy of early vaccination with live attenuated measles vaccine for hematopoietic stem cell transplant recipients and solid organ transplant recipients
Groeneweg, L., Loeffen, Y. G. T., Versluys, A. B., Wolfs, T. F. W.
Vaccine. 2021
Abstract
BACKGROUND AND OBJECTIVE Vaccination with the live attenuated measles vaccine is currently recommended two years after hematopoietic stem cell transplantation (HSCT) and generally contraindicated after solid organ transplantation (SOT) due to safety concerns. However, in the last few years new data on the administration of the measles vaccine to HSCT recipients less two years post-transplantation and to SOT recipients have become available. This new data may change current guidelines and practices. The objective of this review is to provide an overview of the current data on the safety and efficacy of early measles vaccination for HSCT- and SOT recipients. METHOD PubMed and EMBASE were searched from the earliest date available through October 2019 to identify all research that reported on the safety and efficacy of measles vaccination after SOT or less than two years after HSCT. RESULTS A total of ten studies was included in this review. In the six studies that evaluated the efficacy of measles vaccination after SOT, seroconversion rates ranged from 41 to 100% after one dose and 73 to 100% after two doses. In the four studies that evaluated the efficacy of measles vaccination less than two years after HSCT, seroconversion rates ranged from 33 to 100% after one dose and 100% after two doses. In all studies, the administration of the measles vaccine after transplantation was considered to be safe. There were no cases of infection with the attenuated vaccine strain, and there were no adverse events related to the vaccination. CONCLUSION Data on the administration of the measles vaccine after SOT and less than two years after HSCT is scarce. However, the current data available suggest that it is efficacious and well tolerable. Therefore, early measles vaccination could be considered in selected groups of SOT- and HSCT recipients during increased measles transmission or an outbreak setting.
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3.
Vaccine Responses in Adult Hematopoietic Stem Cell Transplant Recipients: A Comprehensive Review
Janssen, M., Bruns, A., Kuball, J., Raijmakers, R., van Baarle, D.
Cancers. 2021;13(23)
Abstract
Consensus on timing of post-hematopoietic stem cell transplantation (HSCT) vaccination is currently lacking and is therefore assessed in this review. PubMed was searched systematically for articles concerning vaccination post-HSCT and included a basis in predefined criteria. To enable comparison, data were extracted and tables were constructed per vaccine, displaying vaccine response as either seroprotection or seroconversion for allogeneic HSCT (alloHSCT) and autologous HSCT (autoHSCT) separately. A total of 33 studies were included with 1914 patients in total: 1654 alloHSCT recipients and 260 autoHSCT recipients. In alloHSCT recipients, influenza vaccine at 7-48 months post-transplant resulted in responses of 10-97%. After 12 months post-transplant, responses were >45%. Pneumococcal vaccination 3-25 months post-transplant resulted in responses of 43-99%, with the response increasing with time. Diphtheria, tetanus, pertussis, poliomyelitis and Haemophilus influenzae type b at 6-17 months post-transplant: 26-100%. Meningococcal vaccination at 12 months post-transplant: 65%. Hepatitis B vaccine at 6-23 months post-transplant: 40-94%. Measles, mumps and rubella at 41-69 months post-transplant: 19-72%. In general, autoHSCT recipients obtained slightly higher responses compared with alloHSCT recipients. Conclusively, responses to childhood immunization vaccines post-HSCT are poor in comparison with healthy individuals. Therefore, evaluation of response might be indicated. Timing of revaccination is essential for optimal response. An individualized approach might be necessary for optimizing vaccine responses.
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4.
A systematic literature review of the recombinant subunit herpes zoster vaccine use in immunocompromised 18-49 year old patients
Racine, É, Gilca, V., Amini, R., Tunis, M., Ismail, S., Sauvageau, C.
Vaccine. 2020;38(40):6205-6214
Abstract
BACKGROUND The adjuvanted recombinant zoster vaccine (RZV) is indicated for prevention of herpes zoster (HZ) in adults aged ≥50 years. Questions regarding the use of RZV in immunocompromised patients < 50-year-old, who are at increased risk for HZ, were raised. OBJECTIVES The objective of this systematic review was to consolidate existing evidences on safety, immunogenicity and efficacy of RZV in immunocompromised adults aged 18-49 years. METHODS Four databases were searched. Preferred Reporting Items for Systematic review and Meta-Analysis Protocols (PRISMA-P) guidelines were followed. Screening and classification of search items was performed using the web-based platform DistillerSR. RESULTS The search identified 1389 potentially relevant records. Six studies fulfilled inclusion criteria. The proportion of patients aged 18-49 varied between 23 and 62%. Pain at injection site (98.6%) and fatigue (75.3%) were the most common adverse events. The proportion of patients reporting serious adverse events (SAEs) ranged between 8.1 and 30.8% in RZV and between 4.1 and 36.5% in placebo groups. SAEs deemed related to vaccination were reported in < 1% of patients in both RZV and placebo groups. The proportion of patients that experienced clinically significant underlying disease-related events ranged between 0.0 and 20.0% in RZV and 0.0 and 26.7% in placebo groups. The humoral and cell-mediated immune response rate ranged between 65.4 and 96.2% and 50.0-93.0%, respectively. Vaccine efficacy in hematopoietic stem cell transplant patients was 72% (95%CI, 39-88%) in 18-49-year-olds and 67% (95%CI, 53-78%) in ≥ 50-year-olds (median follow-up 21 months). Vaccine efficacy in ≥ 18-year-old patients with hematologic malignancies was estimated at 87.2% (95%CI, 44.3-98.6%) up to 13 months post-vaccination. CONCLUSIONS Results suggest that RZV has an acceptable safety profile and induces immunity in an important proportion of ≥ 18-year-old immunocompromised patients. Longer follow-up studies are warranted to assess the duration of RZV induced immunity in immunocompromised patients.
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5.
Revisiting role of vaccinations in donors, transplant recipients, immunocompromised hosts, travelers and household contacts of stem cell transplant recipients
Majeed, A., Harris, Z., Brucks, E., Hinchman, A., Farooqui, A. A., Tariq, M. J., Tamizhmani, K., Riaz, I. B., McBride, A., Latif, A., et al
Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation. 2019
Abstract
Vaccination is an effective strategy to prevent infections in immunocompromised hematopoietic stem cell transplant (HSCT) recipients. Pre-transplant vaccination of influenza, pneumococcus (PCV 7), H. Influenzae type b, diphtheria, tetanus and hepatitis B, both in donors and transplant recipients, produces high antibody titers in patients compared to recipient vaccination only. Transplant recipients are immunocompromised, live vaccines should be avoided with few exceptions. Transplant recipients should get inactive vaccinations when possible in order to prevent infection. This includes vaccination against influenza, pneumococcus, H. Influenzae type b, diphtheria, tetanus, pertussis, meningococcus, measles, mumps, rubella, polio, hepatitis A, Human Papilloma Virus (HPV) and hepatitis B. Close contacts of transplant recipients can safely get vaccinations (inactive and few live vaccines) as per their need and schedule. If transplant recipients wish to travel; they might need to get themselves vaccinated against endemic diseases which are prevalent in such areas. There is paucity of data on the role of vaccinations for patients receiving novel immunotherapy such as bispecific antibodies and chimeric antigen receptor T cells despite data on prolonged B cell depletion and higher risk of opportunistic infections.
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6.
Lower Genital Tract Precancer and Cancer in Hematopoietic Cell Transplant Survivors and the Role of HPV: A Systematic Review and Future Perspectives
Tanweer, M. S., Aljurf, M., Savani, B. N., Iqbal, P. K., Hashmi, S.
Clinical Hematology International. 2019;1(3):142-153
Abstract
Female recipients of hematopoietic cell transplant (HCT) may develop lower genital tract (LGT) dysplasia or new malignancies. A comprehensive systematic review to delineate the occurrence and risk factors for post-HCT LGT precancer and cancer in women was conducted via electronic search of the Cochrane Library, PubMed, Embase, Wiley Online Library, from 1990 to 2018. All studies on the risk, presentation, or incidence of LGT (cervix, vulva, vagina) precancer or cancer post-HCT were included. Reviews, case reports, meta-analysis, book chapters, and studies without the relevant clinical outcomes were excluded. Post-HCT incidence and risk factors for developing LGT precancer or cancer were assessed and determined. Twenty-two out of the original 344 studies met the selection criteria. The risk of LGT cancers in allo-HCT recipients was found to be significantly higher than in the general population, with the standardized incidence ratios of 1.5-48 for cervical cancer and from 19 to 287 for dysplasia. Our review portrays an increased risk of premalignant and malignant neoplasms of female LGT, which have an incompletely described epidemiology and outcomes. Similar to other immunocompromised states, HCT recipients require specific cervical screening guidelines and can greatly benefit from HPV vaccinations. However, there is a lack of prospective data regarding optimum cervical screening in HCT recipients and limited programs offer HPV vaccinations worldwide.
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7.
Long-term pneumococcal vaccine immunogenicity following allogeneic hematopoietic stem cell transplantation
Langedijk, A. C., van Aalst, M., Meek, B., van Leeuwen, E. M. M., Zeerleder, S., Meijer, E., Hazenberg, M. D., Grobusch, M. P., Goorhuis, A.
Vaccine. 2018
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Full text
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Editor's Choice
Abstract
Infection with Streptococcus pneumoniae is a life-threatening, but vaccine preventable complication in patients with allogeneic hematopoietic stem cell transplantation (allo-HSCT). The international consensus on post allo-HSCT immunization schedules, starting 3-6months after HSCT, focuses on short-term immunogenicity while long-term immunogenicity is not well characterized. The current Dutch immunization schedule, which starts at 12months post allo-HSCT, was developed as a result of concerns on the coverage of long-term immunogenicity in international guidelines. We recently encountered two cases of allo-HSCT recipients who developed invasive pneumococcal disease (IPD) despite adequate revaccinations, which led us to question the immunogenicity of pneumococcal vaccinations in this patient group, and whether the currently existing vaccination schedules are appropriate. We included allo-HSCT recipients, vaccinated from one year after transplantation, and tested antibody responses to pneumococcal vaccination. We also performed a systematic review. Antibody concentrations were measured in 42 of 103 (41%) patients, with a response rate of 85% to PCV13 and 62% to PPSV23-unique serotypes. In six relevant studies, protection rates varied between 64 and 98%. Antibody responses in early and late vaccination schedules were similar, but adequate antibody responses were maintained better after late vaccination. Therefore, we propose a vaccination schedule that combines the advantages of early and late vaccination. This new schedule has been introduced since March 2018 in the two academic hospitals in Amsterdam, The Netherlands.
PICO Summary
Population
103 allo-HSCT recipients; 42 pts had antibody concentrations measured
Intervention
‘Late’ schedule pneumococcal vaccination >1 year after transplantation
Comparison
Systematic review evidence used to compare ‘early’ and ‘late’ vaccination schedule
Outcome
Response rate of 85% to PCV13 and 62% to PPSV23-unique serotypes. Antibody responses in early and late vaccination schedules were similar, but adequate antibody responses were maintained better after late vaccination.
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8.
Vaccinating donors for hematopoietic cell transplantation: A systematic review and future perspectives
Muhsen, I. N., Aljurf, M., Wingard, J. R., Poland, G. A., Komanduri, K. V., Whitaker, J. A., Hashmi, S. K.
Vaccine. 2018
Abstract
Allogeneic hematopoietic cell transplantation (Allo-HCT) recipients are at an increased risk of infectious complications, which is a major cause of morbidity and mortality post-transplant. Vaccination of donors is one of the strategies that has been studied to improve immune reconstitution post-transplant, however the efficacy and safety of this strategy is not well reviewed in the literature. In this systematic review we sought to evaluate the current strategies of donor vaccination along with their immunogenicity, effectiveness and safety. Utilizing strict selection criteria with defined MeSH terminology, an electronic search was conducted from the following databases: Medline, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews and Scopus. Abstracts of various professional society meetings were also screened and hand searching of various reviews and guideline articles was carried out. The full text of 52 articles were reviewed, from which 5 articles satisfied the inclusion/exclusion criteria for effectiveness and immunogenicity trials and 1 article was included for safety data. Jadad score was used to assess the quality of included studies. The results of the included studies were inconsistent, and the studies were generally of suboptimal methodological quality. Most of the included studies (n=3) investigated the use of more than one vaccine, however not all commonly used vaccines in HCT were investigated. None of the studies reported any long-term benefits for HCT recipients of vaccinated donors. Only one study reported safety data of using vaccination in donors. Given the suboptimal quality of the studies, and questionable effectiveness, donor vaccination cannot be recommended for all. Prospective high-quality vaccine trials in HCT donors are needed.
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Safety of live vaccinations on immunosuppressive therapy in patients with immune-mediated inflammatory diseases, solid organ transplantation or after bone-marrow transplantation - A systematic review of randomized trials, observational studies and case reports. [Review]
Croce, E., Hatz, C., Jonker, E. F., Visser, L. G., Jaeger, V. K., Buhler, S.
Vaccine. 2017;35(9):1216-1226
Abstract
BACKGROUND Live vaccines are generally contraindicated on immunosuppressive therapy due to safety concerns. However, data are limited to corroborate this practice. OBJECTIVES To estimate the safety of live vaccinations in patients with immune-mediated inflammatory diseases (IMID) or solid organ transplantation (SOT) on immunosuppressive treatment and in patients after bone-marrow transplantation (BMT). DATA SOURCES A search was conducted in electronic databases (Cochrane, Pubmed, Embase) and additional literature was identified by targeted searches. ELIGIBILITY CRITERIA Randomized trials, observational studies and case reports. POPULATION Patients with IMID or SOT on immunosuppressive treatment and BMT patients <2years after transplantation. INTERVENTION/VACCINATIONS LOOKED AT Live vaccinations: mumps, measles, rubella (MMR), yellow fever (YF), varicella vaccine (VV), herpes zoster (HZ), oral typhoid, oral polio, rotavirus, Bacillus Calmette-Guerin (BCG), smallpox. DATA EXTRACTION One author performed the data extraction using predefined data fields. It was cross-checked by two other authors. RESULTS 7305 articles were identified and 64 articles were included: 40 on IMID, 16 on SOT and 8 on BMT patients. In most studies, the administration of live vaccines was safe. However, some serious vaccine-related adverse events occurred. 32 participants developed an infection with the vaccine strain; in most cases the infection was mild. However, in two patients fatal infections were reported: a patient with RA/SLE overlap who started MTX/dexamethasone treatment four days after the YFV developed a yellow fever vaccine-associated viscerotropic disease (YEL-AVD) and died. The particular vaccine lot was found to be associated with a more than 20 times risk of YEL-AVD. One infant whose mother was under infliximab treatment during pregnancy received the BCG vaccine at the age of three months and developed disseminated BCG infection and died. An immunogenicity assessment was performed in 43 studies. In most cases the patients developed satisfactory seroprotection rates. In the IMID group, YFV and VV demonstrated high seroconversion rates. MTX and tumor necrosis factor inhibitory therapy appeared to reduce immune responses to VV and HZ vaccine, but not to MMR and YF-revaccination. Seroconversion in SOT and BMT patients showed mostly higher rates for rubella than for measles, mumps and varicella. LIMITATIONS Risk of bias was high in the majority of studies since 39 of them were observational and 17 were case series/case reports. Only eight studies were randomized trials. BMT patient numbers included in this review were low. CONCLUSIONS Although live vaccinations were safe and sufficiently immunogenic in most studies, some serious reactions and vaccine-related infections were reported in immunosuppressed IMID and SOT patients. Apart from mild vaccine-related infections MMR and VV vaccines were safe when administered less than two years after BMT. IMPLICATIONS OF KEY FINDINGS Until further data are available, live vaccinations under most immunosuppressive treatments should only be administered after a careful risk benefit assessment of medications and dosages. FUNDING None.Copyright © 2017 Elsevier Ltd. All rights reserved.