Glukhova SI. Vaccination of pneumococcal infection in patients with rheumatic diseases (according to the V.A. Nasonova Research Institute of Rheumatology)

Background. Infections of the lower respiratory tract (LRT) and ENT organs in patients with rheumatic diseases (RD) are an urgent problem of rheumatology, the real solution of which can be vaccination. However, there is still insufficient data on the clinical efficacy, immunogenicity, and safety of pneumococcal vaccines in rheumatological patients.

The aim – to evaluate the clinical efficacy, immunogenicity, and safety of the 23-valent polysaccharide pneumococcal vaccine (PPV-23) in patients with RD who were observed at the V.A. Nasonova Research Institute of Rheumatology.

Materials and methods. An open prospective study included 254 patients with RD, including 97 with rheumatoid arthritis (RA), 52 with ankylosing spondylitis (AS), 27 with psoriatic arthritis (PsA), 78 with systemic lupus erythematosus (SLE), including 18 with secondary antiphospholipid syndrome. PPV-23 was administered in a single dose (0.5 ml) intramuscularly. The clinical efficacy of vaccination during the 12-month follow-up period was assessed by the frequency of reported infections of LRT and ENT organs. The level of post-vaccination antibodies (AT) was determined by enzyme immunoassay (ELISA) using a commercial EIA PCP IgG kit (Test Line Clinical Diagnostics, Czech Republic) initially, 1–3 and 12 months after vaccination. The safety of vaccination was determined by the frequency and severity of post-vaccination reactions and the effect on activity and course of RD.

Results. The clinical efficacy of PPV-23 during a 12-month follow-up was confirmed in 92.1% of patients with RD. A statistically significant increase in AT levels was detected 1–3 and 12 months after vaccination. 87.5% of patients with RA, 61.5% with AS, 72.7% with PsA, and 56.0% with SLE were “responders” to PPV-23. Post-vaccination local reactions in the vast majority of cases (94.1%) were mild or moderate and stopped on their own. Systemic reactions were rare, mild, and short-term. There was no negative effect of vaccination on the activity of RD, as well as the occurrence of new autoimmune phenomena.

Conclusion. The data obtained indicate sufficient clinical efficacy, immunogenicity, and safety of PPV-23 in patients with RD.

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