İmmün yetmelikli hastalarda aşı ile korunabilen hastalıklara karşı önerilen aşı programlarının yeterliliğinin retrospektif olarak değerlendirilmesi
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Tarih
2019
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Ege Üniversitesi, Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Çalışmanın ana amacı retrospektif olarak immün yetmezlikli hastalarda aşı ile korunabilen hastalıklara karşı aşı öncesi ve sonrası immün yanıtı değerlendirmektir. İkincil amaçlar ise immün yetmezlikli hastalarda bağışıklama şemasının gözden geçirilmesi, aşılama programı hakkında ilgili klinisyenlerin algısını arttırmak ve bağışıklama alışkanlığının kazandırılmasıdır. Gereç ve Yöntem: Ege Üniversitesi Enfeksiyon Hastalıkları polikliniğine veya aşı polikliniğine 1 Ocak 2016-8 Ekim 2018 tarihleri arasında başvuran kemik iliği nakilli, böbrek nakilli ve HIV pozitif hastalar retrospektif olarak taranmıştır. Belirtilen hasta gruplarında pnömokok, hepatit B ve hepatit A aşısı uygulanan, aşı öncesi ve aşı sonrası serolojik testleri bulunan hastaların demografik özellikleri, immün yetmezlik durumu ve aşı yanıtları kaydedilmiştir. Aşı yanıtı ve aşı yanıtını etkileyen faktörler değerlendirilmiştir. Bulgular: Çalışma kapsamında değerlendirilen hasta sayısı 168'dir ( 25 kemik iliği nakilli, 15 böbrek nakilli ve 128 HIV pozitif). Organ nakilli hastalarda nakil sonrası aşı başlanma medyan süresi sırasıyla kemik iliği nakillilerde 7 ay, böbrek nakillilerde 26 aydır (p=0,010). Çalışma kapsamında değerlendirilen üç immüm yetmezlikli hasta grubunda pnömokok aşısı sonrası istatiksel anlamlı antikor titrelerinde artış saptanmıştır, sırasıyla kemik iliği nakillilerde p=0,001 ,böbrek nakillilerde p=0,036 ve HIV pozitif hastalarda p=000 olarak bulunmuştur. Hepatit B aşısı uygulanan 12 kemik iliği nakilli hastanın sekizinde (%66,6) aşı sonrası serokonversiyon görülmüştür. Böbrek nakilli 15 hastanın sadece beşine nakil öncesi hepatit B aşısı uygulanmıştı, nakil sonrası hepatit B aşısı ile ise altı hastanın ikisinde bağışıklık gelişmiştir. HIV pozitif olgularda CD4 sayısı ile bazal pnömokok antikoru ve aşı sonrası pnömokok antikoru arasında korelasyon saptanmamıştır. CD4 sayısı <350 hücre/mm3 olan olgularda aşı ile antikor yanıtı artanların oranı %81,8 iken, ≥350 hücre/mm3 olan olgularda % 84 saptanmıştır. CD4 sayısına göre pnömokok antikorundaki artış arasında istatiksel anlamlı ilişki saptanmamıştır (p=0,609). CD4 sayısının Hepatit B aşı yanıtına etkisi değerlendirildiğinde; CD4 sayısı <350 hücre/mm3 olan olgularda bağışıklık %56,3 oranında iken, CD4 sayısı350 hücre/mm3 olan olgularda bağışıklık oranı %88,7 saptanmıştır. CD4 sayısının ≥350 hücre/mm3 olması ile hepatit B aşısına bağışıklık yanıt istatiksel anlamlı olarak artmaktadır (p=0,008). HIV RNA düzeyi ile hepatit B aşısına yanıt arasında ilişki saptanmamıştır (p=0,35). Hepatit A aşısı uygulanan 48 HIV pozitif hastanın 46'sında (%95) aşı sonrası bağışıklık gelişmiştir. Sonuç: Çalışmamızın sonucunda tüm immünsupresif hasta gruplarında pnömokok aşı etkinliğinin gösterilmiş olması nedeniyle pnömokok aşısı immünsupresif hastalara uygulanmalıdır. Böbrek nakilli hastalarda nakil sonrası aşı yanıtı azaldığından bu hastaların nakil öncesi aşılanması önemlidir. HIV pozitif hastalarda CD4 sayısı ile pnömokok aşısına yanıt arasında ilişki gözlenmezken, CD4 sayısının hepatit B aşısına yanıtı etkilediği gösterilmiştir. İmmün yetmezlikli hastaların rehber önerileri doğrultusunda aşıları yapılmalıdır.
Objective: Retrospective evaluation of before and after immune responses among the immunocompromised patients by the vaccination against vaccine-preventable diseases was themain objective of our study. Secondary objectives were to review the vaccination schedule of the immunocompromised patients, to increase the perception of the clinicians about vaccination program and to gain the vaccination habitude. Material and Method: Bone marrow transplanted, renal transplanted and HIV positive patients who were admitted to Ege University Outpatient or Vaccination Clinic between the dates of January 1st 2016 – October 8th 2018, were screened retrospectively. Patients in these group of diseases whose serological results were available before and after the vaccination against Pneumococcus, Hepatitis B and Hepatitis A, were recorded in the terms of demographic features, immune deficiency status and immune responses to vaccinations together with affecting factors. Results: Total number of 168 patients (25 bone marrow transplanted, 15 renal transplanted and 128 HIV positive) were included in this study. Median duration of the vaccination start for the bone marrow transplanted patients were recorded as 7 days and for the renal transplanted patiens as 26 months (p=0,010). According to our study results, there was statistically significant increase in antibody titers after the vaccination in all of the three immunecompromised patient groups which were found as p=0,001 for the bone marrow transplanted, p=0,036 for the renal transplanted and p=000 for the HIV positive patients, respectively.Seroconversation was seen in 8 out of 12 (66.6%) bone marrow transplanted patients after the Hepatitis B vaccination. Only 5 out of 15 renal transplanted patients had Hepatitis B vaccination before the transplantation and after the transplantation 2 out of 6 patients had immunisation via Hepatitis B vaccination. In HIV positive patients, there was no correlation between the CD4 titer with basal pneumococcal antibody titer and pneumococcal antibody titer after the vaccination. Antibody response rate via vaccination was 81.8% for the patients with CD4<350 cell/mm3 whereas 84% for the patients with CD4350 cell/mm3. The increase of pneumococcal antibody titers according to CD4 levels was not found as statistically significant (p=0,609). On the other hand, Hepatitis B antibody response rate via vaccination was 56,3% for the patients with CD4<350 cell/mm3 whereas 88,7% for the patients with CD4350 cell/mm3 which was found as statistically significant (p=0,008). There was no correlation between the HIV RNA levels and Hepatitis B vaccine response rate (p=0,35). 46 out of 48 (95%) Hepatitis A vaccinated HIV positive patients had the immunity after the vaccination. Conclusion: Pneumococcal vaccination should be done for immunocompromised patients according to our study results which shows the enough efficacy of vaccination in all group of these patients. Because of the decreasing vaccine response rates after the renal transplantation, it is important that these group of patients should be vaccinated before the transplantation. Although there was no relationship between the CD4 level and pneumococcal vaccine response in HIV positive patients, CD4 level was shown to affect the Hepatitis B vaccine response rate. Finally, vaccination should be performed according to guidelines for the immunocompromised patients.
Objective: Retrospective evaluation of before and after immune responses among the immunocompromised patients by the vaccination against vaccine-preventable diseases was themain objective of our study. Secondary objectives were to review the vaccination schedule of the immunocompromised patients, to increase the perception of the clinicians about vaccination program and to gain the vaccination habitude. Material and Method: Bone marrow transplanted, renal transplanted and HIV positive patients who were admitted to Ege University Outpatient or Vaccination Clinic between the dates of January 1st 2016 – October 8th 2018, were screened retrospectively. Patients in these group of diseases whose serological results were available before and after the vaccination against Pneumococcus, Hepatitis B and Hepatitis A, were recorded in the terms of demographic features, immune deficiency status and immune responses to vaccinations together with affecting factors. Results: Total number of 168 patients (25 bone marrow transplanted, 15 renal transplanted and 128 HIV positive) were included in this study. Median duration of the vaccination start for the bone marrow transplanted patients were recorded as 7 days and for the renal transplanted patiens as 26 months (p=0,010). According to our study results, there was statistically significant increase in antibody titers after the vaccination in all of the three immunecompromised patient groups which were found as p=0,001 for the bone marrow transplanted, p=0,036 for the renal transplanted and p=000 for the HIV positive patients, respectively.Seroconversation was seen in 8 out of 12 (66.6%) bone marrow transplanted patients after the Hepatitis B vaccination. Only 5 out of 15 renal transplanted patients had Hepatitis B vaccination before the transplantation and after the transplantation 2 out of 6 patients had immunisation via Hepatitis B vaccination. In HIV positive patients, there was no correlation between the CD4 titer with basal pneumococcal antibody titer and pneumococcal antibody titer after the vaccination. Antibody response rate via vaccination was 81.8% for the patients with CD4<350 cell/mm3 whereas 84% for the patients with CD4350 cell/mm3. The increase of pneumococcal antibody titers according to CD4 levels was not found as statistically significant (p=0,609). On the other hand, Hepatitis B antibody response rate via vaccination was 56,3% for the patients with CD4<350 cell/mm3 whereas 88,7% for the patients with CD4350 cell/mm3 which was found as statistically significant (p=0,008). There was no correlation between the HIV RNA levels and Hepatitis B vaccine response rate (p=0,35). 46 out of 48 (95%) Hepatitis A vaccinated HIV positive patients had the immunity after the vaccination. Conclusion: Pneumococcal vaccination should be done for immunocompromised patients according to our study results which shows the enough efficacy of vaccination in all group of these patients. Because of the decreasing vaccine response rates after the renal transplantation, it is important that these group of patients should be vaccinated before the transplantation. Although there was no relationship between the CD4 level and pneumococcal vaccine response in HIV positive patients, CD4 level was shown to affect the Hepatitis B vaccine response rate. Finally, vaccination should be performed according to guidelines for the immunocompromised patients.
Açıklama
Anahtar Kelimeler
İmmün Yetmezlik, Bağışıklama, Aşı, Immun Deficiency, İmmunisation, Vaccine
