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Are immunosuppressive medications associated with decreased responses to routine immunizations? A systematic review.
Vaccine. 2012 Feb 14; 30(8):1413-24.V

Abstract

BACKGROUND

Long-term immunosuppressive medications are being used more commonly for a variety of medical conditions, including immune-mediated diseases and organ transplantation. While these medications are often necessary, they are associated with an increased risk of serious infections. Vaccination may be a way to prevent a variety of infections but vaccine responses among patients receiving immunosuppressive therapies have been variable.

PURPOSE

To systematically review the literature describing immune responses among patients on immunosuppressive therapies to vaccinations including influenza, pneumococcal, meningococcal, hepatitis A and B, tetanus toxoid, pertussis, varicella, and zoster.

DATA SOURCES

English language citations in the MEDLINE and EMBASE databases from 1985 to 2010.

STUDY SELECTION

Two reviewers independently screened titles and abstracts to identify prospective, controlled studies reporting pre- and post-vaccination titers of recommended vaccines in patients receiving long-term immunosuppressive therapies for full-text review.

DATA EXTRACTION

Three reviewers independently assessed study characteristics including treatment regimens and pre- and post-vaccination titers.

DATA SYNTHESIS

Of the 972 identified titles, fifteen met inclusion criteria. Ten studies assessed the effects of immunosuppressive medications on responses to influenza vaccine, four studies investigated responses following pneumococcal vaccination, and one study assessed both influenza and pneumococcal vaccination. Five of the studies that evaluated influenza vaccination showed partially diminished responses among individuals receiving immunosuppressive therapies, while one of the pneumococcal vaccine studies showed significantly decreased responses following vaccination. Patients treated with more than one immunosuppressive medication were the least likely to respond to vaccination.

LIMITATIONS

The heterogeneity of reported outcomes limits generalizeability.

CONCLUSIONS

Immunosuppressive therapy, particularly combination regimens, may blunt response to influenza and pneumococcal vaccinations. To ensure the best chance of response, immunizations should be administered prior to initiation of immunosuppressive medications whenever possible.

Authors+Show Affiliations

Division of Gastroenterology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, United States.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Review
Systematic Review

Language

eng

PubMed ID

22197580

Citation

Agarwal, Nikhil, et al. "Are Immunosuppressive Medications Associated With Decreased Responses to Routine Immunizations? a Systematic Review." Vaccine, vol. 30, no. 8, 2012, pp. 1413-24.
Agarwal N, Ollington K, Kaneshiro M, et al. Are immunosuppressive medications associated with decreased responses to routine immunizations? A systematic review. Vaccine. 2012;30(8):1413-24.
Agarwal, N., Ollington, K., Kaneshiro, M., Frenck, R., & Melmed, G. Y. (2012). Are immunosuppressive medications associated with decreased responses to routine immunizations? A systematic review. Vaccine, 30(8), 1413-24. https://doi.org/10.1016/j.vaccine.2011.11.109
Agarwal N, et al. Are Immunosuppressive Medications Associated With Decreased Responses to Routine Immunizations? a Systematic Review. Vaccine. 2012 Feb 14;30(8):1413-24. PubMed PMID: 22197580.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Are immunosuppressive medications associated with decreased responses to routine immunizations? A systematic review. AU - Agarwal,Nikhil, AU - Ollington,Kevin, AU - Kaneshiro,Marc, AU - Frenck,Robert, AU - Melmed,Gil Y, Y1 - 2011/12/21/ PY - 2011/07/27/received PY - 2011/11/26/revised PY - 2011/11/29/accepted PY - 2011/12/27/entrez PY - 2011/12/27/pubmed PY - 2012/5/24/medline SP - 1413 EP - 24 JF - Vaccine JO - Vaccine VL - 30 IS - 8 N2 - BACKGROUND: Long-term immunosuppressive medications are being used more commonly for a variety of medical conditions, including immune-mediated diseases and organ transplantation. While these medications are often necessary, they are associated with an increased risk of serious infections. Vaccination may be a way to prevent a variety of infections but vaccine responses among patients receiving immunosuppressive therapies have been variable. PURPOSE: To systematically review the literature describing immune responses among patients on immunosuppressive therapies to vaccinations including influenza, pneumococcal, meningococcal, hepatitis A and B, tetanus toxoid, pertussis, varicella, and zoster. DATA SOURCES: English language citations in the MEDLINE and EMBASE databases from 1985 to 2010. STUDY SELECTION: Two reviewers independently screened titles and abstracts to identify prospective, controlled studies reporting pre- and post-vaccination titers of recommended vaccines in patients receiving long-term immunosuppressive therapies for full-text review. DATA EXTRACTION: Three reviewers independently assessed study characteristics including treatment regimens and pre- and post-vaccination titers. DATA SYNTHESIS: Of the 972 identified titles, fifteen met inclusion criteria. Ten studies assessed the effects of immunosuppressive medications on responses to influenza vaccine, four studies investigated responses following pneumococcal vaccination, and one study assessed both influenza and pneumococcal vaccination. Five of the studies that evaluated influenza vaccination showed partially diminished responses among individuals receiving immunosuppressive therapies, while one of the pneumococcal vaccine studies showed significantly decreased responses following vaccination. Patients treated with more than one immunosuppressive medication were the least likely to respond to vaccination. LIMITATIONS: The heterogeneity of reported outcomes limits generalizeability. CONCLUSIONS: Immunosuppressive therapy, particularly combination regimens, may blunt response to influenza and pneumococcal vaccinations. To ensure the best chance of response, immunizations should be administered prior to initiation of immunosuppressive medications whenever possible. SN - 1873-2518 UR - https://www.unboundmedicine.com/medline/citation/22197580/full_citation L2 - https://linkinghub.elsevier.com/retrieve/pii/S0264-410X(11)01905-0 DB - PRIME DP - Unbound Medicine ER -