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Hepatitis A vaccine for immunosuppressed patients with rheumatoid arthritis: a prospective, open-label, multi-centre study.
Travel Med Infect Dis. 2014 Mar-Apr; 12(2):134-42.TM

Abstract

BACKGROUND

Hepatitis A vaccine is the most frequently used travel vaccine, yet data are scarce about its ability to induce protection in patients with concurrent immunosuppressive treatment. We assessed the immunogenicity of this vaccine in rheumatoid arthritis (RA) patients treated with tumour necrosis factor-inhibitors (TNFi) and/or methotrexate (MTX).

METHODS

Hepatitis A vaccine was administered to non-immune RA patients at 0 and 6 months. Hepatitis A virus (HAV) antibodies were assessed at 0, 1, 6, 7, 12, and 24 months with a quantitative Chemiluminescent Microparticle Immuno Assay (CMIA) for HAV-IgG. Samples from month 1, 6, and 7 were, in addition, analysed with a microparticle EIA (MEIA) for anti-HAV IgM + IgG.

RESULTS

The final study population consisted of 53 patients treated with TNFi (n = 15), TNFi + MTX (n = 21) or MTX (n = 17). One and six months after the first dose, 10% and 33% of the patients had attained seroprotection. One and six months after the second dose 83% and 72% were seroprotected. At month 24, 86% of the vaccinees showed protective levels.

CONCLUSIONS

Two doses of hepatitis A vaccine at a 6-month interval provided protection for most immunosuppressed RA patients. A single dose does not seem to afford sufficient protection to this group of patients.

Authors+Show Affiliations

Karolinska Institutet, Dept. of Medicine/Solna, Unit for Infectious Diseases, SE 17176 Stockholm, Sweden; Dept. of Communicable Diseases Control and Prevention, SE 118 91 Stockholm, Sweden. Electronic address: helena.hervius-askling@sll.se.Karolinska Institutet, Dept. of Medicine/Solna, Unit for Infectious Diseases, SE 17176 Stockholm, Sweden; Centre for Clinical Research, Sörmland, Uppsala University, SE 631 88 Eskilstuna, Sweden. Electronic address: lars.rombo@telia.com.Unit for Clinical Therapy Research, Inflammatory Diseases (ClinTRID), Karolinska Institutet, SE-17176 Stockholm Sweden. Electronic address: ronald.van.vollenhoven@ki.se.Dept. of Infectious Diseases, Karlstad County Hospital, SE 651 85 Karlstad, Sweden. Electronic address: ingemar.hallen@liv.se.Dept. of Rheumatology, Mälar Hospital, SE 631 88 Eskilstuna, Sweden. Electronic address: ake.thorner@dll.se.Dept. of Clinical Microbiology, Karolinska University Hospital, SE 17176 Stockholm, Sweden. Electronic address: margareta.nordin@karolinska.se.Swiss Tropical and Public Health Institute, CH-4051 Basel, Switzerland. Electronic address: herzog.ch47@gmail.com.Division of Infectious Diseases, Department of Medicine, Helsinki University Central Hospital, FI-00029 HUCH Helsinki, Finland; Department of Medicine, FI-00014 University of Helsinki, Finland. Electronic address: anu.kantele@hus.fi.

Pub Type(s)

Clinical Trial
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

24529746

Citation

Askling, Helena H., et al. "Hepatitis a Vaccine for Immunosuppressed Patients With Rheumatoid Arthritis: a Prospective, Open-label, Multi-centre Study." Travel Medicine and Infectious Disease, vol. 12, no. 2, 2014, pp. 134-42.
Askling HH, Rombo L, van Vollenhoven R, et al. Hepatitis A vaccine for immunosuppressed patients with rheumatoid arthritis: a prospective, open-label, multi-centre study. Travel Med Infect Dis. 2014;12(2):134-42.
Askling, H. H., Rombo, L., van Vollenhoven, R., Hallén, I., Thörner, Å., Nordin, M., Herzog, C., & Kantele, A. (2014). Hepatitis A vaccine for immunosuppressed patients with rheumatoid arthritis: a prospective, open-label, multi-centre study. Travel Medicine and Infectious Disease, 12(2), 134-42. https://doi.org/10.1016/j.tmaid.2014.01.005
Askling HH, et al. Hepatitis a Vaccine for Immunosuppressed Patients With Rheumatoid Arthritis: a Prospective, Open-label, Multi-centre Study. Travel Med Infect Dis. 2014 Mar-Apr;12(2):134-42. PubMed PMID: 24529746.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Hepatitis A vaccine for immunosuppressed patients with rheumatoid arthritis: a prospective, open-label, multi-centre study. AU - Askling,Helena H, AU - Rombo,Lars, AU - van Vollenhoven,Ronald, AU - Hallén,Ingemar, AU - Thörner,Åke, AU - Nordin,Margareta, AU - Herzog,Christian, AU - Kantele,Anu, Y1 - 2014/01/29/ PY - 2013/11/12/received PY - 2014/01/08/revised PY - 2014/01/13/accepted PY - 2014/2/18/entrez PY - 2014/2/18/pubmed PY - 2014/12/19/medline KW - Hepatitis A KW - Immunosuppression KW - Rheumatoid arthritis KW - TNF-inhibitors KW - Vaccination SP - 134 EP - 42 JF - Travel medicine and infectious disease JO - Travel Med Infect Dis VL - 12 IS - 2 N2 - BACKGROUND: Hepatitis A vaccine is the most frequently used travel vaccine, yet data are scarce about its ability to induce protection in patients with concurrent immunosuppressive treatment. We assessed the immunogenicity of this vaccine in rheumatoid arthritis (RA) patients treated with tumour necrosis factor-inhibitors (TNFi) and/or methotrexate (MTX). METHODS: Hepatitis A vaccine was administered to non-immune RA patients at 0 and 6 months. Hepatitis A virus (HAV) antibodies were assessed at 0, 1, 6, 7, 12, and 24 months with a quantitative Chemiluminescent Microparticle Immuno Assay (CMIA) for HAV-IgG. Samples from month 1, 6, and 7 were, in addition, analysed with a microparticle EIA (MEIA) for anti-HAV IgM + IgG. RESULTS: The final study population consisted of 53 patients treated with TNFi (n = 15), TNFi + MTX (n = 21) or MTX (n = 17). One and six months after the first dose, 10% and 33% of the patients had attained seroprotection. One and six months after the second dose 83% and 72% were seroprotected. At month 24, 86% of the vaccinees showed protective levels. CONCLUSIONS: Two doses of hepatitis A vaccine at a 6-month interval provided protection for most immunosuppressed RA patients. A single dose does not seem to afford sufficient protection to this group of patients. SN - 1873-0442 UR - https://www.unboundmedicine.com/medline/citation/24529746/Hepatitis_A_vaccine_for_immunosuppressed_patients_with_rheumatoid_arthritis:_a_prospective_open_label_multi_centre_study_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1477-8939(14)00035-0 DB - PRIME DP - Unbound Medicine ER -