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Safety and immunogenicity of tetanus/diphtheria vaccination in patients with rheumatic diseases-a prospective multi-centre cohort study

Bühler, Silja and Jaeger, Veronika Katharina and Adler, Sabine and Bannert, Bettina and Brümmerhoff, Carolin and Ciurea, Adrian and Distler, Oliver and Franz, Juliane and Gabay, Cem and Hagenbuch, Niels and Herzog, Christian and Hasler, Paul and Kling, Kerstin and Kyburz, Diego and Müller, Rüdiger and Nissen, Michael John and Siegrist, Claire-Anne and Villiger, Peter Matthias and Walker, Ulrich A. and Hatz, Christoph. (2019) Safety and immunogenicity of tetanus/diphtheria vaccination in patients with rheumatic diseases-a prospective multi-centre cohort study. Rheumatology, 58 (9). pp. 1585-1596.

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Official URL: https://edoc.unibas.ch/71950/

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Abstract

We aimed to assess the safety and immunogenicity of a diphtheria/tetanus vaccine booster dose in three different patient groups with rheumatic diseases on a variety of immunosuppressive/immunomodulatory medications compared with healthy controls (HCs).; We conducted a multi-centre prospective cohort study in Switzerland. We enrolled patients with RA, axial SpA/PsA, vasculitis (Behçet's disease, ANCA-associated vasculitis) and HCs. Diphtheria/tetanus vaccination was administered according to the Swiss vaccination recommendations. Blood samples were drawn before vaccination, and 1 month and 3 months afterwards. Antibody concentrations against vaccine antigens were measured by ELISA. Immunogenicity was compared between patient and medication groups. A mixed model was applied for multivariate analysis. Missing data were dealt with using multiple imputation.; Between January 2014 and December 2015, we enrolled 284 patients with rheumatic diseases (131 RA, 114 SpA/PsA, 39 vasculitis) and 253 HCs. Of the patients, 89% were on immunosuppressive/immunomodulatory medication. Three months post-vaccination 100% of HCs vs 98% of patients were protected against tetanus and 84% vs 73% against diphtheria. HCs and SpA/PsA patients had significantly higher responses than RA and vasculitis patients. Assessing underlying diseases and medications in a multivariate model, rituximab was the only factor negatively influencing tetanus immunogenicity, whereas only MTX treatment had a negative influence on diphtheria antibody responses. No vaccine-related serious adverse events were recorded.; Diphtheria/tetanus booster vaccination was safe. Tetanus vaccination was immunogenic; the diphtheria component was less immunogenic. Vaccine responses were blunted by rituximab and MTX.; ClinicalTrials.gov, http://clinicaltrials.gov, Identifier: NCT01947465.
Faculties and Departments:03 Faculty of Medicine > Departement Public Health > Sozial- und Präventivmedizin > Medical Services (Neumayr)
09 Associated Institutions > Swiss Tropical and Public Health Institute (Swiss TPH) > Department of Medicine (MED) > Medical Services (Neumayr)
09 Associated Institutions > Swiss Tropical and Public Health Institute (Swiss TPH)
UniBasel Contributors:Herzog, Christian and Kling, Kerstin and Hatz, Christoph
Item Type:Article, refereed
Article Subtype:Research Article
Publisher:Univ. Press
ISSN:1462-0332
Note:Publication type according to Uni Basel Research Database: Journal article
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Last Modified:18 Sep 2019 07:05
Deposited On:18 Sep 2019 07:05

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