Department of Infectious Diseases, Austin Health, Heidelberg, VIC, Australia.
Department of General Medicine, Austin Health, Heidelberg, VIC, Australia.
J Travel Med. 2018 Jan 1;25(1). doi: 10.1093/jtm/tay018.
Biologic therapy has revolutionized the management of refractory chronic autoimmune and auto-inflammatory disease, as well as several malignancies, providing rapid symptomatic relief and/or disease remission. Patients receiving biologic therapies have an improved quality of life, facilitating travel to exotic destinations and potentially placing them at risk of a range of infections. For each biologic agent, we review associated travel-related infection risk and expected travel vaccine response and effectiveness.
A PUBMED search [vaccination OR vaccine] AND/OR ['specific vaccine'] AND/OR [immunology OR immune response OR response] AND [biologic OR biological OR biologic agent] was performed. A review of the literature was performed in order to develop recommendations on vaccination for patients in receipt of biologic therapy travelling to high-risk travel destinations.
There is a paucity of literature in this area, however, it is apparent that travel-related infection risk is increased in patients on biologic therapy and when illness occurs they are at a higher risk of complication and hospitalization. Patients in receipt of biologic agents are deemed as having a high level of immunosuppression-live vaccines, including the yellow fever vaccine, are contraindicated. Inactivated vaccines are considered safe; however, vaccine response can be attenuated by the patient's biologic therapy, thereby resulting in reduced vaccine effectiveness and protection.
Best practice requires a collaborative approach between the patient's primary healthcare physician, relevant specialist and travel medicine expert, who should all be familiar with the immunosuppressive and immunomodulatory effects resulting from the biologic therapies. Timing of vaccines should be carefully planned, and if possible, vaccination provided well before established immunosuppression.
生物疗法彻底改变了难治性慢性自身免疫和自身炎症性疾病以及多种恶性肿瘤的治疗方法，为患者提供了快速的症状缓解和/或疾病缓解。接受生物疗法的患者生活质量得到改善，这使得他们能够前往异国他乡旅行，但也使他们面临一系列感染的风险。对于每种生物制剂，我们都要评估其与旅行相关的感染风险，以及预期的旅行疫苗反应和效果。
我们在 PubMed 上进行了一次搜索，搜索词包括“疫苗”或“疫苗接种”，以及“特定疫苗”、“免疫”或“免疫反应”、“生物制剂”或“生物”。为了制定针对接受生物治疗并前往高风险旅行目的地的患者的疫苗接种建议，我们对文献进行了回顾。
虽然这方面的文献很少，但很明显，接受生物治疗的患者在旅行时面临更高的感染风险，而且如果患病，他们的并发症和住院风险更高。接受生物制剂的患者被认为具有高度免疫抑制状态——活疫苗，包括黄热病疫苗，是禁忌的。灭活疫苗被认为是安全的；然而，患者的生物治疗可能会削弱疫苗反应，从而导致疫苗效果和保护作用降低。
最佳实践需要患者的初级保健医生、相关专家和旅行医学专家之间的协作方法，他们都应该熟悉生物疗法产生的免疫抑制和免疫调节作用。疫苗接种时间应仔细规划，如果可能的话，应在建立免疫抑制之前进行接种。
