Centre for Inflammatory Diseases, School of Clinical Sciences, Monash University, 246 Clayton Road, Clayton, Victoria 3168, Australia; Monash Infectious Diseases, Monash Health, 246 Clayton Road, Clayton, Victoria 3168, Australia.
Centre for Inflammatory Diseases, School of Clinical Sciences, Monash University, 246 Clayton Road, Clayton, Victoria 3168, Australia; Monash Infectious Diseases, Monash Health, 246 Clayton Road, Clayton, Victoria 3168, Australia.
Vaccine. 2018 Oct 8;36(42):6253-6261. doi: 10.1016/j.vaccine.2018.08.069. Epub 2018 Sep 11.
This narrative review summarizes the current literature relating to pneumococcal vaccination in adult solid organ transplant (SOT) recipients, who are at risk of invasive pneumococcal disease (IPD) with its attendant high morbidity and mortality. The effect of the pneumococcal polysaccharide vaccine has been examined in several small cohort studies in SOT recipients, most of which were kidney transplant recipients. The outcomes for these studies have been laboratory seroresponses or functional antibody titers. Overall, in most of these studies the transplant recipients were capable of generating measurable serological responses to pneumococcal vaccination but these responses were less than those of healthy controls. A mathematical model estimated the effectiveness of polysaccharide vaccination in SOT recipients to be one third less than those of patients with HIV. The evidence for the efficacy of the pneumococcal conjugate vaccine in SOT is based on a small number of randomized controlled trials in liver and kidney transplant recipients. These trials demonstrated that SOT recipients mounted a serological response following vaccination however there was no benefit to the use of prime boosting (conjugate vaccine followed by polysaccharide vaccine). Currently there are no randomized studies investigating the clinical protection rate against IPD after pneumococcal vaccination by either vaccine type or linked to vaccine titers or other responses against pneumococcus. Concerns that vaccination may increase the risk of adverse alloresponses such as rejection and generation of donor specific antibodies are not supported by studies examining this aspect of vaccine safety. Pneumococcal vaccination is a potentially important strategy to reduce IPD in SOT recipients and is associated with excellent safety. Current international recommendations are based on expert opinion from conflicting data, hence there is a clear need for further high-quality studies in this high-risk population examining optimal vaccination regimens. Such studies should focus on strategies to optimize functional immune responses.
这篇叙述性综述总结了目前与成人实体器官移植（SOT）受者中肺炎球菌疫苗接种相关的文献，这些受者存在侵袭性肺炎球菌病（IPD）的风险，其伴随的发病率和死亡率较高。已经在几项 SOT 受者的小型队列研究中检查了肺炎球菌多糖疫苗的效果，其中大多数是肾移植受者。这些研究的结果是实验室血清学反应或功能性抗体滴度。总体而言，在这些研究中，大多数移植受者能够对肺炎球菌疫苗接种产生可测量的血清学反应，但这些反应低于健康对照组。数学模型估计 SOT 受者中多糖疫苗的有效性比 HIV 患者低三分之一。SOT 中肺炎球菌结合疫苗有效性的证据基于少数针对肝和肾移植受者的随机对照试验。这些试验表明，SOT 受者在接种疫苗后产生了血清学反应，但疫苗初免-加强（结合疫苗后接种多糖疫苗）并没有带来益处。目前，尚无研究调查肺炎球菌疫苗接种后预防 IPD 的临床保护率，无论是哪种疫苗类型或与疫苗滴度或针对肺炎球菌的其他反应相关联。接种疫苗可能会增加不良同种反应（如排斥和产生供体特异性抗体）的风险的担忧，这一观点并未得到研究疫苗安全性的研究的支持。肺炎球菌疫苗接种是降低 SOT 受者 IPD 的潜在重要策略，且具有极好的安全性。目前的国际建议是基于相互矛盾的数据的专家意见，因此，在这一高危人群中，需要进一步进行高质量的研究，以检查最佳疫苗接种方案。这些研究应侧重于优化功能性免疫反应的策略。
