Papp Kim A, Haraoui Boulos, Kumar Deepali, Marshall John K, Bissonnette Robert, Bitton Alain, Bressler Brian, Gooderham Melinda, Ho Vincent, Jamal Shahin, Pope Janet E, Steinhart A Hillary, Vinh Donald C, Wade John
1 K Papp Clinical Research, Waterloo, ON, Canada.
2 Probity Medical Research, Waterloo, ON, Canada.
J Cutan Med Surg. 2019 Jan/Feb;23(1):50-74. doi: 10.1177/1203475418811335. Epub 2018 Nov 21.
: Patients with immune-mediated diseases on immunosuppressive therapies have more infectious episodes than healthy individuals, yet vaccination practices by physicians for this patient population remain suboptimal.
: To evaluate the safety and efficacy of vaccines in individuals exposed to immunosuppressive therapies and provide evidence-based clinical practice recommendations.
: A literature search for vaccination safety and efficacy in patients on immunosuppressive therapies (2009-2017) was conducted. Results were assessed using the Grading of Recommendation, Assessment, Development, and Evaluation system.
: Several immunosuppressive therapies attenuate vaccine response. Thus, vaccines should be administered before treatment whenever feasible. Inactivated vaccines can be administered without treatment discontinuation. Similarly, evidence suggests that the live zoster vaccine is safe and effective while on select immunosuppressive therapy, although use of the subunit vaccine is preferred. Caution regarding other live vaccines is warranted. Drug pharmacokinetics, duration of vaccine-induced viremia, and immune response kinetics should be considered to determine appropriate timing of vaccination and treatment (re)initiation. Infants exposed to immunosuppressive therapies through breastmilk can usually be immunized according to local guidelines. Intrauterine exposure to immunosuppressive agents is not a contraindication for inactivated vaccines. Live attenuated vaccines scheduled for infants and children ⩾12 months of age, including measles, mumps, rubella, and varicella, can be safely administered as sufficient time has elapsed for drug clearance.
: Immunosuppressive agents may attenuate vaccine responses, but protective benefit is generally maintained. While these recommendations are evidence based, they do not replace clinical judgment, and decisions regarding vaccination must carefully assess the risks, benefits, and circumstances of individual patients.
接受免疫抑制治疗的免疫介导疾病患者比健康个体有更多的感染发作，但医生针对这一患者群体的疫苗接种做法仍不理想。
评估疫苗在接受免疫抑制治疗个体中的安全性和有效性，并提供基于证据的临床实践建议。
对免疫抑制治疗患者的疫苗接种安全性和有效性进行文献检索（2009 - 2017年）。使用推荐分级、评估、制定和评价系统对结果进行评估。
几种免疫抑制治疗会减弱疫苗反应。因此，只要可行，应在治疗前接种疫苗。灭活疫苗可在不中断治疗的情况下接种。同样，有证据表明，在接受特定免疫抑制治疗时，活带状疱疹疫苗是安全有效的，尽管首选使用亚单位疫苗。对于其他活疫苗则需谨慎。应考虑药物药代动力学、疫苗诱导的病毒血症持续时间和免疫反应动力学，以确定合适的疫苗接种时间和治疗（重新）开始时间。通过母乳接触免疫抑制治疗的婴儿通常可根据当地指南进行免疫接种。宫内接触免疫抑制剂并非灭活疫苗的禁忌证。对于12个月及以上的婴幼儿计划接种的减毒活疫苗，包括麻疹、腮腺炎、风疹和水痘疫苗，由于已有足够时间清除药物，因此可以安全接种。
免疫抑制剂可能会减弱疫苗反应，但通常仍能维持保护作用。虽然这些建议是基于证据的，但它们不能取代临床判断，关于疫苗接种的决定必须仔细评估个体患者的风险、益处和具体情况。
