轻度至中度先天性免疫缺陷患者的医生疫苗接种实践及免疫缺陷病疫苗接种完整性的回顾性研究：加拿大免疫研究网络的结果
Physician vaccination practices in mild to moderate inborn errors of immunity and retrospective review of vaccine completeness in IEI: results from the Canadian Immunization Research Network.
作者信息
Suresh Sneha, Zafack Joseline, Pham-Huy Anne, Derfalvi Beata, Sadarangani Manish, McConnell Athena, Tapiéro Bruce, Halperin Scott A, De Serres Gaston, M Pernica Jeffrey, Top Karina A
机构信息
Division of Immunology, Department of Pediatrics, Edmonton Clinic Health Academy, 3-529, 11405 87 Ave, Edmonton, AB, T6G 1C9, Canada.
Division of Infectious Disease and IHOPE, Department of Paediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, Canada.
出版信息
Allergy Asthma Clin Immunol. 2022 Apr 9;18(1):32. doi: 10.1186/s13223-022-00667-1.
BACKGROUND AND OBJECTIVES
Safety and effectiveness concerns may preclude physicians from recommending vaccination in mild/moderate inborn errors of immunity (IEI). This study describes attitudes and practices regarding vaccination among physicians who care for patients with mild/moderate B cell or mild/moderate combined immunodeficiencies (CID) and vaccination completeness among patients diagnosed with IEIs.
METHODS
Canadian physicians caring for children with IEI were surveyed about attitudes and practices regarding vaccination in mild/moderate IEI. Following informed consent, immunization records of pediatric patients with IEI evaluated before 7 years of age were reviewed. Vaccine completeness was defined at age 2 years as 4 doses of diphtheria-tetanus-pertussis (DTaP), 3 doses pneumococcal conjugate (PCV), and 1 dose measles-mumps-rubella (MMR) vaccines. At 7 years 5 doses of DTP and 2 doses MMR were required.
RESULTS
Forty-five physicians from 8 provinces completed the survey. Most recommended inactivated vaccines for B cell deficiency: (84% (38/45) and CID (73% (33/45). Fewer recommended live attenuated vaccines (B cell: 53% (24/45), CID 31% (14/45)). Of 96 patients with IEI recruited across 7 centers, vaccination completeness at age 2 was 25/43 (58%) for predominantly antibody, 3/13 (23%) for CID, 7/35 (20%) for CID with syndromic features, and 4/4 (100%) for innate/phagocyte defects. Completeness at age 7 was 15%, 17%, 5%, and 33%, respectively.
CONCLUSION
Most physicians surveyed recommended inactivated vaccines in children with mild to moderate IEI. Vaccine completeness for all IEI was low, particularly at age 7. Further studies should address the reasons for low vaccine uptake among children with IEI and whether those with mild-moderate IEI, where vaccination is recommended, eventually receive all indicated vaccines.
背景与目的
安全和有效性方面的担忧可能使医生无法推荐对患有轻度/中度先天性免疫缺陷（IEI）的患者进行疫苗接种。本研究描述了负责照顾患有轻度/中度B细胞或轻度/中度联合免疫缺陷（CID）患者的医生对疫苗接种的态度和做法，以及被诊断为IEI的患者的疫苗接种完整性。
方法
对加拿大负责照顾患有IEI儿童的医生进行了调查，了解他们对轻度/中度IEI疫苗接种的态度和做法。在获得知情同意后，对7岁前接受评估的儿科IEI患者的免疫记录进行了审查。2岁时的疫苗接种完整性定义为4剂白喉-破伤风-百日咳（DTaP）疫苗、3剂肺炎球菌结合疫苗（PCV）和1剂麻疹-腮腺炎-风疹（MMR）疫苗。7岁时需要接种5剂白喉-破伤风-百日咳疫苗和2剂MMR疫苗。
结果
来自8个省份的45名医生完成了调查。大多数医生推荐对B细胞缺陷患者接种灭活疫苗（84%（38/45））和对CID患者接种灭活疫苗（73%（33/45））。推荐接种减毒活疫苗的医生较少（B细胞缺陷：53%（24/45），CID：31%（14/45））。在7个中心招募的96名IEI患者中，2岁时的疫苗接种完整性在主要为抗体缺陷患者中为25/43（58%），在CID患者中为3/13（23%），在具有综合征特征的CID患者中为7/35（20%），在先天性/吞噬细胞缺陷患者中为4/4（100%）。7岁时的疫苗接种完整性分别为15%、17%、5%和33%。
结论
大多数接受调查的医生推荐对轻度至中度IEI儿童接种灭活疫苗。所有IEI患者的疫苗接种完整性都很低，尤其是在7岁时。进一步的研究应探讨IEI儿童疫苗接种率低的原因，以及那些被推荐接种疫苗的轻度至中度IEI患者最终是否接种了所有指定疫苗。
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