4(th) Department of Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece.
4(th) Department of Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece.
Vaccine. 2024 Sep 17;42(22):126001. doi: 10.1016/j.vaccine.2024.05.049. Epub 2024 May 24.
Immunogenicity of influenza and pneumococcal vaccines varies and requires further elucidation in patients with multiple sclerosis (MS) under treatment with disease-modifying therapies (DMTs).
Adult MS patients who consented with vaccination after standard-of-care consultation by their treating physicians were enrolled. All received a single dose of an inactivated quadrivalent influenza vaccine and of the 23-valent pneumococcal vaccine. A blood sample was collected before and after four weeks of vaccination for measurement of antibodies against Influenza A, B and S. pneumoniae. Patients were followed-up for adverse events and MS relapse for 12 months.
One hundred and seventy-two patients (65.7 % female, mean age 42 ± 13 years old, mean MS duration 7.6 ± 7.2 years, 81.4 % under DMTs) were enrolled from November 2019 to March 2020. Antibody measurements were available for 151 patients. Seropositivity for anti-PPSV23 did not differ between baseline and at 4 weeks of follow-up (n = 56, 37.1 %). There was a significant increase of absolute antibody titers post-vaccination for both influenza A and B (p < 0.001). For Influenza A, seropositivity was evident for 57 (37.7 %) patients at 4 weeks compared to 19 (12.6 %) patients at baseline (p < 0.001). For Influenza Β, 110 (72.8 %) seroconverted 4 weeks after vaccination compared to 12 (7.9 %) at baseline (p < 0.001). Interferon and fumarate did not affect influenza seroconversion while rituximab was associated with lower titers. Mild local AEs (pain, edema) were observed in 23.8 %; no severe AE was reported. Thirty-four patients (19.8 %) had a relapse during the 12-month follow-up; none was attributed to the vaccination.
Seroconversion in MS patients on treatment was more frequent following influenza compared to PPSV23 vaccination. Rituximab had an effect on the height of the immune response. Better immunization coverage as well as future evaluation of the breadth of immune response elicited by immunization is necessary for these patients.
流感和肺炎球菌疫苗的免疫原性存在差异，在接受疾病修正疗法（DMT）治疗的多发性硬化症（MS）患者中需要进一步阐明。
经主治医生标准护理咨询后同意接种疫苗的成年 MS 患者被纳入研究。所有患者均接受一剂四价流感疫苗和 23 价肺炎球菌疫苗的接种。在接种后 4 周采集血样，以测量针对流感 A、B 和 S. pneumoniae 的抗体。对患者进行了 12 个月的不良事件和 MS 复发随访。
2019 年 11 月至 2020 年 3 月，共纳入 172 名患者（65.7%为女性，平均年龄 42±13 岁，平均 MS 病程 7.6±7.2 年，81.4%正在接受 DMT）。151 名患者的抗体检测结果可用。接种后 4 周，抗 PPSV23 的血清阳性率与基线时无差异（n=56，37.1%）。两种流感疫苗接种后绝对抗体滴度均显著升高（p<0.001）。对于流感 A，与基线时的 19 例（12.6%）相比，接种后 4 周时血清阳性的患者有 57 例（37.7%）（p<0.001）。对于流感 B，接种后 4 周时 110 例（72.8%）发生血清转化，而基线时仅 12 例（7.9%）（p<0.001）。干扰素和富马酸不会影响流感血清转化率，而利妥昔单抗与较低的滴度相关。23.8%的患者观察到轻度局部不良反应（疼痛、肿胀）；未报告严重不良反应。在 12 个月的随访期间，有 34 名患者（19.8%）发生复发；没有复发与疫苗接种有关。
与 PPSV23 接种相比，接受治疗的 MS 患者接种流感疫苗后更常发生血清转化。利妥昔单抗对免疫反应的强度有影响。需要更好地为这些患者进行免疫接种覆盖率，并进一步评估免疫接种引起的免疫反应广度。
