• Coronavirus disease 2019
• herpes zoster
• immunocompromised
• influenza
• solid organ transplantation
• travel medicine
• vaccination

• Humans
• Vaccination/methods
• Transplant Recipients
• Immunocompromised Host
• Organ Transplantation
• Vaccines/administration & dosage
• Vaccines/immunology
• Vaccine-Preventable Diseases/prevention & control
• Vaccine Efficacy

• Humans
• Pneumococcal Vaccines
• Vaccines, Conjugate
• Streptococcus pneumoniae
• Pneumonia, Pneumococcal/prevention & control
• Pneumococcal Infections/prevention & control
• Antibodies, Bacterial

• Kidney transplantation
• Pneumococcal antigens
• Sequential vaccination
• Serotype specific immunity
• Streptococcus pneumoniae
• Vaccination

• Humans
• Antibody Formation
• Kidney Transplantation
• Transplant Recipients
• Antibodies, Bacterial
• Vaccines, Conjugate
• Double-Blind Method
• Pneumococcal Vaccines
• Streptococcus pneumoniae
• Pneumococcal Infections/prevention & control
• Vaccination

• Rudolf-Ackermann-Stiftung
• Universitätsklinikum Essen (8912)

• Adults
• Immunogenicity
• Kidney transplant recipient
• Pneumococcal conjugate vaccine
• Pneumococcal polysaccharide vaccine

In organ transplant recipients, the rate of invasive pneumococcal diseases is 25 times greater than in the general population. Vaccination against S. pneumoniae is recommended in this cohort because it reduces the incidence of this severe form of pneumococcal infection. Previous studies indicate that transplant recipients can produce specific antibodies after pneumococcal vaccination. However, it remains unclear if vaccination also induces specific cellular immunity. In the current study on 38 kidney transplant recipients, we established an interferon-γ ELISpot assay that can detect serotype-specific cellular responses against S. pneumoniae. The results indicate that sequential vaccination with the conjugated vaccine Prevenar 13 and the polysaccharide vaccine Pneumovax 23 led to an increase of serotype-specific cellular immunity. We observed the strongest responses against the serotypes 9N and 14, which are both components of Pneumovax 23. Cellular responses against S. pneumoniae correlated positively with specific IgG antibodies (r = 0.32, p = 0.12). In conclusion, this is the first report indicating that kidney transplant recipients can mount specific cellular responses after pneumococcal vaccination. The ELISpot we established will allow for further investigations. These could help to define, for example, factors influencing specific cellular immunity in immunocompromised cohorts or the duration of cellular immunity after vaccination.

• interferon-γ ELISpot
• kidney transplant recipients
• pneumococcal conjugate and polysaccharide vaccines
• sequential vaccination
• serotype specific cellular immunity

• Bacterial infections (BI)
• lung transplantation

• Solid organ Transplantation
• Vaccine

• PCV13
• PPSV23
• Pneumococcal polysaccharide vaccine
• hyporesponsiveness
• pneumococcal conjugate vaccine
• revaccination
• sequential vaccination

• dialysis
• kidney transplant recipient
• pneumococcal disease
• pneumococcal vaccination

• Influenza
• Invasive pneumococcal disease
• Liver transplantation
• Vaccination
• Viral hepatitis A
• Viral hepatitis B

• Kidney transplant recipients
• Opsonophagocytic assay
• Pneumococcal antibody global serum assays
• Pneumococcal conjugate vaccine
• Pneumococcal vaccination in immunocompromised individuals
• Serotype specific

Infectious complications are a significant cause of morbidity and mortality in patients with malignancies specifically when receiving anticancer treatments. Prevention of infection through vaccines is an important aspect of clinical care of cancer patients. Immunocompromising effects of the underlying disease as well as of antineoplastic therapies need to be considered when devising vaccination strategies. This guideline provides clinical recommendations on vaccine use in cancer patients including autologous stem cell transplant recipients, while allogeneic stem cell transplantation is subject of a separate guideline. The document was prepared by the Infectious Diseases Working Party (AGIHO) of the German Society for Hematology and Medical Oncology (DGHO) by reviewing currently available data and applying evidence-based medicine criteria.

• Anti-Infective Agents/therapeutic use
• Communicable Diseases/drug therapy
• Communicable Diseases/etiology
• Hematologic Neoplasms/therapy
• Humans
• Neoplasms/therapy
• Practice Guidelines as Topic/standards
• Prognosis
• Stem Cell Transplantation/adverse effects
• Vaccination/standards

• UM1 AI104681 NIAID NIH HHS

• clinical research/practice
• infectious disease
• organ transplantation in general
• preventive healthcare
• vaccine

• Immunizations
• Kidney transplant
• Serological response
• Transplant outcomes
• Vaccines

• 13-valent
• Pneumococcal vaccine
• Prevenar
• Transplantation

Infectious disease is recognized as an important complication among patients with end-stage renal disease, contributing to excess morbidity and health care costs. However, recent epidemiological studies have revealed that even mild to moderate stages of chronic kidney disease (CKD) substantially increase risk of infection. Regarding underlying mechanisms, evidence suggests various aspects of altered immune response in patients with CKD including impaired function of T cells, B cells and neutrophil. Multiple conditions surrounding CKD, such as older age, diabetes, and cardiovascular disease are important contributors in the increased susceptibility to infection in this population. In addition, several mechanisms impairing immune function have been hypothesized including accumulated uremic toxins, increased oxidative stress, endothelial dysfunction, low-grade inflammation, and mineral and bone disorders. In terms of prevention strategies, influenza and pneumococcal vaccines are most feasible and important. Nevertheless, the extent of vaccine utilization in CKD has not been well documented. In addition, antibody response to vaccination may be reduced in CKD patients, and thus a vaccine delivery strategy (e.g., dose and frequency) may need to be optimized among patients with CKD. Through this review, we demonstrate that infection is a major but underrecognized complication of CKD. As CKD is recognized as a serious public health issue, dedicated research is needed to better characterize the burden of infectious disease associated with CKD, understand the pathophysiology of infection in patients with CKD, and develop effective strategies to prevent infection and its sequela in this high risk population.

• Bloodstream infections
• Chronic kidney disease
• Infections
• Influenza vaccination
• Pneumococcal vaccination
• Pneumonia
• Renal failure

• kidney transplantation
• luminex technology
• pneumococcal antigen
• serotype-specific antibody response

• Conjugate pneumococcal vaccine
• Immunosuppression
• Pneumococcal polysaccharide vaccine
• Systemic lupus erythematosus

• Antibodies
• Asthma
• Capsular polysaccharide serotypes
• Corticosteroids
• Invasive pneumococcal disease
• Obstructive airways disease
• PPSV23
• Pneumococcal polysaccharide vaccine
• Pneumococcal vaccine
• Prevention
• Serology
• Vaccination
• Vaccine responsiveness

Pneumonia is the fourth-leading cause of death globally, and Streptococcus pneumoniae is the most important causative pathogen. Because the incidence of pneumococcal diseases is likely to increase with the aging society, we should determine an optimal strategy for pneumococcal vaccination. While consensus indicates that 23-valent pneumococcal polysaccharide vaccine prevents invasive pneumococcal diseases (IPD), its effects on community-acquired pneumonia (CAP) remain controversial. Recently, a 13-valent pneumococcal conjugate vaccine (PCV13) was released. The latest clinical study (CAPiTA study) showed that PCV13 reduced vaccine-type CAP and IPD. Based on these results, the Advisory Committee on Immunization Practices recommended initial vaccination with PCV13 for the elderly. Scientific evidence regarding immunosenescence is needed to determine a more ideal vaccination strategy for the elderly with impaired innate and adaptive immunity. Continuing research on the cost effectiveness of new vaccine strategies considering constantly changing epidemiology is also warranted.

• aging
• elderly
• pneumococcal conjugate vaccine
• pneumococcal diseases
• pneumococcal polysaccharide vaccine
• pneumococcal vaccines
• senescence

In many industrialized countries routine vaccination with the 23-valent pneumococcal polysaccharide vaccine (PPSV-23) is recommended to prevent pneumococcal disease in the elderly. However, vaccine-induced immunity wanes after a few years, and there are controversies around revaccination with PPSV-23. Here, we systematically assessed the effectiveness and safety of PPSV-23 revaccination.

We conducted a systematic literature review in MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials from inception to June 2015. We included all study types that compared effectiveness, immunogenicity and/or safety of PPSV-23 as a primary vs. a revaccination dose in persons aged 50 years and older. With respect to immunogenicity, we calculated the ratio of geometric mean antibody concentrations and opsonophagocytic indexes at identical time-points after primary and revaccination. Additionally, we compared rates and severity of adverse events (AEs) after primary and revaccination.

We included 14 observational studies. 10 studies had a prospective design and analysed data on (i) the same individuals after a first and a second dose of PPSV-23 given 1 to 10 years later (n = 5) or (ii) two groups consisting of participants receiving PPSV-23 who were either vaccine-naïve or had received a first PPSV-23 dose 3 to 13 years earlier (n = 5). Three studies used electronic data bases to compare AEs after primary vs. revaccination doses of PPSV-23 after 1 to 10 years and one study had a cross-sectional design. Number of participants in the non-register-based and register-based studies ranged from 29 to 1414 and 360 to 316,000, respectively. 11 out of 14 included studies were at high risk of bias, three studies had an unclear risk of bias. None of the studies reported data on clinical effectiveness. Immunogenicity studies revealed that during the first two months antibody levels tended to be lower after revaccination as compared to primary vaccination. Thereafter, no obvious differences in antibody levels were observed. Compared to primary vaccination, revaccination was associated with an increased risk of local and systemic AEs, which, however, were usually mild and self-limiting. The risk and severity of AEs appeared to decrease with longer intervals between primary and revaccination.

Data comparing the effectiveness of primary vs. revaccination with PPSV-23 are still lacking, because there are no studies with clinical endpoints. Data from observational studies indicates that revaccination with PPSV-23 is likely to induce long-term antibody levels that are comparable to those after primary vaccination. Given the high disease burden and the waning of vaccine-induced immunity, revaccination with PPSV-23 could be considered in the elderly. The increased risk of local and systemic AEs can likely be mitigated when giving revaccination at least five years after the primary dose. Adequately powered randomized controlled trials using clinical endpoints are urgently needed.

The online version of this article (doi:10.1186/s12879-016-2040-y) contains supplementary material, which is available to authorized users.

• children
• infection
• kidney transplant
• vaccine

• Immunization
• Organ transplantation
• Vaccines

• Guidelines
• Infection
• Lupus systémique
• Recommandations
• Systemic lupus erythematosus
• Vaccination

• Adolescent
• Adult
• France
• Humans
• Immunocompromised Host
• Infection Control/methods
• Infection Control/standards
• Infections/diagnosis
• Lupus Erythematosus, Systemic/complications
• Lupus Erythematosus, Systemic/diagnosis
• Lupus Erythematosus, Systemic/immunology
• Lupus Erythematosus, Systemic/therapy
• Practice Guidelines as Topic
• Review Literature as Topic
• Vaccination/standards
• Young Adult

HIV infection impairs maintenance of immunological memory, yet few studies of HIV-positive adults receiving 7-valent pneumococcal conjugate vaccine (PCV7) have followed them beyond the first year. We determined and compared the durability of serological responses and the clinical outcomes of HIV-positive adults annually for five years following vaccination with one or two doses of PCV7.

In this non-randomized clinical trial, 221 pneumococcal vaccine-naïve HIV-positive adults receiving one (n=109) or two doses four weeks apart (n=112) of PCV7 between 2008 and 2010 were longitudinally followed for evaluation of significant serological response and for episodes of pneumonia and invasive pneumococcal disease.

At the time of vaccination, the two groups were well matched for age, risk factors, combination antiretroviral therapy (cART) coverage, CD4 count and plasma HIV RNA load (PVL). At the end of five years, the CD4 counts for the one- and two-dose groups had increased from 407 and 406 to 550 and 592 cells/µL, respectively, and 82.4 and 81.6% of the participants had fully suppressed PVL. Significant immune responses to ≥2 serotypes persisted for 67.9 vs 78.6%, 64.2 vs 71.4%, 66.1 vs 71.4%, 57.8 vs 69.6% in the second, third, fourth and fifth years after one and two doses of PCV7 in the intention-to-treat analysis, respectively. In multivariate analysis, immunization with two doses of PCV7 (odds ratio (OR) 1.71, 95% confidence interval (CI) 1.10 to 2.65, p=0.016), concurrent cART (OR 2.16, 95% CI 1.16 to 4.00, p=0.015) and CD4 proliferation (OR 1.12, 95% CI 1.01 to 1.27, p=0.031) were predictive of persistent serological responses in the fifth year. Only one patient in the one-dose group had documented pneumococcal pneumonia (non-bacteraemic) and none had invasive pneumococcal disease in the 6.5 years of follow-up.

One or two doses of PCV7 achieve durable seroprotective responses in HIV-treated participants; however, two doses may be more robust than one dose in a larger study population or in real-world populations with less cART coverage.

• Streptococcus pneumoniae
• anti-capsular antibody
• immunogenicity
• invasive pneumococcal disease
• serological response

• Children with comorbidities
• Germany
• Invasive pneumococcal disease
• Pneumococcal conjugate vaccination
• School-aged children
• Vaccination implication

In the general population, pneumococcal polysaccharide vaccines (PPV) decrease the incidence of invasive pneumococcal disease (IPD) whereas the impact on the prevention of noninvasive pneumococcal disease is less clear. As compared with PPV, pneumococcal conjugate vaccines (PCV) provoke a higher, longer-lasting immune response resulting in a 45% decreased incidence in vaccine-type pneumonia, and a 75% decrease in vaccine-type IPD.

Literature review on pneumococcal vaccination in end-stage renal disease.

As compared with the general population, patients with chronic kidney disease (CKD) suffer increased mortality and morbidity from pneumococcal disease (PD), being up to 10-fold for those treated with dialysis. Numerous, usually small and methodological heterogeneous studies demonstrate that PPV provokes a serological response in dialysis patients, kidney transplant recipients, children with nephrotic syndrome and CKD patients receiving immunosuppressive medication. This response is of less intensity and duration than in healthy controls. Similar observations were made for the PCV. The protective value of these vaccine-elicited anti-pneumococcal antibodies in the CKD population remains to be substantiated. For patients treated with dialysis, epidemiological data demonstrate a correlation—which does not equal causality—between pneumococcal vaccination status and a slightly decreased total mortality. Clinical outcome data on the effectiveness of pneumococcal vaccination in the prevention of morbidity and mortality in the CKD population are lacking.

Awaiting better evidence, pneumococcal vaccination should be advocated in all patients with CKD, as early in their disease course as possible. The ACIP schedule recommends a PCV-13 prime vaccination followed by a PPV-23 repeated vaccine at least 8 weeks later in pneumococcal non-vaccinated patients, and a PCV-13 vaccine at least 1 year after the latest PPV vaccine in previously vaccinated patients. In the UK, vaccination with PPV-23 only is recommended. There exist no good data supporting re-vaccination after 5 years in the dialysis population.

• antibody
• dialysis
• pneumococcal vaccination
• prevention
• transplantation

In solid organ transplant (SOT) recipients, Streptococcus pneumoniae can cause substantial morbidity and mortality ranging from non-invasive to invasive diseases, including pneumonia, bacteremia, and meningitis, with a risk of invasive pneumococcal disease 12 times higher than that observed in non-immunocompromised patients. Moreover, pneumococcal infection has been related to graft dysfunction. Several factors have been involved in the risk of pneumococcal disease in SOT recipients, such as type of transplant, time since transplantation, influenza activity, and nasopharyngeal colonization. Pneumococcal vaccination is recommended for all SOT recipients with 23-valent pneumococcal polysaccharides vaccine. Although immunological rate response is appropriate, it is lower than in the rest of the population, decreases with time, and its clinical efficacy is variable. Booster strategy with 7-valent pneumococcal conjugate vaccine has not shown benefit in this population. Despite its relevance, there are few studies focused on invasive pneumococcal disease in SOT recipients. Further studies addressing clinical, microbiological, and epidemiological data of pneumococcal disease in the transplant setting as well as new strategies for improving the protection of SOT recipients are warranted.

• Transplantation
• Pneumococcal infections
• Pneumococcal serotypes
• Nasopharyngeal carriage
• Pneumococcal vaccine

• 23-Valent pneumococcal vaccinations
• Invasive pneumococcal disease, Streptococcal pneumonia
• Systematic review

• Invasive pneumococcal disease
• Pneumococcal
• Pneumonia
• Pulmonary
• Streptococcus pneumoniae
• Vaccination

• Chronic Disease
• Humans
• Lung Diseases/complications
• Pneumococcal Vaccines
• Pneumonia, Pneumococcal/etiology
• Pneumonia, Pneumococcal/prevention & control
• Risk Factors
• Vaccination/methods
• Vaccination/standards

• T32 HL082547 NHLBI NIH HHS
• 5 T32 HL 82547-7 NHLBI NIH HHS

• Anti-opportunistic infections
• Antifungal agents
• Benzylthioquinolinium iodides
• Craig plot
• Cryptolepine
• Structure–activity relationships
• Substituted quinolinium salts