The protection of immunocompromised patients against measles, rubella, diphtheria and tetanus
Keywords:primary immunodeficiency, replacement therapy, children, vaccination, immunosuppressive therapy, specific antibodies to measles, rubella, diphtheria and tetanus
Purpose - to study the state of protection against vaccine-controlled infections in children with primary immunodeficiency (PID) and in children on immunosuppressive therapy.
Materials and methods. The object of the study was the level of intensity of humoral immunity against viral (measles, rubella) and bacterial (diphtheria, tetanus) vaccine-controlled infections in immunosuppressed patients. Protective levels of specific IgG antibodies against vaccine antigens were determined in 58 children with primary immunodeficiency and 20 children receiving immunosuppressive therapy. Among the 58 children with primary immunodeficiency, there were 26 children with preserved antibody function and 32 children with antibody deficiencies and combined immunodeficiencies on immunoglobulin replacement therapy. The state of immunity of immunocompromised patients was compared with that of healthy children in the control group.
Results. In the group of children with PID with preserved antibody function, vaccinated against measles, rubella and 94.4% of children had a protective level of antibodies against measles, 100% of children against rubella. 78.6% of vaccinated children in this group were protected against tetanus and only 57.1% were protected against diphtheria. All children with PID with impaired antibody production receiving intravenous immunoglobulin replacement therapy (IVIG) were protected against measles, rubella, diphtheria, and tetanus. Among 10 patients on immunosuppressive therapy vaccinated against measles and rubella, antibodies to the measles virus in the protective titer were detected in 80% of children, to rubella - in 90% of patients in this group. Almost all children with rheumatic diseases on immunosuppressive therapy vaccinated against tetanus and diphtheria were protected against these pathogens, except for 2 out of 14 (14,2%) children who did not have antibodies to diphtheria. Children with glomerulonephritis with nephrotic syndrome had insufficient protection against diphtheria and tetanus, only 3 out of 6 (50%) children had antibodies in the protective titer against tetanus, no patient with this pathology had antibodies against diphtheria.
Conclusions. The findings of the studies suggest that most patients with PID with preserved antibody function may develop a sufficient immune response to vaccination against viral (measles, rubella) and bacterial (tetanus) infections. IVIG replacement therapy protects children with PID against vaccine-controlled infections that impair antibody production. Most children with rheumatic diseases vaccinated according to the Calendar before starting immunosuppressive therapy retain postvaccination protection of antibodies against vaccine-controlled infections. Immune protection against vaccine-controlled infections is reduced in patients with glomerulonephritis with nephrotic syndrome, they need close monitoring and, if necessary, replacement therapy with immunoglobulins.
The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies.
No conflict of interests was declared by the authors.
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