Incidence and prevalence of vaccine preventable infections in adult patients with autoimmune inflammatory rheumatic diseases (AIIRD): a systemic literature review informing the 2019 update of the EULAR recommendations for vaccination in adult patients with AIIRD

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Abstract

Objectives

The aims of this study were to update the evidence on the incidence and prevalence rates of vaccine preventable infections (VPI) in patients with autoimmune inflammatory rheumatic diseases (AIIRD) and compare the data to the general population when available.

Methods

A literature search was performed using Medline, Embase and Cochrane library (October 2009 to August 2018). The primary outcome was the incidence or prevalence of VPI in the adult AIIRD population. Meta-analysis was performed when appropriate.

Results

Sixty-three publications out of 3876 identified records met the inclusion criteria: influenza (n=4), pneumococcal disease (n=7), hepatitis B (n=10), herpes zoster (HZ) (n=29), human papillomavirus (HPV) infection (n=13). An increased incidence of influenza and pneumococcal disease was reported in patients with AIIRD. HZ infection-pooled incidence rate ratio (IRR) was 2.9 (95% CI 2.4 to 3.3) in patients with AIIRD versus general population. Among AIIRD, inflammatory myositis conferred the highest incidence rate (IR) of HZ (pooled IRR 5.1, 95% CI 4.3 to 5.9), followed by systemic lupus erythematosus (SLE) (pooled IRR 4.0, 95% CI 2.3 to 5.7) and rheumatoid arthritis (pooled IRR 2.3, 95% CI 2.1 to 2.6). HPV infection-pooled prevalence ratio was 1.6, 95% CI 0.7 to 3.4 versus general population, based on studies mainly conducted in the SLE population in Latin America and Asia. Pooled prevalence of hepatitis B surface antigen and hepatitis B core antibody in patients with AIIRD was similar to the general population, 3%, 95% CI 1% to 5% and 15%, 95% CI 7% to 26%, respectively.

Conclusion

Current evidence shows an increased risk of VPI in patients with AIIRD, emphasising that prevention of infections is essential in these patients.

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Anifrolumab, an Anti–Interferon‐α Receptor Monoclonal Antibody, in Moderate‐to‐Severe Systemic Lupus Erythematosus

Richard Furie, Munther A. Khamashta, Joan Merrill … (2017)

Objective To assess the efficacy and safety of anifrolumab, a type I interferon (IFN) receptor antagonist, in a phase IIb, randomized, double‐blind, placebo‐controlled study of adults with moderate‐to‐severe systemic lupus erythematosus (SLE). Methods Patients (n = 305) were randomized to receive intravenous anifrolumab (300 mg or 1,000 mg) or placebo, in addition to standard therapy, every 4 weeks for 48 weeks. Randomization was stratified by SLE Disease Activity Index 2000 score (<10 or ≥10), oral corticosteroid dosage (<10 or ≥10 mg/day), and type I IFN gene signature test status (high or low) based on a 4‐gene expression assay. The primary end point was the percentage of patients achieving an SLE Responder Index (SRI[4]) response at week 24 with sustained reduction of oral corticosteroids (<10 mg/day and less than or equal to the dose at week 1 from week 12 through 24). Other end points (including SRI[4], British Isles Lupus Assessment Group [BILAG]–based Composite Lupus Assessment [BICLA], modified SRI[6], and major clinical response) were assessed at week 52. The primary end point was analyzed in the modified intent‐to‐treat (ITT) population and type I IFN–high subpopulation. The study result was considered positive if the primary end point was met in either of the 2 study populations. The Type I error rate was controlled at 0.10 (2‐sided), within each of the 2 study populations for the primary end point analysis. Results The primary end point was met by more patients treated with anifrolumab (34.3% of 99 for 300 mg and 28.8% of 104 for 1,000 mg) than placebo (17.6% of 102) (P = 0.014 for 300 mg and P = 0.063 for 1,000 mg, versus placebo), with greater effect size in patients with a high IFN signature at baseline (13.2% in placebo‐treated patients versus 36.0% [P = 0.004] and 28.2% [P = 0.029]) in patients treated with anifrolumab 300 mg and 1,000 mg, respectively. At week 52, patients treated with anifrolumab achieved greater responses in SRI(4) (40.2% versus 62.6% [P < 0.001] and 53.8% [P = 0.043] with placebo, anifrolumab 300 mg, and anifrolumab 1,000 mg, respectively), BICLA (25.7% versus 53.5% [P < 0.001] and 41.2% [P = 0.018], respectively), modified SRI(6) (28.4% versus 49.5% [P = 0.002] and 44.7% [P = 0.015], respectively), major clinical response (BILAG 2004 C or better in all organ domains from week 24 through week 52) (6.9% versus 19.2% [P = 0.012] and 17.3% [P = 0.025], respectively), and several other global and organ‐specific end points. Herpes zoster was more frequent in the anifrolumab‐treated patients (2.0% with placebo treatment versus 5.1% and 9.5% with anifrolumab 300 mg and 1,000 mg, respectively), as were cases reported as influenza (2.0% versus 6.1% and 7.6%, respectively), in the anifrolumab treatment groups. Incidence of serious adverse events was similar between groups (18.8% versus 16.2% and 17.1%, respectively). Conclusion Anifrolumab substantially reduced disease activity compared with placebo across multiple clinical end points in the patients with moderate‐to‐severe SLE.

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Incidence and prevalence of hepatitis C in prisons and other closed settings: results of a systematic review and meta-analysis.

Karolien P B Van den Bergh, Sarah Larney, Holly Hagan … (2013)

People detained in prisons and other closed settings are at elevated risk of infection with hepatitis C virus (HCV). We undertook a systematic review and meta-analysis with the aim of determining the rate of incident HCV infection and the prevalence of anti-HCV among detainees in closed settings. We systematically searched databases of peer-reviewed literature and widely distributed a call for unpublished data. We calculated summary estimates of incidence and prevalence among general population detainees and detainees with a history of injection drug use (IDU), and explored heterogeneity through stratification and meta-regression. The summary prevalence estimates were used to estimate the number of anti-HCV positive prisoners globally. HCV incidence among general detainees was 1.4 per 100 person-years (py; 95% confidence interval [CI]: 0.1, 2.7; k = 4), and 16.4 per 100 py (95% CI: 0.8, 32.1; k = 3) among detainees with a history of IDU. The summary prevalence estimate of anti-HCV in general detainees was 26% (95% CI: 23%, 29%; k = 93), and in detainees with a history of IDU, 64% (95% CI: 58%, 70%; k = 51). The regions of highest prevalence were Central Asia (38%; 95% CI 32%, 43%; k = 1) and Australasia (35%; 95% CI: 28%, 43%; k = 9). We estimate that 2.2 million (range: 1.4-2.9 million) detainees globally are anti-HCV positive, with the largest populations in North America (668,500; range: 553,500-784,000) and East and Southeast Asia (638,000; range: 332,000-970,000). HCV is a significant concern in detained populations, with one in four detainees anti-HCV-positive. Epidemiological data on the extent of HCV infection in detained populations is lacking in many countries. Greater attention towards prevention, diagnosis, and treatment of HCV infection among detained populations is urgently required. Copyright © 2013 by the American Association for the Study of Liver Diseases.

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Real-world comparative risks of herpes virus infections in tofacitinib and biologic-treated patients with rheumatoid arthritis.

Jeffrey Curtis, Fenglong Xie, Huifeng Yun … (2016)

To evaluate the risks of herpes zoster (HZ) and herpes simplex virus (HSV) infection associated with tofacitinib compared with biologic agents among patients with rheumatoid arthritis (RA).

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Author and article information

Journal

Journal ID (nlm-ta): RMD Open

Journal ID (iso-abbrev): RMD Open

Journal ID (hwp): rmdopen

Journal ID (publisher-id): rmdopen

Title: RMD Open

Publisher: BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )

ISSN (Electronic): 2056-5933

Publication date Collection: 2019

Publication date (Electronic): 19 September 2019

Volume: 5

Issue: 2

Electronic Location Identifier: e001041

Affiliations

[1 ] departmentDepartment of Rheumatology , Tel Aviv Sourasky Medical Center , Tel Aviv, Israel

[2 ] departmentSackler Faculty of Medicine , Tel Aviv University , Tel Aviv, Israel

[3 ] departmentMedical Microbiology and Infection Prevention , UMCG , Groningen, The Netherlands

[4 ] departmentRheumatology and Clinical Immunology , UMCG , Groningen, The Netherlands

[5 ] departmentInternal Medicine and Allergology, Rheumatology and Clinical Immunology , UMC Utrecht , Utrecht, The Netherlands

[6 ] departmentInternal Medicine (Infectious Diseases) , Treant Care Group , Hoogeveen, The Netherlands

[7 ] departmentInternal Medicine , Martini Hospital , Groningen, The Netherlands

[8 ] departmentZabludowicz Center for Autoimmune Diseases , Sheba Medical Center , Tel Hashomer, Israel

[9 ] departmentDepartment of Rheumatology , Leiden University Medical Center , Leiden, The Netherlands

[10 ] departmentDipartimento di Medicina Clinica e Molecolare , Sapienza University of Rome , Roma, Italy

[11 ] departmentDepartment of Rheumatology, Hôpital Cochin , Université Paris Descartes , Paris, France

[12 ] departmentDepartment of Clinical Sciences Lund, Section for Rheumatology , Lund University and Skåne University Hospital , Lund, Sweden

[13 ] departmentDepartment of Rheumatology and Clinical Immunology , University Medical Center Utrecht and Utrecht University , Utrecht, The Netherlands

[14 ] departmentInstitute of Clinical Medicine, Section of Rheumatology , Aarhus University Hospital , Aarhus, Denmark

[15 ] departmentClinical Immunology and Rheumatology , Academic Medical Center, University of Amsterdam , Amsterdam, The Netherlands

[16 ] departmentDepartment of Rheumatology , Zuyderland Medical Centre , Heerlen, The Netherlands

[17 ] departmentDepartment of Rheumatology and Clinical Immunology , Justus-Liebig-University , Giessen, Germany

[18 ] departmentDepartment of Rheumatology , King Christian X's Hospital for Rheumatic Diseases , Graasten, Denmark

[19 ] departmentDepartment of Thrombosis and Haemophilia , Guy's and St Thomas' Hospital , London, United Kingdom

[20 ] Tel Aviv, Israel

[21 ] Elgin, UK

[22 ] departmentCenter for Chronic Immunodeficiency , Faculty of Medicine, University of Freiburg, University Medical Center Freiburg , Freiburg, Germany

[23 ] departmentDepartment of Pediatric Rheumatology , Wilhelmina Children's Hospital, University Medical Center Utrecht , Utrecht, The Netherlands

Author notes

[Correspondence to ] Dr Victoria Furer; furer.rheum@ 123456gmail.com

Author information

Victoria Furer http://orcid.org/0000-0001-5193-4207

Christien Rondaan http://orcid.org/0000-0002-4558-1270

Nancy Agmon-Levin https://orcid.org/0000-0001-9514-3677

Maxime Dougados https://orcid.org/0000-0003-3009-6229

Meliha Crnkic Kapetanovic https://orcid.org/0000-0002-7853-514X

Jacob M van Laar https://orcid.org/0000-0001-5544-5785

Annette Ladefoged de Thurah https://orcid.org/0000-0003-0103-4328

Robert Landewé https://orcid.org/0000-0002-0577-6620

Anna Molto http://orcid.org/0000-0003-2246-1986

Ori Elkayam https://orcid.org/0000-0001-9329-3639

Article

Publisher ID: rmdopen-2019-001041

DOI: 10.1136/rmdopen-2019-001041

PMC ID: 6803008

PubMed ID: 31673420

SO-VID: 17c43615-99de-4203-81ae-ba620baeba06

License:

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

History

Date received : 27 June 2019

Date revision received : 09 August 2019

Date accepted : 11 August 2019

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Keywords: autoimmune diseases,epidemiology,infections,vaccination

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Keywords: autoimmune diseases, epidemiology, infections, vaccination

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Incidence and prevalence of vaccine preventable infections in adult patients with autoimmune inflammatory rheumatic diseases (AIIRD): a systemic literature review informing the 2019 update of the EULAR recommendations for vaccination in adult patients with AIIRD

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Most cited references 78

Anifrolumab, an Anti–Interferon‐α Receptor Monoclonal Antibody, in Moderate‐to‐Severe Systemic Lupus Erythematosus

Incidence and prevalence of hepatitis C in prisons and other closed settings: results of a systematic review and meta-analysis.

Real-world comparative risks of herpes virus infections in tofacitinib and biologic-treated patients with rheumatoid arthritis.

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Cited by 60

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