Safety of live vaccines on immunosuppressive or immunomodulatory therapy — a retrospective study in three Swiss Travel Clinics

Article Article scientifique Article Safety of live vaccines on immunosuppressive or immunomodulatory therapy — a retrospective study in three Swiss Travel Clinics eng 2017-12-20 2018-01-01 author Huber Fabienne author Ehrensperger Benoît 661093 author Hatz Christoph author Chappuis François 34709 author Bühler Silja author Eperon Gilles Alain 105583 tax082 10.1093/jtm/tax082 29394383 1195-1982 https://academic.oup.com/jtm/article/doi/10.1093/jtm/tax082/4763691 Background: Patients increasingly benefit from immunosuppressive/immunomodulatory medications for a range of conditions allowing them a lifestyle similar to healthy individuals, including travel. However, the administration of live vaccines to immunodeficient patients bears the risk of replication of the attenuated vaccine microorganism. Therefore, live vaccines are generally contraindicated on immunosuppression. Data on live vaccinations on immunosuppressive/immunomodulatory medication are scarce. We identified all travellers seeking pre-travel advice in three Swiss travel clinics with a live vaccine during immunosuppressive/immunomodulatory therapy to ascertain experienced side effects. A retrospective and multi-centre study design was chosen to increase the sample size. Methods: This study was conducted in the travel clinics of the University of Zurich; the Swiss TPH, Basel; and Geneva University Hospitals. Travellers on immunosuppressive/immunomodulatory therapy who received live vaccines [yellow fever vaccination (YFV), measles/mumps/rubella (MMR), varicella and/ or oral typhoid vaccination (OTV)] between 2008 and 2015 were identified and interviewed. A total of 60 age- and sex-matched controls (matched to Basel/Zurich travel clinics travellers) were included. Results: Overall, 197 patients were identified. And 116 patients (59%) and 60 controls were interviewed. YFV was administered 92 times, MMR 21 times, varicella 4 times and OTV 6 times to patients on immunosuppressive/immunomodulatory therapy. Most common medications were corticosteroids (n = 45), mesalazine (n = 28) and methotrexate (n = 19). Live vaccines were also administered on biological treatment, e.g. TNF-alpha inhibitors (n = 8). Systemic reactions were observed in 12.2% of the immunosuppressed vs 13.3% of controls; local reactions in 7.8% of the immunosuppressed vs 11.7% of controls. In controls, all reactions were mild/moderate. In the immunosuppressed, 2/21 severe reactions occurred: severe local pain on interferon-beta and severe muscle/joint pain on sulfasalazine. Conclusion: Safety of live vaccines given to immunosuppressed patients cannot be concluded. However, it is re-assuring that in the examined patient groups no serious side effects or infections by the attenuated vaccine strain occurred. Live vaccine, immunosuppressive therapy Measles, mumps, rubella vaccine Oral typhoid vaccine Varicella vaccine Yellow fever vaccine Dewey 613 64 Département de santé et médecine communautaires 22A false Journal of travel medicine 25 1 2cb55e18-e309-498c-95e7-a92895463493 Article (Published version) Public Article-scientifique-from-unpaywall.pdf 354819 application/pdf openAccess Faculté de médecine / Section de médecine clinique / Département de santé et médecine communautaires

Title	Published in	Year	Views	Downloads

La tolérance des vaccins vivants chez les personnes sous traitement immunosuppresseurs et/ou immunomodulateur		2020	362	194
Safety of live vaccines on immunosuppressive or immunomodulatory therapy — a retrospective study in three Swiss Travel Clinics	Journal of travel medicine	2018	176	854

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Ehrensperger, Benoît