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*It is only for medical professionals to read for reference.
Conclusion: It is safer for people with low immune function to receive inactivated vaccines; there is no contraindication to vaccination for patients receiving immunosuppressive therapy; there is no clinically significant interaction between vaccines and biological agents for the time being.
At present, the number of new crown vaccination in China has exceeded 15 million [1], and the vaccination work has been carried out steadily and orderly, striving to curb the spread of the epidemic as soon as possible.
On the other hand, since the beginning of winter, local sporadic cases and clusters of new coronary pneumonia have been reported in many places in China.
As of 9:00 on January 22, there are 6 high-risk areas and 61 medium-risk areas across the country.
The pneumonia epidemic and the acceleration of vaccination have once again become the focus of global attention.
In recent years, a variety of new-generation biological immune preparations have been approved in China, which has brought a great leap forward in the modern treatment of autoimmune diseases such as rheumatoid arthritis, psoriasis, ankylosing spondylitis and uveitis.
Tumor necrosis factor (TNF) inhibitors are the most commonly used first-line biological agents in clinical practice in China.
Take Xiu Mei Le (generic name: Adalimumab), which has been ranked first in global drug sales for many years, as an example.
So far, 17 indications have been approved worldwide, spanning rheumatism and skin diseases.
, Digestive diseases, fundus diseases and other fields, applicable to a wide range of people.
However, many physicians worry that biological immune preparations may affect immune function.
Therefore, in a special period, many international guidelines and expert suggestions have put forward a complete reference plan for this group of people.
In response to the following three common questions, this article will summarize the relevant recommendations of the guide and answer them one by one for you.
Can people with weakened immune function get those vaccines? Pneumonia vaccines can be divided into inactivated vaccines, live attenuated vaccines, and mRNA vaccines.
Compared with live attenuated vaccines, inactivated vaccines need to be vaccinated more frequently, the type of immune response triggered is single, but the safety is higher, and the storage and transportation conditions are relatively simple.
The currently approved new coronavirus vaccines around the world are mainly inactivated vaccines and mRNA vaccines.
At present, the new coronavirus vaccines approved for public vaccination in my country, such as Beijing Kexingzhongwei and Sinopharm Group, are all inactivated vaccines.
Can patients with impaired immune function be vaccinated? What types of vaccines can be vaccinated? In this regard, the guidelines have long made suggestions.
In 2013, the Infectious Diseases Association of the United States (IDSA) issued the "Clinical Practice Guidelines for Vaccination of People with Impaired Immune Function", which clearly pointed out [2]: Inactivated vaccines can be vaccinated ≥ 2 weeks before immunosuppression; live vaccines should be used for immunosuppression.
Vaccination ≥ 4 weeks before, should avoid vaccination within 2 weeks after the start of immunosuppression.
The new version of the "American Advisory Committee on Immunization Implementation (ACIP) Immunization Practice Guidelines" states [3]: For safety reasons, patients with altered immune function should avoid live vaccines; after the patient’s immune capacity has changed, certain vaccinations can be prevented The risk and severity of the disease will increase accordingly.
Therefore, it is particularly recommended that these patients receive certain vaccines (such as inactivated vaccines, etc.
); changes in the immune function of patients may affect the effect of inactivated vaccines.
To sum up, it can be seen that individuals with impaired immune function and low immunity are high-risk groups of severe new coronary pneumonia.
Under the premise of no other contraindications, they still need to be actively vaccinated with inactivated vaccines.
Should patients receiving biological immunosuppressive therapy be vaccinated against the new coronavirus? In response to the recent concern about the new coronavirus vaccine, as the vaccination work continues to accelerate, based on the current status of the pneumonia epidemic and past clinical experience, a number of foreign authoritative experts and societies such as: ACIP, British Rheumatology Society (BSR), and the United States The Psoriasis Foundation (NPF) and the British Gastroenterology Society (BSG) have all made recommendations for immune-compromised people to vaccinate against the new coronavirus.
In general, patients with low immune function are at relatively high risk of contracting new coronary pneumonia and developing severe pneumonia.
Therefore, if there are no contraindications, authoritative societies in various countries still recommend that they should be vaccinated against the new coronavirus.
Receiving immunosuppressive therapy (including biological immunosuppressive agents) is not a contraindication to the new coronavirus vaccine.
However, doctors should clearly inform patients that people with weakened immune systems may experience unsatisfactory immune responses after vaccination.
The specific recommendations of each university are as follows [4-7]: Table 1 Recommendations of authoritative societies for vaccination of immune-compromised people.
Does the vaccine interact with biological immunosuppressants? Taking the previously described biological immunosuppressant adalimumab as an example, it has a very wide range of indications worldwide and is one of the commonly used clinical biological agents.
Information from the COVID-19 drug interaction test at the University of Liverpool suggests that although there is currently no clinical study on the co-treatment of vaccines and adalimumab, it is unlikely to have clinical significance based on the effects of vaccines currently known on drugs.
Of drug interactions [8].
There are currently no specific data on the use of the new crown vaccine for patients receiving adalimumab, and the impact of adalimumab on the response of the new crown vaccine is unclear, but overall, patients receiving the SARS CoV-2 vaccine are treated with adalimumab The management of this should be at the discretion of the healthcare provider.
Summarizing the past IDSA guidelines and ACIP guidelines pointed out that for people receiving immunosuppressive therapy, inactivated vaccines can still be vaccinated.
As the new crown pneumonia epidemic is raging around the world, universities will generally actively recommend people who are receiving immunosuppressive therapy (including biological immunosuppressants) to receive new crown virus vaccines to reduce new crown pneumonia infections and reduce disease mortality.
Information from the COVID-19 drug interaction test at the University of Liverpool suggests that adalimumab and the vaccine are unlikely to have clinically significant drug interactions.
References: [1]http: //paper.
people.
com.
cn / rmrbwap / html / 202101/21 / nw.
D110000renmrb_ 20210121_ 1-13.
htm[2]Rubin LG,Levin MJ,Ljungman P,et al.
Infectious Diseases Society of America.
2013 IDSA clinical practice guideline for vaccination of the immunocompromised host.
Clin Infect Dis.
2014 Feb;58(3):309-18.
[3]BEST PRACTICES GUIDANCE OF THE ADVISORY COMMITTEE ON IMMUNIZATION PRACTICES (ACIP) .
Centers for Disease Control and Prevention Web site.
https:// www.
cdc.
gov/ vaccines/ hcp/ acip-recs/ general-recs/downloads/general-recs.
pdf[4]Coronavirus Disease (COVID-19).
Vaccines.
Centers for Disease Control and Prevention Web site.
https:// www.
cdc.
gov/coronavirus/2019-ncov/vaccines/index.
html.
Updated January 11, 2021.
Accessed January 12, 2021.
[5]COVID- 19 guidance.
British Society for Rheumatology Web site.
https: // www.
rheumatology.
org.
uk / practicequality/ covid-19-guidance.
Updated January 5, 2021.
Accessed January 8, 2021.
[6]COVID-19 task force guidance statements.
National Psoriasis Foundation Web site.
https: //www.
psoriasis.
org/covid -19-task-force-guidance-statements/.
Updated December 12, 2020.
Accessed January 8, 2021.
[7]British Society of Gastroenterology Inflammatory Bowel Disease Section and IBD Clinical Research Group position statement on SARS CoV-2 vaccination.
British Society of Gastroenterology Website.
https: //www.
bsg.
org.
uk/ wp-content/uploads/2021/01/British-Society-of-Gastroenterology-Inflammatory-Bowel-Disease-section-and-IBD-Clinical-Research -Group-position-statement-on-SARS-CoV2-Vaccination.
pdf.
Updated January 4, 2021.
Accessed January 8, 2021.
[8]COVID-19 drug interactions.
University of LiverpoolWeb site.
http://www.
covid19 -druginteractions.
org /.
Accessed January 8, 2021.
Conclusion: It is safer for people with low immune function to receive inactivated vaccines; there is no contraindication to vaccination for patients receiving immunosuppressive therapy; there is no clinically significant interaction between vaccines and biological agents for the time being.
At present, the number of new crown vaccination in China has exceeded 15 million [1], and the vaccination work has been carried out steadily and orderly, striving to curb the spread of the epidemic as soon as possible.
On the other hand, since the beginning of winter, local sporadic cases and clusters of new coronary pneumonia have been reported in many places in China.
As of 9:00 on January 22, there are 6 high-risk areas and 61 medium-risk areas across the country.
The pneumonia epidemic and the acceleration of vaccination have once again become the focus of global attention.
In recent years, a variety of new-generation biological immune preparations have been approved in China, which has brought a great leap forward in the modern treatment of autoimmune diseases such as rheumatoid arthritis, psoriasis, ankylosing spondylitis and uveitis.
Tumor necrosis factor (TNF) inhibitors are the most commonly used first-line biological agents in clinical practice in China.
Take Xiu Mei Le (generic name: Adalimumab), which has been ranked first in global drug sales for many years, as an example.
So far, 17 indications have been approved worldwide, spanning rheumatism and skin diseases.
, Digestive diseases, fundus diseases and other fields, applicable to a wide range of people.
However, many physicians worry that biological immune preparations may affect immune function.
Therefore, in a special period, many international guidelines and expert suggestions have put forward a complete reference plan for this group of people.
In response to the following three common questions, this article will summarize the relevant recommendations of the guide and answer them one by one for you.
Can people with weakened immune function get those vaccines? Pneumonia vaccines can be divided into inactivated vaccines, live attenuated vaccines, and mRNA vaccines.
Compared with live attenuated vaccines, inactivated vaccines need to be vaccinated more frequently, the type of immune response triggered is single, but the safety is higher, and the storage and transportation conditions are relatively simple.
The currently approved new coronavirus vaccines around the world are mainly inactivated vaccines and mRNA vaccines.
At present, the new coronavirus vaccines approved for public vaccination in my country, such as Beijing Kexingzhongwei and Sinopharm Group, are all inactivated vaccines.
Can patients with impaired immune function be vaccinated? What types of vaccines can be vaccinated? In this regard, the guidelines have long made suggestions.
In 2013, the Infectious Diseases Association of the United States (IDSA) issued the "Clinical Practice Guidelines for Vaccination of People with Impaired Immune Function", which clearly pointed out [2]: Inactivated vaccines can be vaccinated ≥ 2 weeks before immunosuppression; live vaccines should be used for immunosuppression.
Vaccination ≥ 4 weeks before, should avoid vaccination within 2 weeks after the start of immunosuppression.
The new version of the "American Advisory Committee on Immunization Implementation (ACIP) Immunization Practice Guidelines" states [3]: For safety reasons, patients with altered immune function should avoid live vaccines; after the patient’s immune capacity has changed, certain vaccinations can be prevented The risk and severity of the disease will increase accordingly.
Therefore, it is particularly recommended that these patients receive certain vaccines (such as inactivated vaccines, etc.
); changes in the immune function of patients may affect the effect of inactivated vaccines.
To sum up, it can be seen that individuals with impaired immune function and low immunity are high-risk groups of severe new coronary pneumonia.
Under the premise of no other contraindications, they still need to be actively vaccinated with inactivated vaccines.
Should patients receiving biological immunosuppressive therapy be vaccinated against the new coronavirus? In response to the recent concern about the new coronavirus vaccine, as the vaccination work continues to accelerate, based on the current status of the pneumonia epidemic and past clinical experience, a number of foreign authoritative experts and societies such as: ACIP, British Rheumatology Society (BSR), and the United States The Psoriasis Foundation (NPF) and the British Gastroenterology Society (BSG) have all made recommendations for immune-compromised people to vaccinate against the new coronavirus.
In general, patients with low immune function are at relatively high risk of contracting new coronary pneumonia and developing severe pneumonia.
Therefore, if there are no contraindications, authoritative societies in various countries still recommend that they should be vaccinated against the new coronavirus.
Receiving immunosuppressive therapy (including biological immunosuppressive agents) is not a contraindication to the new coronavirus vaccine.
However, doctors should clearly inform patients that people with weakened immune systems may experience unsatisfactory immune responses after vaccination.
The specific recommendations of each university are as follows [4-7]: Table 1 Recommendations of authoritative societies for vaccination of immune-compromised people.
Does the vaccine interact with biological immunosuppressants? Taking the previously described biological immunosuppressant adalimumab as an example, it has a very wide range of indications worldwide and is one of the commonly used clinical biological agents.
Information from the COVID-19 drug interaction test at the University of Liverpool suggests that although there is currently no clinical study on the co-treatment of vaccines and adalimumab, it is unlikely to have clinical significance based on the effects of vaccines currently known on drugs.
Of drug interactions [8].
There are currently no specific data on the use of the new crown vaccine for patients receiving adalimumab, and the impact of adalimumab on the response of the new crown vaccine is unclear, but overall, patients receiving the SARS CoV-2 vaccine are treated with adalimumab The management of this should be at the discretion of the healthcare provider.
Summarizing the past IDSA guidelines and ACIP guidelines pointed out that for people receiving immunosuppressive therapy, inactivated vaccines can still be vaccinated.
As the new crown pneumonia epidemic is raging around the world, universities will generally actively recommend people who are receiving immunosuppressive therapy (including biological immunosuppressants) to receive new crown virus vaccines to reduce new crown pneumonia infections and reduce disease mortality.
Information from the COVID-19 drug interaction test at the University of Liverpool suggests that adalimumab and the vaccine are unlikely to have clinically significant drug interactions.
References: [1]http: //paper.
people.
com.
cn / rmrbwap / html / 202101/21 / nw.
D110000renmrb_ 20210121_ 1-13.
htm[2]Rubin LG,Levin MJ,Ljungman P,et al.
Infectious Diseases Society of America.
2013 IDSA clinical practice guideline for vaccination of the immunocompromised host.
Clin Infect Dis.
2014 Feb;58(3):309-18.
[3]BEST PRACTICES GUIDANCE OF THE ADVISORY COMMITTEE ON IMMUNIZATION PRACTICES (ACIP) .
Centers for Disease Control and Prevention Web site.
https:// www.
cdc.
gov/ vaccines/ hcp/ acip-recs/ general-recs/downloads/general-recs.
pdf[4]Coronavirus Disease (COVID-19).
Vaccines.
Centers for Disease Control and Prevention Web site.
https:// www.
cdc.
gov/coronavirus/2019-ncov/vaccines/index.
html.
Updated January 11, 2021.
Accessed January 12, 2021.
[5]COVID- 19 guidance.
British Society for Rheumatology Web site.
https: // www.
rheumatology.
org.
uk / practicequality/ covid-19-guidance.
Updated January 5, 2021.
Accessed January 8, 2021.
[6]COVID-19 task force guidance statements.
National Psoriasis Foundation Web site.
https: //www.
psoriasis.
org/covid -19-task-force-guidance-statements/.
Updated December 12, 2020.
Accessed January 8, 2021.
[7]British Society of Gastroenterology Inflammatory Bowel Disease Section and IBD Clinical Research Group position statement on SARS CoV-2 vaccination.
British Society of Gastroenterology Website.
https: //www.
bsg.
org.
uk/ wp-content/uploads/2021/01/British-Society-of-Gastroenterology-Inflammatory-Bowel-Disease-section-and-IBD-Clinical-Research -Group-position-statement-on-SARS-CoV2-Vaccination.
pdf.
Updated January 4, 2021.
Accessed January 8, 2021.
[8]COVID-19 drug interactions.
University of LiverpoolWeb site.
http://www.
covid19 -druginteractions.
org /.
Accessed January 8, 2021.
