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[Specific features of diphtheria vaccinal process in children with rheumatic diseases]
Iu V Koshcheeva1, S M Kharit, N M Kalinina
1Research Institute of Child Infections, Russian Center of Emergency and Radiation Medicine, St. Petersburg, Russia.
Insights
Children with rheumatic diseases can be safely immunized against diphtheria. Diphtheria vaccination (DT) is well-tolerated and does not worsen their condition, even with ongoing therapies.
Area of Science:
- Pediatric Rheumatology
- Immunology
- Vaccinology
Context:
- Rheumatic diseases affect children's immune systems.
- Diphtheria immunization is crucial for public health.
- Assessing vaccine safety in immunocompromised populations is vital.
Purpose:
- To evaluate the safety and immunological response to diphtheria immunization in children with rheumatic diseases.
- To determine if diphtheria vaccination impacts the course of rheumatic diseases.
- To assess the immune status and antibody production following diphtheria vaccination.
Summary:
- 55 children (6-15 years) with rheumatic diseases received diphtheria immunization during remission or while on therapy.
- The diphtheria vaccinal process was mostly asymptomatic and did not affect the rheumatic disease course.
- Immunization led to transient immune status changes, restoring inhibited characteristics like TNF-alpha and IL-2 production.
Impact:
- Diphtheria vaccination with reduced antigen toxoids is safe for children with rheumatic diseases.
- It does not cause excessive antigenic stimulation or immunopathological shifts.
- Protective diphtheria antibody levels are maintained long-term, even with immunosuppressive therapy.
Abstract:
Clinical and immunological examination of 55 children aged 6-15 years with rheumatic diseases, immunized against diphtheria, was carried out. All children were immunized at the stage of clinical and laboratory remission and in some cases while undergoing a prolonged course of cytostatic therapy or therapy with nonsteroid anti-inflammatory remedies. This examination demonstrated that in the overwhelming majority of children with rheumatic diseases the diphtheria vaccinal process took an asymptomatic course and had no influence on the course of the main disease. Specific features, characteristic of the immune status of this group of children, were established. In the course of the vaccinal process the restoration of the initially inhibited characteristics (the production of TNF-alpha and IL-2) to normal values were shown to occur, which was indicative of the fact that the reserve capacities of immunocompetent cells were retained in these patients. This study also revealed that immunization of children with rheumatic diseases with adsorbed DT and D toxoids with reduced antigen content was not excessive antigenic stimulation for such children, as it did not lead to immunopathological shifts, but induced transient phase changes in immunological characteristics, similar to those in healthy children. Protective levels of antibodies to diphtheria were shown to retain for a long time with considerable prolongation of intervals between booster injections. The simultaneous course of immunosuppressive maintenance therapy in the average dosage used for the corresponding age group did not inhibit the production of protective antibodies.