目的:安全性和有效性问题可能会妨碍医生推荐针对轻度/中度先天性免疫错误(IEI)的疫苗接种。这项研究描述了在诊断为IEI的患者中,照顾轻度/中度B细胞或轻度/中度联合免疫缺陷(CID)患者的医生对疫苗接种的态度和做法,以及疫苗接种完整性。
方法:对照顾IEI儿童的加拿大医生对轻度/中度IEI疫苗接种的态度和做法进行了调查。知情同意后,我们回顾了在7岁之前评估的IEI儿科患者的免疫接种记录.疫苗完整性在2岁时定义为4剂白喉-破伤风-百日咳(DTaP),3剂肺炎球菌缀合物(PCV),和1剂麻疹-腮腺炎-风疹(MMR)疫苗。7年时,需要5剂DTP和2剂MMR。
结果:来自8个省的45名医生完成了调查。最推荐的B细胞缺乏症灭活疫苗:(84%(38/45)和CID(73%(33/45))。推荐的减毒活疫苗较少(B细胞:53%(24/45),CID31%(14/45))。在7个中心招募的96名IEI患者中,2岁时主要抗体的疫苗接种完整性为25/43(58%),3/13(23%)对于CID,7/35(20%)对于具有综合征特征的CID,先天性/吞噬细胞缺陷为4/4(100%)。7岁时的完整性为15%,17%,5%,33%,分别。
结论:大多数接受调查的医生建议对患有轻度至中度IEI的儿童接种灭活疫苗。所有IEI的疫苗完整性都很低,特别是在7岁的时候。进一步的研究应解决IEI儿童疫苗摄入量低的原因,以及是否患有轻度-中度IEI的儿童,推荐接种疫苗的地方,最终获得所有指定的疫苗。
OBJECTIVE: Safety and effectiveness concerns may preclude physicians from recommending vaccination in mild/moderate inborn errors of immunity (IEI). This study describes attitudes and practices regarding vaccination among physicians who care for patients with mild/moderate B cell or mild/moderate combined immunodeficiencies (CID) and vaccination completeness among patients diagnosed with IEIs.
METHODS: Canadian physicians caring for children with IEI were surveyed about attitudes and practices regarding vaccination in mild/moderate IEI. Following informed consent, immunization records of pediatric patients with IEI evaluated before 7 years of age were reviewed. Vaccine completeness was defined at age 2 years as 4 doses of diphtheria-tetanus-pertussis (DTaP), 3 doses pneumococcal conjugate (PCV), and 1 dose measles-mumps-rubella (MMR) vaccines. At 7 years 5 doses of DTP and 2 doses MMR were required.
RESULTS: Forty-five physicians from 8 provinces completed the survey. Most recommended inactivated vaccines for B cell deficiency: (84% (38/45) and CID (73% (33/45). Fewer recommended live attenuated vaccines (B cell: 53% (24/45), CID 31% (14/45)). Of 96 patients with IEI recruited across 7 centers, vaccination completeness at age 2 was 25/43 (58%) for predominantly antibody, 3/13 (23%) for CID, 7/35 (20%) for CID with syndromic features, and 4/4 (100%) for innate/phagocyte defects. Completeness at age 7 was 15%, 17%, 5%, and 33%, respectively.
CONCLUSIONS: Most physicians surveyed recommended inactivated vaccines in children with mild to moderate IEI. Vaccine completeness for all IEI was low, particularly at age 7. Further studies should address the reasons for low vaccine uptake among children with IEI and whether those with mild-moderate IEI, where vaccination is recommended, eventually receive all indicated vaccines.