RESUMEN
Yellow Fever (YF) vaccination is suggested to induce a large number of adverse events (AE) and suboptimal responses in patients with autoimmune diseases (AID); however, there have been no studies on 17DD-YF primary vaccination performance in patients with AID. This prospective non-interventional study conducted between March and July, 2017 assessed the safety and immunogenicity of planned 17DD-YF primary vaccination in patients with AID. Adult patients with AID (both sexes) were enrolled, along with healthy controls, at a single hospital (Vitória, Brazil). Included patients were referred for planned vaccination by a rheumatologist; in remission, or with low disease activity; and had low level immunosuppression or the attending physician advised interruption of immunosuppression for safety reasons. The occurrence of AE, neutralizing antibody kinetics, seropositivity rates, and 17DD-YF viremia were evaluated at various time points (day 0 (D0), D3, D4, D5, D6, D14, and D28). Individuals evaluated (n = 278), including patients with rheumatoid arthritis (RA; 79), spondyloarthritis (SpA; 59), systemic sclerosis (8), systemic lupus erythematosus (SLE; 27), primary Sjögren's syndrome (SS; 54), and healthy controls (HC; 51). Only mild AE were reported. The frequency of local and systemic AE in patients with AID and HC did not differ significantly (8 vs. 10% and 21 vs. 32%; p = 1.00 and 0.18, respectively). Patients with AID presented late seroconversion profiles according to kinetic timelines of the plaque reduction neutralization test (PRNT). PRNT-determined virus titers (copies/mL) [181 (95% confidence interval (CI), 144-228) vs. 440 (95% CI, 291-665), p = 0.004] and seropositivity rate (78 vs. 96%, p = 0.01) were lower in patients with AID after 28 days, particularly those with SpA (73%) and SLE (73%), relative to HC. The YF viremia peak (RNAnemia) was 5-6 days after vaccination in all groups. In conclusion, consistent seroconversion rates were observed in patients with AID and our findings support that planned 17DD-YF primary vaccination is safe and immunogenic in patients with AID.
Asunto(s)
Enfermedades Autoinmunes/complicaciones , Vacuna contra la Fiebre Amarilla/inmunología , Vacuna contra la Fiebre Amarilla/uso terapéutico , Fiebre Amarilla/prevención & control , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Anticuerpos Neutralizantes/sangre , Anticuerpos Neutralizantes/inmunología , Anticuerpos Antivirales/sangre , Anticuerpos Antivirales/inmunología , Brasil , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Adulto JovenRESUMEN
As manifestações otorrinolaringológicas nas doenças reumáticas representam um desafio diagnóstico para o reumatologista, o otorrinolaringologista e o médico generalista. Comumente, sintomas otorrinolaringológicos representam um sinal inicial de uma doença assintomática ou uma desordem auto-imune não diagnosticada, que freqüentemente exige um imediato e agressivo tratamento imunossupressor. Distúrbios auditivos podem ser vistos em pacientes com lúpus eritematoso sistêmico (LES), granulomatose de Wegener (GW), policondrite recidivante (PR), poliarterite nodosa, síndrome de Cogan, síndrome de Sjõgren e menos freqüentemente na síndrome de Churg-Strauss e doença de Behçet. O nariz e seios paranasais são variavelmente afetados durante o curso da GW, síndrome de Churg-Strauss, PR e sarcoidose. Ulcerações mucosas recorrentes são comuns no LES e doença de Behçet. Xerostomia é uma manifestação comum da síndrome de Sjõgren primária e secundária; aumento da glândula salivar pode ser visto nesses pacientes, assim como nos pacientes com sarcoidose. A articulação cricoaritenóide pode ser envolvida durante o curso da artrite reumatóide, espondilite anquilosante e gota; alterações osteoartríticas também têm sido descritas. Disfunção do nervo trigeminal pode ocorrer em pacientes com síndrome de Sjõgren, esclerose sistêmica, LES e doença mista do tecido conjuntivo. Paralisia facial periférica tem sido descrita como complicação do curso da síndrome de Sjõgren e sarcoidose.