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Vaccine. 2020 Jan 3. pii: S0264-410X(19)31694-9. doi: 10.1016/j.vaccine.2019.12.042. [Epub ahead of print]

Long-term immunogenicity after yellow fever vaccination in immunosuppressed and healthy individuals.

Author information

1
Department of Public Health / Division of Infectious Diseases, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland.
2
Department of Rheumatology, University Hospital of Zurich, Zurich, Switzerland.
3
Division of Rheumatology, University Hospital of Geneva, Geneva, Switzerland.
4
Department of Rheumatology, Cantonal Hospital Aarau, Aarau, Switzerland.
5
Division of Rheumatology, Department of Internal Medicine, Cantonal Hospital St. Gallen, St. Gallen, Switzerland; Division of Rheumatology and Clinical Immunology, Department of Internal Medicine Ludwig-Maximilians-University Munich, Germany.
6
Robert Koch-Institut (RKI), Berlin, Germany.
7
Department of Rheumatology and Clinical Immunology/Allergology, University Hospital of Bern, Bern, Switzerland.
8
Department of Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands.
9
Department of Rheumatology, University Hospital Basel, Basel, Switzerland.
10
Department of Public Health / Division of Infectious Diseases, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland; Department of Medicine and Diagnostics, Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Switzerland; Division of Infectious Diseases & Hospital Epidemiology, Kantonsspital St. Gallen, Switzerland.
11
Department of Public Health / Division of Infectious Diseases, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland; Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine & I. Department of Medicine University Medical Center Hamburg-Eppendorf, Hamburg, Germany. Electronic address: silja.buehler@bnitm.de.

Abstract

BACKGROUND:

The live-attenuated yellow fever vaccine (YFV) is generally contraindicated in immunosuppressed patients. Our aim was to investigate if immunosuppressive therapy impairs the long-term protection against yellow fever virus in patients who had received YFV prior to the start of their immunosuppressive therapy.

METHODS:

Our study examined 35 healthy individuals and 40 immunosuppressed patients with autoimmune diseases or organ transplants. All individuals had received YFV prior to the onset of their immunosuppression. We analysed the long-term influence of the immunosuppressive therapy on the YFV protective immunity by measuring neutralising antibodies (NA) with the Plaque Reduction Neutralisation Test (PRNT). We assessed risk factors for a negative PRNT result (titre below 1: 10) and their influence on the magnitude of the NA.

RESULTS:

A median time interval of 21.1 years (interquartile range 14.4-31.3 years) after the YFV in all patients, a total of 35 immunosuppressed patients (88%) were seropositive (PRNT ≥ 1:10) compared to 31 patients (89%) in the control group. The geometric mean titres of NA did not differ between the groups. The duration of an underlying rheumatic disease was the only risk factor found for a lower magnitude of NA. An insufficient level of NA was found in nine subjects (12%) who had received a single dose of YFV (in one subject, the number of YFV doses was unknown).

CONCLUSION:

The use of an immunosuppressive drug started after the administration of the YFV did not affect long-term persistence of NA. A second dose of YFV may be necessary to secure long-term immunity.

KEYWORDS:

Immunosuppression; Long-term immune response; Neutralising antibodies; Travel medicine; Yellow fever vaccination

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