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Avaliação da eficácia da vacina da varicela em doentes transplantados renais
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Resumo(s)
A varicela em doentes imunocomprometidos pode ter graves complicações, pelo que é recomendada a vacinação antes do transplante. No entanto a sua eficácia nesta população não está bem comprovada.
Objetivos: Avaliar 1) taxa de imunidade pré-transplante para varicela; 2) presença de títulos protetores de anticorpos anti-VVZ nos doentes vacinados; 3) correlação entre serologia pós transplante e idade de transplantação, estadio de DRC na vacinação, terapêutica imunossupressora, intervalos entre vacinação, transplante e serologias, vacina utilizada; 4) incidência e gravidade de varicela nos doentes transplantados vacinados e não vacinados.
Métodos: Estudo transversal descritivo (Janeiro - Abril 2015). Recolhidos dados epidemiológicos, referentes ao transplante e vacinação contra a varicela. Determinados títulos de imunoglobulina G anti-VVZ, no grupo de doentes transplantados vacinados.
Resultados: 45 doentes, 10 vacinados; destes, 4 mantém serologias positivas, 3 são seronegativos e 3 têm serologias equívocas. 2/3 dos seronegativos, metade dos positivos e 1/3 dos equívocos fizeram imunoglobulina anti-timócito. Todos os doentes seronegativos se encontravam em estadio 5 de DRC na altura da vacinação. Registaram-se dois casos de varicela nos 4 doentes seronegativos não vacinados; nos doentes vacinados não se registaram casos da doença.
Conclusões: Salienta-se a importância de monitorizar a eficácia da vacina nos doentes transplantados e de ponderar medidas de profilaxia secundária naqueles seronegativos, apesar da vacinação.
Varicella in immunocompromised patients may have severe complications. That is why it is recommended for patients to be vaccinated before transplant. However, its efficacy in this population is not well proven. Objectives: To evaluate 1) pre-transplant immunity rate for Varicella 2) presence of protective titers of anti-VZV antibodies in vaccinated patients; 3) correlation between post-transplant serology and age of transplantation, CKD stage at time of vaccination, immunosuppressive therapy, intervals between vaccination, transplantation and serology and vaccine used; 4) incidence and severity of Varicella in transplanted patients vaccinated and unvaccinated. Methods: Descriptive cross-sectional study (January - April 2015). Collected epidemiological data related to transplantation and vaccination against Varicella. Determined titers of anti-VZV immunoglobulin G in vaccinated patients. Results: 45 patients, 10 vaccinated; of these, 4 remain with positive serology, 3 are seronegative and 3 have equivocal results. 2/3 of the seronegative, half of the positive and 1/3 of the equivocal patients were medicated with anti-thymocyte immunoglobulin. All the seronegative patients were in stage 5 of CRD at time of vaccination. There were two cases of Varicella in 4 non-vaccinated seronegative patients; there were no cases of the disease in vaccinated patients. Conclusions: We would like to emphasize the importance of monitoring the efficacy of the vaccine in transplanted patients and to consider the use of secondary prophylaxis measures in those who remain seronegative, despite of vaccination.
Varicella in immunocompromised patients may have severe complications. That is why it is recommended for patients to be vaccinated before transplant. However, its efficacy in this population is not well proven. Objectives: To evaluate 1) pre-transplant immunity rate for Varicella 2) presence of protective titers of anti-VZV antibodies in vaccinated patients; 3) correlation between post-transplant serology and age of transplantation, CKD stage at time of vaccination, immunosuppressive therapy, intervals between vaccination, transplantation and serology and vaccine used; 4) incidence and severity of Varicella in transplanted patients vaccinated and unvaccinated. Methods: Descriptive cross-sectional study (January - April 2015). Collected epidemiological data related to transplantation and vaccination against Varicella. Determined titers of anti-VZV immunoglobulin G in vaccinated patients. Results: 45 patients, 10 vaccinated; of these, 4 remain with positive serology, 3 are seronegative and 3 have equivocal results. 2/3 of the seronegative, half of the positive and 1/3 of the equivocal patients were medicated with anti-thymocyte immunoglobulin. All the seronegative patients were in stage 5 of CRD at time of vaccination. There were two cases of Varicella in 4 non-vaccinated seronegative patients; there were no cases of the disease in vaccinated patients. Conclusions: We would like to emphasize the importance of monitoring the efficacy of the vaccine in transplanted patients and to consider the use of secondary prophylaxis measures in those who remain seronegative, despite of vaccination.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2015
Palavras-chave
Vacina contra varicela Transplante de órgãos Eficácia Rim Pediatria