Certain diseases can affect the defensive response capacity and thereby increase the risk of suffering infections with serious consequences. Those affected need special attention when adopting preventive measures, among which the administration of vaccines that give them adequate protection stands out.
“Immunosuppressed patients, or those who suffer from some chronic pathologies, may see their response capacity altered as a result of the disease itself or because some of their treatments affect precisely the reaction of the immune system,” explains Juan Rodríguez, a doctor specializing in preventive medicine at the Son Espases University Hospital, in Palma de Mallorca.
For his part, Ángel Gil, professor of Preventive Medicine and Public Health at the Rey Juan Carlos University, in Madrid, points out that, although the immunosuppressed are high-risk groups for any infectious disease, not all of them present the same vulnerability, “not all They have such a compromised immune system. ”
Vaccination can prevent diseases that can be fatal or leave sequelae and reduce the quality of life of people who suffer from them. And this is especially important in immunosuppressed individuals due to certain pathologies or treatments, since their condition may imply poor control of the infection, that they recover worse or even worsen their underlying disease.
In the first place, this type of patient must be correctly immunized against respiratory pathogens, such as pneumococcus , since, according to Dr. Rodríguez, the “incidence of severe invasive pneumococcal disease increases twelve times on average and requires the use of special guidelines with mixed schemes ”. Another basic immunization would be anti-flu , whose annual administration –particularly quadrivalent– is recommended both for immunocompromised patients and for their partners, caregivers or health workers.
An example of a dangerous ailment for people with a weakened immune system is herpes zoster , popularly known as shingles. The probabilities of suffering from this viral condition increase after the age of fifty, and exponentially in patients undergoing treatment for cancer, with autoinflammatory diseases or bone marrow transplants; for the latter, the risk would increase up to nine times compared to healthy people. Although, “the problem is not the higher incidence in these people, but the high frequency of complications,” says Rodríguez.
For their part, HIV- infected patients who become infected with the human papillomavirus (HPV) also have a higher risk of developing genital cancer compared to the general population, so HPV vaccination is also important for these people.
Two other recommended immunizations are those to combat meningococcus B and meningococcus ACWY, both indicated in people with asplenia – absence of spleen -, complement deficiency – a group of proteins linked to the defensive system – and in treatment with eculizumab, which is used in certain rare diseases. Also vaccination against whooping cough, especially in adults who suffer from chronic respiratory diseases such as asthma or COPD, would make it possible to avoid complications associated with this pathology.
However, some vaccines – specifically, those that are attenuated or “live microorganisms” – would be contraindicated in immunocompromised people. These vaccines, such as those for chickenpox, MMR or rotavirus, are composed of pathogens that have been selected after losing their infective capacity. “In situations of immunosuppression or immunodeficiency, the microorganisms in the vaccine are capable of replicating and producing the infection against which we wanted to protect,” warns Rodríguez.
In the case of covid-19, none of the authorized formulas is contraindicated in chronic and immunosuppressed patients. These compounds use adenovirus technology or are based on recombinant RNA platforms, so there is no living vector that can replicate once inoculated . Thus, “inactivated vaccines can be administered without problem, as long as the patient is clinically stable,” says Ángel Gil.
According to Dr. Rodríguez, the implementation of the vaccination schedule for people at risk has been heterogeneous in the different autonomous communities and for the different risk groups. For example, the degree of implementation of immunization guidelines for chronic diseases such as COPD or chronic kidney or liver failure could be “lower” than others.
Regarding the future, Rodríguez considers that it is most likely that the vaccination of healthy adults or those with certain age-related pathologies – diabetes, COPD, moderate kidney or liver failure – will be carried out in health centers, as well as occurs in children; while people with more serious pathologies that require hospital management – for example, transplants, people with cancer or immunosuppressive or biological treatments – are immunized in hospitals.
It is a reality that we are living longer and longer, and that we are increasingly aware of having the highest quality of life possible. But, with age, aging of our immune system occurs, which is known as immunosenescence . To cope with its effects, many tools must be incorporated, including immunization against diseases that especially affect older people.
“The vaccines recommended for older people in the future would be the flu, the pneumococcus or the herpes zoster,” says Rodríguez. In addition, he adds that women over the age of sixty should be evaluated on complete vaccination against tetanus .
Regarding covid-19, Gil points out that we know with certainty that “antibody levels drop between 5% and 10% six months after receiving the full regimen, as occurs in most vaccines.” Therefore, although the need to resort to a booster or booster dose is not currently indicated, studies are already being carried out to determine its administration, both in people at risk and in the general population.
