Immunisation in the current management of cystic fibrosis patients.
Although no special recommendations exist, clearly patients with cystic fibrosis (CF) can benefit from immunisation. We reviewed the literature regarding vaccination in CF and other chronic diseases. CF subjects should follow national immunisation programmes without delay to obtain optimal vaccination coverage. Indeed they may escape normal programmes due to frequent hospital admissions and school absenteeism and may be more at risk to get "vaccine-controlled" diseases at any age. There is no uniform European immunisation schedule for basic infant and childhood vaccines or for vaccines against hepatitis A (HAV) and B (HBV), varicella (VZ) and booster vaccinations. HAV and HBV vaccination is appropriate in CF as recommended in general for patients with chronic liver disease (CLD). Varicella (VZ) vaccination is not recommended in all European countries. There are no recent data about possible worsening of pulmonary status following VZ in CF, but it is known to cause pulmonary damage in non-CF adults and to be potentially fatal post transplantation and during steroid treatment. Therefore it is recommended at least for seronegative adolescents and transplant candidates. Influenza vaccine is recommended annually for CF patients aged > or =6 months. Pneumococcal vaccine is generally indicated for CF patients. RSV infection might play a role in the initial Pseudomonas colonization and the decline in pulmonary function. However no RSV vaccine is available at present. There are no recommendations for palivizumab in CF as an alternative but expensive prophylaxis. Anti-bacterial vaccinations protecting directly against Pseudomonas aeruginosa colonisation are promising for the future, potential candidates are currently being assessed in phase III clinical trials. More studies are needed to complete recommendations especially for CF adults and transplant candidates.
Department of Paediatrics, Paediatric Respiratory Medicine, Infectious Diseases and Cystic Fibrosis Clinic, Academisch Ziekenhuis-Vrije Universiteit Brussel (AZ-VUB), Laarbeeklaan 101, B-1090 Brussels, Belgium. anne.malfroot@az.vub.ac.be
Anne
A
Malfroot
Georgios
G
Adam
Oana
O
Ciofu
Gerd
G
Döring
Christiane
C
Knoop
Aloïs B
AB
Lang
Pierre
P
Van Damme
Isi
I
Dab
Andrew
A
Bush
D000293:Adolescent; D000328:Adult; D001428:Bacterial Vaccines / Q000627:therapeutic use; D002648:Child; D003550:Cystic Fibrosis / Q000150:complications* / Q000276:immunology; D005060:Europe; D006801:Humans; D017589:Immunization Programs; D011014:Pneumonia / Q000517:prevention & control*; D018410:Pneumonia, Bacterial / Q000517:prevention & control; D011024:Pneumonia, Viral / Q000517:prevention & control; D017410:Practice Guidelines as Topic; D014611:Vaccination / Q000592:standards*; D014612:Vaccines / Q000008:administration & dosage*; D014765:Viral Vaccines / Q000627:therapeutic use
D001428:Bacterial Vaccines; D014612:Vaccines; D014765:Viral Vaccines