vspВопросы современной педиатрииCurrent Pediatrics1682-55271682-5535Издательство «ПедиатрЪ»10.15690/vsp.v19i3.2114vsp-2427Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИORIGINAL ARTICLESЭффективность пневмококковой полисахаридной конъюгированной адсорбированной 13-валентной вакцины у больных системным ювенильным идиопатическим артритом, получающих генно-инженерные биологические препараты (тоцилизумаб или канакинумаб): проспективное когортное исследованиеEfficacy of Pneumococcal Polysaccharide Conjugate Vaccine (13-valent, Adsorbed) in Patients with Systemic Juvenile Idiopathic Arthritis Treated with Genetically Engineered Biologic Drugs (Tocilizumab or Canakinumab): Prospective Cohort Studyhttps://orcid.org/0000-0002-3874-4721АлексееваЕ. И.AlexeevaEkaterina I.

119991, Москва, Ломоносовский пр-т, д. 2/62

Moscow

ВаньковаД. Д.VankovaDariya D.

Ванькова Дарья Дмитриевна, аспирант ревматологического отделения

119991, Москва, Ломоносовский пр-т, д. 2/62

Moscow

DD1201@mail.ruДворяковскаяТ. М.DvoryakovskayaTatyana M.

119991, Москва, Ломоносовский пр-т, д. 2/62

Moscow

ИсаеваК. Б.IsaevaKsenia B.

119991, Москва, Ломоносовский пр-т, д. 2/62

Moscow

ДенисоваР. В.DenisovaRina V.

119991, Москва, Ломоносовский пр-т, д. 2/62

Moscow

МамутоваА. В.MamutovaAnna V.

119991, Москва, Ломоносовский пр-т, д. 2/62

Moscow

ЧомахидзеА. М.ChomakhidzeAleksandra M.

119991, Москва, Ломоносовский пр-т, д. 2/62

Moscow

РадыгинаТ. В.RadyginaTatyana V.

119991, Москва, Ломоносовский пр-т, д. 2/62

Moscow

ЗубковаИ. В.ZubkovaIrina V.

119991, Москва, Ломоносовский пр-т, д. 2/62

Moscow

ТкаченкоН. Е.TkachenkoNatalia E.

119991, Москва, Ломоносовский пр-т, д. 2/62

Moscow

ФетисоваА. Н.FetisovaAnna N.

119991, Москва, Ломоносовский пр-т, д. 2/62

Moscow

ЛомакинаО. Л.LomakinaOlga L.

119991, Москва, Ломоносовский пр-т, д. 2/62

Moscow

ОрловаЯ. О.OrlovaYanina O.

119991, Москва, Ломоносовский пр-т, д. 2/62

Moscow

КурдупМ. К.KurdupMariya K.

119991, Москва, Ломоносовский пр-т, д. 2/62

Moscow

ГотьеМ. С.GautierMarina S.

119991, Москва, Ломоносовский пр-т, д. 2/62

Moscow

КреховаЕ. А.KrekhovaElizaveta A.

119991, Москва, Ломоносовский пр-т, д. 2/62

Moscow

ШингароваМ. Ш.ShingarovaMeyri S.

119991, Москва, Ломоносовский пр-т, д. 2/62

Moscow

ГалкинаО. П.GalkinaOlga P.

Москва

Moscow

Национальный медицинский исследовательский центр здоровья детей; Первый Московский государственный медицинский университет им. И.М. Сеченова (Сеченовский Университет)РоссияNational Medical Research Center for Children's Health; Sechenov First Moscow State Medical University (Sechenov University)Russian FederationНациональный медицинский исследовательский центр здоровья детейРоссияNational Medical Research Center for Children's HealthRussian FederationПервый Московский государственный медицинский университет им. И.М. Сеченова (Сеченовский Университет)РоссияNational Medical Research Center for Children's HealthRussian Federation202031072020193190199Copyright © Алексеева Е.И., Ванькова Д.Д., Дворяковская Т.М., Исаева К.Б., Денисова Р.В., Мамутова А.В., Чомахидзе А.М., Радыгина Т.В., Зубкова И.В., Ткаченко Н.Е., Фетисова А.Н., Ломакина О.Л., Орлова Я.О., Курдуп М.К., Готье М.С., Крехова Е.А., Шингарова М.Ш., Галкина О.П., 20202020Алексеева Е.И., Ванькова Д.Д., Дворяковская Т.М., Исаева К.Б., Денисова Р.В., Мамутова А.В., Чомахидзе А.М., Радыгина Т.В., Зубкова И.В., Ткаченко Н.Е., Фетисова А.Н., Ломакина О.Л., Орлова Я.О., Курдуп М.К., Готье М.С., Крехова Е.А., Шингарова М.Ш., Галкина О.П.Alexeeva E.I., Vankova D.D., Dvoryakovskaya T.M., Isaeva K.B., Denisova R.V., Mamutova A.V., Chomakhidze A.M., Radygina T.V., Zubkova I.V., Tkachenko N.E., Fetisova A.N., Lomakina O.L., Orlova Y.O., Kurdup M.K., Gautier M.S., Krekhova E.A., Shingarova M.S., Galkina O.P.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://vsp.spr-journal.ru/jour/article/view/2427Обоснование

Обоснование. Иммуногенность 13-валентной пневмококковой вакцины (ПКВ13) у детей с системным ювенильным идиопатическим артритом (сЮИА) остается неизученной. Противоречивыми остаются и оценки влияния генно-инженерных биологических препаратов (ГИБП) на результаты пневмококковой вакцинации.

Цель исследования — изучить эффективность ПКВ13 у пациентов с сЮИА при лечении моноклональными антителами к рецептору интерлейкина (IL) 6 (тоцилизумаб) или IL 1β (канакинумаб).

Методы

Методы. В исследование включали больных в возрасте до 18 лет с сЮИА в стадии ремиссии или активного заболевания, вакцинированных ПКВ13. Вакцину вводили однократно, в дозе 0,5 мл, внутримышечно на фоне терапии ГИБП либо за 3 нед до назначения ГИБП впервые (у пациентов в стадии активного заболевания). Вакцинацию считали эффективной при достижении минимального защитного уровня антител к капсульному полисахариду пневмококка (анти-SPP IgG; ≥ 7 Ед/мл) или нарастании концентрации анти-SPP IgG ≥ 2 раз через 4 нед после вакцинации. Уровень анти-SPP IgG детектировали с помощью иммуноферментного анализа.

Результаты

Результаты. В исследование были включены 53 пациента (27 девочек) в стадии ремиссии сЮИА и 25 (16 девочек) — в стадии активной болезни, медиана возраста составила 13,3 и 10,8 года, тоцилизумаб/канакинумаб получали 43/10 и 18/7 больных соответственно. Через 4 нед после вакцинации минимальный значимый уровень анти-SPP IgG и двукратное увеличение уровня анти-SPP IgG были зафиксированы у 49/53 (92%) и 32/53 (60%) пациентов с сЮИА в стадии ремиссии, а также у 22/25 (88%) и 18/25 (72%) пациентов в стадии активного заболевания соответственно. Иммуногенность ПКВ13 у больных сЮИА в стадии ремиссии и активного заболевания, а среди последних — у исходно получавших и не получавших ГИБП, не различалась.

Заключение

Заключение. Иммунизация ПКВ13 позволяет достичь защитной концентрации антител у большинства пациентов с сЮИА детского возраста вне зависимости от стадии болезни и предшествующей терапии ГИБП.

Background

Background. Immunological potency of 13-valent pneumococcal vaccine (PCV-13) in children with systemic juvenile idiopathic arthritis (SJIA) is still unstudied. Estimates of the genetically engineered biologic drugs (GEBD) effects on pneumococcal vaccination results also remain controversial.

Objective

Objective. The aim of the study was to explore the PCV-13 efficacy in patients with SJIA and who is on treatment with monoclonal antibodies against interleukin 6 receptor (tocilizumab) and interleukin 8 receptor beta (canakinumab).

Methods

Methods. The study included patients under the age of 18 with SJIA in remission or active form of disease vaccinated with PCV-13. The vaccine was administered in single dose of 0.5 ml intramuscularly in patients on treatment with GEBD or 3 weeks before GEBD administration for the first time (for patients with active disease). Vaccination was considered effective at achievement of the minimum protective level of antibodies to capsular polysaccharide of pneumococcus (anti-SPP IgG; ≥ 7 U/ml) or increase of anti-SPP IgG level ≥ 2 times in 4 weeks after vaccination. The anti-SPP IgG levels were measured with enzyme immunoassay.

Results

Results. The study included 53 patients (27 girls) in remission of SJIA and 25 (16 girls) in active disease. Median age was 13.3 and 10.8 years respectively. Tocilizumab/canakinumab was administrated in 43/10 and 18/7 patients respectively. Minimum significant anti-SPP IgG level and two-fold increase in anti-SPP IgG level were recorded in 49/53 (92%) and 32/53 (60%) patients with SJIA in remission, as well as in 22/25 (88%) and 18/25 (72%) patients in active disease respectively. PCV-13 immunological potency in patients with SJIA in remission and in active disease (in those who were initially administrated and who did not receive GEBD) did not differ.

Conclusion

Conclusion. PCV-13 vaccination allows to achieve protective antibodies level in most of the patients with SJIA in children population regardless of the disease stage and the history of GEBD administration.

пневмококковая вакцинасистемный ювенильный идиопатический артритгенно-инженерные биологические препаратытоцилизумабканакинумабиммуногенностьанти-SPP IgGpneumococcal vaccinesystemic juvenile idiopathic arthritisgenetically engineered biologic drugstocilizumabcanakinumabimmunological potencyanti-SPP IgGВакцина ПКВ13 была приобретена за счет средств региональной общественной организации «Лига содействия клиническим исследованиям и защите прав участников фармацевтического рынка» (Москва). Организация не участвовала в планировании и проведении настоящего исследования, а также в подготовке и публикации статьи.PCV-13 was purchased out of the funds of regional public organization «The League of Clinical Research» (Moscow). The organization was not involved in the planning and conducting of the present study, nor in the preparation and publication of the article.ReferencesГатторно М. Аутовоспалительные заболевания у детей // Вопросы современной педиатрии. — 2014. — Т. 13. — № 2. — С. 55–64. doi: 10.15690/vsp.v13i2.973.Gattorno M. Autoinflammatory diseases in children. Current Pediatrics. 2014;13(2):55–64. (In Russ). doi: 10.15690/vsp.v13i2.973.Юношеский артрит с системным началом. Клинические рекомендации [интернет]. — М.: Союз педиатров России; 2016. Доступно по: http://cr.rosminzdrav.ru/#!/recomend/58. Ссылка активна на 12.02.2019.Yunosheskij artrit s sistemnym nachalom. Klinicheskie rekomendatsii [Internet]. Moscow: Soyuz pediatrov Rossii; 2016. (In Russ). Доступно по: http://cr.rosminzdrav.ru/#!/recomend/58. Ссылка активна на 12.02.2019.Machado SH, Xavier RM. Safety of tocilizumab in the treatment of juvenile idiopathic arthritis. Expert Opin Drug Saf. 2017;16(4): 493–500. doi: 10.1080/14740338.2017.1303479.Machado SH, Xavier RM. Safety of tocilizumab in the treatment of juvenile idiopathic arthritis. Expert Opin Drug Saf. 2017;16(4): 493–500. doi: 10.1080/14740338.2017.1303479.Roszkiewicz J, Orczyk K, Smolewska E. Tocilizumab in the treatment of systemic-onset juvenile idiopathic arthritis — singlecentre experience. Reumatologia. 2018;56(5):279–284. doi: 10.5114/reum.2018.79497.Roszkiewicz J, Orczyk K, Smolewska E. Tocilizumab in the treatment of systemic-onset juvenile idiopathic arthritis — singlecentre experience. Reumatologia. 2018;56(5):279–284. doi: 10.5114/reum.2018.79497.Grevich S, Shenoi S. Update on the management of systemic juvenile idiopathic arthritis and role of IL-1 and IL-6 inhibition. Adolesc Health Med Ther. 2017;8:125–135. doi: 10.2147/AHMT. S109495.Grevich S, Shenoi S. Update on the management of systemic juvenile idiopathic arthritis and role of IL-1 and IL-6 inhibition. Adolesc Health Med Ther. 2017;8:125–135. doi: 10.2147/AHMT. S109495.Bracaglia C, Prencipe G, De Benedetti F. Macrophage activation syndrome: different mechanisms leading to a one clinical syndrome. Pediatr Rheumatol Online J. 2017;15(1):5. doi: 10.1186/s12969-016-0130-4.Bracaglia C, Prencipe G, De Benedetti F. Macrophage activation syndrome: different mechanisms leading to a one clinical syndrome. Pediatr Rheumatol Online J. 2017;15(1):5. doi: 10.1186/s12969-016-0130-4.Davies HD; Committee on infectious diseases. Infectious complications with the use of biologic response modifiers in infants and children. Pediatrics. 2016;138(2):e20161209. doi: 10.1542/peds.2016-1209.Davies HD; Committee on infectious diseases. Infectious complications with the use of biologic response modifiers in infants and children. Pediatrics. 2016;138(2):e20161209. doi: 10.1542/peds.2016-1209.van Assen S, Agmon-Levin N, Elkayam O, et al. EULAR recommendations for vaccination in adult patients with autoimmune inflammatory rheumatic diseases. Ann Rheum Dis. 2011;70(3): 414–422. doi: 10.1136/ard.2010.137216.van Assen S, Agmon-Levin N, Elkayam O, et al. EULAR recommendations for vaccination in adult patients with autoimmune inflammatory rheumatic diseases. Ann Rheum Dis. 2011;70(3): 414–422. doi: 10.1136/ard.2010.137216.Singh JA, Furst DE, Bharat A, et al. 2012 update of the 2008 American College of Rheumatology recommendations for the use of disease-modifying antirheumatic drugs and biologic agents in the treatment of rheumatoid arthritis. Arthritis Care Res (Hoboken). 2012;64(5):625–639. doi: 10.1002/acr.21641.Singh JA, Furst DE, Bharat A, et al. 2012 update of the 2008 American College of Rheumatology recommendations for the use of disease-modifying antirheumatic drugs and biologic agents in the treatment of rheumatoid arthritis. Arthritis Care Res (Hoboken). 2012;64(5):625–639. doi: 10.1002/acr.21641.Cassidy JT, Petty RE, Laxer RM, Lindsley CB. Textbook of pediatric rheumatology. 6th ed. Philadelphia: Saunders Elsevier; 2011. 794 p.Cassidy JT, Petty RE, Laxer RM, Lindsley CB. Textbook of pediatric rheumatology. 6th ed. Philadelphia: Saunders Elsevier; 2011. 794 p.Farmaki E, Kanakoudi-Tsakalidou F, Spoulou V, et al. The effect of anti-TNF treatment on the immunogenicity and safety of the 7-valent conjugate pneumococcal vaccine in children with juvenile idiopathic arthritis. Vaccine. 2010;28(31):5109–5113. doi: 10.1016/j.vaccine.2010.03.080.Farmaki E, Kanakoudi-Tsakalidou F, Spoulou V, et al. The effect of anti-TNF treatment on the immunogenicity and safety of the 7-valent conjugate pneumococcal vaccine in children with juvenile idiopathic arthritis. Vaccine. 2010;28(31):5109–5113. doi: 10.1016/j.vaccine.2010.03.080.Aikawa NE, Franca IL, Ribeiro AC, et al. Short and long-term immunogenicity and safety following the 23-valent polysaccharide pneumococcal vaccine in juvenile idiopathic arthritis patients under conventional DMARDs with or without anti-TNF therapy. Vaccine. 2015;33(5):604–609. doi: 10.1016/j.vaccine.2014.12.030.Aikawa NE, Franca IL, Ribeiro AC, et al. Short and long-term immunogenicity and safety following the 23-valent polysaccharide pneumococcal vaccine in juvenile idiopathic arthritis patients under conventional DMARDs with or without anti-TNF therapy. Vaccine. 2015;33(5):604–609. doi: 10.1016/j.vaccine.2014.12.030.Rakoczi E, Perge B, Vegh E, et al. Evaluation of the immunogenicity of the 13-valent conjugated pneumococcal vaccine in rheumatoid arthritis patients treated with etanercept. Joint Bone Spine 2016;83:675–679. doi: 10.1016/j.jbspin.2015.1.Rakoczi E, Perge B, Vegh E, et al. Evaluation of the immunogenicity of the 13-valent conjugated pneumococcal vaccine in rheumatoid arthritis patients treated with etanercept. Joint Bone Spine 2016;83:675–679. doi: 10.1016/j.jbspin.2015.1.Алексеева Е.И., Дворяковская Т.М., Денисова Р.В. и др. Имму низация пневмококковой полисахаридной вакциной детей с ювенильным идиопатическим артритом без системных проявлений: результаты проспективного исследования // Вопросы современной педиатрии. — 2017. — Т. 16. — № 6. — С. 493–501. doi: 10.15690/vsp.v16i6.1822.Alexeeva EI, Dvoryakovskaya TM, Denisova RV, et al. Immunization with a pneumococcal polysaccharide vaccine in children with juvenile idiopathic arthritis without systemic manifestations: a prospective study. Current Pediatrics. 2017;16(6):493–501. [In Russ). doi: 10.15690/vsp.v16i6.1822.Nagel J, Saxne T, Geborek P, et al. Treatment with belimumab in systemic lupus erythematosus does not impair antibody response to 13-valent pneumococcal conjugate vaccine. Lupus. 2017;26(10):1072–1081. doi: 10.1177/0961203317695465.Nagel J, Saxne T, Geborek P, et al. Treatment with belimumab in systemic lupus erythematosus does not impair antibody response to 13-valent pneumococcal conjugate vaccine. Lupus. 2017;26(10):1072–1081. doi: 10.1177/0961203317695465.Nived P, Nagel J, Saxne T, et al. Immune response to pneumococcal conjugate vaccine in patients with systemic vasculitis receiving standard of care therapy. Vaccine. 2017;35(29); 3639–3646. doi: 10.1016/j.vaccine.2017.05.044.Nived P, Nagel J, Saxne T, et al. Immune response to pneumococcal conjugate vaccine in patients with systemic vasculitis receiving standard of care therapy. Vaccine. 2017;35(29); 3639–3646. doi: 10.1016/j.vaccine.2017.05.044.Ravelli A, Martini A. Juvenile idiopathic arthritis. Lancet. 2007; 369(9563):767–778. doi: 10.1016/S0140-6736(07)60363-8.Ravelli A, Martini A. Juvenile idiopathic arthritis. Lancet. 2007; 369(9563):767–778. doi: 10.1016/S0140-6736(07)60363-8.Федеральные клинические рекомендации по оказанию медицинской помощи детям с ювенильным артритом [интернет]. — М.: Союз педиатров России; 2013. Доступно по: https://minzdrav.gov-murman.ru/documents/poryadki-okazaniya-meditsinskoy-pomoshchi/_kr_ua.pdf. Ссылка активна на 04.07.2020.Federal’nye klini cheskie reko mendatsii po okazaniyu meditsinskoi pomoshchi detyam s yuvenil’nym artritom [Internet]. Moscow: Soyuz pediatrov Rossii; 2013. (In Russ). Доступно по: https://minzdrav.gov-murman.ru/documents/poryadki-okazaniya-meditsinskoy-pomoshchi/_kr_ua.pdf. Ссылка активна на 04.07.2020.Recommendations to assure the quality, safety and efficacy of pneumococcal conjugate vaccines-proposed replacement of TRS 927, Annex 2, ECBS, 19 to 23 October 2009. Available online: https://www.who.int/biologicals/publications/trs/areas/vaccines/pneumo/en. Accessed on June 01, 2020.Recommendations to assure the quality, safety and efficacy of pneumococcal conjugate vaccines-proposed replacement of TRS 927, Annex 2, ECBS, 19 to 23 October 2009. Available online: https://www.who.int/biologicals/publications/trs/areas/vaccines/pneumo/en. Accessed on June 01, 2020.Алексеева Е.И., Ломакина О.Л., Валиева С.И. и др. Особенности лекарственной терапии детей с системным ювенильным идиопатическим артритом: результаты анализа Общероссийского регистра Союза педиатров России // Вопросы современной педиатрии. — 2016. — Т. 15. — № 1. — С. 59–67. doi: 10.15690/vsp.v15i1.1500.Alekseeva YeI, Lomakina OL, Valieva SI, et al. Features of the drug therapy of children with systemic juvenile idiopathic arthritis: analysis results of the All-russian register of the Union of pediatricians of Russia. Current Pediatrics. 2016;15(1):59-67. (In Russ). doi: 10.15690/vsp.v15i1.1500.Guideline on clinical evaluation of vaccines. EMEA/CHMP/VWP/164653/05 Rev. 1. Available online: https://www.ema.europa.eu/en/documents/scientific-guideline/draft-guideline-clinicalevaluation-vaccines-revision-1_en.pdf. Accessed on June 30, 2020.Guideline on clinical evaluation of vaccines. EMEA/CHMP/VWP/164653/05 Rev. 1. Available online: https://www.ema.europa.eu/en/documents/scientific-guideline/draft-guideline-clinicalevaluation-vaccines-revision-1_en.pdf. Accessed on June 30, 2020.Voysey M, Sadarangani M, Pollard AJ, Fanshawe TR. Com puting threshold antibody levels of protection in vaccine clinical trials: An assessment of methodological bias. PLoS One. 2018;13(9): e0202517. doi: 10.1371/journal.pone.0202517.Voysey M, Sadarangani M, Pollard AJ, Fanshawe TR. Com puting threshold antibody levels of protection in vaccine clinical trials: An assessment of methodological bias. PLoS One. 2018;13(9): e0202517. doi: 10.1371/journal.pone.0202517.Harris JG, Maletta KI, Ren B, Olson JC. Improving Pneumococcal Vaccination Rate in the Pediatric Rheumatology Clinic. Pediatrics. 2015;136(3):e681–686. doi: 10.1542/peds.2014-2512.Harris JG, Maletta KI, Ren B, Olson JC. Improving Pneumococcal Vaccination Rate in the Pediatric Rheumatology Clinic. Pediatrics. 2015;136(3):e681–686. doi: 10.1542/peds.2014-2512.Никитюк Н.Ф., Глущенко В.А., Панин И.В. Организация иммунопрофилактики лиц с нарушениями в состоянии здоровья // БИОпрепараты. Профилактика, диагностика, лечение. — 2016. — Т. 16. — № 1. — С. 35–42. doi: 10.30895/2221-996X-2016-16-1-35-42.Nikityuk NF, Glushchenko VA, Panin IV. Scientific and methodical approaches to organizing and conducting immunization in patients with health disorders. BIOpreparations. Prevention, Diagnosis, Treatment. 2016;16(1):35–42. (In Russ). doi: 10.30895/2221-996X-2016-16-1-35-42.Bingham CO, Rizzo W, Kivitz A, et al. Humoral immune response to vaccines in patients with rheumatoid arthritis treated with tocilizumab: results of a randomised controlled trial (VISARA). Ann Rheum Dis. 2014;74(5):818–822. doi: 10.1136/annrheumdis-2013-204427.Bingham CO, Rizzo W, Kivitz A, et al. Humoral immune response to vaccines in patients with rheumatoid arthritis treated with tocilizumab: results of a randomised controlled trial (VISARA). Ann Rheum Dis. 2014;74(5):818–822. doi: 10.1136/annrheumdis-2013-204427.Hua C, Barnetche T, Combe B, et al. Effect of methotrexate, antitumor necrosis factor α, and rituximab on the immune response to influenza and pneumococcal vaccines in patients with rheumatoid arthritis: a systematic review and meta-analysis. Arthritis Care Res (Hoboken). 2014;66(7):1016–1026. doi: 10.1002/acr.22246.Hua C, Barnetche T, Combe B, et al. Effect of methotrexate, antitumor necrosis factor α, and rituximab on the immune response to influenza and pneumococcal vaccines in patients with rheumatoid arthritis: a systematic review and meta-analysis. Arthritis Care Res (Hoboken). 2014;66(7):1016–1026. doi: 10.1002/acr.22246.Mori S, Ueki Y, Akeda Y, et al. Pneumococcal polysaccharide vaccination in rheumatoid arthritis patients receiving tocilizumab therapy. Ann Rheum Dis. 2013;72(8):1362–1366. doi: 10.1136/annrheumdis-2012-202658.Mori S, Ueki Y, Akeda Y, et al. Pneumococcal polysaccharide vaccination in rheumatoid arthritis patients receiving tocilizumab therapy. Ann Rheum Dis. 2013;72(8):1362–1366. doi: 10.1136/annrheumdis-2012-202658.Centers for Disease Control and Prevention (CDC), Advisory Committee on Immunization Practices. Updated recommendations for prevention of invasive pneumococcal disease among adults using the 23-valent pneumococcal polysaccharide vaccine (PPSV23). MMWR Morb Mortal Wkly Rep. 2010;59(34): 1102–1106.Centers for Disease Control and Prevention (CDC), Advisory Committee on Immunization Practices. Updated recommendations for prevention of invasive pneumococcal disease among adults using the 23-valent pneumococcal polysaccharide vaccine (PPSV23). MMWR Morb Mortal Wkly Rep. 2010;59(34): 1102–1106.Greenberg RN, Gurtman A, Frenck RW, et al. Sequential administration of 13-valent pneumococcal conjugate vaccine and 23-valent pneumococcal polysaccharide vaccine in pneumococcal vaccine-naive adults 60–64 years of age. Vaccine. 2014;32(20): 2364–2374. doi: 10.1016/j.vaccine.2014.02.002.Greenberg RN, Gurtman A, Frenck RW, et al. Sequential administration of 13-valent pneumococcal conjugate vaccine and 23-valent pneumococcal polysaccharide vaccine in pneumococcal vaccine-naive adults 60–64 years of age. Vaccine. 2014;32(20): 2364–2374. doi: 10.1016/j.vaccine.2014.02.002.Jackson LA, Gurtman A, van Cleeff M, et al. Influence of initial vaccination with 13-valent pneumococcal conjugate vaccine or 23-valent pneumococcal polysaccharide vaccine on anti-pneumococcal responses following subsequent pneumococcal vaccinationJackson LA, Gurtman A, van Cleeff M, et al. Influence of initial vaccination with 13-valent pneumococcal conjugate vaccine or 23-valent pneumococcal polysaccharide vaccine on anti-pneumococcal responses following subsequent pneumococcal vaccinationin adults 50 years and older. Vaccine. 2013;31(35):3594–3602. doi: 10.1016/j.vaccine.2013.04.084.in adults 50 years and older. Vaccine. 2013;31(35):3594–3602. doi: 10.1016/j.vaccine.2013.04.084.Lesprit P, Pedrono G, Molina J-M. Immunological efficacy of a prime-boost pneumococcal vaccination in HIV-infected adults. AIDS. 2007;21(18):2425–2434. doi: 10.1097/QAD.0b013e3282887e91.Lesprit P, Pedrono G, Molina J-M. Immunological efficacy of a prime-boost pneumococcal vaccination in HIV-infected adults. AIDS. 2007;21(18):2425–2434. doi: 10.1097/QAD.0b013e3282887e91.Nguyen MTT, Lindegaard H, Hendricks O, et al. Initial serological response after prime-boost pneumococcal vaccination in rheumatoid arthritis patients: results of a randomized controlled trial. J Rheumatol. 2017;44(12):1794–803. doi: 10.3899/jrheum.161407Nguyen MTT, Lindegaard H, Hendricks O, et al. Initial serological response after prime-boost pneumococcal vaccination in rheumatoid arthritis patients: results of a randomized controlled trial. J Rheumatol. 2017;44(12):1794–803. doi: 10.3899/jrheum.161407Jaeger VK, Hoffman HM, van der Poll T, et al. Safety of vaccinations in patients with cryopyrin-associated periodic syndromes: a prospective registry based study. Rheumatology (Oxford). 2017;56(9):1484–1491. doi: 10.1093/rheumatology/kex185.Jaeger VK, Hoffman HM, van der Poll T, et al. Safety of vaccinations in patients with cryopyrin-associated periodic syndromes: a prospective registry based study. Rheumatology (Oxford). 2017;56(9):1484–1491. doi: 10.1093/rheumatology/kex185.Furer V, Rondaan C, Heijstek MW, et al. 2019 update of EULAR recommendations for vaccination in adult patients with autoimmune inflammatory rheumatic diseases. Ann Rheum Dis. 2020; 79(1):39–52. doi: 10.1136/annrheumdis-2019-215882.Furer V, Rondaan C, Heijstek MW, et al. 2019 update of EULAR recommendations for vaccination in adult patients with autoimmune inflammatory rheumatic diseases. Ann Rheum Dis. 2020; 79(1):39–52. doi: 10.1136/annrheumdis-2019-215882.

The authors declare that there are no conflicts of interest present.