ERS 2022:Your Chronic Respiratory Disease Patients: What Do You Know About their Risk of Infectious Disease?
This session focused on the burden of preventable infections like herpes zoster and pertussis in patients with chronic respiratory conditions and the importance of adult vaccination.
The talk discussed epidemiology and the risk of pertussis in adults with chronic respiratory diseases. Guideline recommendations for vaccination in adults with COPD and asthma have also been discussed. In the last century, high vaccine coverage rates have been achieved in the pediatric age. Pre-and post-immunization epidemiology is related to immunological pressure exerted by vaccination. The age distribution in pertussis has shifted towards adults in some countries. Little is known about pertussis in children; however, in populations like newborns, infants, adolescents, young adults, adults, elderly and immunized subjects, reliable epidemiological data is unavailable because of atypical and non-specific features, under-notification, and under or missed diagnosis.
The international and national authorities highlight the importance of adult immunization in COVID-19. Tdap recommendations for adults have been reinforced during the COVID-19 pandemic. Protection from pertussis wanes over time, but Tdap boosters are immunogenic and effective. Global and international authorities increasingly recommend pertussis boosters throughout life. However, Tdap vaccine uptake is suboptimal in adults. Low vaccine uptake and the lack of natural boosting due to social distancing during the COVID-19 pandemic may leave adults particularly susceptible to pertussis. Pertussis awareness and adult vaccine uptake could be achieved by strengthening and harmonizing guidelines, healthcare personnel (HCPs) recommendations, and public education on pertussis and the benefits of vaccination—adults with COPD and asthma risk more pertussis and pertussis-related hospitalizations. The Centers for Disease Control and Prevention (CDC) recommends the Tdap vaccination for adults with COPD (or asthma) in those who were not vaccinated in adolescents. The Advisory Committee on Immunization Practice (ACIP) recommends that adults aged 19 years and older receive an annual booster dose every ten years of either tetanus and diphtheria (Td) or tetanus, diphtheria, and acellular pertussis (Tdap) vaccine.
The next talk highlighted the risk of shingles and the evolving prevention strategies. Herpes zoster (HZ) is caused by the reactivation of the dominant varicella-zoster virus (VZV). Approximately 99.5% of adults ≥40 years of age show serologic evidence of VZV infection, and 1 in 3 individuals develop shingles in their lifetime in the US. The incidence of HZ is predicted to increase, presenting a growing burden in patients with comorbidities. Symptoms and complications may be more severe and longer lasting than in non-immunocompromised patients. There is a need for greater awareness of the risk of shingles in patients with chronic underlying diseases. Patients with COPD or asthma have an increased risk of shingles. The incidence of HZ is high after organ transplantation, with a risk of severe complications. The CDC recommends the zoster vaccine to protect against shingles for adults with COPD aged ≥50 years. Several countries and GOLD recommend HZ immunization in patients with COPD and asthma.
The last talk in the session focused on ways to increase vaccine coverage in respiratory disease patients. There is a wide gap between vaccine availability and prescription. Many patients with chronic respiratory diseases are unaware of the risks. Knowledge about pertussis, attitudes and practice among HCPs is responsible for adult vaccination. A strong recommendation from HCPs is essential in increasing adult vaccination coverage. In addition, recommendations from medical societies and health ministries can help increase adult Tdap vaccination coverage.
European Respiratory Society (ERS) International Congress 2022, 3rd-6th Sept. 2022, Barcelona
