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ABSTRACT
Introduction: This review analyzes the efficacy of pneumococcal vaccinations in lung transplant patients before and after transplantation.
Areas covered: This review addresses the risk for respiratory infections, in particular pneumococcal infections, in lung transplantation patients in the context of immunodeficiency and immunosuppressive medication. Vaccination is recommended to counteract the increased risk of pneumococcal infection, and the relevant guidelines are discussed in this review. The design of specific vaccination schedules is required because of the impaired antibody response in specific patient categories.
Expert opinion: Lung transplantation candidates should be vaccinated with pneumococcal vaccines prior to transplantation. Currently, the 23-valent pneumococcal polysaccharide vaccine offers the broadest coverage, but the antibody response should be monitored. New generation pneumococcal conjugate vaccines with equally broad serotype coverage could be used in the future. During the post-transplantation period, the immune status of the patients should be monitored regularly, and vaccination should be repeated when indicated.
Acknowledgments
We thank Samuel Max and Tiara Dusselier for their stimulating interest and valuable suggestions during preparation of the manuscript.
Article highlights
Lung transplant patients are at an increased risk for pneumococcal and other lower respiratory infections, due to their immunosuppressed state.
Lung transplant recipients suffering from invasive pneumococcal disease or one episode of (any cause) pneumonia alone have a significantly increased mortality rate.
Pneumococcal vaccination of lung transplant patients improves disease outcome and survival; it also serves as screening method for humoral immune deficiency.
Pre-transplantation vaccination with 23 valent pneumococcal polysaccharide vaccine and/or a 13 valent (or higher) conjugate vaccine is recommended.
The humoral immune status in lung transplant recipients declines post-transplantation.
23 valent pneumococcal polysaccharide vaccine provides the broadest serotype coverage, although pneumococcal conjugate vaccines that provide broader protection are emerging.
Current guidelines could be updated; re-vaccination one-year post-transplantation should be considered and serum immunoglobulin level, IgG subclasses, and anti-pneumococcal antibodies should be periodically monitored.
Disclosure Statement
The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.
Reviewer Disclosures
A reviewer on this manuscript has disclosed involvement in Pfizer supported projects. All other peer reviewers on this manuscript have no relevant financial or other relationships to disclose