Immunizing adult respiratory patients, shall we dance along?
Vacunación en el paciente respiratorio adulto, ¿bailamos?
Felipe Villar-Álvareza,b,c,
, David de la Rosa-Carrillod, Fernando Fariñas-Guerreroe,f
Corresponding author
a Servicio de Neumología, Instituto de Investigación Sanitaria, Fundación Jiménez Díaz. Madrid, Spain
b Centro de Investigación Biomédica en Red, Enfermedades Respiratorias, Madrid, Spain
c Universidad Autónoma de Madrid, Madrid, Spain
d Servicio de Neumología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
e Servicio de Neumología, IIS Fundación Jiménez Díaz. Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES). Universidad Autónoma de Madrid, Madrid, Spain
f Instituto de Inmunología clínica y Enfermedades Infecciosa. Grupo YNMUN Biomedicina, Spain
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"tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "161" "paginaFinal" => "163" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Felipe Villar-Álvarez, David de la Rosa-Carrillo, Fernando Fariñas-Guerrero" "autores" => array:3 [ 0 => array:4 [ "nombre" => "Felipe" "apellidos" => "Villar-Álvarez" "email" => array:1 [ 0 => "fvillarleon@yahoo.es" ] "referencia" => array:4 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "af0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "af0010" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "af0015" ] 3 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cr0005" ] ] ] 1 => array:3 [ "nombre" => "David" "apellidos" => "de la Rosa-Carrillo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "PC_affAQ4bnOuesR" ] ] ] 2 => array:3 [ "nombre" => "Fernando" "apellidos" => "Fariñas-Guerrero" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">e</span>" "identificador" => "PC_affvEULqLMbBD" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">f</span>" "identificador" => "PC_affNw4a9dDBV3" ] ] ] ] "afiliaciones" => array:6 [ 0 => array:3 [ "entidad" => "Servicio de Neumología, Instituto de Investigación Sanitaria, Fundación Jiménez Díaz. Madrid, Spain" "etiqueta" => "a" "identificador" => "af0005" ] 1 => array:3 [ "entidad" => "Centro de Investigación Biomédica en Red, Enfermedades Respiratorias, Madrid, Spain" "etiqueta" => "b" "identificador" => "af0010" ] 2 => array:3 [ "entidad" => "Universidad Autónoma de Madrid, Madrid, Spain" "etiqueta" => "c" "identificador" => "af0015" ] 3 => array:3 [ "entidad" => "Servicio de Neumología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain" "etiqueta" => "d" "identificador" => "PC_affAQ4bnOuesR" ] 4 => array:3 [ "entidad" => "Servicio de Neumología, IIS Fundación Jiménez Díaz. Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES). Universidad Autónoma de Madrid, Madrid, Spain" "etiqueta" => "e" "identificador" => "PC_affvEULqLMbBD" ] 5 => array:3 [ "entidad" => "Instituto de Inmunología clínica y Enfermedades Infecciosa. Grupo YNMUN Biomedicina, Spain" "etiqueta" => "f" "identificador" => "PC_affNw4a9dDBV3" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cr0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Vacunación en el paciente respiratorio adulto, ¿bailamos?" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="p0005" class="elsevierStylePara elsevierViewall">The covid-19 pandemic has demonstrated the power of vaccination in the control of a serious infectious disease. Prior to this, respiratory patients had to live with the recommendation of the influenza vaccine and the doubt of whether or not to take the pneumococcal vaccine. Thus, in a disease as common as chronic obstructive pulmonary disease (COPD), only 42.7% of doctors recommended vaccination against influenza and 25.3% against pneumococcus,<a class="elsevierStyleCrossRef" href="#bb0005"><span class="elsevierStyleSup">1</span></a> very low figures if the primary objective is to prevent exacerbations in these patients.</p><p id="p0010" class="elsevierStylePara elsevierViewall">This pandemic also brought us other concepts that we began to coin, first as interesting and then as necessary, namely immunosenescence and immune fitness. Immunosenescence is a gradual deterioration of the immune system caused by advancing age that contributes to a pro-inflammatory environment (inflammaging), with a greater tendency to develop chronic inflammation, autoimmune diseases and cancer.<a class="elsevierStyleCrossRef" href="#bb0010"><span class="elsevierStyleSup">2</span></a> Immunosenescence plays a key role in the development of some respiratory diseases that are more common in older age, such as COPD, adult asthma, diffuse interstitial lung disease and respiratory infections in the elderly. This is why we are also moving closer and closer to the presence of an “old age” phenotype in these diseases.<a class="elsevierStyleCrossRef" href="#bb0015"><span class="elsevierStyleSup">3</span></a></p><p id="p0015" class="elsevierStylePara elsevierViewall">Immune fitness, on the other hand, encompasses the establishment of lifestyle habits that can improve our immune capacity, such as: not smoking, limiting alcohol consumption, having adequate eating habits and good social relations, exercising and establishing a correct vaccination programme. All of this improves the quality of the immune response to certain infectious agents and slows down the process of immunosenescence.<a class="elsevierStyleCrossRef" href="#bb0015"><span class="elsevierStyleSup">3</span></a></p><p id="p0020" class="elsevierStylePara elsevierViewall">COPD is probably the chronic respiratory disease where vaccination is most strongly recommended, and in clinical guidelines, such as GOLD and GesEPOC,<a class="elsevierStyleCrossRef" href="#bb0020"><span class="elsevierStyleSup">4</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bb0025"><span class="elsevierStyleSup">5</span></a> the pneumococcal and influenza vaccines have been joined by other dance partners, such as those for covid-19, pertussis and herpes zoster (HZ). Respiratory syncytial virus (RSV) will be the next to hit the dance floor. In immunosuppressed or transplanted Respiratory patients, immunization programmes are also gaining momentum with the advent of new vaccines. But it is in other diseases, such as asthma, diffuse interstitial disease, bronchiectasis or chronic bronchial infection, where infections consume more health care resources and condition the prognosis of patients, and where vaccines, whose main objective is the prevention of infection by specific pathogens, should play a more relevant role.</p><p id="p0025" class="elsevierStylePara elsevierViewall">SARS-CoV-2 coronavirus infection has demonstrated the vulnerability of our immune system. Current covid-19 vaccines are not only safe and effective in preventing severe disease and mortality, but have currently been the most useful preventive tool for pandemic control. The future of vaccination against SARS-CoV-2 will depend critically on the effectiveness and nature of the vaccines, people's Confidence in them and vaccine strategies, together with the evolution of the virus in the post-pandemic period, where SARS-CoV-2 is likely to become endemic and require specific attention in the vaccination schedules of the chronic respiratory patient.<a class="elsevierStyleCrossRef" href="#bb0030"><span class="elsevierStyleSup">6</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bb0035"><span class="elsevierStyleSup">7</span></a></p><p id="p0030" class="elsevierStylePara elsevierViewall">The indication for influenza and pneumococcal vaccination is established in the adult vaccination schedule. The former has played a key role in reducing exacerbations of COPD and asthma, and forms part of the recommendations of most clinical management guidelines.<a class="elsevierStyleCrossRef" href="#bb0020"><span class="elsevierStyleSup">4</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bb0025"><span class="elsevierStyleSup">5</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bb0040"><span class="elsevierStyleSup">8</span></a> Pneumococcal vaccines have also been shown to reduce exacerbations such as COPD. The new PCV15 and PCV20 conjugate vaccines have been approved for active immunization for the prevention of invasive disease and pneumonia caused by Streptococcuspneumoniae in individuals 18 years of age and older. PCV15 induces an immune response comparable to PCV13 for the 13 shared serotypes and elicits a superior response for serotypes 3, 22F and 33F.<a class="elsevierStyleCrossRef" href="#bb0045"><span class="elsevierStyleSup">9</span></a> The immune response of PCV20 was non-inferior to PCV13 and those of 6 additional serotypes of PPSV23 in the 60<span class="elsevierStyleHsp" style=""></span>+ population. It also induced robust responses to all 20 vaccine serotypes in all age groups, and is expected to extend protection against pneumococcal disease in adults.<a class="elsevierStyleCrossRef" href="#bb0050"><span class="elsevierStyleSup">10</span></a> With the approval of these new conjugate vaccines, current vaccination recommendations should be revised, including the simplest schedule to implement and ensuring the best protection against pneumococcal disease.</p><p id="p0035" class="elsevierStylePara elsevierViewall">Pertussis, our invisible enemy, is a highly contagious infectious disease, under-diagnosed and with an increasing rate of infections and mortality in the adult population over 65 years of age.<a class="elsevierStyleCrossRef" href="#bb0055"><span class="elsevierStyleSup">11</span></a> Therefore, the recommendation of pertussis vaccination in the adult vaccination schedule could go beyond a booster dose at 65 years of age or earlier.<a class="elsevierStyleCrossRef" href="#bb0060"><span class="elsevierStyleSup">12</span></a> The Centre for Disease Control and Prevention (CDC) already suggests such vaccination in adulthood every 10 years.<a class="elsevierStyleCrossRef" href="#bb0065"><span class="elsevierStyleSup">13</span></a> This has already been echoed in the most important COPD management guidelines, which advise vaccination with dTpa in adult patients with COPD who were not vaccinated in adolescence.<a class="elsevierStyleCrossRef" href="#bb0020"><span class="elsevierStyleSup">4</span></a> In the future, and with the advent of more studies with robust results, asthma and COPD clinical guidelines should include immunization recommendations close to those of the CDC.</p><p id="p0040" class="elsevierStylePara elsevierViewall">Immunosenescence, immunosuppressed states and chronic respiratory diseases, such as COPD, increase the risk of HZ and postherpetic neuralgia, dance partners to be avoided given their clinical impact, especially after the age of 50 years. The efficacy of the new HZ subunit-adjuvanted recombinant vaccine is 97.2% in individuals over 50 years of age and is maintained up to 7.1 years after initial vaccination.<a class="elsevierStyleCrossRef" href="#bb0070"><span class="elsevierStyleSup">14</span></a> In addition, efficacy against HZ is 84.5% in patients with respiratory disorders such as asthma or COPD.<a class="elsevierStyleCrossRef" href="#bb0075"><span class="elsevierStyleSup">15</span></a> In line with the CDC, the GOLD guidelines have included the recommendation of HZ vaccination in COPD patients from the age of 50 years.<a class="elsevierStyleCrossRef" href="#bb0020"><span class="elsevierStyleSup">4</span></a> This vaccine should also form part of the vaccination schedule for respiratory patients.</p><p id="p0045" class="elsevierStylePara elsevierViewall">Heavenly music comes from the results of new vaccines against respiratory syncytial virus (RSV), a virus that can lead to exacerbation of underlying chronic respiratory diseases, hospitalization and death.<a class="elsevierStyleCrossRef" href="#bb0080"><span class="elsevierStyleSup">16</span></a> Data show very high vaccine efficacy against confirmed cases of severe lower respiratory tract disease and RSV acute respiratory infection in adults over 60 years of age; regardless of the severity of RSV-associated illness, RSV subtype and underlying comorbidities.<a class="elsevierStyleCrossRef" href="#bb0085"><span class="elsevierStyleSup">17</span></a> Therefore, clinical guidelines should include the recommendation for RSV vaccination in their new updates. The future will also be based on the use of monoclonal antibodies.</p><p id="p0050" class="elsevierStylePara elsevierViewall">The last lyrics of this song should be given for the creation of an immunization schedule for the adult respiratory patient, ordering each of the 6 vaccines previously mentioned. And here, the authorities, the health personnel and, above all, the respiratory patients must dance.</p><span id="s0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0015">Funding</span><p id="p0055" class="elsevierStylePara elsevierViewall">This article did not receive any funding.</p></span><span id="s0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0020">Authorship</span><p id="p0060" class="elsevierStylePara elsevierViewall">All authors have made a substantial contribution to the design and writing of the manuscript, as well as to the critical review of its content.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:2 [ "identificador" => "s0005" "titulo" => "Funding" ] 1 => array:2 [ "identificador" => "s0010" "titulo" => "Authorship" ] 2 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="np4005">Please cite this article as: Villar-Álvarez F, de la Rosa-Carrillo D, Fariñas-Guerrero F. Vacunación en el paciente respiratorio adulto, ¿bailamos? Vacunas. 2023. <span class="elsevierStyleInterRef" id="ir3005" href="https://doi.org/10.1016/j.vacun.2023.04.005">https://doi.org/10.1016/j.vacun.2023.04.005</span></p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bs0005" "bibliografiaReferencia" => array:17 [ 0 => array:3 [ "identificador" => "bb0005" "etiqueta" => "1." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Variability in adherence to clinical practice guidelines and recommendations in COPD outpatients: a multi-level, cross-sectional analysis of the EPOCONSUL study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Calle Rubio" 1 => "J.L. López-Campos" 2 => "J.J. Soler-Cataluña" 3 => "B. Alcázar Navarrete" 4 => "J.B. Soriano" 5 => "J.M. 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