免疫功能低下成年人的呼吸道合胞病毒疫苗接种

摘要(中文译文)

呼吸道合胞病毒（RSV）是免疫功能低下成人下呼吸道疾病的主要原因，包括实体器官和造血干细胞移植受者。2023年三种针对老年人的RSV疫苗获批上市后，越来越多的免疫功能低下个体符合接种条件，尽管这些人群在很大程度上被排除在关键性3期试验之外。我们综合了评估免疫功能低下成人RSV疫苗的前瞻性免疫原性研究和大型真实世界有效性分析的新兴数据。体液免疫应答减弱且呈异质性，移植人群中的血清转化率通常在30%~60%之间，并受移植后时间、淋巴细胞计数以及暴露于抗代谢药物（如霉酚酸酯）的强烈影响。尽管抗体应答降低，免疫功能低下成人中第一季疫苗针对住院的有效性一般在65%~75%之间。两季分析显示保护作用衰减，且较免疫功能正常个体更为明显。细胞免疫应答，尤其是CD4 T细胞应答，可能在血清学应答减弱的情况下仍得以保留，提示仅凭抗体检测可能低估临床保护作用。尽管免疫原性降低且持久性较免疫功能正常成人更短，RSV疫苗接种仍可提供针对重症的有意义保护。在高危亚组中，优化接种时机、加强免疫策略以及整合被动免疫方法值得进一步研究。

Abstract

Respiratory syncytial virus (RSV) is a major cause of lower respiratory tract disease in immunocompromised adults, including solid organ and hematopoietic stem cell transplant recipients. Following the 2023 licensure of three RSV vaccines for older adults, increasing numbers of immunocompromised individuals have become eligible for vaccination, although these populations were largely excluded from pivotal phase 3 trials. We synthesize emerging data from prospective immunogenicity studies and large real-world effectiveness analyses evaluating RSV vaccines in immunocompromised adults. Humoral immune responses are attenuated and heterogeneous, with seroconversion rates commonly ranging from 30-60% in transplant populations and strongly influenced by time since transplantation, lymphocyte counts, and exposure to antimetabolites such as mycophenolate. Despite reduced antibody responses, first-season vaccine effectiveness against hospitalization is generally between 65% and 75% in immunocompromised adults. Two-season analyses demonstrate waning protection, more pronounced than in immunocompetent individuals. Cellular immune responses, particularly CD4 T-cell responses, may be preserved despite diminished serologic responses, suggesting that antibody measurements alone may underestimate clinical protection. Although immunogenicity is reduced and durability shorter than in immunocompetent adults, RSV vaccination provides meaningful protection against severe disease. Optimization of vaccination timing, booster strategies, and integration of passive immunization approaches warrant further study in high-risk subgroups.

如何引用

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