Reducing the risk of exacerbations in COPD by consequential vaccination

Exacerbations in COPD (chronic obstructive pulmonary disease) deteriorate symptoms and quality of life, and the risk of hospitalization, disease progression and death increases. Among the main goals of COPD therapy are therefore the prevention and reduction of this complication. A particularly effective strategy is vaccination against pathogens of respiratory infections, emphasizes PD Dr.Jessica Rademacher, Senior Physician at the Clinic for Pneumology and Infectiology and Head of the Antibiotic Stewardship Program at Hannover Medical School (MHH) in a topical review, published in the EUROPEAN RESPIRATORY REVIEW SERIES. However, the infectiologist criticized that the Immunization rate continues to be „suboptimal“.

COPD is the third most common cause of death worldwide, with a constantly rising incidence. Acute exacerbations of COPD (AECOPD) are critical, mostly caused by respiratory pathogens. At least three quarters of the exacerbations are of infectious origin, and in 30 percent germs can be proven. At the head of this list is Streptococcus pneumoniae, followed by influenza, SARS-CoV2 and RS-V (respiratory syncytial virus). Vaccines are available for the prevention of most of these infections. „Only recently has a new pneumococcal conjugate vaccine been approved by the FDA, with high immunogenicity against 20 serotypes and the induction of a robust immune response“, explains Dr. Susanne Simon, specialist at the Clinic for Pneumology and Infectiology at the MHH and lead author of the review. Also relevant is the vaccination against influenza, a virus which, as the second most frequently occurring, is associated with acute severe COPD. More than 10 percent of influenza cases in patients with COPD can be prevented by vaccination. However, if the immune response tends to be weak, the efficacy varies according to subtype. High-dose vaccines and adjuvanted vaccines, as are now available, can render the vaccination more effective. 
The RS virus is considered to be one of the most important viral pathogens, which can also trigger an  AECOPD. The first approved vaccine candidate for those over 60 years of age was RSVPref3. In the meantime, further RSV vaccines are now available for this age group. Vaccination against SARS-CoV2 is also worth it, looking at the AECOPD risk. It lowers the AECOPD-associated hospitalization by 50 percent, particularly due to the total reduction of acute viral infections. 
The general problem is: The vaccination rates are, despite the known significant role of vaccinations for chronic underlying diseases, still suboptimal and do not reach the goals set by the WHO. „All patients with COPD, irrespective of age, should be given the appropriate vaccinations for the prevention of respiratory infections“, explained Professor Dr. Tobias Welte, Director of the Department of Pulmonary and Infectious Diseases at the MHH. The review of the three BREATH scientists summarizes the recommendations. In their opinion, the vaccination status of patients with COPD should therefore be checked once a year. Alongside the standard vaccinations against diphtheria/tetanus/pertussis, vaccinations against the respiratory pathogens mentioned should be administered and patients over 50 years should also be vaccinated against Herpes zoster. For the annual flu vaccination, a high-dose or an adjuvanted quadrivalent influenza vaccine should also be used, to protect against pneumococci a single-dose of PCV20 as well as a basic immunization and booster vaccination against SARS-CoV2 with an mRNA vaccine. Welte summed up: „The prevention of airway infections in COPD is the cornerstone in the prophylaxis of exacerbations“.

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Text: Beate Fessler / BREATH

(from left to right) Prof. Dr. T. Welte, PD Dr. J. Rademacher, Dr. S. Simon