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Journal of Investigative Dermatology ; 143(5 Supplement):S38, 2023.
Article in English | EMBASE | ID: covidwho-2294989


Vaccines based on recombinant mRNA technology helped to control the pandemic caused by the severe acute respiratory syndrome Coronavirus-2 (SARS-CoV-2). Clinical trials for showed that these vaccines are safe and effective and promote a strong type 1 driven T cell response. Yet, several reports claimed that SARS-CoV-2 mRNA vaccination might favor the onset, worsening or the reactivation of autoimmune disorders like pemphigus and bullous pemphigoid. However, no study demonstrated a direct immunological link between mRNA vaccination and disease appearance/worsening. We aimed to analyze the immunological and clinical effects exerted by mRNA booster vaccinations for SARS-CoV-2 in a cohort of patients with pemphigus (n=9), bullous pemphigoid (n=4) and in healthy individuals (n=5). Patients and healthy individuals were monitored at baseline, and after two and four weeks of mRNA vaccination. We assessed the clinical disease status, antibodies against the SARS-CoV-2 spike protein, antibody levels for BP180/230, DSG1/3 and tetanustoxoid. We also determined the distribution of peripheral T helper / T follicular cell subsets, intracellular cytokine production of T cells and cytokine serum levels. Our results show that booster vaccination increased anti spike protein IgG, while tetanustoxoid igC and skin-specific autoantibody titers were not or minimally affected. We observed an increase in Th1/Th17.1 cells, together with an increase in the intracellular production of IFN-gamma, IL-4 and IL-21 in peripheral T cells of pemphigus patients. Importantly, clinical activity in both remittent patients and in patients with active disease remained stable. In summary, vaccination with mRNA vaccines induced a specific activation of the humoral system with production of protective antibodies against the Sars-CoV-2 spike protein without affecting autoimmune disease activity in patients with pemphigus and bullous pemphigoid.Copyright © 2023

Value in Health ; 25(7):S345, 2022.
Article in English | EMBASE | ID: covidwho-1926720


Objectives: Since the COVID-19 pandemic, the potential for vaccines to reduce pressure on health care systems has received much attention. However, evaluation of how vaccination may impact health system pressure is hindered by lack of a formal definition and measurement framework. We developed an approach for defining health system pressure and measuring its impact in healthcare settings and applied this approach to respiratory syncytial virus (RSV) and Clostridioides difficile (C. difficile) infections. Methods: We conducted a targeted literature review and assessed hospital guidelines for prevention and control of RSV and C. difficile infections in hospital settings in Germany, Italy, and the UK. The definition and framework were tested via semi-structured interviews among healthcare professionals. Results: Health system pressure can be generally defined as resource utilisation given a pre-set usable capacity. Its impact can be measured as the opportunity cost of actions taken to prevent or mitigate pressure. Actions to prevent or mitigate pressure due to RSV or C difficile can be classified by their impact on staff (labour resources), stuff (non-labour resources and materials), and structure capacity. Increased staffing needs drive RSV pressure during the RSV respiratory season and are considered to be extremely likely and extremely costly by 75% of the interviewees. C. difficile pressure is driven by the activation of outbreak-induced infection control protocols, which are likely to affect every capacity dimensions according to over 60% of the interviewees, and lead to large costs of infrastructure needed to isolate patients. In general, actions to mitigate pressure are associated with higher costs than actions used to prevent pressure before it occurs. Conclusions: This research describes a novel definition and framework for health system pressure. Further development and application of this framework may enable HTA bodies to describe and measure the potential impact of vaccination on health care systems.

Value in Health ; 24:S117, 2021.
Article in English | ScienceDirect | ID: covidwho-1251386