Chronic Obstructive Pulmonary Disease (COPD) is the third leading cause of death after heart disease and stroke. Patients with COPD exhibit altered lung defenses and frequently have multiple comorbidities. They are especially vulnerable to viral and bacterial lung infections, which are major causes of frequent exacerbation and hospitalization. Because of impaired mucociliary clearance and production of the specific cell adhesion molecules that mediate attachment of bacteria and viruses COPD patients become more susceptible to respiratory infections. In these patients, a cell adhesion molecule for Streptococcus pneumonia and untypable Haemophillus influenza (platelet adhesion factor receptor) and recently a cell adhesion molecule for rhinovirus (ICAM1) are significantly elevated than non-COPD patients. An elevated level of these proteins may be the causative factor for increased respiratory infection and bacterial colonization.
A vaccine is the most common way to immunize a person against infection. It works by giving a substance that contains a very small part of or a weakened form of an infectious agent like a virus or bacterium. It stimulates the body’s immune system to produce antibodies that are then able to recognize and effectively destroy the infection.
Mainly two types of vaccination are advised in COPD patients –
- Pneumococcal vaccine:
It protects against the most common bacterial cause of pneumonia, caused by Streptococcus pneumonia. There are mainly two types of pneumococcal vaccines which are recommended, pneumococcal polysaccharide vaccines (PPV23) and pneumococcal conjugate vaccines (PCV13).
Pneumococcal polysaccharide vaccines contain serotype-specific polysaccharide antigens only, which induce T- cell-independent antibody production from B cells without producing memory B-cells. For this reason, these responses tend to wane over time. This immunological antibody response is age and serotype dependent and is lower in the elderly population than in younger populations.
Pneumococcal conjugate vaccines contain pneumococcal polysaccharide antigens covalently linked to an immunogenic carrier protein that together induce T-cell-dependent humoral immune responses and stimulate T-cells to help B-cells to produce antibodies to the vaccine and generate immune memory. These characteristics can improve the magnitude and duration of the initial immune response and potentially allow the immune system to respond more effectively to subsequent exposure to vaccine-type pneumococcal strain.
The current recommendation for COPD patients is, 1 dose of PPV 23, if PCV13 has been given, then give PPV 23 after 1 year of receiving PCV 13. 1 dose of PPV23 after 5 years of receiving PPV23 at age < 65 years in case of immunocompetent persons aged ≥65 years of age. 1 dose of PPV23 for persons aged 19 to 64 years (immunocompetent).
- Flu vaccine:
There are many different strains of flu. Type A virus causes the most severe disease and is associated with epidemics and pandemics. Spontaneous mutations in the viral surface proteins, haemaglutinin, and neuraminidase, are responsible for so-called ‘antigenic drift’. If this results in changes in the viral amino acid structure, pre-existing antibodies might be unable to bind to viral particles to a sufficient extent to prevent disease. This phenomenon is responsible for annual influenza waves observed worldwide. The ERS/ESCMID guidelines recommend that the influenza vaccine should be given yearly to people at increased risk of complications due to influenza. Vaccination should be given to immunocompetent adults belonging to one or more of the following categories: over 65 years of age; resident in an institution (such as a nursing home); chronic cardiac disease; chronic lung disease; diabetes mellitus; chronic renal disease; haemoglobinopathies; and women who will be in the second or third trimester of pregnancy during the influenza season. In addition, the guidelines suggest yearly vaccination for healthcare personnel, especially in settings where elderly people or other high-risk groups are treated.
Dr. Swarup Paul, Associate Consultant – Pulmonology, Anaesthesia & Critical Care, Narayana Multispeciality Hospital, Barasat