感染性疾病与免疫（英文）-17页_167kb

Expert Recommendation Summary: COVID-19 Vaccination in Patients with Chronic Liver Diseases, Tuberculosis, or Rheumatic Diseases

Overview

This expert recommendation addresses COVID-19 vaccination prioritization for patients with chronic liver diseases, tuberculosis, or rheumatic diseases. Vaccination should be considered a priority for these high-risk groups due to increased susceptibility to SARS-CoV-2 infection and severe illness. Key considerations include patient stability, contraindications, and continuation of existing therapies. Specific population details and adjustments based on current evidence are provided.

Chronic Liver Diseases

• General Priority: Vaccination is recommended as a priority for stable patients with chronic liver disease to reduce infection risk.
• Eligibility: Patients in stable condition with normal liver biochemistry parameters and no contraindications should receive the vaccine. Vaccination should be postponed for those with untreated or unstable liver disease, acute comorbidities, or uncontrolled conditions.
• Recommendations:
  • Prefer inactivated vaccines where appropriate.
  • Continue original therapeutic drugs during vaccination.
  • Monitor liver biochemical parameters pre- and post-vaccination.
  • Reinforce epidemic prevention measures after vaccination.
• Evidence: Limited high-quality evidence exists on vaccine response and adverse effects; recommendations are based on existing guidelines and clinical experience.

Tuberculosis

• General Priority: Vaccination is strongly recommended for patients with tuberculosis to prevent COVID-19 severe outcomes.
• Eligibility: Vaccinate patients who have completed standardized TB treatment and are stable. Avoid vaccination in active or untreated tuberculosis. Co-infection increases severe COVID-19 risk.
• Recommendations:
  • Use inactivated vaccines as preferred based on Chinese data.
  • Continue anti-tuberculosis treatment during vaccination.
  • Specialist evaluation required before vaccination.
  • Vaccinate close contacts (e.g., caregivers) to protect vulnerable patients.
• Evidence: Paucity of data on vaccine efficacy and safety in TB patients; guidelines emphasize caution due to potential immune interactions.

Rheumatic Diseases

• General Priority: Individualized vaccination decisions are crucial, prioritizing stable patients to balance benefits and risks.
• Eligibility: Adult patients in a stable disease phase with no contraindications should be vaccinated. Active disease or untreated conditions may delay vaccination. The use of immunosuppressive agents does not universally preclude vaccination but requires careful assessment.
• Recommendations:
  • Prefer inactivated vaccines.
  • Continue most immunosuppressive therapies, with specific adjustments for certain drugs (e.g., suspend methotrexate for 1 week post-vaccination).
  • Rheumatologists should be involved in shared decision-making with patients and primary care physicians.
  • No significant increased risk of disease worsening outweighs vaccine benefits; continue protective measures like mask-wearing.
• Evidence: Vitamin on vaccine response variation with immunosuppressive use; recommendations align with international guidelines (e.g., ACR, EULAR).

General Notes:

• Guidance is based on domestic and international evidence, but high-quality data for these populations are limited; recommendations may evolve with new studies.
• Close contacts of patients should be vaccinated for indirect protection.
• Follow-up and monitoring are emphasized to ensure patient safety.