2023-06-09 10:51:48
The preventive medicine It is the medical specialty that deals with the prevention of diseases. Traditionally, it has played a key role in the individualization and immunization of vulnerable patients. The value of the services of this specialty of medicine in the vaccination of the immunosuppressed patient has been one of the questions that the specialists participating in the II Conference on Immunization of the Immunocompromised Patientorganized by the Jiménez Díaz Foundation University Hospital in Madrid, have put on the table.
“Physicians specializing in preventive medicine have and have had a excellent training in vaccines and other passive immunization therapiessuch as convalescent plasma, specific immunoglobulins and of course monoclonal antibodies. But the change in recent years has been exponential with respect to the previous one”, Helena Moza Moríñigo, head of the Immunization Unit of the Preventive Medicine Service of the Fundación Jiménez Díaz in Madrid, and speaker at one of the discussion table under the title ‘Presentation of the Timming document on optimization of immunization in patients with immunocompromised’.
Therapies and treatments for patients with inflammatory diseases of any kind have evolved a lot in recent years. But the same thing has also happened with the pathologies and deregulations of the immune system and the treatments for oncohaematological patients and their drugs, since prolong the survival and quality of life of vulnerable patients. “In many cases, treatments leave patients exposed to certain communicable diseases. So, in case of having preparations that can prevent infection, it is a medical and sanitary duty to offer the patient this preventive therapy at the best moment”, he affirms.
“When we are faced with polytreated and complex patients, with a depleted and in some cases exhausted immune system, it is important not only that they receive an adequate vaccine or preventive therapy, but also ensure it is done at the optimal time to obtain a good immune response. If this moment does not exist, we use the passive immunization or antibiotic prophylaxis that we have available”, Moza qualifies. Regarding the role of the specialist in preventive medicine, Moza considers that “this must evolve to accompany the clinician in the process, leading, knowing the pharmacological targets and the infectious risks that these new drugs may entail”. In turn, he emphasizes the importance of putting the patient at the center and having the capacity, through the available diagnostic tests, to decide how to optimize the immunization of these patients.
Diversity in the immunocompromised patient
The 60 years constitute the age in which the immune system begins to be more weakened. Ten years later (from the age of 70), various studies confirm that 75 percent of the population suffer from more than two associated chronic diseases. The current population pyramid shows that a 20 percent of the population is over 60 years old. However, in the coming years that figure will rise to 30 percent. “The diversity of immunocompromised patients is infinite. The truth is that knowing the different degrees of immunocompromise and the different risks should be part of the knowledge of the doctor in charge of their protection and preventionsays Moza.
The expert considers it necessary to have a subspecialization and additional training in immunology and immunosuppression inside of preventive medicine specialty, which currently does not exist today. “In order to offer a patient the best preventive option, it is necessary to know how to interpret immunological diagnostic tests through training in Immunoinfectology and specific Vaccinology. The evolution of this knowledge has been rapid, which is why it requires continuous updating, and whoever dedicates himself to this must have almost exclusive dedication”, he adds.
Finally, Moza believes that immunization must be approached from two points of view. In the first place, from population immunization through established vaccination campaigns and calendars; and secondly, from the point of view of the vulnerable population, it must be approached individually. “Individualized immunization must use the relevant diagnostic and decision tests and the vaccines and passive immunization preparations,” he concludes.
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