MMR + varicella zoster vaccine (MMRV zoster vaccine)

[Intrathecal immunoglobulin administration for refractory viral central nervous system infection after allogeneic hematopoietic stem cell transplantation].

Matsuo Masaaki M, Kusakabe Shinsuke S, Kurashige Ryumei R, Fukushima Kentaro K et al.

Central nervous system (CNS) viral infections after allogeneic hematopoietic stem cell transplantation are associated with poor prognosis and have limited therapeutic options. We report three cases of refractory CNS viral infection treated by combination therapy with antiviral agents and intrathecal immunoglobulin administration. Case 1 involved cytomegalovirus encephalitis, Case 2 varicella zoster virus meningitis, and Case 3 human herpesvirus 6 encephalitis; all were resistant to antiviral agents. Two patients achieved viral DNA negativity in cerebrospinal fluid, and none experienced adverse events related to intrathecal injection. Although no intrathecal immunoglobulin products have been approved for use in Japan, our findings suggest that this treatment may be a viable option in selected refractory cases. Further studies are warranted to clarify the optimal agent, dosage, and schedule.

Reversible temporal artery halo sign in polymerase chain reaction-confirmed herpes zoster ophthalmicus without corticosteroid exposure.

Yang Howard Jie HJ, Lin Emily Yiming EY, Deva Rajeev R, Morand Eric E

COVID-19 Vaccine Knowledge, Practice, and Attitudes Among Hemodialysis Patients in Egypt, Kenya, and Cameroon: A Multicenter Study.

Elsayed Enass E, Kotb Khaled M KM, Heiba Ahmed A, Elhussini Manal Shaker MS et al.

Patients receiving hemodialysis (HD) are at increased risk of severe coronavirus disease 2019 (COVID-19) and were prioritized for vaccination, yet vaccine hesitancy remains common. We assessed COVID-19 vaccine knowledge, acceptance, and attitudes among patients receiving HD in Egypt, Kenya, and Cameroon and identified factors associated with vaccine acceptance, prior infection, willingness to receive future doses, and postvaccination complications. Multicenter cross-sectional survey study. Between March 2021 and April 2022, 765 patients receiving maintenance HD and 196 non-dialysis controls were recruited from dialysis centers in Egypt, Kenya, and Cameroon. Sociodemographic characteristics, clinical comorbidities, prior COVID-19, sources of vaccine information, and exposure to vaccinated or infected relatives. COVID-19 vaccine acceptance, willingness to receive future doses, prior infection, and post-vaccination complications. Structured questionnaires assessed knowledge, practices, and attitudes toward COVID-19 vaccination. Multivariable logistic regression identified factors independently associated with study outcomes. Vaccine acceptance was lower among patients receiving HD than nondialysis controls (58.2% vs 96.2%). Fear of side effects was the most common reason for refusal (39.3%). Postvaccination complications were less frequent among patients receiving HD (22.3% vs 44.3%). Hesitancy was more common among women, younger participants, and those with comorbidities or no prior COVID-19. Having vaccinated or previously infected relatives was associated with a greater willingness to receive future doses. Cross-sectional design limits causal inference. Nonprobability sampling and unmatched controls may limit generalizability. COVID-19 cases may have been underreported because of limited testing. COVID-19 vaccine hesitancy among patients receiving HD is driven by fear, misinformation, and sociodemographic factors. Targeted education and improved access to reliable vaccine information may help increase uptake in this population.

Outcomes of tofacitinib dose reduction in patients with ulcerative colitis in stable remission: a long-term follow-up of the randomized RIVETING trial.

Rubin David T DT, Panés Julian J, Torres Joana J, Kobayashi Taku T et al.

Tofacitinib is an oral Janus kinase inhibitor used for the treatment of ulcerative colitis. This study evaluated efficacy/safety of dose reduction to tofacitinib 5 mg twice daily (BID) versus remaining on 10 mg BID in patients in stable remission on 10 mg BID. RIVETING, a phase 3b/4, double-blind, randomized, parallel-group trial, enrolled patients in stable remission (≥6 months) and corticosteroid-free (≥4 weeks) who received tofacitinib 10 mg BID for ≥2 years. Efficacy was reported to month (M)30 and safety was reported throughout. One hundred and forty patients were randomized (1:1) to tofacitinib 5 or 10 mg BID; 50.0% and 62.9%, respectively, maintained modified Mayo score remission at M30. Remission rate differences at M30 between doses were generally greater in patients with a baseline endoscopic subscore of 1 versus 0, and with versus without tumor necrosis factor inhibitor (TNFi) failure. 11/14 patients who dose-escalated from 5 to 10 mg BID following relapse recaptured remission (median 4.8 months). Serious infection and herpes zoster incidence rates were numerically higher with tofacitinib 10 versus 5 mg BID; overall, adverse event rates were generally similar between doses. Patients on tofacitinib 10 mg BID generally maintained modified Mayo score remission through M30 after reduction to 5 mg BID; most patients who relapsed recaptured remission after dose-escalating back to 10 mg BID. Efficacy was more likely to be maintained following dose reduction in patients with baseline endoscopic subscore 0 versus 1, without versus with prior TNFi failure. Serious infection and herpes zoster incidence was higher with tofacitinib 10 versus 5 mg BID, consistent with known safety profile. NCT03281304.