A Double-Blind, Randomized Trial of High-Dose vs Standard-Dose Influenza Vaccine in Adult Solid-Organ Transplant Recipients

Natori, Yoichiro; Shiotsuka, Mika; Slomovic, Jaclyn; Höschler, Katja; Ferreira, Victor H; Ashton, Peter D.; Rotstein, Coleman; Lilly, Les; Schiff, Jeffrey; Singer, Lianne G.; Humar, Atul; Kumar, Deepali

doi:10.1093/cid/cix1082

Cited by 148 publications

(151 citation statements)

References 27 publications

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“…The major findings of our study were as follows: (1) for influenza A, which is comparable with seroconversion rates after influenza vaccination in this population. [35][36][37][38][39] In addition, the poor HI antibody response in transplant recipients has important methodologic implications for epidemiologic studies. The fact that there is a hyporesponsive subpopulation among transplant recipients, which does not develop HI antibodies in response to influenza vaccination or to natural infection explains the difficulties that have been experienced so far in finding clearly superior alternative vaccine strategies compared to the standard vaccine.…”

Section: Discussionmentioning

confidence: 99%

Humoral response to natural influenza infection in solid organ transplant recipients

Hirzel

Ferreira

L'Huillier

et al. 2019

American Journal of Transplantation

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The humoral immune response of transplant recipients to influenza vaccination has been studied in detail. In contrast, the hemagglutinin inhibiting (HI) antibody response evoked by natural influenza infection and its impact on viral kinetics is unknown. In this prospective, multicenter, cohort study of natural influenza infection in transplant recipients, we measured HI antibody titers at presentation and 4 weeks later. Serial nasopharyngeal viral loads were determined using a quantitative influenza A polymerase chain reaction (PCR). We analyzed 196 transplant recipients with influenza infection. In the cohort of organ transplant patients with influenza A (n = 116), seropositivity rates for strain‐specific antibodies were 44.0% (95% confidence interval [CI] 31.5‐53.2%) at diagnosis and 64.7% (95% CI 55.4‐72.9%) 4 weeks postinfection. Seroconversion was observed in 32.8% (95% CI 24.7‐41.9%) of the cases. Lung transplant recipients were more likely to seroconvert (P = .002) and vaccine recipients were less likely to seroconvert (P = .024). A subset of patients (n = 30) who were unresponsive to prior vaccination were also unresponsive to natural infection. There was no correlation between viral kinetics and antibody response. This study provides novel data on the seroresponse to influenza infection in transplant patients and its relationship to a number of parameters including a prior vaccination status, virologic measures, and clinical variables.

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Section: Discussionmentioning

confidence: 99%

Humoral response to natural influenza infection in solid organ transplant recipients

Hirzel

Ferreira

L'Huillier

et al. 2019

American Journal of Transplantation

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“…Intradermal IV-A/B vaccine does not appear to result in improved protection responses in lung transplant recipients and is therefore not preferred over standard injectable vaccine (92). Use of high-dose vaccines has been associated with improved seroconversion and higher postimmunization geometric mean titers (93,94). Whether or not high-dose vaccines should indeed be preferred requires larger, preferably multicenter studies.…”

Section: Carv-specific Aspects In Transplant Patients Influenza Virusesmentioning

confidence: 99%

Community-Acquired Respiratory Viruses in Transplant Patients: Diversity, Impact, Unmet Clinical Needs

2019

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SUMMARY Patients undergoing solid-organ transplantation (SOT) or allogeneic hematopoietic cell transplantation (HCT) are at increased risk for infectious complications. Community-acquired respiratory viruses (CARVs) pose a particular challenge due to the frequent exposure pre-, peri-, and posttransplantation. Although influenza A and B viruses have a top priority regarding prevention and treatment, recent molecular diagnostic tests detecting an array of other CARVs in real time have dramatically expanded our knowledge about the epidemiology, diversity, and impact of CARV infections in the general population and in allogeneic HCT and SOT patients. These data have demonstrated that non-influenza CARVs independently contribute to morbidity and mortality of transplant patients. However, effective vaccination and antiviral treatment is only emerging for non-influenza CARVs, placing emphasis on infection control and supportive measures. Here, we review the current knowledge about CARVs in SOT and allogeneic HCT patients to better define the magnitude of this unmet clinical need and to discuss some of the lessons learned from human influenza virus, respiratory syncytial virus, parainfluenzavirus, rhinovirus, coronavirus, adenovirus, and bocavirus regarding diagnosis, prevention, and treatment.

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“…In fact, clinical evidence of influenza-inactivated vaccine effectiveness after allo-HSCT is very limited [16]. Strategies based on an influenza vaccine with a higher antigen dose [17], multiple vaccine doses [18], or adjuvanted vaccines [19] might improve immune responses, although no controlled trials have been performed.…”

mentioning

confidence: 99%

Clinical Effectiveness of Influenza Vaccination After Allogeneic Hematopoietic Stem Cell Transplantation: A Cross-sectional, Prospective, Observational Study

Piñana

Pérez

Montoro

et al. 2018

Clinical Infectious Diseases

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A Double-Blind, Randomized Trial of High-Dose vs Standard-Dose Influenza Vaccine in Adult Solid-Organ Transplant Recipients

Abstract: NCT03139565.

Cited by 148 publications

References 27 publications

Humoral response to natural influenza infection in solid organ transplant recipients

Humoral response to natural influenza infection in solid organ transplant recipients

Community-Acquired Respiratory Viruses in Transplant Patients: Diversity, Impact, Unmet Clinical Needs

Clinical Effectiveness of Influenza Vaccination After Allogeneic Hematopoietic Stem Cell Transplantation: A Cross-sectional, Prospective, Observational Study

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