A Systematic Review of Safety and Immunogenicity of Influenza Vaccination Strategies in Solid Organ Transplant Recipients

Chong, Pearlie P.; Handler, Lara; Weber, David J.

doi:10.1093/cid/cix1081

Cited by 28 publications

(29 citation statements)

References 26 publications

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“…36 Influenza vaccine is well tolerated in SOT recipients, and adverse events to vaccination are usually mild and short lived. 41 Recent randomized controlled trials found increased immunogenicity in SOT recipients using a highdose vaccine or a booster strategy using two doses of the standard dose vaccine 5 weeks apart. 42,43 These approaches can be particularly used in case of an expected lower response to the vaccine due to en hanced immunosuppression.…”

Section: Prevention/prophylaxismentioning

confidence: 99%

RNA respiratory viral infections in solid organ transplant recipients: Guidelines from the American Society of Transplantation Infectious Diseases Community of Practice

Manuel

Estabrook

2019

Clinical Transplantation

148

117

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These updated guidelines from the Infectious Diseases Community of Practice of the American Society of Transplantation review the diagnosis, prevention, and management of RNA respiratory viral infections in the pre‐ and post‐transplant period. Viruses reviewed include influenza, respiratory syncytial virus (RSV), parainfluenza, rhinovirus, human metapneumovirus (hMPV), and coronavirus. Diagnosis is by nucleic acid testing due to improved sensitivity, specificity, broad range of detection of viral pathogens, automatization, and turnaround time. Respiratory viral infections may be associated with acute rejection and chronic lung allograft dysfunction in lung transplant recipients. The cornerstone of influenza prevention is annual vaccination and in some cases antiviral prophylaxis. Treatment with neuraminidase inhibitors and other antivirals is reviewed. Prevention of RSV is limited to prophylaxis with palivizumab in select children. Therapy of RSV upper or lower tract disease is controversial but may include oral or aerosolized ribavirin in some populations. There are no approved vaccines or licensed antivirals for parainfluenza, rhinovirus, hMPV, and coronavirus. Potential management strategies for these viruses are given. Future studies should include prospective trials using contemporary molecular diagnostics to understand the true epidemiology, clinical spectrum, and long‐term consequences of respiratory viruses as well as to define preventative and therapeutic measures.

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Section: Prevention/prophylaxismentioning

confidence: 99%

RNA respiratory viral infections in solid organ transplant recipients: Guidelines from the American Society of Transplantation Infectious Diseases Community of Practice

Manuel

Estabrook

2019

Clinical Transplantation

148

117

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“…Influenza vaccination can induce antibody mediated rejection by increasing donor specific anti-human leukocyte antigen (HLA) antibodies (DSA) ( 16 – 20 ). Recognition of donor HLA in the graft by recipient’s T cells can stimulate allograft rejection by the activation of a pro-inflammatory response that includes the activation of B cells producing DSA that can be associated with the development of chronic allograft injury ( 21 , 22 ). In addition, using strategies to increase vaccination efficacy (high-dose vaccines, booster doses, and adjuvanted vaccines) may contribute to increased allograft rejection and graft dysfunction.…”

Section: Introductionmentioning

confidence: 99%

Effect of Influenza Vaccination Inducing Antibody Mediated Rejection in Solid Organ Transplant Recipients

et al. 2020

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Introduction Our goal was to study whether influenza vaccination induced antibody mediated rejection in a large cohort of solid organ transplant recipients (SOTR). Methods Serum anti-Human Leukocyte Antigen (HLA) antibodies were determined using class I and class II antibody-coated latex beads (FlowPRA TM Screening Test) by flow cytometry. Anti-HLA antibody specificity was determined using the single-antigen bead flow cytometry (SAFC) assay and assignation of donor specific antibodies (DSA) was performed by virtual-crossmatch. Results We studied a cohort of 490 SOTR that received an influenza vaccination from 2009 to 2013: 110 (22.4%) received the pandemic adjuvanted vaccine, 59 (12%) within the first 6 months post-transplantation, 185 (37.7%) more than 6 months after transplantation and 136 (27.7%) received two vaccination doses. Overall, no differences of anti-HLA antibodies were found after immunization in patients that received the adjuvanted vaccine, within the first 6 months post-transplantation, or based on the type of organ transplanted. However, the second immunization dose increased the percentage of patients positive for anti-HLA class I significantly compared with patients with one dose (14.6% vs. 3.8%; P = 0.003). Patients with pre-existing antibodies before vaccination (15.7% for anti-HLA class I and 15.9% for class II) did not increase reactivity after immunization. A group of 75 (14.4%) patients developed de novo anti-HLA antibodies, however, only 5 (1.02%) of them were DSA, and none experienced allograft rejection. Only two (0.4%) patients were diagnosed with graft rejection with favorable outcomes and neither of them developed DSA. Conclusion Our results suggest that influenza vaccination is not associated with graft rejection in this cohort of SOTR.

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“…There were evidences that HSCT population could benefit from vaccination [35][36][37][38], and the latest recommendation was to start inactivated vaccines from 3 months after transplant [39]. However, a systematic review showed that seasonal inactivated influenza vaccine remained suboptimal in SOT recipients [40]. No consensus guidelines on influenza vaccination for patients with malignancies, but timing of vaccination was recommended more than two weeks before receiving chemotherapy or between chemotherapy cycles in order to enhance humoral responses [3].…”

Section: Discussionmentioning

confidence: 99%

Influenza infection in immunosuppressed patients: clinical characteristics, risk factors and effect of antiviral therapy

Liu

Wang

Chen

et al. 2020

Preprint

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Background: Influenza infection was a vital threat to immunosuppressed patients with longer viral shedding; however, data on these populations in China are still lacking. We analyzed clinical characteristics, risk factors for admission to intensive care unit (ICU) and death, and effect of antiviral therapy in these populations. Methods:We analyzed 73 immunosuppressed inpatients tested positive for influenza virus using reverse-transcription polymerase chain reaction during the 2018-2019 influenza season. Medical data were analyzed using descriptive statistics. Univariate analysis and multivariate logistics analysis were used to identify risk factors. Results:The most common immunosuppression type was malignancies with chemotherapy 73.9%(54/73), then hematopoietic stem cell transplantation 19.2% (14/73). The most common presenting symptom was fever in 91.8% (67/73) patients, then cough 59.6% (34/57) and muscular soreness 35.1% (20/57). Complications and co-infections were found in 38.4% (28/73) and 17.8% (13/73) patients respectively, which significantly prolonged the hospital stay. Antiviral treatment after 48 hours was significantly associated with admission to ICU, mechanical ventilation and death.Combination and double dose of neuraminidase inhibitors did not significantly reduce the admission to ICU and death. 15.1% (11/73) patients were admitted to ICU and 8.2% (6/73) patients died. Risk factors for admission to ICU were long symptom onset (OR 5.60, P=0.018) and co-infection with other infections (OR 68.66, P=0.019), and presence of dyspnea was independently associated with death (OR 48.00, P=0.003) through multivariate logistics analysis. Seasonal influenza vaccination in preceding 12 months only took up 2.7% (2/73).

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A Systematic Review of Safety and Immunogenicity of Influenza Vaccination Strategies in Solid Organ Transplant Recipients

Cited by 28 publications

References 26 publications

RNA respiratory viral infections in solid organ transplant recipients: Guidelines from the American Society of Transplantation Infectious Diseases Community of Practice

RNA respiratory viral infections in solid organ transplant recipients: Guidelines from the American Society of Transplantation Infectious Diseases Community of Practice

Effect of Influenza Vaccination Inducing Antibody Mediated Rejection in Solid Organ Transplant Recipients

Influenza infection in immunosuppressed patients: clinical characteristics, risk factors and effect of antiviral therapy

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