Humoral immune response and delayed type hypersensitivity to influenza vaccine in patients with diabetes mellitus

Abstract

Summary.The antibody response and delayed type hypersensitivity reaction to commercially available trivalent influenza vaccine in 159 patients with diabetes mellitus was compared with response and reaction in 28 healthy volunteers. A correction for prevaccination titres was made. No differences were found between diabetic patients and control subjects with respect to antibody response to the three vaccine strains as measured by the difference between geometric mean titres of post-and prevaccination sera. In Type 1 (insulin-dependent) diabetic patients the incidence of non-responders to two vaccine components was significantly increased (p< 0.05). The delayed type hypersensitivity reaction to influenza antigen was significantly decreased in patients with high concentrations of glycosylated haemoglobin (p<0.01). These findings suggest a role for impaired immune response in the increased influenza morbidity and mortality in patients with diabetes mellitus. Implications for therapy and vaccination strategy are discussed.

Common infections in diabetes: pathogenesis, management and relationship to glycaemic control

“…The clinical relevance of these observations is unclear since the antibody response and protection after vaccination against the common infections, influenza, pneumococcal infection and hepatitis B show adequate responses in patients with diabetes [35][36][37][38][39][40][41][42][43][44]. Thus, we support the recommendation that adult diabetic patients receive the influenza vaccine before every epidemic season and the polysaccharide pneumococcal vaccine on one occasion followed by a booster at 5 years [45][46][47][48][49].…”

“…Diabetic patients have a sixfold higher relative risk of hospitalisation than non-diabetic individuals during influenza epidemics [45]. This observation might reflect an increased incidence of secondary staphylococcal pneumonia [45], but metabolic compromise and the high prevalence of co-morbid conditions, such as cardiac failure, are also important [89].…”

Influenza Vaccination and Risk of Incident Myocardial Infarction

“…22 Because persons with diabetes mellitus may have an impaired antibody response to the influenza vaccine, the efficacy of the vaccine may be diminished in this group. 31,32 Nonetheless, this impaired response would not seem to be a likely basis for an increased risk of incident MI during months when influenza activity is expected to be high among diabetics who were vaccine recipients in this study and a review of the current medical literature does not provide any plausible mechanism for the association of influenza vaccination with an increased risk of MI among persons with diabetes mellitus. Residual confounding may explain these findings, as it is possible that among persons with diabetes mellitus, those at higher risk of cardiac events were more likely to have received influenza vaccine.…”

Reduced protection against hepatitis B virus following vaccination in patients with Type 1 (insulin-dependent) diabetes

“…In the case of a secondary immune response (as might be the case with vaccination with influenza virus or a multiple antigenic challenge like the Multitest) a memory T cell is responsible for the expansion of a clone of sensitised lymphocytes and this process does not require, as does the primary response, a normal CD4/CD8 lymphocyte ratio [17]. This may explain our finding that in diabetic patients a normal antibody titre is generated following the influenza vaccine [9] but not the B hepatitis vaccine. Poor metabolic control may cause impaired immune responses in diabetic patients [18]; but this was not the case in our study since all patients were well controlled throughout the period of follow-up, suggesting that the primary defect is immunological.…”

“…Antigenic challenges in vivo using the trivalent influenza vaccine have shown normal antibody titres [8] or slightly impaired response in patients with high levels of glycosylated haemoglobin [9]; furthermore, an intradermal test using various antigens to evaluate the delayed hypersensitivity response was normal in the majority of diabetic patients [10]. In vivo studies of the immune response may therefore give a better indication as to whether secondary immunodeficiency is a feature of patients with diabetes of long duration.…”