Immunogenicity and safety of double versus standard dose of the seasonal influenza vaccine in solid-organ transplant recipients: A randomized controlled trial

Alternative-Dose versus Standard-Dose Trivalent Influenza Vaccines for Immunocompromised Patients: A Meta-Analysis of Randomised Control Trials

“…In total, 443 articles were identified in the initial literature search, and full-text reviews were conducted for 20 articles after abstract and title screening. Finally, eight articles [7,10,11,12,13,14,15,16] involving 1020 patients were included in the systematic review and meta-analysis (Figure 1).…”

“…Of the included articles, five trials were double-blind [7,11,13,14,15], and the others had an open-label design [10,12,16]. The present meta-analysis contained three phase I [11,13,15], three phase II [12,14,16] and two phase III trials [7,10] with relative good quality (Table 1 and Figure S1). The dominate influenza strains were A/H3N2 and A/H1N1 among the studies.…”

“…Though annual immunization with inactivated influenza vaccine has been recommended, the response to influenza vaccination in immunocompromised patients is heterogeneous and suboptimal, with strain-specific rates of seroprotection that range from 15 to 90% [6,7,8], generally lower than the response in immunocompetent individuals [9]. Therefore, various strategies to improve influenza vaccine immunogenicity responses have been attempted including two vaccine doses (booster) in the same influenza season [10] and high-dose vaccines (two- or four-fold dose) [7,11,12,13,14,15,16]; in a similar vein, these alternative ‘higher-dose’ influenza vaccination strategies have been developed to ameliorate serologic responses. The increase in serum antibody responses is expected to be correlated with an increase in vaccine immunogenicity responses [17].…”

Vaccinations in kidney transplant recipients: Clearing the muddy waters

“…Natori et al[16] showed significantly increased immunogenicity with high dose (60 mg) as compared to standard dose of influenza vaccine in SOT recipients. Since, high dose vaccine is not commercially available outside of North America, Mombelli et al[17] recently compared efficacy of double dose (30 mg) versus standard dose (15 mg) of inactivated trivalent influenza vaccine in SOT recipients and found a trend towards increased vaccine response and significantly higher rates of seroprotection with double dose, without any increase in vaccine-related serious adverse events. Another strategy that has been shown to be effective is to administer a booster dose five weeks after initial dose that led to significantly increased sero-conversion rates to all strains of influenza[18].…”

Estudo piloto randomizado controlado e aberto para avaliação da imunogenicidade e segurança de três esquemas de administração da vacina influenza trivalente em receptores de transplante renal

“…Também identificou-se a necessidade de tratar os títulos de anticorpos pré-vacinais como fator confundidor e corrigi-los na análise estatística com preferência para regressão logística(82).Estudos de vacinas de influenza mostram imunogenicidade reduzida e mais heterogênea em imunodeprimidos do que na população geral. Estima-se uma taxa média de resposta vacinal de 50% (variando de 10% a 90%) em receptores de TOS, em comparacão à taxas de aproximadamente 80-90% em adultos da populacão geral(84,85). com população predominantemente de adultos do sexo masculino (868 de 943 -92%), com 422 transplantes de rim, 229 de fígado, 181 de pulmão, 89 de coração, 21 múltiplos órgãos e um de intestino.…”