Serological response to influenza A H1N1 vaccine (Pandemrix®) and seasonal influenza vaccine 2009/2010 in renal transplant recipients and in hemodialysis patients

Abstract

In the present study, antibody response to seasonal influenza vaccination and to the adjuvanted one-shot influenza A H1N1 vaccine (Pandemrix(®)) was investigated in 57 hemodialysis (HD) patients and 48 renal transplant (RT) recipients. Specific antibodies were measured by hemagglutination inhibition (HI) test using a pandemic H1N1 strain and a seasonal H3N2 virus. HI titers of ≥1:40 were considered as protective. Hemodialysis patients showed seroprotection against pandemic H1N1 in 35.1%, against seasonal influenza in 36.8% and against both in 14.0%. In comparison, renal transplant recipients developed protective antibody titers against the pandemic H1N1 virus in 47.9%, against the seasonal H3N2 strain in 31.3% and against both in 18.8%. HD patients and renal transplant recipients younger than 60 years developed protective antibody response to the pandemic influenza H1N1 vaccine in 50.0% of the HD patients and 55.2% of the RT recipients and against seasonal influenza in 45.0/20.7% (HD/RT) of the cases. Patients aged ≥60 years showed seroprotection against pandemic influenza in 27.0/36.8% (HD/RT) and against seasonal influenza in 32.4/47.4% (HD/RT). Side effects were reported in only four patients. In hemodialysis patients and renal transplant recipients, vaccination against pandemic H1N1 and seasonal influenza is well tolerated. However, more than a half of these patients did not develop seroprotective antibody levels. Thus, new vaccines and altered vaccination regimes are likely necessary to achieve relevant antibody levels in these patient groups.

Prevalence of antibodies against influenza A and B viruses in children in Germany, 2008 to 2010

“…In children, the overall prevalence of antibodies to influenza A was 87.6%, reflecting the epidemiological dominance of seasonal and pandemic influenza A over influenza B between 2007 and 2010 in Germany [30][31][32], and assuming that antibodies persist at least six months after infection or vaccination [23]. The seroprevalence showed an age-dependent increase until the age of nine to 10 years, when nearly all children had developed antibodies against influenza A virus.…”

“…Testing of defined serum samples from children [2], newborns and their mothers [22] by several commercial ELISAs, including the haemagglutination inhibition assay [23], revealed sensitivities ≥97% and no crossreactivities between influenza A and B virus or to other viral pathogens for the ELISAs used in this study. Both ELISAs were carried out manually and used for qualitative and semi-quantitative antibody testing.…”

Influenza vaccination in patients with end-stage renal disease

“…In most of the cases, lower seroprotection and seroconversion rates and lower geometric mean antibody titers (GMT) were evidenced. This was observed with both TIV and pandemic vaccines, in adults and children, with whichever vaccine was used [57, [68][69][70]. A good example with respect to the use of the traditional TIV is provided by the study by Vogtländer et al, who found that TIV administration was associated with a fourfold rise in serum HI titers in significantly lower percentages of HD adult patients than in healthy controls (p < 0.05) [68].…”

Immunizations following solid-organ transplantation

“…In transplantation, there are limited data on adjuvanted seasonal influenza vaccine; however, an adjuvanted pandemic vaccine that used the ASO3 adjuvant system was widely used in the clinical setting and studied during the 2009 influenza A pandemic. In studies to date, adjuvanted pandemic influenza vaccine does not appear to have greater immunogenicity compared with standard vaccine [27][28][29][30][31]. High-dose vaccines containing four times the standard antigen have also become available and data suggest that these have improved efficacy in the older age groups [32]; however, there are no safety and immunogenicity data for this formulation in transplantation.…”