The immunogenicity of seasonal and pandemic influenza vaccination in autoimmune inflammatory rheumatic patients—a 6-month follow-up prospective study

Abstract

Introduction Influenza may cause severe complications in patients with autoimmune inflammatory rheumatic disease (AIRD), to whom vaccinations are especially recommended. However, AIRD patients require cautious scrutiny of immunogenicity as they might exhibit poor antibody response to vaccination, especially when taking immunomodulatory medications. Aim The aim was to determine immunogenicity of seasonal and pandemic influenza vaccine in AIRD patients, its timeline/ persistence, and influence of medications on immune response. Methods One hundred and thirty-seven AIRD and 54 healthy controls were vaccinated with trivalent seasonal influenza. After 3-5 weeks, 15 healthy controls and 93 AIRD were vaccinated with pandemic influenza vaccine, and 63 of patients were vaccinated a second time after 3-5 weeks. Sera were collected before vaccination, 18-90 days after each vaccination, and more than 180 days after the last vaccination. The immune response was measured using hemagglutination inhibition (HI) assay and IgG/IgA antibodies against influenza A/B with ELISA. Results Our findings indicate that following vaccination with seasonal influenza vaccine, seroprotection, seroresponse, and change in geometric mean titers (GMT) in AIRD patients was not compromised compared to healthy. Similarly, we report for pandemic influenza vaccination little added benefit of the second dose. We confirm lowest increase in HI titer in rituximab-treated AIRD compared to other medications. Vaccination largely tilts the balance from negative ELISA A IgG and IgA titers to positive titers in seasonal H1N1 seroresponsive AIRD patients and controls. A significant decrease in HI GMT and seroprotection was observed only in AIRD at > 180 days after vaccination highlighting an absent persistence of immunogenic response in AIRD patients. Due to high initial HI titers for influenza vaccine, we foresee their benefit in personalized medicine in the future. Conclusion Influenza vaccination is immunologically active for AIRD, with little value of the second dose of the pandemic vaccine and further scrutiny on persistence of immune response to vaccine in AIRD is needed.

An evidence-based guide to SARS-CoV-2 vaccination of patients on immunotherapies in dermatology

“…156 In patients exposed to rituximab, most studies found a reduced humoral response to pneumococcal, 101,112,115,[126][127][128]135,157 hepatitis B, 136 and influenza vaccination. 73,108,111,116,122,130,142,144 Rituximab exposure did not significantly affect humoral response to seasonal influenza vaccination in patients with autoimmune blistering disease. 104 Blauvelt et al 153 found that patients with moderate to severe atopic dermatitis treated with dupilumab did not have a decreased humoral response to meningococcal and tetanus/diphtheria/pertussis vaccination.…”

Impact of disease-modifying antirheumatic drugs on vaccine immunogenicity in patients with inflammatory rheumatic and musculoskeletal diseases

“…Rituximab [14][15][16][17][18][19][20][21] and MTX 14 22 23 reduce influenza vaccine immunogenicity. Abatacept likely impairs immunogenicity though data are limited.…”

Efficacy of inactivated vaccines in patients treated with immunosuppressive drug therapy

“…18 Several studies in patients with autoimmune diseases failed to show reduced immune response to influenza vaccination in patients on immunosuppressive therapy with corticosteroids and/ or DMARDs, TNF inhibitors, or IL-6 receptor antagonists compared with either healthy controls or patients not on immunotherapy. [68][69][70] For patients with autoimmune diseases on immunosuppressant therapy, the ability of influenza vaccination to induce an immune response depends on the type of drug therapy used for treatment.…”