Two Doses of Inactivated Influenza Vaccine Improve Immune Response in Solid Organ Transplant Recipients: Results of TRANSGRIPE 1–2, a Randomized Controlled Clinical Trial

Cordero, Elisa; Roca-Oporto, Cristina; Bulnes-Ramos, Ángel; Aydillo, Teresa; Gavaldá, Joan; Moreno, Asunción; Torre-Cisneros, J; Montejo, José Miguel; Fortün, Jesús; Muñóz, Patricia; Sabé, N.; Fariñas, María Carmen; Blanes-Julia, Marino; López‐Medrano, Francisco; Suárez-Benjumea, Alejandro; Martínez‐Atienza, Juliana; Rosso-Fernández, Clara; Pérez‐Romero, Pilar

doi:10.1093/cid/ciw855

Cited by 97 publications

(107 citation statements)

References 36 publications

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“…The major findings of our study were as follows: (1) for influenza A, which is comparable with seroconversion rates after influenza vaccination in this population. [35][36][37][38][39] In addition, the poor HI antibody response in transplant recipients has important methodologic implications for epidemiologic studies. The fact that there is a hyporesponsive subpopulation among transplant recipients, which does not develop HI antibodies in response to influenza vaccination or to natural infection explains the difficulties that have been experienced so far in finding clearly superior alternative vaccine strategies compared to the standard vaccine.…”

Section: Discussionmentioning

confidence: 99%

Humoral response to natural influenza infection in solid organ transplant recipients

Hirzel

Ferreira

L'Huillier

et al. 2019

American Journal of Transplantation

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The humoral immune response of transplant recipients to influenza vaccination has been studied in detail. In contrast, the hemagglutinin inhibiting (HI) antibody response evoked by natural influenza infection and its impact on viral kinetics is unknown. In this prospective, multicenter, cohort study of natural influenza infection in transplant recipients, we measured HI antibody titers at presentation and 4 weeks later. Serial nasopharyngeal viral loads were determined using a quantitative influenza A polymerase chain reaction (PCR). We analyzed 196 transplant recipients with influenza infection. In the cohort of organ transplant patients with influenza A (n = 116), seropositivity rates for strain‐specific antibodies were 44.0% (95% confidence interval [CI] 31.5‐53.2%) at diagnosis and 64.7% (95% CI 55.4‐72.9%) 4 weeks postinfection. Seroconversion was observed in 32.8% (95% CI 24.7‐41.9%) of the cases. Lung transplant recipients were more likely to seroconvert (P = .002) and vaccine recipients were less likely to seroconvert (P = .024). A subset of patients (n = 30) who were unresponsive to prior vaccination were also unresponsive to natural infection. There was no correlation between viral kinetics and antibody response. This study provides novel data on the seroresponse to influenza infection in transplant patients and its relationship to a number of parameters including a prior vaccination status, virologic measures, and clinical variables.

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Section: Discussionmentioning

confidence: 99%

Humoral response to natural influenza infection in solid organ transplant recipients

Hirzel

Ferreira

L'Huillier

et al. 2019

American Journal of Transplantation

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“…At present, a clinical trial of vaccines administered bi-yearly in older adults is underway (: NCT02655874). The benefit of two-dose influenza vaccines has been shown under somewhat different circumstances in studies of solid organ transplant recipients where a second influenza vaccine dose after 5 weeks resulted in higher rates of seroconversion and seroprotection (defined as titer ≥1:40) (211). Frail older adults who were non-responders to an initial dose of influenza vaccine showed a decline in antibody titers to the A/H3N2 strain following a booster dose of influenza vaccine and derived no clinical benefit from this booster strategy (212).…”

Section: Alterations To Vaccine Designmentioning

confidence: 99%

Impact of Aging and Cytomegalovirus on Immunological Response to Influenza Vaccination and Infection

et al. 2017

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The number of people over the age of 60 is expected to double by 2050 according to the WHO. This emphasizes the need to ensure optimized resilience to health stressors in late life. In older adults, influenza is one of the leading causes of catastrophic disability (defined as the loss of independence in daily living and self-care activities). Influenza vaccination is generally perceived to be less protective in older adults, with some studies suggesting that the humoral immune response to the vaccine is further impaired in cytomegalovirus (CMV)-seropositive older people. CMV is a β-herpes virus infection that is generally asymptomatic in healthy individuals. The majority of older adults possess serum antibodies against the virus indicating latent infection. Age-related changes in T-cell-mediated immunity are augmented by CMV infection and may be associated with more serious complications of influenza infection. This review focuses on the impact of aging and CMV on immune cell function, the response to influenza infection and vaccination, and how the current understanding of aging and CMV can be used to design a more effective influenza vaccine for older adults. It is anticipated that efforts in this field will address the public health need for improved protection against influenza in older adults, particularly with regard to the serious complications leading to loss of independence.

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“…To investigate the role of a booster influenza dose in improving influenza vaccine effectiveness in SOT patients, a Spanish multicenter collaborative study enrolled 499 adult SOT recipients to receive either 1 seasonal influenza vaccine dose or 2 doses separated by 5 weeks . Study subjects were liver, kidney, heart, or lung recipients ≥16 years of age at the time of enrollment in the 2012‐2013 influenza season.…”

Section: Influenzamentioning

confidence: 99%

“…Study subjects were liver, kidney, heart, or lung recipients ≥16 years of age at the time of enrollment in the 2012‐2013 influenza season. Per protocol analysis demonstrated significantly higher rates of seroconversion and seroprotection for booster recipients compared to single‐dose recipients at 10 weeks post–initial influenza vaccine . Notably, no differences were present between the 2 groups at 1 year following vaccination.…”

Section: Influenzamentioning

confidence: 99%

Vaccines in pediatric transplant recipients—Past, present, and future

Dulek

Maurice

Halasa

2018

Pediatric Transplantation

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Infections significantly impact outcomes for solid organ and hematopoietic stem cell transplantation in children. Vaccine-preventable diseases contribute to morbidity and mortality in both early and late posttransplant time periods. Several infectious diseases and transplantation societies have published recommendations and guidelines that address immunization in adult and pediatric transplant recipients. In many cases, pediatric-specific studies are limited in size or quality, leading to recommendations being based on adult data or mixed adult-pediatric studies. We therefore review the current state of evidence for selected immunizations in pediatric transplant recipients and highlight areas for future investigation. Specific attention is given to studies that enrolled only children.

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Two Doses of Inactivated Influenza Vaccine Improve Immune Response in Solid Organ Transplant Recipients: Results of TRANSGRIPE 1–2, a Randomized Controlled Clinical Trial

Abstract: EudraCT (2011-003243-21).

Cited by 97 publications

References 36 publications

Humoral response to natural influenza infection in solid organ transplant recipients

Humoral response to natural influenza infection in solid organ transplant recipients

Impact of Aging and Cytomegalovirus on Immunological Response to Influenza Vaccination and Infection

Vaccines in pediatric transplant recipients—Past, present, and future

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