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Furlong E, Kotecha RS. Lessons learnt from influenza vaccination in immunocompromised children undergoing treatment for cancer. THE LANCET. CHILD & ADOLESCENT HEALTH 2023; 7:199-213. [PMID: 36706776 DOI: 10.1016/s2352-4642(22)00315-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 10/27/2022] [Accepted: 10/28/2022] [Indexed: 01/26/2023]
Abstract
Influenza infection contributes substantially to global morbidity and mortality, with children undergoing treatment for cancer among the most vulnerable due to immunosuppression associated with disease and treatment. However, influenza remains one of the most common vaccine-preventable diseases. Despite international guidelines recommending inactivated influenza vaccination on the basis of data supporting efficacy and an excellent safety profile in this population, uptake has often been suboptimal due to persisting hesitancy among both patients and oncologists regarding the ability of the vaccine to mount a sufficient immune response, the optimal vaccine schedule and timing, and the best method to assess response in immunocompromised populations. In this Review, we discuss the evidence regarding influenza vaccination in children with cancer, factors that influence response, and highlight strategies to optimise vaccination. Host immune factors play a substantial role, thus principles learnt from influenza vaccination can be broadly applied for the use of inactivated vaccines in children with cancer.
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Affiliation(s)
- Eliska Furlong
- Department of Clinical Haematology, Oncology, Blood and Marrow Transplantation, Perth Children's Hospital, Perth, WA, Australia; Leukaemia Translational Research Laboratory, Telethon Kids Cancer Centre, Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
| | - Rishi S Kotecha
- Department of Clinical Haematology, Oncology, Blood and Marrow Transplantation, Perth Children's Hospital, Perth, WA, Australia; Leukaemia Translational Research Laboratory, Telethon Kids Cancer Centre, Telethon Kids Institute, University of Western Australia, Perth, WA, Australia; Curtin Medical School, Curtin University, Perth, WA, Australia.
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Mikulska M, Cesaro S, de Lavallade H, Di Blasi R, Einarsdottir S, Gallo G, Rieger C, Engelhard D, Lehrnbecher T, Ljungman P, Cordonnier C. Vaccination of patients with haematological malignancies who did not have transplantations: guidelines from the 2017 European Conference on Infections in Leukaemia (ECIL 7). THE LANCET. INFECTIOUS DISEASES 2019; 19:e188-e199. [PMID: 30744964 DOI: 10.1016/s1473-3099(18)30601-7] [Citation(s) in RCA: 81] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 08/21/2018] [Accepted: 09/18/2018] [Indexed: 12/28/2022]
Abstract
Patients with haematological malignancies are at high risk of infection because of various mechanisms of humoral and cell-mediated immune deficiencies, which mainly depend on underlying disease and specific therapies. Some of these infections are vaccine preventable. However, these malignancies are different from each other, and the treatment approaches are diverse and rapidly evolving, so it is difficult to have a common programme for vaccination in a haematology ward. Additionally, because of insufficient training about the topic, vaccination is an area often neglected by haematologists, and influenced by cultural differences, even among health-care workers, in compliance to vaccines. Several issues are encountered when addressing vaccination in haematology: the small size of the cohorts that makes it difficult to show the clinical benefits of vaccination, the subsequent need to rely on biological parameters, their clinical pertinence not being established in immunocompromised patients, scarcity of clarity on the optimal timing of vaccination in complex treatment schedules, and the scarcity of data on long-term protection in patients receiving treatments. Moreover, the risk of vaccine-induced disease with live-attenuated vaccines strongly limits their use. Here we summarise guidelines for patients without transplantations, and address the issue by the haematological group-myeloid and lymphoid-of diseases, with a special consideration for children with acute leukaemia.
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Affiliation(s)
- Malgorzata Mikulska
- University of Genoa (DISSAL) and IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Simone Cesaro
- Pediatric Hematology Oncology Unit, Department of Mother and Child, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Hugues de Lavallade
- Deparment of Haematological Medicine, King's College Hospital NHS Foundation Trust, London, UK
| | - Roberta Di Blasi
- Haematology Department, Henri Mondor Hospital, Assistance Publique-Hopitaux de Paris, Créteil, France
| | - Sigrun Einarsdottir
- Section of Hematology, Department of Medicine, Sahlgrenska University Hospital, Sahlgrenska Academy, Göteborg, Sweden
| | - Giuseppe Gallo
- Pediatric Hematology Oncology Unit, Department of Mother and Child, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Christina Rieger
- Department of Hematology Oncology, University of Munich, Germering, Germany
| | - Dan Engelhard
- Department of Pediatrics, Hadassah-Hebrew University Medical Center, Ein-Kerem Jerusalem, Israel
| | - Thomas Lehrnbecher
- Paediatric Haematology and Oncology Department, Hospital for Children and Adolescents, University of Frankfurt, Frankfurt, Germany
| | - Per Ljungman
- Department of Cellular Therapy and Allogenenic Stem Cell Transplantation, Karolinska University Hospital, Stockholm, Sweden; Karolinska Institutet, Stockholm, Sweden
| | - Catherine Cordonnier
- Haematology Department, Henri Mondor Hospital, Assistance Publique-Hopitaux de Paris, Créteil, France; University Paris-Est Créteil, Créteil, France.
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Doganis D, Kafasi A, Dana H, Spanakis N, Baka M, Pourtsidis A, Sdogou T, Vintila A, Rafailidou V, Chantzi P, Servitzoglou M, Bouhoutsou D, Varvoutsi M, Kosmidis H, Tsolia M. Immune response to influenza vaccination in children with cancer. Hum Vaccin Immunother 2018; 14:2310-2317. [PMID: 29708816 DOI: 10.1080/21645515.2018.1470734] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
The aim of this study was to evaluate the ability of influenza immunization to evoke a protective immune response among children with cancer. We evaluated 75 children with cancer who received influenza vaccination. Hemagglutination Inhibition Antibody titers were determined before and after vaccination. The protective rates after vaccination were 79% for H1N1, 75% for H3N2 and 59% for influenza B virus whereas the seroconversion rates were 54%, 44% and 43% respectively. The differences pre- and post-vaccination were significant regardless the method which was used: seroprotection changes, seroconversion and geometric mean titers analyses. Variables such as the pre-vaccination antibody titers, the time when the responses were measured after the vaccination, the age and the type of malignancy as well as the absolute lymphocyte count were found to be correlated with the immune response but the findings were different for each vaccine subunit. In conclusion, influenza vaccination provides protection in a remarkable proportion of pediatric cancer patients whereas this protection is more obvious against H1N1 and H3N2 compared to influenza B. The immune response after vaccination is significant and seems to be influenced by a variety of factors.
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Affiliation(s)
- Dimitrios Doganis
- a Oncology Department , P & A Kyriakou Children's Hospital , Athens , Greece
| | - Athanasia Kafasi
- b Department of Microbiology , National and Kapodistrian University of Athens (NKUA), School of Medicine , Athens , Greece
| | - Helen Dana
- a Oncology Department , P & A Kyriakou Children's Hospital , Athens , Greece
| | - Nikolaos Spanakis
- b Department of Microbiology , National and Kapodistrian University of Athens (NKUA), School of Medicine , Athens , Greece
| | - Margarita Baka
- a Oncology Department , P & A Kyriakou Children's Hospital , Athens , Greece
| | | | - Triantafyllia Sdogou
- c Second Department of Paediatrics , National and Kapodistrian University of Athens (NKUA), School of Medicine, P. and A. Kyriakou Children's hospital , Athens , Greece
| | - Artemis Vintila
- c Second Department of Paediatrics , National and Kapodistrian University of Athens (NKUA), School of Medicine, P. and A. Kyriakou Children's hospital , Athens , Greece
| | - Vaia Rafailidou
- a Oncology Department , P & A Kyriakou Children's Hospital , Athens , Greece
| | - Panagiota Chantzi
- a Oncology Department , P & A Kyriakou Children's Hospital , Athens , Greece
| | - Marina Servitzoglou
- a Oncology Department , P & A Kyriakou Children's Hospital , Athens , Greece
| | - Despina Bouhoutsou
- a Oncology Department , P & A Kyriakou Children's Hospital , Athens , Greece
| | - Maria Varvoutsi
- a Oncology Department , P & A Kyriakou Children's Hospital , Athens , Greece
| | - Helen Kosmidis
- a Oncology Department , P & A Kyriakou Children's Hospital , Athens , Greece
| | - Maria Tsolia
- c Second Department of Paediatrics , National and Kapodistrian University of Athens (NKUA), School of Medicine, P. and A. Kyriakou Children's hospital , Athens , Greece
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Influenza and Pneumococcal Vaccination in Hematological Malignancies: a Systematic Review of Efficacy, Effectiveness, and Safety. Mediterr J Hematol Infect Dis 2016; 8:e2016044. [PMID: 27648207 PMCID: PMC5016013 DOI: 10.4084/mjhid.2016.044] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 08/15/2016] [Indexed: 12/13/2022] Open
Abstract
Background The risk of getting influenza and pneumococcal disease is higher in cancer patients, and serum antibody levels tend to be lower in patients with hematological malignancy. Objective To assess flu and pneumococcal vaccinations efficacy, effectiveness, and safety in onco-hematological patients. Methods Two systematic reviews and possible meta-analysis were conducted to summarize the results of all primary study in the scientific literature about the flu and pneumococcal vaccine in onco-hematological patients. Literature searches were performed using Pub-Med and Scopus databases. StatsDirect 2.8.0 was used for the analysis. Results 22 and 26 studies were collected respectively for flu and pneumococcal vaccinations. Protection rate of booster dose was 30% (95% CI=6–62%) for H1N1. Pooled prevalence protection rate of H3N2 and B was available for meta-analysis only for first dose, 42.6% (95% CI=23.2 – 63.3 %) and 39.6 % (95% CI=26%–54.1%) for H3N2 and B, respectively. Response rate of booster dose resulted 35% (95% CI=19.7–51.2%) for H1N1, 23% (95% CI=16.6–31.5%) for H3N2, 29% (95% CI=21.3–37%) for B. Conclusion Despite the low rate of response, flu, and pneumococcal vaccines are worthwhile for patients with hematological malignancies. Patients undergoing chemotherapy in particular rituximab, splenectomy, transplant recipient had lower and impaired response. No serious adverse events were reported for both vaccines.
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Ide Y, Imamura Y, Ohfuji S, Fukushima W, Ide S, Tsutsumi C, Koga M, Maeda K, Hirota Y. Immunogenicity of a monovalent influenza A(H1N1)pdm09 vaccine in patients with hematological malignancies. Hum Vaccin Immunother 2015; 10:2387-94. [PMID: 25424946 DOI: 10.4161/hv.29094] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Patients with hematological malignancies have high risk for morbidity and mortality from influenza. This study was conducted to evaluate the immunogenicity and reactogenicity of an influenza A(H1N1)pdm09 vaccine among such subjects. Fifty subjects were vaccinated twice during the 2009-2010 season. The antibody response was expressed in terms of mean fold rise (MFR) of geometric mean titer, seroresponse proportion (sR), and seroprotection proportion (sP). The first vaccination induced only a small response, and additional antibody was acquired after the second dose (MFR 2.3 and 3.9, sR 32% and 54%, and sP 30% and 48% after the first and the second vaccination, respectively). Rituximab treatment showed an especially inhibitory effect (MFR 1.3, sR 9% and sP 0%). When analyzed using logistic regression models, only rituximab was found to have an independent effect; the adjusted odds ratio for sR was 0.09 (P = 0.05). Influenza vaccination of patients with hematological malignancies resulted in adepuate response, and the second vaccination induced additional antibody. It is therefore recommended to vaccinate this group twice.
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Affiliation(s)
- Yuichiro Ide
- a Department of Public Health; Osaka City University Graduate School of Medicine; Osaka, Japan
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Havers F, Fry A, Peacock G, Finelli L. Influenza vaccination and treatment in children with neurologic disorders. THERAPEUTIC ADVANCES IN VACCINES 2014; 2:95-105. [PMID: 24982759 PMCID: PMC4063242 DOI: 10.1177/2051013613519217] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Influenza viruses cause substantial morbidity in children each year, especially among children with specific chronic conditions. In particular, neurologic disorders have emerged as a strong risk factor for influenza-related complications. Children with these disorders may be vulnerable due to diminished respiratory muscle strength, decreased muscle tone or impaired mobility, which can compromise pulmonary function and the ability to handle secretions. Although they represent a small fraction of the general pediatric population, children with neurologic disorders make up a disproportionately high number of those children who are hospitalized and die as a result of influenza-associated complications. Annual vaccination is the most effective way to prevent influenza and its complications, and is recommended for all children 6 months through 18 years of age, including children with neurologic disorders. Family members and those who work with these children in institutional, educational and daycare settings should also be vaccinated against influenza annually. However, there have been few studies of influenza vaccination specifically in this population. In addition, vaccine effectiveness may vary from year to year and vaccination will not prevent all infections. Early empiric antiviral treatment should be started promptly in these children if they present to healthcare providers with symptoms suspicious for influenza. This article reviews influenza epidemiology in children with neurologic disorders and what is known about vaccines and other methods of protecting this vulnerable population from influenza-related complications.
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Affiliation(s)
- Fiona Havers
- MHS Influenza Division, Centers for Disease Control and Prevention, 1600 Clifton Road NE, MS A-32, Atlanta, GA 30333, USA
| | - Alicia Fry
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Georgina Peacock
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Lyn Finelli
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Ottóffy G, Horváth P, Muth L, Sólyom A, Garami M, Kovács G, Nyári T, Molnár D, Pauler G, Jankovics I. Immunogenicity of a 2009 pandemic influenza virus A H1N1 vaccine, administered simultaneously with the seasonal influenza vaccine, in children receiving chemotherapy. Pediatr Blood Cancer 2014; 61:1013-6. [PMID: 24395342 DOI: 10.1002/pbc.24893] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Accepted: 11/12/2013] [Indexed: 11/07/2022]
Abstract
BACKGROUND No examination of simultaneous vaccination against pandemic H1N1 and the seasonal influenza virus strains, in children with cancer receiving chemotherapy, are yet published. We investigated the immunogenicity of a whole-virion, inactivated, adjuvanted pandemic H1N1, and seasonal influenza vaccines administered simultaneously to children with cancer undergoing chemotherapy. PROCEDURE We prospectively enrolled 27 pediatric patients receiving therapy for various types of cancer. All received influenza vaccination once in a seasonal risk period. We checked hemaglutination-inhibition (HAI) antibody titers in the sera of patients before, and 21-28 days after vaccination. Seroprotective titer was defined as an antibody titer ≥ 40, and seroresponse as ≥ 4-fold increase in antibody titers after vaccination. RESULTS The pre- and post-vaccination seroprotective rates were H1N1: 33-48%, H3N2: 56-78%, B: 0-15% for seasonal influenza, and for pandemic H1N1: 15-37%. The seroresponse rates for seasonal influenza H1N1, H3N2, and B were 22%, 37%, and 22%, respectively, and 30% for the pandemic H1N1 vaccine. CONCLUSIONS Whole-virion, inactivated, adjuvanted vaccine for the pandemic H1N1 Influenza A virus and the seasonal influenza vaccines were found safe and partially immunogenic in children with cancer receiving chemotherapy. The only determinants of responsiveness were lymphocyte count and serum immunoglobulin-G. Only influenza B vaccine elicited significant differences in differences in pre- and post-vaccination seroprotective rates. The response to vaccination for pandemic H1N1 is as effective as other vaccines, however administration of a single vaccine during chemotherapy is more comfortable for pediatric cancer patients.
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Affiliation(s)
- Gábor Ottóffy
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Faculty of Medicine, University of Pécs, Pécs, Hungary
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Kersun LS, Reilly A, Coffin SE, Boyer J, Luning Prak ET, McDonald K, Hou X, Jawad AF, Sullivan KE. A prospective study of chemotherapy immunologic effects and predictors of humoral influenza vaccine responses in a pediatric oncology cohort. Influenza Other Respir Viruses 2013; 7:1158-67. [PMID: 23199016 PMCID: PMC4634289 DOI: 10.1111/irv.12058] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Pediatric oncology patients represent a cohort of individuals uniquely at risk of complications from influenza, yet less likely to respond to the vaccine. It is not yet clear how to best protect this vulnerable population. METHODS We performed a prospective analysis of 177 pediatric oncology patients to define the predictors of influenza vaccine responses. Each variable was examined over three time points and a repeated measure analysis was performed. RESULTS Patients with ALL vaccinated during induction phase had superior influenza vaccine responses than those subjects vaccinated during post-induction or maintenance phases (P=0·0237). Higher aggregate HAI titer responses were associated with a higher baseline B-cell count (P=0·0240), and higher CD4 and CD8 influenza-specific T-cell responses, suggesting prior antigen exposure is a significant contributor. The solid tumor cohort had equivalent responses during all time frames of chemotherapy. DISCUSSION The optimal protection from influenza of pediatric patients on chemotherapy should include vaccination, but it is clear that not all patients produce high titers of antibodies after vaccination. This study identified biomarkers that could be used to individualize vaccine approaches. Immunologic predictors might have a role in targeting resources, as B-cell counts predicted of vaccine responses among the patients with ALL.
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Affiliation(s)
- Leslie S. Kersun
- Division of Oncology, Department of Pediatrics, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Anne Reilly
- Division of Oncology, Department of Pediatrics, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Susan E. Coffin
- Division of Infectious Diseases, Department of Pediatrics, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jean Boyer
- Abramson Cancer Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Eline T. Luning Prak
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Kenyetta McDonald
- Division of Allergy Immunology, Department of Pediatrics, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Xiaoling Hou
- Department of Pediatrics, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Abbas F. Jawad
- Department of Pediatrics, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Kathleen E. Sullivan
- Division of Allergy Immunology, Department of Pediatrics, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
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Leahy TR, Smith OP, Bacon CL, Storey L, Lynam P, Gavin PJ, Butler KM, O'Marcaigh AS. Does vaccine dose predict response to the monovalent pandemic H1N1 influenza a vaccine in children with acute lymphoblastic leukemia? A single-centre study. Pediatr Blood Cancer 2013; 60:1656-61. [PMID: 23682005 DOI: 10.1002/pbc.24589] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2013] [Accepted: 04/09/2013] [Indexed: 02/01/2023]
Abstract
BACKGROUND Vaccination against influenza is an important strategy in preventing severe infection among children with acute lymphoblastic leukemia (ALL). Successful vaccination depends on both vaccine and host-related factors. We conducted a study on factors predicting the immunogenicity of the monovalent pandemic H1N1 (pH1N1) influenza A vaccine in children with ALL. METHODS Children with ALL in our hospital were recruited and received two doses of the inactivated split-virion AS03-adjuvanted vaccine. The serological response was measured before each vaccine dose (Day 0 and 28) and 3 months after the second dose. Antibody titres were measured using a hemagglutination-inhibition assay. Seroconversion was defined as a ≥fourfold increase in antibody titre and a post-vaccination titre ≥1:40. RESULTS Pre and post-vaccination titres were available from 45 children with ALL after one dose of the vaccine and 39 children after two doses. The seroconversion rate was 11.1% after one dose and 25.6% after the second dose. Univariate analysis demonstrated a significantly higher (P = 0.01) seroconversion rate among children who received the adult dose (0.5 ml) of the vaccine and a trend towards increased seroconversion (P = 0.07) by multivariate analysis. Factors including age, gender, lymphocyte count, treatment phase and regimen did not significantly affect the seroconversion rate. Children who received the adult dose demonstrated a significantly greater magnitude of serological response after both one dose (P = 0.04) and two doses (P = 0.001). CONCLUSIONS These data suggest that the immunogenicity of the pH1N1 vaccine among children with ALL is improved by repeated and adult doses of the vaccine.
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Affiliation(s)
- T Ronan Leahy
- Department of Paediatric Infectious Diseases and Immunology, Our Lady's Children's Hospital, Crumlin, Dublin, Ireland.
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Campos LMA, Silva CA, Aikawa NE, Jesus AA, Moraes JCB, Miraglia J, Ishida MA, Bueno C, Pereira RMR, Bonfa E. High Disease Activity: An Independent Factor for Reduced Immunogenicity of the Pandemic Influenza A Vaccine in Patients With Juvenile Systemic Lupus Erythematosus. Arthritis Care Res (Hoboken) 2013; 65:1121-7. [DOI: 10.1002/acr.21948] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2012] [Accepted: 12/21/2012] [Indexed: 12/24/2022]
Affiliation(s)
| | - Clovis A. Silva
- Faculdade de Medicina da Universidade de São Paulo; Sao Paulo; Brazil
| | - Nadia E. Aikawa
- Faculdade de Medicina da Universidade de São Paulo; Sao Paulo; Brazil
| | - Adriana A. Jesus
- Faculdade de Medicina da Universidade de São Paulo; Sao Paulo; Brazil
| | | | - Joao Miraglia
- Instituto Butantan, Fundação Butantan; Sao Paulo; Brazil
| | | | - Cleonice Bueno
- Faculdade de Medicina da Universidade de São Paulo; Sao Paulo; Brazil
| | | | - Eloisa Bonfa
- Faculdade de Medicina da Universidade de São Paulo; Sao Paulo; Brazil
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Abstract
Vaccination of immunocompromised patients is challenging both regarding efficacy and safety. True efficacy data are lacking so existing recommendations are based on immune responses and safety data. Inactivated vaccines can generally be used without risk but the patients who are most at risk for infectious morbidity and mortality as a result of their severely immunosuppressed state are also those least likely to respond to vaccination. However, vaccination against pneumococci, Haemophilus influenzae and influenza are generally recommended. Live vaccines must be used with care because the risk for vaccine-associated disease exists.
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Affiliation(s)
- Per Ljungman
- Department of Haematology, Karolinska University Hospital, Division of Haematology, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden.
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12
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Doganis D, Tsolia M, Dana H, Bouhoutsou D, Pourtsidis A, Baka M, Varvoutsi M, Servitzoglou M, Kosmidis H. Compliance with immunization against H1N1 influenza virus among children with cancer. Pediatr Hematol Oncol 2013; 30:149-53. [PMID: 23301621 DOI: 10.3109/08880018.2012.753961] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
In this report, we describe the experience with immunization against pandemic influenza A H1N1 in children with cancer treated at a pediatric oncology department during the pandemic season (2009). According to the guidelines, vaccination of all children with cancer receiving chemotherapy as well as those who had completed treatment was scheduled. Among the 140 children who were eligible for immunization, 122 were immunized, achieving a compliance rate of 87% despite negative publicity and low vaccine uptake in the general population. The vaccine was tolerated and none of the vaccinated children developed influenza. It is concluded that high immunization rates can be achieved among pediatric oncology patients.
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Affiliation(s)
- Dimitrios Doganis
- Pediatric Oncology Department, P. & A. Kyriakou Children's Hospital, University of Athens, Athens, Greece.
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13
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Kersun LS, Reilly AF, Coffin SE, Sullivan KE. Protecting pediatric oncology patients from influenza. Oncologist 2013; 18:204-11. [PMID: 23370325 PMCID: PMC3579605 DOI: 10.1634/theoncologist.2012-0401] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2012] [Accepted: 01/10/2013] [Indexed: 01/14/2023] Open
Abstract
Influenza is a common respiratory pathogen. Its severity can be unpredictable, but people with chronic illness are at increased risk of severe infection, complications, and death from influenza. This review examines evidence to support various strategies to protect pediatric oncology patients from influenza-related morbidity. Influenza vaccination should be considered standard. Additional evidence-supported measures include antiviral treatment, antiviral prophylaxis, cohorting of patients, and hospital infection control measures. Data from other high-risk populations support the vaccination of family members, double-dose or high-dose vaccination, and the use of barrier methods. These measures have the potential to optimize patient outcomes because there will be fewer treatment interruptions for acute illness. These strategies can also protect patients from prolonged hospitalizations and morbidity related to influenza.
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Affiliation(s)
| | | | | | - Kathleen E. Sullivan
- Allergy Immunology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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14
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Engelhard D, Mohty B, de la Camara R, Cordonnier C, Ljungman P. European guidelines for prevention and management of influenza in hematopoietic stem cell transplantation and leukemia patients: summary of ECIL-4 (2011), on behalf of ECIL, a joint venture of EBMT, EORTC, ICHS, and ELN. Transpl Infect Dis 2013; 15:219-32. [DOI: 10.1111/tid.12054] [Citation(s) in RCA: 80] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2012] [Revised: 11/19/2012] [Accepted: 11/23/2012] [Indexed: 12/22/2022]
Affiliation(s)
| | - B. Mohty
- Department of Hematology; Geneva University Hospital; Geneva; Switzerland
| | - R. de la Camara
- Department of Hematology; University Hospital La Princesa; Madrid; Spain
| | - C. Cordonnier
- Department of Hematology; Henri Mondor Teaching Hospital; Assistance Publique-Hopitaux de Paris and Paris Est-Créteil University; Créteil; France
| | - P. Ljungman
- Department of Haematology; Karolinska University Hospital and Division of Haematology; Department of Medicine; Karolinska Institutet/Huddinge; Stockholm; Sweden
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15
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Vaccination of immunocompromised hosts. Vaccines (Basel) 2013. [DOI: 10.1016/b978-1-4557-0090-5.00016-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] Open
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16
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Abstract
BACKGROUND The hemato-oncology community has been seriously concerned about the H1N1 pandemic of 2009. Here, we report on the evaluation of the immunogenicity and tolerability of H1N1v monovalent vaccines in young patients with cancer during this pandemic. PROCEDURE Between December 7, 2009 and February 26, 2010, 20 children receiving chemotherapy for solid tumors at the Institute of Hematology and Pediatric Oncology of Lyon, were immunized by 2 doses of either AS03-adjuvanted or nonadjuvanted vaccine. The level of specific antibodies was assessed at D21 and D42. RESULTS Seroconversion was observed in 13 of the 20 cases (65%), and 18 of 20 cases (90%) had protective titers after the 2 doses. Exploratory univariate analysis failed to show a significant influence of prevaccination lymphocyte counts on seroresponse rates. CONCLUSIONS These data suggest that H1N1v monovalent vaccines were well tolerated by young cancer patients while on chemotherapy and achieved protective immune response in most cases.
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Effectiveness of the monovalent AS03-adjuvanted influenza A(H1N1)pdm09 vaccine against hospitalization in children because of influenza. Vaccine 2012; 30:5699-702. [PMID: 22819987 DOI: 10.1016/j.vaccine.2012.07.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2012] [Revised: 07/02/2012] [Accepted: 07/10/2012] [Indexed: 11/21/2022]
Abstract
We studied the effectiveness of the AS03-adjuvanted monovalent vaccine (Pandemrix(®)) for the prevention of severe pandemic influenza A(H1N1)pdm09 in children, in 2009. All children hospitalized for influenza-like illness in Stockholm County during the peak of the pandemic were included. We compared the frequency of vaccinated children between influenza A(H1N1)pdm09 PCR positive cases and PCR negative controls in a retrospective case-control study. 95 cases and 177 controls were identified. About half of the children in both groups were between 6 months and 2 years of age. Only 1/95 (1%) cases had been vaccinated more than 14 days prior to admission, compared to 23/177 controls (13%), corresponding to a vaccine effectiveness, adjusted for co-morbid conditions, of 91% (95% confidence interval [CI] 30-99). In contrast, the risk for being a case was significantly higher among children vaccinated between 1 and 14 days prior to hospitalization, than among those who were non-vaccinated 13/95 vs. 7/177 (OR 3.6, 95% CI 1.4-9.5). We conclude that a single dose of adjuvanted vaccine was highly protective against hospitalization for influenza A(H1N1)pdm09 in children 6 month to 17 years. The reason for the increased rate of hospitalizations with confirmed influenza in children just following immunization is unclear and should be studied further.
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18
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Abstract
Influenza causes substantial morbidity in children in the United States each year. The 2009 influenza A (H1N1) pandemic disproportionately affected the pediatric population and resulted in a substantially increased number of hospitalizations and deaths among children. Early influenza antiviral treatment reduces the duration of illness, frequency of complications, antibiotic use, and health care utilization costs attributable to influenza. A comprehensive strategy to reduce influenza-associated hospitalizations and deaths among children should include empiric antiviral treatment for suspected or confirmed influenza of any severity in children who are hospitalized; who have severe, complicated, or progressive illness; or who are at high risk for influenza complications. Here, we summarize data on the burden of influenza among children in the United States, the indications for influenza antiviral treatment among children, the available evidence for influenza antiviral treatment, and antiviral treatment considerations, including resistance and adverse events.
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19
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Abstract
In English literature, there are only 2 specific series of pandemic H1N1 influenza infection in children with leukemia. To increase knowledge about pandemic influenza in children with leukemia and better understand the risk factors for severe disease, we have presented the clinical characteristics of 8 children with acute leukemia and pandemic influenza treated at our center. The mean age of the children (4 girls and 4 boys) was 6.7±2.0 years (range, 4 to 10 y). All these children [3 acute lymphoblastic leukemia and 5 acute myeloid leukemia (AML) cases] were receiving chemotherapy during the course of infection, except 1 who was found to be H1N1 positive at the same time that she was diagnosed with AML. Among the other 7 patients undergoing chemotherapy, 4 were receiving induction, 1 was receiving consolidation, and 2 were undergoing maintenance chemotherapy. In our series, 1 patient with AML had a fatal course. She had recently received a chemotherapy bloc. Her neutrophil count was 0 during the course of H1N1 infection. She developed acute respiratory distress syndrome within a short time after the symptoms commenced and she died within 4 days. In conclusion, the clinical course of H1N1 infection may be fatal in rare cases of leukemic children receiving chemotherapy. Thus, vaccination is advisable for all leukemic children, especially for those under maintenance chemotherapy, as it might be life saving during such pandemics.
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Beck CR, McKenzie BC, Hashim AB, Harris RC, Zanuzdana A, Agboado G, Orton E, Béchard-Evans L, Morgan G, Stevenson C, Weston R, Mukaigawara M, Enstone J, Augustine G, Butt M, Kim S, Puleston R, Dabke G, Howard R, O'Boyle J, O'Brien M, Ahyow L, Denness H, Farmer S, Figureroa J, Fisher P, Greaves F, Haroon M, Haroon S, Hird C, Isba R, Ishola DA, Kerac M, Parish V, Roberts J, Rosser J, Theaker S, Wallace D, Wigglesworth N, Lingard L, Vinogradova Y, Horiuchi H, Peñalver J, Nguyen-Van-Tam JS. Influenza vaccination for immunocompromised patients: systematic review and meta-analysis from a public health policy perspective. PLoS One 2011; 6:e29249. [PMID: 22216224 PMCID: PMC3245259 DOI: 10.1371/journal.pone.0029249] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2011] [Accepted: 11/23/2011] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Immunocompromised patients are vulnerable to severe or complicated influenza infection. Vaccination is widely recommended for this group. This systematic review and meta-analysis assesses influenza vaccination for immunocompromised patients in terms of preventing influenza-like illness and laboratory confirmed influenza, serological response and adverse events. METHODOLOGY/PRINCIPAL FINDINGS Electronic databases and grey literature were searched and records were screened against eligibility criteria. Data extraction and risk of bias assessments were performed in duplicate. Results were synthesised narratively and meta-analyses were conducted where feasible. Heterogeneity was assessed using I(2) and publication bias was assessed using Begg's funnel plot and Egger's regression test. Many of the 209 eligible studies included an unclear or high risk of bias. Meta-analyses showed a significant effect of preventing influenza-like illness (odds ratio [OR]=0.23; 95% confidence interval [CI]=0.16-0.34; p<0.001) and laboratory confirmed influenza infection (OR=0.15; 95% CI=0.03-0.63; p=0.01) through vaccinating immunocompromised patie nts compared to placebo or unvaccinated controls. We found no difference in the odds of influenza-like illness compared to vaccinated immunocompetent controls. The pooled odds of seroconversion were lower in vaccinated patients compared to immunocompetent controls for seasonal influenza A(H1N1), A(H3N2) and B. A similar trend was identified for seroprotection. Meta-analyses of seroconversion showed higher odds in vaccinated patients compared to placebo or unvaccinated controls, although this reached significance for influenza B only. Publication bias was not detected and narrative synthesis supported our findings. No consistent evidence of safety concerns was identified. CONCLUSIONS/SIGNIFICANCE Infection prevention and control strategies should recommend vaccinating immunocompromised patients. Potential for bias and confounding and the presence of heterogeneity mean the evidence reviewed is generally weak, although the directions of effects are consistent. Areas for further research are identified.
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Affiliation(s)
- Charles R Beck
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, United Kingdom.
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Yen TY, Jou ST, Yang YL, Chang HH, Lu MY, Lin DT, Lin KH, Huang LM, Chang LY. Immune response to 2009 pandemic H1N1 influenza virus A monovalent vaccine in children with cancer. Pediatr Blood Cancer 2011; 57:1154-8. [PMID: 21425448 DOI: 10.1002/pbc.23113] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2010] [Accepted: 02/08/2011] [Indexed: 11/06/2022]
Abstract
PURPOSE This study investigated the immune response to 2009 pandemic H1N1 influenza monovalent vaccine in children with cancer receiving chemotherapy. METHODS We enrolled 25 pediatric patients. Ten patients younger than 10 years old received two vaccinations and the remaining 15 patients older than 10 years old received one. We checked hemagglutination-inhibition (HAI) antibody titers in sera of patients before and 3-4 weeks after vaccination. Seroprotective titer was defined as HAI antibody titer ≥ 40 and seroresponse as ≥ 4-fold increase in HAI antibody titers after vaccination. RESULTS The pre- and post-vaccination seroprotective rates were 52% and 72% (P = 0.24). Sixteen (64%) patients were possibly exposed to 2009 pandemic H1N1 influenza previously, and there was significant association between possible exposure and pre-vaccination seroprotective rate (P = 0.03). Post-vaccination seroresponse rate was 32%, and seroresponse was greater in patients without pre-vaccination seroprotective titer than those with pre-vaccination seroprotective titer (50% vs. 15%, P = 0.07). Children with lymphocyte counts above 1,500/µl during vaccination period had better seroresponse than those with lymphocyte counts below 1,500/µl (P = 0.008). Post-vaccination geometric mean titer (GMT) significantly increased in patients younger than 10 years receiving two vaccinations (pre- and post-vaccination GMT were 21.4 and 60.6, respectively; P = 0.025). CONCLUSIONS Monovalent vaccine for the 2009 pandemic H1N1 influenza A was found to be partially immunogenic in children with cancer, as evidenced by 32% of seroresponse rate. Immune response can be improved with vaccinations administered to patients whose absolute lymphocyte counts returned to a level of 1,500/µl or higher.
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Affiliation(s)
- Ting-Yu Yen
- Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
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Aikawa NE, Campos LMA, Silva CA, Carvalho JF, Saad CGS, Trudes G, Duarte A, Miraglia JL, Timenetsky MDCS, Viana VST, França ILA, Bonfa E, Pereira RMR. Glucocorticoid: major factor for reduced immunogenicity of 2009 influenza A (H1N1) vaccine in patients with juvenile autoimmune rheumatic disease. J Rheumatol 2011; 39:167-73. [PMID: 22089462 DOI: 10.3899/jrheum.110721] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVE To assess the immunogenicity and safety of non-adjuvanted influenza A H1N1/2009 vaccine in patients with juvenile autoimmune rheumatic disease (ARD) and healthy controls, because data are limited to the adult rheumatologic population. METHODS A total of 237 patients with juvenile ARD [juvenile systemic lupus erythematosus (JSLE), juvenile idiopathic arthritis (JIA), juvenile dermatomyositis (JDM), juvenile scleroderma, and vasculitis] and 91 healthy controls were vaccinated. Serology for anti-H1N1 was performed by hemagglutination inhibition assay. Seroprotection rate, seroconversion rate, and factor-increase in geometric mean titer (GMT) were calculated. Adverse events were evaluated. RESULTS Age was comparable in patients and controls (14.8 ± 3.0 vs 14.6 ± 3.7 years, respectively; p = 0.47). Three weeks after immunization, seroprotection rate (81.4% vs 95.6%; p = 0.0007), seroconversion rate (74.3 vs 95.6%; p < 0.0001), and the factor-increase in GMT (12.9 vs 20.3; p = 0.012) were significantly lower in patients with juvenile ARD versus controls. Subgroup analysis revealed reduced seroconversion rates in JSLE (p < 0.0001), JIA (p = 0.008), JDM (p = 0.025), and vasculitis (p = 0.017). Seroprotection (p < 0.0001) and GMT (p < 0.0001) were decreased only in JSLE. Glucocorticoid use and lymphopenia were associated with lower seroconversion rates (60.4 vs 82.9%; p = 0.0001; and 55.6 vs 77.2%; p = 0.012). Multivariate logistic regression including diseases, lymphopenia, glucocorticoid, and immunosuppressants demonstrated that only glucocorticoid use (p = 0.012) remained significant. CONCLUSION This is the largest study to demonstrate a reduced but adequate immune response to H1N1 vaccine in patients with juvenile ARD. It identified current glucocorticoid use as the major factor for decreased antibody production. The short-term safety results support its routine recommendation for patients with juvenile ARD. ClinicalTrials.gov; NCT01151644.
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Affiliation(s)
- Nadia E Aikawa
- Faculdade de Medicina da Universidade de São Paulo, Disciplina de Reumatologia, Av. Dr. Arnaldo 455, Cerqueira César, Sao Paulo, SP, Brazil 01246-903
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23
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Abstract
During the 2009 influenza A (H1N1) pandemic several pandemic H1N1 vaccines were licensed using fast track procedures, with relatively limited data on the safety in children and adolescents. Different extensive safety monitoring efforts were put in place to ensure timely detection of adverse events following immunization. These combined efforts have generated large amounts of data on the safety of the different pandemic H1N1 vaccines, also in children and adolescents. In this overview we shortly summarize the safety experience with seasonal influenza vaccines as a background and focus on the clinical and post marketing safety data of the pandemic H1N1 vaccines in children. We identified 25 different clinical studies including 10,505 children and adolescents, both healthy and with underlying medical conditions, between the ages of 6 months and 23 years. In addition, large monitoring efforts have resulted in large amounts of data, with almost 13,000 individual case reports in children and adolescents to the WHO. However, the diversity in methods and data presentation in clinical study publications and publications of spontaneous reports hampered the analysis of safety of the different vaccines. As a result, relatively little has been learned on the comparative safety of these pandemic H1N1 vaccines - particularly in children. It should be a collective effort to give added value to the enormous work going into the individual studies by adhering to available guidelines for the collection, analysis, and presentation of vaccine safety data in clinical studies and to guidance for the clinical investigation of medicinal products in the pediatric population. Importantly the pandemic has brought us the beginning of an infrastructure for collaborative vaccine safety studies in the EU, USA and globally.
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Meier S, Bel M, L'huillier A, Crisinel PA, Combescure C, Kaiser L, Grillet S, Pósfay-Barbe K, Siegrist CA. Antibody responses to natural influenza A/H1N1/09 disease or following immunization with adjuvanted vaccines, in immunocompetent and immunocompromised children. Vaccine 2011; 29:3548-57. [PMID: 21419775 DOI: 10.1016/j.vaccine.2011.02.094] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2011] [Revised: 02/10/2011] [Accepted: 02/26/2011] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To compare antibody responses elicited by influenza A/H1N1/09 disease and immunization with adjuvanted vaccines, in immunocompetent or immunocompromised children. STUDY DESIGN Prospective parallel cohort field study enrolling children with confirmed influenza A/H1N1/09 disease or immunized with 1 (immunocompetent) or 2 (immunocompromised) doses of influenza A/H1N1/09 squalene-based AS03- or MF59-adjuvanted vaccines. Antibody geometric mean titers (GMT) were measured by hemagglutination inhibition (HAI) and microneutralization (MN) assays 4-6 weeks after vaccination/disease. Vaccine adverse events were self-recorded in a 7-day diary. RESULTS Antibody titers were as high in 48 immunocompetent children after a single immunization (HAI and MN seroprotection rates: 98%; HAI-GMT: 395, MN-GMT: 370) as in 51 convalescent children (seroprotection rates: 98% (HAI) and 92% (MN); GMT: 350 (HAI) and 212 (MN). Twenty-seven immunocompromised children reached slightly lower seroprotection rates (HAI: 89%, MN: 85%) but similar antibody titers (HAI-GMT: 306, MN-GMT: 225) after 2 immunizations. Adverse events increased with age (P=0.01) and were more frequent with Pandemrix® than Focetria® (P=0.03). CONCLUSIONS Similarly high seroresponses may be expected in immunocompetent children after a single dose of adjuvanted vaccines as responses of convalescent children. Two vaccine doses were sufficient for most immunocompromised children. TRIAL REGISTRATION NCT0102293 and NCT01022905.
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Affiliation(s)
- Sara Meier
- Center for Vaccinology and Neonatal Immunology, Department of Pediatrics and Pathology-Immunology, University Hospitals of Geneva & Faculty of Medicine, University of Geneva, Switzerland
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