Humoral and cellular immune responses to influenza vaccination in children with cancer receiving chemotherapy

Abstract

Abstract. The immune response to influenza vaccination in children with cancer is controversial. The objective of this study was to characterize the cellular and humoral immune responses to an influenza vaccine in children with cancer who were receiving chemotherapy. In this study, children with cancer, who were not previously immunized, received an influenza vaccine via intramuscular injection. Blood samples were obtained prior to and at 4 weeks after immunization. Antibodies were measured using a hemagglutination inhibition (HI) assay. Cell-mediated immunity was measured by specific lymphoproliferation with 3 H-thymidine incorporation and by measuring cell frequencies following staining with monoclonal antibodies (CD8, CD4, CD19, CD45RA and CD27) using flow cytometry following incubation with the influenza antigen for 5 days. Geometric mean titers (GMT), mean counts per minute (cpm), cell frequencies prior to and following vaccination and percentage patient responses were compared using the Mann-Whitney non-parametric U and Chi-square tests; where p<0.05 was considered to indicate a statistically significant result. A total of 56 children were included. Their mean age was 6.64±3.61 years. Acute lymphoblastic leukemia (ALL) was diagnosed in 75, solid tumors in 23 and lymphoma in 2% of the children. Subjects with titers ≥40 hemagglutination units (HU) increased from 43% prior to vaccination to 73% following vaccination (p=0.01), whereas the GMT increased from 31.35 [95% confidence interval (CI), 29-111] to 143.45 HU (95% CI, 284-640) following vaccination (p<0.001). An increase in CD45RA expression in CD8 + T cells was observed following vaccination (p=0.01). An increase in CD27 expression was observed in the CD4/8-negative cell population stimulated with the influenza antigen following vaccination (p<0.05). No serious adverse effects were observed. An increase in the seropositivity rate and GMT values following influenza vaccination were also observed. Influenza immunization was well tolerated among these children with cancer and increased the humoral and cellular immune responses with the activation of probable lymphoid precursors. IntroductionThe influenza virus is a pathogen that causes respiratory disease in humans and has the potential to cause epidemics and pandemics (1). During the 1918 pandemic, 40-50 million individuals succumbed to the disease globally (2). During the 2009 pandemic, 17,483 mortalities were reported to the World Health Organization with an estimate of 200 million H1N1 influenza cases worldwide for December 2010 (3). In the United States, influenza is more frequent in winter and is associated with 36,000 mortalities annually (4). In Mexico, influenza has been associated with 7-12% of respiratory infections in certain areas (5,6).Influenza infection is characterized by sudden respiratory symptoms (fever, myalgia, headache, coughing, pharyngeal aching and rhinitis) (7). The uncomplicated disease improves within 3-7 days. However, in certain individuals with risk factors, complications may...

Immune response to influenza vaccination in children with cancer

“…In line with previous reports, influenza vaccine was shown to be well tolerated with a low reactogenicity rate. 7,8,12,16 However, immunogenicity results are not comparable in all previous studies. 6,9 Patients recruited in different studies differ with regard to cancer type and treatment status.…”

“…11 Furthermore, there is a variety concerning the type of vaccine that has been administered and the dosage or the number of doses used. 7,8,[10][11][12][16][17][18][19][20][21][22][23][24][25][26][27] The related studies were also conducted during different influenza seasons. To our knowledge, four studies have evaluated the use of trivalent inactivated vaccine in patients with various types of cancer as in our study.…”

“…To our knowledge, four studies have evaluated the use of trivalent inactivated vaccine in patients with various types of cancer as in our study. Previous studies have shown a range of pre-vaccination seroprotective rates from 27%-43% for H1N1, 20%-68% for H3N2 and 0-31% for B 7,8,12,23 . In our cohort, pre-vaccination seroprotective rates were 52% for H1N1, 49% for H3N2, and 39% for B strain confirming that pre-vaccination seroprotective rates were higher for influenza viruses H1N1 and H3N2 than for B.…”

“…[8][9][10][11] To date, no major concerns regarding the safety of influenza vaccines have been reported. 7,8,12 Nevertheless, concerns regarding the effectiveness of influenza immunization in children with cancer may explain the low compliance rate in this population. 13,14 However, we have previously reported high compliance rates from our center over the 2009-2012 influenza seasons with an increasing rate from 87 to 95%.…”

Influenza A/H1N1 in Pediatric Oncology Patients

“…8 Overall, in previous reports, influenza A/H1N1 infections in pediatric oncology patients were mild in most cases but was associated with substantial morbidity in a proportion of patients, especially in those who received intensive immunosuppressive therapy or when anti-influenza treatment was delayed. [13][14][15][16] However, influenza vaccination within the first 6 months following bone marrow transplantation (BMT) was ineffective. [13][14][15][16] However, influenza vaccination within the first 6 months following bone marrow transplantation (BMT) was ineffective.…”