Immunogenicity of trivalent influenza vaccines in patients with chronic kidney disease undergoing hemodialysis: MF59-adjuvanted versus non-adjuvanted vaccines

Noh, Ji Yun; Song, Joon Young; Choi, Won Suk; Jacob, Louis; Seo, Yu Bin; Kwon, Young Joo; Ko, Gang Jee; Ryong, Dae; Kang, Young Sun; Lee, Young Ki; Cheong, Hee Jin; Kim, Woo Joo

doi:10.1080/21645515.2016.1191717

Cited by 28 publications

(27 citation statements)

References 22 publications

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“…As with hepatitis B vaccines, the use of various adjuvants (like MF59‐FLUA, AS02‐ or AS04c) increase seroconversion rates compared to the nonadjuvanted ones in various groups of ESRD patients from various countries. In a comparative study of an adjuvanted vs a nonadjuvanted trivalent vaccine against influenza, the seroconversion rate of all 3 vaccine strains at 1 month postvaccination was significantly higher in the MF59‐adjuvanted group than in the nonadjuvanted group (47.7% vs 17.4%, A/H1N1; 42.0% vs 16.3%, A/H3N2; 31.8% vs 7.0%, B, P < .01) . Similar results have been shown in other equivalent studies …”

Section: Influenzasupporting

confidence: 86%

Vaccination practices in dialysis patients: A narrative review

Kosmadakis

Albaret

Correia

et al. 2018

Seminars in Dialysis

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In a period of turmoil concerning vaccination practices, there is a serious conflict between scientifically reasonable, evidence-based guidelines and the far-fetched rumors or misconceptions concerning the vaccination practices in the general population. When a significant portion of the medical and paramedical personnel may be deliberately unvaccinated against common biological agents, achieving effective vaccination rates in the dialysis population may be complicated. Vaccination rates are unacceptably low in dialysis patients and seroconversion rates are even lower; further, serological follow-up is generally poor. The particularly anergic immune system of the advanced chronic kidney disease patients is partly a cause of both high rates of infection and low rates of seroconversions. This narrative review is an effort to summarize current knowledge concerning the vaccination practices in dialysis patients with some specific recommendations based on these facts. Of particular interest is a new vaccine, the Zoster Recombinant, Adjuvanted Vaccine (Shingrix), which we will include in our discussion.

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Section: Influenzasupporting

confidence: 86%

Vaccination practices in dialysis patients: A narrative review

Kosmadakis

Albaret

Correia

et al. 2018

Seminars in Dialysis

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“…The CDC reports similar vaccine effectiveness in successive years (47% versus 40%, respectively); virulence has not, as of yet, been reported for 2016-2017 (21). We had postulated that the effect of the high-dose vaccine would be greater in older individuals in light of a number of studies that have shown a decline in the seroresponse to the influenza vaccine with age (7,13,15,22). Although the magnitude of reduced risk of high-dose versus standard dose vaccine with hospitalization was larger in the $65 versus ,65-year-old age groups in both influenza seasons, an interaction of age with vaccine type was not statistically significant.…”

Section: Discussionmentioning

confidence: 96%

“…Adjuvanted vaccines contain a high purified protein (e.g., squalene or tocopherol) that stimulates the immune response, and they have an advantage over the high-dose vaccine of being able to be produced in large quantities relatively quickly, because they do not require as much influenza antigen. Studies in the dialysis population have shown a greater seroresponse to an adjuvanted influenza vaccine compared with the standard dose vaccine (9,22,29,30), although no study has assessed effects on clinical outcomes (22). A comparison of adjuvanted and high-dose vaccines has also not been done in the dialysis population or the general population.…”

Section: Discussionmentioning

confidence: 99%

High-Dose Seasonal Influenza Vaccine in Patients Undergoing Dialysis

Miskulin

Weiner

Tighiouart

et al. 2018

CJASN

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Background and objectives High-dose influenza vaccine, which contains fourfold more antigen than standard dose, is associated with fewer cases of influenza and less influenza-related morbidity in the elderly general population. Whether the high-dose influenza vaccine benefits patients on dialysis, whose immune response to vaccination is less robust than that of healthy patients, is uncertain. Design, setting, participants, & measurements We compared hospitalizations and deaths during the 2015-2016 and 2016-2017 influenza seasons by vaccine type (standard trivalent, standard quadrivalent, and high-dose trivalent influenza vaccine) administered within a national dialysis organization. The association of vaccine type with outcomes was estimated using Cox proportional hazards regression with adjustment for patient factors and "center effect." Analyses were stratified by age and dialysis modality. Results Between September 1 and December 31, 2015, standard dose trivalent, standard dose quadrivalent, and high-dose trivalent influenza vaccines were administered to 3057 (31%), 5981 (61%), and 805 (8%) patients, respectively. The adjusted rates of first hospitalizations by vaccine type during the influenza season were 8.43, 7.88, and 7.99 per 100 patient-months, respectively, and the adjusted rates of death were 1.00, 0.97, and 1.04, respectively. These differences were not significant. In 2016, 3614 (39%) received quadrivalent vaccine, and 5700 (61%) received high-dose trivalent vaccine. The adjusted rates of first hospitalization by vaccine type were 8.71 and 8.04 per 100 patient-months, respectively, and the adjusted rates of death were 0.98 and 1.02, respectively. Receipt of high dose was associated with a significant reduction in hospitalization (hazard ratio, 0.93; 95% confidence interval, 0.86 to 1.00; P=0.04); there was no significant association with death. There was no significant heterogeneity of either association by age group or dialysis modality.

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“…43 For example, immunity resulting from single-dose vaccines may wane before the end of an influenza season, leading to suggestions that patients on dialysis should receive high-dose or adjuvanted influenza vaccines. 44,45 Given that vaccines have not been developed for the majority of viruses responsible for ILI, the nephrology community should expect at most a modest benefit from any dialysis population-wide influenza vaccination program, as well as supporting future efforts to explore the immune response to vaccinations in such patients.…”

Section: Discussionmentioning

confidence: 99%

Excess Deaths Attributable to Influenza-Like Illness in the ESRD Population

Gilbertson

Rothman

Chertow

et al. 2019

JASN

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Background Morbidity and mortality vary seasonally. Timing and severity of influenza seasons contribute to those patterns, especially among vulnerable populations such as patients with ESRD. However, the extent to which influenza-like illness (ILI), a syndrome comprising a range of potentially serious respiratory tract infections, contributes to mortality in patients with ESRD has not been quantified.Methods We used data from the Centers for Disease Control and Prevention (CDC) Outpatient Influenzalike Illness Surveillance Network and Centers for Medicare and Medicaid Services ESRD death data from 2000 to 2013. After addressing the increasing trend in deaths due to the growing prevalent ESRD population, we calculated quarterly relative mortality compared with average third-quarter (summer) death counts. We used linear regression models to assess the relationship between ILI data and mortality, separately for quarters 4 and 1 for each influenza season, and model parameter estimates to predict seasonal mortality counts and calculate excess ILI-associated deaths.Results An estimated 1% absolute increase in quarterly ILI was associated with a 1.5% increase in relative mortality for quarter 4 and a 2.0% increase for quarter 1. The average number of annual deaths potentially attributable to ILI was substantial, about 1100 deaths per year.Conclusions We found an association between community ILI activity and seasonal variation in all-cause mortality in patients with ESRD, with ILI likely contributing to .1000 deaths annually. Surveillance efforts, such as timely reporting to the CDC of ILI activity within dialysis units during influenza season, may help focus attention on high-risk periods for this vulnerable population.

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Immunogenicity of trivalent influenza vaccines in patients with chronic kidney disease undergoing hemodialysis: MF59-adjuvanted versus non-adjuvanted vaccines

Abstract: The MF59-adjuvanted influenza vaccine showed better immunogenicity than the non-adjuvanted influenza vaccine in CKD patients undergoing HD.

Cited by 28 publications

References 22 publications

Vaccination practices in dialysis patients: A narrative review

Vaccination practices in dialysis patients: A narrative review

High-Dose Seasonal Influenza Vaccine in Patients Undergoing Dialysis

Excess Deaths Attributable to Influenza-Like Illness in the ESRD Population

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