Serological response to influenza vaccine after hematopoetic stem cell transplantation

Abstract

Vaccination is the best strategy to prevent influenza infection that is a potential cause of morbidity and mortality in immunosuppressed patients. Here, we evaluated the factors that may affect serological response to influenza vaccine in patients who have undergone hematopoetic stem cell transplantation (HSCT). Sixty-one HSCT recipients were included in the study during the 2007-2008 influenza season. Serum samples prior to vaccination and 6-10 weeks after vaccination were collected. Samples were assayed for antibodies to influenza virus A/H1N1, A/H3N2, and B strains by hemagglutination-inhibition assay. The patients were followed in terms of clinical symptoms up to the next influenza season and for adverse effects within a month after vaccination. Overall, pre-vaccine seroprotection rate against all vaccine antigens (A/H1N1, A/H3N2, and B antigens) was 45.1%, post-vaccine seroprotection rate 91% and seroconversion rate was 28.3%. Seroconversion rates were found to be low against B in patients who were vaccinated in the late influenza season (p = 0.018; respectively). Five patients (10.9%) had no immune response against H1N1. Adverse events were reported in 19.6% (n = 9/46) of the patients. In conclusion, the patients should be vaccinated as early as possible in the influenza season, before they are exposed to the virus.

Seroprotective Titers against 2009 H1N1 Influenza A Virus after Vaccination in Allogeneic Hematopoietic Stem Cell Transplantation Recipients

“…The variable rate of seasonal trivalent influenza vaccination in our cohort (39% in 2009, 37.8% in 2008, 20.7% in 2007, and 13.4% in 2006) makes it difficult to discern the overall vaccine immune response to these antigens versus possible previous seasonal influenza infection. Overall, seroprotection against all of the influenza viruses observed was modest, even in patients who received the trivalent vaccine, with particularly low titers to influenza B, consistent with previous reports [16,17]. …”

Quality Improvement Initiative to Increase Influenza Vaccination in Pediatric Cancer Patients

“…1,2,6-8 Seroconversion rates after vaccination are slightly better when vaccination occurs earlier in the course of anticancer therapy. 9 There is also a varied response depending on the immunosuppressive extent of a patient's antineoplastic regimen, with particularly marked effects in patients undergoing SCT. 8,9 In transplant patients, a recent study in adults found no difference in increased T-cell-mediated immunity in patients given 1 versus 2 doses of the vaccine posttransplantation, arguing that attention to providing $1 dose of the immunization in patients with cancer can produce significant benefit.…”

“…9 There is also a varied response depending on the immunosuppressive extent of a patient's antineoplastic regimen, with particularly marked effects in patients undergoing SCT. 8,9 In transplant patients, a recent study in adults found no difference in increased T-cell-mediated immunity in patients given 1 versus 2 doses of the vaccine posttransplantation, arguing that attention to providing $1 dose of the immunization in patients with cancer can produce significant benefit. 5 Conversely, 2 recent pediatric studies demonstrated better immunogenicity in children with cancer after repeated doses and with use of higher adult doses.…”

How does influenza A-H1N1 infection proceed in allogeneic stem cell transplantation recipients?

“…Post-transplantation immunosuppression remains a major problem for the immunogenicity of the H1N1 vaccine [8,9]. None of the presented patients had been vaccinated.…”