Immunogenicity of a Standard Trivalent Influenza Vaccine in Patients on Long-term Hemodialysis: An Open-Label Trial
Received 8 August 2008; accepted 20 November 2008. published online 02 April 2009.
Refers to article:
Overcoming Challenges to Influenza Vaccination in Patients With CKD
Alexander J. Kallen, Anthony E. Fiore
American Journal of Kidney Diseases
July 2009 (Vol. 54, Issue 1, Pages 6-9) Full Text |
Full-Text PDF (144 KB)
Background
Disturbances in acquired immunity are considered to be responsible, at least in part, for the high infection rate and inadequate response to vaccinations observed in hemodialysis (HD) patients. The present prospective trial aimed to: (1) evaluate the immunogenicity of a standard influenza vaccine in HD patients, and (2) identify determinants of the immune response.
Study Design
Prospective interventional open-label study.
Setting & Participants
201 long-term HD patients and 41 healthy volunteers.
Intervention
Vaccination with a standard trivalent inactivated influenza vaccine.
Outcomes
The primary outcome was seroprotection rate, defined as percentage of participants with an antibody titer of 40 or greater 1 month after vaccination.
Measurements
All antibody titers were determined in duplicate by using the hemagglutination inhibition assay. Regression analyses were performed to investigate the association between demographics, uremic retention solutes (including p–cresol), inflammation, nutrition, iron status, trace elements, and immune response in HD patients.
Results
More than 80% of HD patients showed seroprotection after vaccination. The immune response of HD patients was similar to that of healthy volunteers. Booster vaccination did not improve the immune response. High serum ferritin level was the only parameter independently associated with a better vaccination-induced antibody response in HD patients.
Limitations
A high seroprotection rate at baseline undermined the power to identify clinical determinants of the immune response.
Conclusions
Influenza vaccination is as efficacious in HD patients as in healthy volunteers. With the exception of serum ferritin, none of the investigated parameters of nutrition, inflammation, and dialysis adequacy had a significant impact on the immune response. Our data support annual vaccination of HD patients and question the clinical relevance of disturbances in acquired immunity in contemporary HD patients.
ABSTRACT