tetano
Editor, Senior Moderator
Am J Kidney Dis
. 2022 Mar 11;S0272-6386(22)00527-3.
doi: 10.1053/j.ajkd.2022.01.425. Online ahead of print.
Seroresponse to Inactivated and Recombinant Influenza Vaccines Among Maintenance Hemodialysis Patients
Harold J Manley[SUP] 1 [/SUP], Eduardo K Lacson[SUP] 2 [/SUP], Gideon Aweh[SUP] 3 [/SUP], Nien Chen Li[SUP] 3 [/SUP], Daniel E Weiner[SUP] 4 [/SUP], Dana C Miskulin[SUP] 4 [/SUP], Caroline M Hsu[SUP] 4 [/SUP], Toros Kapoian[SUP] 4 [/SUP], Mary S Hayney[SUP] 5 [/SUP], Klemens B Meyer[SUP] 2 [/SUP], Doug S Johnson[SUP] 3 [/SUP]
Affiliations
Abstract
Rationale & objectives: High dose influenza vaccine provides better protection against influenza infection in older adults than standard dose vaccine. We compared vaccine seroresponse among hemodialysis patients over 4 months following administration of either high dose inactivated (HD-IIV3), standard dose inactivated (SD-IIV4), or recombinant (RIV4) influenza vaccine.
Study design: Prospective observational study.
Setting & participants: Patients at four hemodialysis clinics who received influenza vaccine.
Exposure: Type of influenza vaccine.
Outcome: Hemagglutination inhibition titers (HI) were measured at baseline and at 1, 2, 3, and 4 months following vaccination. The primary outcome was seroprotection rates at HI≥1:40 and HI≥1:160 (antibody levels providing protection from infection in about 50% and 95% immunocompetent individuals, respectively) at 1, 2, 3 and 4 months after vaccination.
Analytical approach: We calculated the geometric mean titers (GMT) as well as the seroprotection and seroconversion rates. Adjusted generalized linear models with additional trend analyses performed to evaluate the association between vaccine type and outcomes.
Results: 254 HD patients received HD-IIV3 (n=141), SD-IIV4 (n=36) or RIV4 (n=77) vaccine. A robust initial seroresponse to influenza A strains was observed after all 3 vaccines. GMT and seroprotection (HI≥1:160 titer) rates against influenza A strains were higher and more sustained with HD-IIV3 compared to SD-IIV4 or RIV4. Greater than 80% of patients vaccinated with HD-IIV3 were seroprotected (HI≥1:160 titer) at month 4 (p<0.001), whereas among patients vaccinated with SD-IIV4 or RIV4 seroprotection rates were similar to baseline. Seroprotection rates were lower against B strains for all vaccines.
Limitations: Due to use of observational data, bias from unmeasured confounders may exist. Some age subgroups were small in number. Clinical outcome data were not available.
Conclusions: Hemodialysis patients achieved high seroprotection rates after all 3 vaccines. The seroresponse waned more slowly with HD-IIV3 compared to SD-IIV4 and RIV4 vaccines.
. 2022 Mar 11;S0272-6386(22)00527-3.
doi: 10.1053/j.ajkd.2022.01.425. Online ahead of print.
Seroresponse to Inactivated and Recombinant Influenza Vaccines Among Maintenance Hemodialysis Patients
Harold J Manley[SUP] 1 [/SUP], Eduardo K Lacson[SUP] 2 [/SUP], Gideon Aweh[SUP] 3 [/SUP], Nien Chen Li[SUP] 3 [/SUP], Daniel E Weiner[SUP] 4 [/SUP], Dana C Miskulin[SUP] 4 [/SUP], Caroline M Hsu[SUP] 4 [/SUP], Toros Kapoian[SUP] 4 [/SUP], Mary S Hayney[SUP] 5 [/SUP], Klemens B Meyer[SUP] 2 [/SUP], Doug S Johnson[SUP] 3 [/SUP]
Affiliations
- PMID: 35288216
- DOI: 10.1053/j.ajkd.2022.01.425
Abstract
Rationale & objectives: High dose influenza vaccine provides better protection against influenza infection in older adults than standard dose vaccine. We compared vaccine seroresponse among hemodialysis patients over 4 months following administration of either high dose inactivated (HD-IIV3), standard dose inactivated (SD-IIV4), or recombinant (RIV4) influenza vaccine.
Study design: Prospective observational study.
Setting & participants: Patients at four hemodialysis clinics who received influenza vaccine.
Exposure: Type of influenza vaccine.
Outcome: Hemagglutination inhibition titers (HI) were measured at baseline and at 1, 2, 3, and 4 months following vaccination. The primary outcome was seroprotection rates at HI≥1:40 and HI≥1:160 (antibody levels providing protection from infection in about 50% and 95% immunocompetent individuals, respectively) at 1, 2, 3 and 4 months after vaccination.
Analytical approach: We calculated the geometric mean titers (GMT) as well as the seroprotection and seroconversion rates. Adjusted generalized linear models with additional trend analyses performed to evaluate the association between vaccine type and outcomes.
Results: 254 HD patients received HD-IIV3 (n=141), SD-IIV4 (n=36) or RIV4 (n=77) vaccine. A robust initial seroresponse to influenza A strains was observed after all 3 vaccines. GMT and seroprotection (HI≥1:160 titer) rates against influenza A strains were higher and more sustained with HD-IIV3 compared to SD-IIV4 or RIV4. Greater than 80% of patients vaccinated with HD-IIV3 were seroprotected (HI≥1:160 titer) at month 4 (p<0.001), whereas among patients vaccinated with SD-IIV4 or RIV4 seroprotection rates were similar to baseline. Seroprotection rates were lower against B strains for all vaccines.
Limitations: Due to use of observational data, bias from unmeasured confounders may exist. Some age subgroups were small in number. Clinical outcome data were not available.
Conclusions: Hemodialysis patients achieved high seroprotection rates after all 3 vaccines. The seroresponse waned more slowly with HD-IIV3 compared to SD-IIV4 and RIV4 vaccines.