Protective effect of A/H1N1 vaccination in immune-mediated disease--a prospectively controlled vaccination study

Rheumatology (Oxford). 2012 Apr;51(4):695-700. doi: 10.1093/rheumatology/ker389. Epub 2011 Dec 14.

Abstract

Objectives: To assess the 2009 influenza vaccine A/H1N1 on antibody response, side effects and disease activity in patients with immune-mediated diseases.

Methods: Patients with RA, SpA, vasculitis (VAS) or CTD (n = 149) and healthy individuals (n = 40) received a single dose of adjuvanted A/H1N1 influenza vaccine. Sera were obtained before vaccination, and 3 weeks, 6 weeks and 6 months thereafter. A/H1N1 antibody titres were measured by haemagglutination inhibition (HAI) assay. Seroprotection was defined as specific antibody titre ≥ 1 : 40, seroconversion as 4-fold increase in antibody titre.

Results: Titres increased significantly in patients and controls with a maximum at Week 3, declining to levels below protection at Month 6 (P < 0.001). Seroprotection was more frequently reached in SpA and CTD than in RA and VAS (80 and 82% and 57 and 47%, respectively). There was a significantly negative impact by MTX (P < 0.001), rituximab (P = 0.0031) and abatacept (P = 0.045). Other DMARDs, glucocorticoids and TNF blockers did not significantly suppress response (P = 0.06, 0.11 and 0.81, respectively). A linear decline in response was noted in patients with increasing age (P < 0.001). Disease reactivation possibly related to vaccination was suspected in 8/149 patients. No prolonged side effects or A/H1N1 infections were noted.

Conclusions: The results show that vaccination response is a function of disease type, intensity and character of medication and age. A single injection of adjuvanted influenza vaccine is sufficient to protect a high percentage of patients. Therefore, differential vaccination recommendations might in the future reduce costs and increase vaccination acceptance.

Publication types

  • Controlled Clinical Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Age Factors
  • Aged
  • Antibodies, Viral / blood*
  • Antibodies, Viral / drug effects
  • Antirheumatic Agents / pharmacology
  • Arthritis, Rheumatoid / immunology
  • Autoimmune Diseases / drug therapy
  • Autoimmune Diseases / immunology*
  • Case-Control Studies
  • Connective Tissue Diseases / immunology
  • Disease Progression
  • Female
  • Hemagglutination Inhibition Tests
  • Humans
  • Immunologic Memory
  • Immunosuppressive Agents / pharmacology
  • Influenza A Virus, H1N1 Subtype / immunology*
  • Influenza Vaccines / adverse effects
  • Influenza Vaccines / immunology*
  • Influenza, Human / prevention & control
  • Male
  • Middle Aged
  • Prospective Studies
  • Rheumatic Diseases / immunology*
  • Sex Factors
  • Spondylarthritis / immunology
  • Vaccination / adverse effects

Substances

  • Antibodies, Viral
  • Antirheumatic Agents
  • Immunosuppressive Agents
  • Influenza Vaccines