Seroconversion of 2009 pandemic influenza A (H1N1) vaccination in kidney transplant patients and the influence of different risk factors
Carregando...
Citações na Scopus
17
Tipo de produção
article
Data de publicação
2013
Título da Revista
ISSN da Revista
Título do Volume
Editora
WILEY-BLACKWELL
Autores
GERHARD, J.
MIRAGLIA, J. L.
PRECIOSO, A. R.
TIMENETSKY, M. dC S. Tavares
Citação
TRANSPLANT INFECTIOUS DISEASE, v.15, n.6, p.612-618, 2013
Resumo
BackgroundInfluenza may present a high morbidity and mortality in solid organ transplanted patients (SOTP). Annual influenza virus vaccine is recommended for SOTP. However, low levels of seroconversion in SOTP have been reported. The aim of this study was to evaluate the immunogenicity of 2009 pandemic influenza A (H1N1) - A(H1N1)pdm09 - vaccine in kidney transplant patients and to analyze which features might affect seroconversion. MethodsThis study was conducted from March to August 2010 at the Renal Transplantation Unit of University of SAo Paulo, Brazil. A total of 85 renal transplant patients attending the outpatient unit received one 15-g intramuscular dose of A(H1N1)pdm09 influenza vaccine (reassortant vaccine virus A/California/7/2009 [NYMC X-179A]). Blood samples were collected immediately before and 21days after the vaccine was given. Antibody response was measured by the standard hemagglutination-inhibition (HI) assay. The primary immunogenicity endpoint for this study was seroconversion in previously seronegative patients (HI titers <1:40), and the secondary endpoint was the identification of features that could affect seroconversion in this population. ResultsFive (5.9%) patients presented HI titers prevaccination 1:40 and were excluded from further analysis. Seroconversion in previously negative patients occurred in 27 (34%) of 80 patients. Prevaccination HI titers geometrical mean was 5.8 and postvaccination 19.6 (ratio 3.4). Significant seroconversion rate factors were female gender, non-Caucasian ethnicity, and post-transplant time before vaccination. No impact was seen on seroconversion for age, donor type, tacrolimus and cyclosporine blood levels, renal function, or blood lymphocyte counts. Mycophenolate (MPA) showed a lower rate of seroconversion when compared with azathioprine. Tacrolimus and cyclosporine had similar seroconversion rates. Sirolimus use was associated with the highest rate of seroconversion, although these patient numbers were low. Immunosuppresssion containing MPA was considerably less effective in seroconversion than drug combinations with no MPA. Patients receiving sirolimus had more chance of seroconversion. HI titers geometric means pre/post vaccine were as follows: MPA (n=56): 5.8/12.8; tacrolimus (n=50): 5.9/16.2; cyclosporine (n=18): 5.4/24.2; azathioprine (n=19): 6.2/51.6; and sirolimus (n=6): 8/80. By univariate analysis, being female and non-White were variables associated with 3.3 times more chance of seroconversion than being male and White. In the multivariate analysis, the variables remaining in the model showed similar hazard ratios. ConclusionsIn this study, the monovalent A(H1N1)pdm09 influenza vaccine demonstrated low rates of seroconversion, particularly in patients on MPA, but with potentially higher response rates in patients on sirolimus.
Palavras-chave
immunosuppression, influenza, influenza vaccine, kidney transplantation, A(H1N1)pdm09
Referências
- Allison AC, 2005, LUPUS, V14, pS2, DOI 10.1191/0961203305lu2109oa
- [Anonymous], 2009, WKLY EPIDEMIOL REC, V84, P301
- Blumberg EA, 1996, CLIN INFECT DIS, V22, P295
- Candon S, 2009, AM J TRANSPLANT, V9, P2346, DOI 10.1111/j.1600-6143.2009.02787.x
- Crum-Cianflone NF, 2011, CLIN INFECT DIS, V52, P138, DOI 10.1093/cid/ciq019
- Danzinger-Isakov L, 2009, AM J TRANSPLANT, V9, pS258, DOI 10.1111/j.1600-6143.2009.02917.x
- Esposito S, 2011, NEPHROL DIAL TRANSPL, V26, P2018, DOI 10.1093/ndt/gfq657
- FDA. Guidance for Industry, 2007, CLIN DAT NEED SUPP L
- Giezeman KM, 2009, VACCINE, V27, P2414, DOI 10.1016/j.vaccine.2009.02.008
- GREENBERG ME, 2009, NEW ENGL J MED, V361, P2405, DOI 10.1056/NEJMOA0907413
- Ison MG, 2007, ANTIVIR THER, V12, P627
- Kendal AP, 1982, CONCEPTS PROCEDURES, pB17
- Keshtkar-Jahromi M, 2008, AM J NEPHROL, V28, P654, DOI 10.1159/000119742
- Kotton CN, 2009, AM J TRANSPLANT, V9, pS273, DOI 10.1111/j.1600-6143.2009.02920.x
- Kumar D, 2010, LANCET INFECT DIS, V10, P521, DOI 10.1016/S1473-3099(10)70133-X
- Mackay HJ, 2011, J CLIN VIROL, V50, P212, DOI 10.1016/j.jcv.2010.11.013
- Miraglia JL, 2011, PLOS ONE, V6, DOI 10.1371/journal.pone.0027214
- Mulley WR, 2012, KIDNEY INT, V82, P212, DOI 10.1038/ki.2012.106
- Nailescu C, 2011, PEDIATR NEPHROL, V26, P459, DOI 10.1007/s00467-010-1729-1
- Plennevaux E, 2010, LANCET, V375, P41, DOI 10.1016/S0140-6736(09)62026-2
- Salles MJC, 2010, CLIN TRANSPLANT, V24, pE17, DOI 10.1111/j.1399-0012.2009.01095.x
- Scharpe J, 2008, AM J TRANSPLANT, V8, P332, DOI 10.1111/j.1600-6143.2007.02066.x
- Smith KGC, 1998, NEPHROL DIAL TRANSPL, V13, P160, DOI 10.1093/ndt/13.1.160
- Struijk GH, 2010, KIDNEY INT, V78, P934, DOI 10.1038/ki.2010.269
- Tremblay CL, 2011, VACCINE, V29, P1359, DOI 10.1016/j.vaccine.2010.12.023
- Turner AP, 2011, AM J TRANSPLANT, V11, P613, DOI 10.1111/j.1600-6143.2010.03407.x
- Vilchez RA, 2002, AM J TRANSPLANT, V2, P287, DOI 10.1034/j.1600-6143.2002.20315.x
- Vilchez R A, 2002, Transpl Infect Dis, V4, P177, DOI 10.1034/j.1399-3062.2002.t01-4-02001.x
- Willcocks LC, 2007, AM J TRANSPLANT, V7, P2006, DOI 10.1111/j.1600-6143.2007.01869.x
- Wu JA, 2010, NEW ENGL J MED, V363, P2416, DOI 10.1056/NEJMoa1006736
- Zhu FC, 2009, NEW ENGL J MED, V361, P2414, DOI 10.1056/NEJMoa0908535