Journal List > Korean J Pediatr Infect Dis > v.19(1) > 1096057

Kim, Song, Lee, and Kim: Assessment of Influenza Vaccine Immunogenicity in Immunocompromized Host During 2009 Influenza Season: A Single Institution Experience

Abstract

Purpose

Although influenza is regarded as one of the major causes of morbidity and mortality in children with cancer, the actual vaccine coverage remains poor. We conducted evaluation of immunogenicity and safety of influenza vaccine in children with cancer.

Methods

In this study, 25 children with cancer who received influenza vaccine (SK influenza IX vaccine®) at the Korea Cancer Center Hospital between October and December 2009 were analyzed. Blood samples of patients were collected twice (at the beginning of this study and at 30th day after vaccination) and their antibody titers were measured using the hemagglutination-inhibition (HI) assay. Immunogenicity of the influenza vaccine was assessed by seroprotection rate on days 0 and 30, seroconversion rate on day 30, and mean fold increase (MFI) of geometric mean titer (GMT) of HI between days 0 and 30.

Results

Any of the subjects in our study did not experienced serious adverse events after influenza vaccination. Seroprotection rates were 68% for H1N1, 40% for H3N2, and 36% for B. Seroconversion rates were 12% for H1N1, 16% for H3N2, and 20% for B. MFIs were 0.9 for H1N1, 1.2 for H3N2, and 1.8 for B.

Conclusion

In the study, we found a limited protective immune response to influenza vaccine, among subjects with cancer. However, some subjects showed seroconversion, and there were no severe adverse events among all subjects, supporting the recommendation of annual influenza vaccination in children with cancer.

Figures and Tables

Fig. 1

MFI of GMT against each influenza antigen. Abbreviations : MFI, mean fold increase; GMT, geometric mean titer.

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Fig. 2

MFI of GMT against each influenza antigen according to different immune state. (A) MFI of GMT against H1N1 antigen according to ALC count (MFI; ALC≤500/µL: 0.70, ALC >500/µL: 0.94). (B) MFI of GMT against H1N1 antigen according to WBC count (MFI; WBC ≤3,000/µL: 0.66, WBC >3,000/µL: 0.96). (C) MFI of GMT against H3N2 antigen according to ALC count (MFI; ALC ≤500/µL :0.71, ALC >500/µL: 1.30). (D) MFI of GMT against H3N2 antigen according to WBC count (MFI; WBC ≤3,000/µL: 0.87, WBC >3,000/µL: 1.27). (E) MFI of GMT against B antigen according to ALC count (MFI; ALC ≤500/µL: 1.00, ALC >500/µL: 2.09). (F) MFI of GMT against B antigen according to WBC count (MFI; WBC ≤3,000/µL: 1.00, WBC >3,000/µL: 2.14). Abbreviations:MFI, mean fold increase; GMT, geometric mean titer; ALC, absolute lymphocyte count.

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Table 1

Patients Characteristics

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*two drugs: cisplatin and adriamycin

three drugs: ifosfamide, adriamycin and etoposide or ifosfamide, adriamycin and dacarbazine

recurrence: cyclophosphamide and topotecan

ALL protocol: prednisolone, vincristine, daunorubicin, L-asparaginase, cytarabine and methotrexate

HDCT: carboplatin, thiotepa and etoposide or ifosfamide, cyclophosphamide and etoposide

Abbreviation: ALL, acute lymphoblastic leukemia

Table 2

Immunogenicity against H1N1

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*two drugs : cisplatin and adriamycin

three drugs : ifosfamide, adriamycin and etoposide or ifosfamide, adriamycin and dacarbazine

recurrence : cyclophosphamide and topotecan

ALL protocol : prednisolone, vincristine, daunorubicin, L-asparaginase, cytarabine and methotrexate

HDCT : carboplatin, thiotepa and etoposide or ifosfamide, cyclophosphamide and etoposide

Abbreviations : ALL, acute lymphoblastic leukemia; HDCT, high dose chemotherapy; ALC, absolute lymphocyte count

Table 3

Immunogenicity against H3N2

kjpid-19-1-i003

*two drugs : cisplatin and adriamycin

three drugs : ifosfamide, adriamycin and etoposide or ifosfamide, adriamycin and dacarbazine

recurrence : cyclophosphamide and topotecan

ALL protocol : prednisolone, vincristine, daunorubicin, L-asparaginase, cytarabine and methotrexate

HDCT : carboplatin, thiotepa and etoposide or ifosfamide, cyclophosphamide and etoposide

Abbreviations) ALL; acute lymphoblastic leukemia, HDCT; high dose chemotherapy, ALC; absolute lymphocyte count

Table 4

Immunogenicity against B

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*two drugs : cisplatin and adriamycin

three drugs : ifosfamide, adriamycin and etoposide or ifosfamide, adriamycin and dacarbazine

recurrence : cyclophosphamide and topotecan

ALL protocol : prednisolone, vincristine, daunorubicin, L-asparaginase, cytarabine and methotrexate

HDCT : carboplatin, thiotepa and etoposide or ifosfamide, cyclophosphamide and etoposide

Abbreviations : ALL, acute lymphoblastic leukemia; HDCT, high dose chemotherapy; ALC; absolute lymphocyte count

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