Assessment of Influenza Vaccine Immunogenicity in Immunocompromized Host During 2009 Influenza Season: A Single Institution Experience

Dong Hwan Kim; Bong Sup Song; Jun Ah Lee; Dong Ho Kim

doi:10.14776/kjpid.2012.19.1.1

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

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

Original Article

Korean Journal of Pediatric Infectious Diseases

Korean Journal of Pediatric Infectious Diseases 2012; 19(1): 1-11.

Published online: 30 April 2012

DOI: https://doi.org/10.14776/kjpid.2012.19.1.1

Assessment of Influenza Vaccine Immunogenicity in Immunocompromized Host During 2009 Influenza Season: A Single Institution Experience

Dong Hwan Kim, M.D., Bong Sup Song, M.D., Jun Ah Lee, M.D., Dong Ho Kim, M.D.

Department of Pediatrics, Korea Cancer Center Hospital, Seoul, Republic of Korea.

Correspondence: Dong Ho Kim, M.D. Department of Pediatrics, Korea Cancer Center Hospital, Seoul, Republic of Korea. Tel: +82-2-970-1298, Fax: +82-2-6008-5748, kdh281920@gmail.com

Received 15 September 2011 Revised 28 October 2011 Accepted 28 October 2011

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.

Keywords: Influenza vaccine, Childhood cancer, Immunogenicity

Figures and Tables

Fig. 1

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

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.

Table 1

Patients Characteristics

^*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

^*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

^*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

^*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

References

1. Lapinsky SE. H1N1 novel influenza A in pregnant and immunocompromised patients. Crit Care Med. 2010. 38:e52–e57.

2. American Academy of Pediatrics Committee on Infectious Diseases. Prevention of influenza: recommendations for influenza immunization of children, 2008-2009. Pediatrics. 2008. 122:1135–1141.

3. Fiore AE, Shay DK, Broder K, Iskander JK, Uyeki TM, Mootrey G, et al. Prevention and control of influenza: recommendations of the Advisory Committee on Immunization Practices (ACIP), 2008. MMWR Recomm Rep. 2008. 57:1–60.

4. Principi N, Esposito S. Are we ready for universal influenza vaccination in paediatrics? Lancet Infect Dis. 2004. 4:75–83.

5. Esposito S, Marchisio P, Principi N. The global state of influenza in children. Pediatr Infect Dis J. 2008. 27:S149–S153.

6. Cho BH, Kolasa MS, Messonnier ML. Influenza vaccination coverage rate among high-risk children during the 2002-2003 influenza season. Am J Infect Control. 2008. 36:582–587.

7. Nakamura MM, Lee GM. Influenza vaccination in adolescents with high-risk conditions. Pediatrics. 2008. 122:920–928.

8. Esposito S, Marchisio P, Droghetti R, Lambertini L, Faelli N, Bosis S, et al. Influenza vaccination coverage among children with high-risk medical conditions. Vaccine. 2006. 24:5251–5255.

9. Loulergue P, Mir O, Alexandre J, Ropert S, Goldwasser F, Launay O. Low influenza vaccination rate among patients receiving chemotherapy for cancer. Ann Oncol. 2008. 19:1658.

10. Matsuzaki A, Suminoe A, Koga Y, Kinukawa N, Kusuhara K, Hara T. Immune response after influenza vaccination in children with cancer. Pediatr Blood Cancer. 2005. 45:831–837.

11. Shahgholi E, Ehsani MA, Salamati P, Maysamie A, Sotoudeh K, Mokhtariazad T. Immunogenicity of trivalent influenza vaccine in children with acute lymphoblastic leukemia during maintenance therapy. Pediatr Blood Cancer. 2010. 54:716–720.

12. Opstelten W, Rimmelzwaan GF, van Essen GA, Bijlsma JW. Influenza vaccination of immunocompromised patients: safe and effective. Ned Tijdschr Geneeskd. 2009. 153:A902.

13. Korea Centers for Disease Control and Prevention. Korean Influenza Surveillance Report, 2007-2008. 2011.

14. Schafer AI, Churchill WH, Ames P, Weinstein L. The influence of chemotherapy on response of patients with hematologic malignancies to influenza vaccine. Cancer. 1979. 43:25–30.

15. Chisholm JC, Devine T, Charlett A, Pinkerton CR, Zambon M. Response to influenza immunisation during treatment for cancer. Arch Dis Child. 2001. 84:496–500.

16. Gross PA, Lee H, Wolff JA, Hall CB, Minnefore AB, Lazicki ME. Influenza immunization in immunosuppressed children. J Pediatr. 1978. 92:30–35.

17. Ljungman P, Avetisyan G. Influenza vaccination in hematopoietic SCT recipients. Bone Marrow Transplant. 2008. 42:637–641.

18. Bektas O, Karadeniz C, Oguz A, Berberoglu S, Yilmaz N, Citak C. Assessment of the immune response to trivalent split influenza vaccine in children with solid tumors. Pediatr Blood Cancer. 2007. 49:914–917.

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