Serological response to the 2009 H1N1 influenza vaccination in patients with inflammatory bowel disease
Serological response to the 2009 H1N1 influenza vaccination in patients with inflammatory bowel disease
复制标题
DOI：
10.1136/gutjnl-2011-300256
复制
发表时间：
2012-03-01
期刊：
影响因子：
24.5
通讯作者：
Sands, Bruce E.
中科院分区：
文献类型：
--
作者：
Cullen, Garret;Bader, Caroline;Sands, Bruce E.
背景流感疫苗接种被推荐用于炎症性肠病（IBD）患者。2009年H1N1流感疫苗在普通人群中产生的血清保护率>85%，但没有关于疫苗在IBD患者中的免疫原性的数据。方法进行了一项观察性前瞻性开放标签研究，以检查2009年H1N1流感疫苗在108例IBD患者中的免疫原性。记录患者详情、药物和疾病活动。测定接种前和接种后血凝素抑制滴度和几何平均滴度。T淋巴细胞活性的功能测定在接种疫苗时在一个子集的患者中进行测量，作为免疫抑制的替代措施。受试者接种疫苗后6个月进行随访。结果108例患者入组，105完成了研究。免疫后血清保护率为50%。免疫抑制受试者的血清保护率低于非免疫抑制受试者（44% vs 64%，p=0.06）。接受联合免疫抑制的受试者中血清保护的比例显著低于未接受免疫抑制的受试者（36% vs 64%，p=0.02）。接受联合免疫抑制的患者的几何平均滴度增加倍数显著低于接受单药免疫抑制的患者（3.5 vs 11.5，p=0.03）。在48名受试者的亚组中进行T淋巴细胞活性测定。具有中等活性的那些具有比具有高活性的那些更低的血清保护（28%对61%，p=0.02）。结论：IBD患者接种2009年H1N1流感疫苗后血清保护率较低，尤其是免疫抑制者。尽管需要研究疫苗在该人群中的临床获益，但IBD患者需要了解这种免疫原性降低。
Background Influenza vaccination is recommended for patients with inflammatory bowel disease (IBD). The 2009 H1N1 influenza vaccine produced seroprotection rates of >85% in the general population but there are no data on the immunogenicity of the vaccine in patients with IBD.Methods An observational prospective open-label study was conducted to examine the immunogenicity of the 2009 H1N1 influenza vaccine in 108 patients with IBD. Patient details, medications and disease activity were recorded. Pre- and post-vaccination haemagglutinin inhibition titres and geometric mean titres were measured. A functional assay of T lymphocyte activity was measured at vaccination in a subset of patients as an alternative measure of immunosuppression. Subjects were followed for 6 months post-vaccination.Results Of 108 patients enrolled, 105 completed the study. The post-vaccination seroprotection rate was 50%. Immunosuppressed subjects had a lower rate of seroprotection than non-immunosuppressed subjects (44% vs 64%, p=0.06). The proportion with seroprotection was significantly lower in subjects on combination immunosuppression than in those receiving no immunosuppression (36% vs 64%, p=0.02). Patients receiving combined immunosuppression had a significantly lower fold increase in geometric mean titres than those on monotherapy immunosuppression (3.5 vs 11.5, p=0.03). An assay of T lymphocyte activity was performed in a subgroup of 48 subjects. Those with intermediate activity had lower seroprotection than those with high activity (28% vs 61%, p=0.02). The vaccine was well tolerated.Conclusions Patients with IBD vaccinated with the 2009 H1N1 influenza vaccine had a low rate of seroprotection, particularly among those who were immunosuppressed. Although there is a need for studies of the clinical benefit of vaccines in this population, patients with IBD need to be aware of this reduced immunogenicity.