Influenza vaccination of dialysis patients: cross-reactivity of induced haemagglutination-inhibiting antibodies to H3N2 subtype antigenic variants is comparable with the response of naturally infected young healthy adults.
BACKGROUND
Annual influenza vaccination is recommended for patients with chronic renal failure, although vaccination responses in haemodialysis (HD) patients may be suboptimal. Typically, the seroreactivity has been analysed against the vaccine virus or the corresponding year's epidemic virus. No studies analysing cross-reactivity against subsequent years' viruses have been presented.


METHODS
Twenty-three chronic HD patients and 26 cardiac patients were, in autumn 1995, vaccinated with a trivalent influenza vaccine. The cross-reacting haemagglutination-inhibiting antibodies to five consecutive years' (the last season 1999-2000) drift variants of H3N2 subtype influenza A virus were measured and compared with those of vaccinated cardiac patients and with those of 26 healthy military conscripts who suffered a serologically confirmed influenza A infection in the season 1995-1996.


RESULTS
The influenza vaccination in HD patients resulted in comparable cross-reacting antibodies to the antibodies induced both by vaccination in cardiac patients and by natural infection in military conscripts. After a steady decline, the cross-reactivity to the latest epidemic virus improved in all the groups. This may be due to two reverted amino acid changes in the HA1 domain of the virus haemagglutinin.


CONCLUSIONS
Influenza vaccination in HD patients is as effective as the vaccination of cardiac patients with normal kidney function. The cross-reactivity of vaccination-induced antibodies is even as good as that of antibodies induced by natural infection of young healthy males. Additionally, vaccination seems to prime the individual beneficially against subsequent years' influenza viruses.
Antonen
Jaakko A
JA
Department of Medicine, Tampere University Hospital and Medical School, University of Tampere, Tampere, Finland. jaakko.antonen@uta.fi
Pyhälä
Reijo
R
Hannula
Päivi M
PM
Ala-Houhala
Ilpo O
IO
Santanen
Riitta
R
Ikonen
Niina
N
Saha
Heikki H T
HH
D000328:Adult; D000914:Antibodies, Viral / Q000032:analysis / Q000096:biosynthesis*; D002318:Cardiovascular Diseases / Q000276:immunology; D016022:Case-Control Studies; D003429:Cross Reactions; D005260:Female; D006385:Hemagglutination Inhibition Tests; D019267:Hemagglutinin Glycoproteins, Influenza Virus / Q000276:immunology; D006801:Humans; D053122:Influenza A Virus, H3N2 Subtype; D009980:Influenza A virus / Q000276:immunology*; D007252:Influenza Vaccines / Q000008:administration & dosage / Q000276:immunology*; D007251:Influenza, Human / Q000276:immunology / Q000517:prevention & control*; D007676:Kidney Failure, Chronic / Q000276:immunology / Q000628:therapy; D008297:Male; D011336:Probability; D012016:Reference Values; D006435:Renal Dialysis / Q000009:adverse effects*; D018570:Risk Assessment; D014807:Vitamin D / Q000627:therapeutic use
D000914:Antibodies, Viral; D019267:Hemagglutinin Glycoproteins, Influenza Virus; D007252:Influenza Vaccines; D014807:Vitamin D