Wegener's granulomatosis patients show an adequate antibody response to influenza vaccination.
OBJECTIVE
Wegener's granulomatosis (WG) is a systemic vasculitis characterised by relapsing and remitting disease activity. Immunosuppressive drugs are used to control disease, but increase susceptibility to infection. Therefore, influenza vaccination should be considered in WG patients. This study was performed to assess the immunogenicity of influenza vaccination in WG patients.


METHODS
A randomised, controlled trial was performed in WG patients with quiescent disease, defined as a Birmingham vasculitis activity score (BVAS) less than 2. Patients were randomly assigned to receive influenza vaccination (n = 49) or to participate as controls (n = 23). In addition, healthy controls (n = 49) were vaccinated. At entry and at 1 and 3-4 months after entry, antibody responses to vaccination were determined. Furthermore, disease activity was measured (BVAS), adverse effects were recorded and antineutrophil cytoplasmic autoantibody (ANCA) titres were determined.


RESULTS
WG patients achieved high seroprotection rates to all three influenza strains, comparable with healthy controls. Only the A/H1N1 strain patients had a lower seroconversion rate (p = 0.002) and geometric mean titre (p = 0.037) than controls. After 1 month, one control and one vaccinated WG patient had developed active disease. At 3-4 months, two additional control patients had developed active disease compared with none of the vaccinated patients (p = 0.099). Vaccination did not influence ANCA titres. Adverse effects did not differ between patients and healthy controls.


CONCLUSIONS
Influenza vaccination in WG patients with quiescent disease induced a sufficient antibody response.


BACKGROUND
NTR1130.
Holvast
A
A
Department of Rheumatology and Clinical Immunology, University Medical Center Groningen, University of Groningen, The Netherlands. B.Holvast@int.umcg.nl
Stegeman
C A
CA
Benne
C A
CA
Huckriede
A
A
Wilschut
J C
JC
Palache
A M
AM
Kallenberg
C G M
CG
Bijl
M
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019268:Antibodies, Antineutrophil Cytoplasmic / Q000097:blood; D000914:Antibodies, Viral / Q000097:blood*; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D005260:Female; D014890:Granulomatosis with Polyangiitis / Q000188:drug therapy / Q000276:immunology*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D053118:Influenza A Virus, H1N1 Subtype / Q000276:immunology*; D007252:Influenza Vaccines / Q000008:administration & dosage / Q000009:adverse effects / Q000276:immunology*; D007251:Influenza, Human / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D009975:Orthomyxoviridae / Q000276:immunology*; D011446:Prospective Studies; D016896:Treatment Outcome; D014657:Vasculitis / Q000276:immunology
D019268:Antibodies, Antineutrophil Cytoplasmic; D000914:Antibodies, Viral; D007166:Immunosuppressive Agents; D007252:Influenza Vaccines