title: Protective effect of A/H1N1 vaccination in immune-mediated disease--a prospectively controlled vaccination study.
abstract: OBJECTIVE
  To assess the 2009 influenza vaccine A/H1N1 on antibody response, side effects and disease activity in patients with immune-mediated diseases.
  
  
  METHODS
  Patients with RA, SpA, vasculitis (VAS) or CTD (n = 149) and healthy individuals (n = 40) received a single dose of adjuvanted A/H1N1 influenza vaccine. Sera were obtained before vaccination, and 3 weeks, 6 weeks and 6 months thereafter. A/H1N1 antibody titres were measured by haemagglutination inhibition (HAI) assay. Seroprotection was defined as specific antibody titre ≥ 1 : 40, seroconversion as 4-fold increase in antibody titre.
  
  
  RESULTS
  Titres increased significantly in patients and controls with a maximum at Week 3, declining to levels below protection at Month 6 (P < 0.001). Seroprotection was more frequently reached in SpA and CTD than in RA and VAS (80 and 82% and 57 and 47%, respectively). There was a significantly negative impact by MTX (P < 0.001), rituximab (P = 0.0031) and abatacept (P = 0.045). Other DMARDs, glucocorticoids and TNF blockers did not significantly suppress response (P = 0.06, 0.11 and 0.81, respectively). A linear decline in response was noted in patients with increasing age (P < 0.001). Disease reactivation possibly related to vaccination was suspected in 8/149 patients. No prolonged side effects or A/H1N1 infections were noted.
  
  
  CONCLUSIONS
  The results show that vaccination response is a function of disease type, intensity and character of medication and age. A single injection of adjuvanted influenza vaccine is sufficient to protect a high percentage of patients. Therefore, differential vaccination recommendations might in the future reduce costs and increase vaccination acceptance.
authors.affiliation: Department of Rheumatology, Clinical Immunology and Allergology, University Hospital and University of Bern, Freiburgstrasse, Bern 3010, Switzerland.
authors.forename: Sabine
authors.initials: S
authors.lastname: Adler
authors.forename: Anne
authors.initials: A
authors.lastname: Krivine
authors.forename: Janine
authors.initials: J
authors.lastname: Weix
authors.forename: Flore
authors.initials: F
authors.lastname: Rozenberg
authors.forename: Odile
authors.initials: O
authors.lastname: Launay
authors.forename: Juerg
authors.initials: J
authors.lastname: Huesler
authors.forename: Loïc
authors.initials: L
authors.lastname: Guillevin
authors.forename: Peter M
authors.initials: PM
authors.lastname: Villiger
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000914:Antibodies, Viral / Q000097:blood* / Q000187:drug effects; D018501:Antirheumatic Agents / Q000494:pharmacology; D001172:Arthritis, Rheumatoid / Q000276:immunology; D001327:Autoimmune Diseases / Q000188:drug therapy / Q000276:immunology*; D016022:Case-Control Studies; D003240:Connective Tissue Diseases / Q000276:immunology; D018450:Disease Progression; D005260:Female; D006385:Hemagglutination Inhibition Tests; D006801:Humans; D007156:Immunologic Memory; D007166:Immunosuppressive Agents / Q000494:pharmacology; D053118:Influenza A Virus, H1N1 Subtype / Q000276:immunology*; D007252:Influenza Vaccines / Q000009:adverse effects / Q000276:immunology*; D007251:Influenza, Human / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012216:Rheumatic Diseases / Q000276:immunology*; D012737:Sex Factors; D025241:Spondylarthritis / Q000276:immunology; D014611:Vaccination / Q000009:adverse effects
chemical_list: D000914:Antibodies, Viral; D018501:Antirheumatic Agents; D007166:Immunosuppressive Agents; D007252:Influenza Vaccines