title: Immune response to influenza vaccination in children treated with methotrexate or/and tumor necrosis factor-alpha inhibitors.
abstract: In children treated with immunosuppressive medication such as methotrexate and tumor necrosis factor-alpha (TNF-α) inhibitors, additional immunizations are recommended because of increased susceptibility to infections. However, it is unclear if adequate antibody response to vaccinations can be established in children receiving methotrexate and/or TNF-α inhibitors. In a prospective open label study, we assessed seroprotection and seroconversion following influenza vaccination during 2 seasons (6 strains) in 36 children with autoimmune disease treated either with methotrexate (n=18), TNF-α inhibitors (n=10) or both (n=8) and a control group of 16 immunocompetent children. Influenza antibody titers were determined by hemagglutinin inhibition assay, before and 4-8 weeks after vaccination. Post-vaccination seroprotection (defined as a titer ≥1:40) did not significantly differ between immunosuppressed and immunocompetent subjects. Seroconversion, defined as the change from a nonprotective (< 1:40) to a protective titer (≥1:40) with at least a 4-fold titer increase, was less likely to occur in immunosuppressed patients, although no significant difference from the control group was established. Safety evaluation of vaccination showed no serious adverse events. Children receiving methotrexate and/or TNF-α inhibitors can be safely and effectively immunized against influenza, with a seroprotection after vaccination comparable to immunocompetent children.
authors.affiliation: Department of Pediatrics, University Children's Hospital, Bern, Switzerland. andreas.woerner@insel.ch
authors.forename: Andreas
authors.initials: A
authors.lastname: Woerner
authors.forename: Marie-Josèphe
authors.initials: MJ
authors.lastname: Sauvain
authors.forename: Christoph
authors.initials: C
authors.lastname: Aebi
authors.forename: Margrit
authors.initials: M
authors.lastname: Otth
authors.forename: Isabel B
authors.initials: IB
authors.lastname: Bolt
mesh_terms: D000293:Adolescent; D000914:Antibodies, Viral / Q000097:blood*; D001327:Autoimmune Diseases / Q000188:drug therapy* / Q000276:immunology; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007121:Immunocompetence; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D053118:Influenza A Virus, H1N1 Subtype / Q000276:immunology; D053122:Influenza A Virus, H3N2 Subtype / Q000276:immunology; D009981:Influenza B virus / Q000276:immunology; D007252:Influenza Vaccines / Q000009:adverse effects / Q000276:immunology* / Q000627:therapeutic use; D007251:Influenza, Human / Q000517:prevention & control*; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use; D011446:Prospective Studies; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors
chemical_list: D000914:Antibodies, Viral; D007166:Immunosuppressive Agents; D007252:Influenza Vaccines; D014409:Tumor Necrosis Factor-alpha; D008727:Methotrexate