title: Vaccination against influenza in patients with systemic sclerosis.
abstract: OBJECTIVE
  To assess the efficacy and safety of the influenza virus vaccine in systemic sclerosis (SSc) patients compared to healthy controls.
  
  
  METHODS
  Twenty-six SSc patients and 16 healthy controls were vaccinated with a trivalent influenza subunit vaccine (H1N1 A/Brisbane/59/2007(TGA 2008/81B) (H1N1), H3N2 A/Uruguay/716/2007 (A/Brisbane/10/2007-like, NIBSC8/124) (H3N2) and B B/Brisbane/60/2008 (TGA 2009/82/B) (B)). The subjects were evaluated on the day of vaccination and 6 weeks later. Disease activity was assessed by the Rodnan score, number of ulcers, number of tender and swollen joints, the presence of dyspnea, cough, dyspepsia and dysphagia, and patient (PDAI) and physician (PHDAI) disease activity evaluation by the visual activity score (VAS), erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) level. The humoral response was evaluated by haemagglutination inhibition (HI).
  
  
  RESULTS
  At baseline, 62%, 15% and 88% of the SSc patients had protective levels against H1N1, H3N2 and B, respectively, versus 56%, 62% and 87% for controls. Six weeks later, the proportion of responders to H1N1 was significantly higher in the SSc patients (73%) compared to controls (37.5%) (p=0.0225). The proportion of responders to H3N2 and B was similar in both groups, and both had a significant increase in geometric mean titers for each antigen. A lower response to H1N1 was associated with interstitial lung disease, while patients on combination calcium channel blockers and iloprost therapy showed significantly better response to H1N1 and B antigens. Most underlying disease activity parameters remained unchanged.
  
  
  CONCLUSIONS
  The influenza virus vaccine was safe and generated a satisfactory humoral response in SSc patients.
authors.affiliation: Department of Rheumatology, Tel Aviv University, Israel. litinskyira@yahoo.com
authors.forename: Ira
authors.initials: I
authors.lastname: Litinsky
authors.forename: Alexandra
authors.initials: A
authors.lastname: Balbir
authors.forename: Devy
authors.initials: D
authors.lastname: Zisman
authors.forename: Michal
authors.initials: M
authors.lastname: Mandelboim
authors.forename: Ella
authors.initials: E
authors.lastname: Mendelson
authors.forename: Joy
authors.initials: J
authors.lastname: Feld
authors.forename: Yolanda
authors.initials: Y
authors.lastname: Braun
authors.forename: Marina
authors.initials: M
authors.lastname: Anouk
authors.forename: Ilana
authors.initials: I
authors.lastname: Kaufman
authors.forename: Daphna
authors.initials: D
authors.lastname: Paran
authors.forename: Dan
authors.initials: D
authors.lastname: Caspi
authors.forename: Ori
authors.initials: O
authors.lastname: Elkayam
mesh_terms: D000328:Adult; D000914:Antibodies, Viral / Q000097:blood; D016022:Case-Control Studies; D005260:Female; D006385:Hemagglutination Inhibition Tests; D006801:Humans; D056724:Immunity, Humoral / Q000187:drug effects; 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 / Q000008:administration & dosage / Q000009:adverse effects / Q000276:immunology*; D007251:Influenza, Human / Q000150:complications / Q000276:immunology / Q000517:prevention & control* / Q000821:virology; D007557:Israel; D008297:Male; D008875:Middle Aged; D012595:Scleroderma, Systemic / Q000150:complications* / Q000175:diagnosis / Q000276:immunology; D013997:Time Factors; D016896:Treatment Outcome; D014611:Vaccination
chemical_list: D000914:Antibodies, Viral; D007252:Influenza Vaccines