title: Risk factors affecting seroconversion after influenza A/H1N1 vaccination in hemodialysis patients.
abstract: BACKGROUND
  Hemodialysis (HD) patients have multiple causes of immune dysfunction and poor immune response to influenza vaccination. We investigated the antibody response rate to a pandemic H1N1/2009 influenza vaccination and clinical parameters influencing the induction of antibody responses in HD patients.
  
  
  METHODS
  A total of 114 HD patients were vaccinated with a monovalent adjuvanted H1N1 inactivated influenza vaccine. Titers of neutralizing antibodies were evaluated by hemagglutination inhibition (HI) assay at pre- and 4 weeks after vaccination. Seroconversion was defined as either a pre-vaccination HI titer < 1:10 and a post vaccination HI titer > 1:40 or a pre-vaccination HI titer ≥ 1:10 and a minimum four-fold rise in post-vaccination HI antibody titer. Seventeen out of 114 HD patients (14.9%) tested positive for antibodies against influenza A/H1N1/2009 before vaccination. The remaining 97 baseline sero-negative patients were included in the analysis.
  
  
  RESULTS
  Only 30 (30.9%) HD patients had seroconversion 4 weeks after vaccination. The elderly patients, those over 65 years of age, showed significantly lower seroconversion rate compared to younger HD patients (20.5% vs. 39.6%, p = 0.042). Furthermore, patients with hemoglobin values less than 10 g/dL had a significantly lower seroconversion rate compared to those with higher hemoglobin values (20.0 vs. 38.6%, p = 0.049). By multivariate logistic regression analysis, only age ≥65 years (OR = 0.336, 95% confidence interval (CI) 0.116-0.971, p = 0.044) and hemoglobin levels <10 g/dL (OR = 0.315, 95% CI 0.106-0.932, p = 0.037) were independently associated with seroconversion after vaccination.
  
  
  CONCLUSIONS
  Our data show that HD patients, especially who are elderly with low hemoglobin levels, are at increased risk for lower seroconversion rate after influenza A/H1N1 vaccination. Further studies are needed to improve the efficacy of vaccination in these high risk patients.
authors.affiliation: 1Myongji Hospital, College of Medicine, Kwandong University, Goyang, Korea.
authors.forename: Sung Jin
authors.initials: SJ
authors.lastname: Moon
authors.forename: Sang Hun
authors.initials: SH
authors.lastname: Lee
authors.forename: Young-Ho
authors.initials: YH
authors.lastname: Byun
authors.forename: Gi Young
authors.initials: GY
authors.lastname: Yun
authors.forename: Seung Kyu
authors.initials: SK
authors.lastname: Kim
authors.forename: Baik-Lin
authors.initials: BL
authors.lastname: Seong
authors.forename: Ah Reum
authors.initials: AR
authors.lastname: Kim
authors.forename: Eun
authors.initials: E
authors.lastname: Sun Park
authors.forename: Hyung-Jong
authors.initials: HJ
authors.lastname: Kim
authors.forename: Jung Eun
authors.initials: JE
authors.lastname: Lee
authors.forename: Sung Kyu
authors.initials: SK
authors.lastname: Ha
authors.forename: Jae Myun
authors.initials: JM
authors.lastname: Lee
authors.forename: Hyeong-Cheon
authors.initials: HC
authors.lastname: Park
mesh_terms: D000914:Antibodies, Viral / Q000097:blood*; D015897:Comorbidity; D005260:Female; D006801:Humans; D053118:Influenza A Virus, H1N1 Subtype; D007252:Influenza Vaccines / Q000627:therapeutic use*; D007251:Influenza, Human / Q000453:epidemiology / Q000276:immunology / Q000517:prevention & control*; D007676:Kidney Failure, Chronic / Q000453:epidemiology / Q000276:immunology* / Q000534:rehabilitation*; D008297:Male; D032541:Mass Vaccination / Q000706:statistics & numerical data; D008875:Middle Aged; D015995:Prevalence; D006435:Renal Dialysis / Q000706:statistics & numerical data*; D056910:Republic of Korea / Q000453:epidemiology; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D000914:Antibodies, Viral; D007252:Influenza Vaccines