Antibody and cell-mediated immune response to whole virion and split virion influenza vaccine in patients with inflammatory bowel disease on maintenance immunosuppressive and biological therapy.
OBJECTIVE
Influenza vaccination is recommended for inflammatory bowel disease (IBD) patients on immunosuppressive therapy. The objective was to evaluate the antibody and cell-mediated immune response to the split and whole virion influenza vaccine in patients with IBD treated with anti-TNF-α and immunosuppressive therapy.


METHODS
One hundred and fifty-six immunocompromised IBD patients were vaccinated. Fifty-three patients (control group) refused vaccination. Split virion vaccine and whole virion vaccine were used. Serum samples were obtained for pre- and postimmunization antibody titers to influenza vaccine (A/California/7/2009 [H1N1], A/Victoria/361/2011 [H3N2], B/Wisconsin/1/2010-like B/Hubei-Wujiagang/158/2009). Cell-mediated response was evaluated using an interferon (INF)-γ, interleukine (IL)-2 and tumor necrosis factor (TNF)-α ELISA.


RESULTS
Postimmunization titers of both influenza subtypes increased significantly after the administration of split virion vaccines compared to the controls and to those who received whole virion vaccine. The antibody titers of Influenza B also increased significantly in patients immunized with split vaccine and treated with anti-TNF-α therapy. After influenza vaccination, the level of serum IL-2 significantly decreased. No serious side effects developed occurred after influenza vaccination, and the influenza-like symptoms did not differ significantly between vaccinated versus control patients. The relapse of the disease was observed in only 10% of the patients and was more common in vaccinated than in control subjects.


CONCLUSIONS
Split virion vaccines seem to be more effective than whole virion vaccines. Measuring the antibody responses is worthwhile in patients treated with immunosuppressants to determine the efficacy of influenza vaccination.
First Department of Medicine, University of Szeged , Szeged , Hungary.
Anita
A
Bálint
Klaudia
K
Farkas
Pallagi-Kunstár
PK
Éva
Gabriella
G
Terhes
Edit
E
Urbán
Mónika
M
Szucs
Tibor
T
Nyári
Zsuzsanna
Z
Bata
Ferenc
F
Nagy
Zoltán
Z
Szepes
Pál
P
Miheller
Katalin
K
Lorinczy
Péter László
PL
Lakatos
Barbara
B
Lovász
Szamosi
S
Tamás
Andrea
A
Kulcsár
Anna
A
Berényi
Dalma
D
Törocsik
Tímea
T
Daróczi
Zoltán
Z
Saródi
Tibor
T
Wittmann
Tamás
T
Molnár
D000328:Adult; D000914:Antibodies, Viral / Q000097:blood*; D001691:Biological Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D007111:Immunity, Cellular; D056724:Immunity, Humoral; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D015212:Inflammatory Bowel Diseases / Q000628:therapy*; D007252:Influenza Vaccines / Q000627:therapeutic use*; D007251:Influenza, Human / Q000517:prevention & control; D029521:Alphainfluenzavirus / Q000276:immunology; D029524:Betainfluenzavirus / Q000276:immunology; D007371:Interferon-gamma / Q000097:blood; D007376:Interleukin-2 / Q000097:blood; D008297:Male; D011446:Prospective Studies; D014409:Tumor Necrosis Factor-alpha / Q000097:blood; D014611:Vaccination; D014771:Virion / Q000276:immunology
D000914:Antibodies, Viral; C573415:IFNG protein, human; C508594:IL2 protein, human; D007166:Immunosuppressive Agents; D007252:Influenza Vaccines; D007376:Interleukin-2; D014409:Tumor Necrosis Factor-alpha; D007371:Interferon-gamma
anti-TNF therapy; cellular immune response; immunosuppression; inflammatory bowel diseases; influenza; vaccination