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Influenza vaccination in children with chronic rheumatic diseases and long-term immunosuppressive therapy
F Kanakoudi-Tsakalidou1, M Trachana, P Pratsidou-Gertsi
1A'Department of Pediatrics, Influenza Reference Center, Aristotle University, Thessaloniki, Greece. flkan@med.auth.gr
Insights
Children with chronic rheumatic diseases (CRD) on immunosuppressants safely receive influenza vaccines, mounting an immune response similar to healthy children. This vaccination is effective and well-tolerated, regardless of treatment or disease type.
Area of Science:
- Pediatric Rheumatology
- Immunology
- Vaccinology
Background:
- Children with chronic rheumatic diseases (CRD) often require long-term immunosuppressive therapy.
- Assessing influenza vaccine immunogenicity and safety in this vulnerable population is crucial for preventing severe illness.
Purpose of the Study:
- To evaluate the immunogenicity, safety, and efficacy of influenza vaccination in pediatric patients with CRD undergoing immunosuppressive treatment.
- To compare vaccine response across different therapeutic regimens and disease types.
Main Methods:
- Seventy children with CRD and five healthy siblings received a split-type influenza vaccine.
- Clinical and laboratory evaluations were conducted at baseline and follow-up points (1, 3, 6 months).
- Antibody titers against influenza antigens (A/Beijing, A/Sydney, B/Beijing) were measured using hemagglutination inhibition assay before and one month post-vaccination.
Main Results:
- High seroprotection rates were achieved: 97.14% for A/Beijing, 100% for A/Sydney, and 80% for B/Beijing.
- Adverse reactions were minimal (local or systemic in 5 patients, local in 1 sibling).
- No significant differences in antibody titers were observed based on therapeutic regimen, age, or CRD type (JIA, SLE).
Conclusions:
- Influenza vaccination is immunogenic and safe in children with CRD on immunosuppressive therapy.
- Vaccine response is comparable to healthy children and not significantly affected by treatment or disease characteristics.
- Influenza vaccination should be recommended for children with CRD to prevent influenza and its complications.
Objective:
To study the immunogenicity, safety and efficacy of influenza vaccine in children with chronic rheumatic diseases (CRD) receiving long-term immunosuppressive therapy.
Methods:
Seventy children (F:M 51:19) with CRD (JIA = 49, SLE = 11, other = 10) aged 4-17 yrs and 5 healthy siblings of the patients (aged < 11 yrs) received a "split type" influenza vaccine (Fluarix SB) licensed for the 1999-2000 winter season. Clinical and laboratory evaluation were performed at study entry and at 1, 3 and 6 months after vaccination. Blood samples were collected before and one month after vaccination and antibody titers to A/Beijing, A/Sydney and B/Beijing influenza antigens were measured using a standardized hemagglutination inhibition assay.
Results:
Patients were assigned to groups according to the therapeutic regimen [prednisone (PDN), PDN plus 1 disease modifying antirheumatic drug (DMARD), PDN plus 2 DMARDs and 1 or 2 DMARDs without PDN]. 5/70 patients reported local (3) or systemic (2) reactions and 1/5 siblings local reaction. Nine more patients reported mild upper respiratory tract symptoms 1-4 weeks post-vaccination. No patient was found to fulfill criteria for deterioration or flare of the underlying disease. At completion of vaccination 97.14% of patients developed protective HI titers to A/Beijing, 100% to A/Sydney and 80% to B/Beijing. No significant difference in the mean geometric titers was found between patients with different therapeutic regimens or age or between those with JIA or SLE. Disease activity was not related with response or non-response to B/Beijing. No patient reported "flu-like" symptoms during the 6-month period of follow-up.
Conclusion:
The results of our study indicate that children with CRD receiving long-term immunosuppressive therapy at conventional doses respond to influenza vaccination similarly to healthy children without serious adverse reactions or disease flares regardless of their age, type of CRD or therapeutic regimen.