Occurrence and protective level of influenza infections using serology in patients with COPD in vaccination study

To investigate the prevalence, occurrence and protective level of influenza infections using serology in patients with chronic obstructive pulmonary disease (COPD) during a one-year influenza vaccination study.

A total of 123 patients with COPD were enrolled during the period of 1997 to 1998. There were 61 patients in the vaccine group and 62 patients in the placebo group with a mean age +/- SD of 67.6 +/- 8.0 and 69.1 +/- 7.5, respectively. The vaccine was composed of influenza A/Texas/36/91 (H1N1), A/Nanchang/933/95 (H3N2) and B/Harbin/07/94 strains. Antibodies to influenza viruses were detected by hemagglutination inhibition (HI) test using antigens of vaccine strains.

The incidence of influenza proven by serological examination was 22/123 (17.9%) cases. Among 17/62 (27.4%) influenza cases in the placebo group representing natural infections, 3 (17.6%) were diagnosed as A (H1N1), 8 (47.1%) as A (H3N2), 3 (17.6%) as type A, 1 (5.9%) as type B and 2 (11.8%) as untypeable viruses. The 8.2% of influenza cases found in the vaccine group was significantly lower than 27.4% of that in the placebo group (Chi-square test, p = 0.01). The protection rate of influenza vaccination was 71%. Among 23 acute blood samples from 22 influenza cases, the titers ranged from < 10 to 20 corresponding to its type/subtype. In the vaccine group, 5 influenza cases occurred at 7, 7, 10, 11 and 11 months after vaccination. The HI antibodies to influenza A (H1N1), A (H3N2) and B viruses at titers of > or = 10 vs > or = 40 were 50.4% vs 21.9%, 54.5% vs 28.5% and 17.9% vs 4.1%, respectively.

The findings indicated that from 1997 to 1998, the occurrence of influenza as natural infection was 27.4%. Influenza A (H3N2) was more frequently prevalent than A (H1N1) and B viruses. The influenza vaccination in COPD patients was effective. The protective HI antibody titers were > or = 40. The patients without protective HI antibody to A (H1N1), A (H3N2) and B viruses were 78.1%, 71.5% and 95.9%, respectively. Such patients were considered to be at high-risk for influenza and recommended to have vaccination.