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Effect of prednisone on response to influenza virus vaccine in asthmatic children
M P Fairchok1, D P Trementozzi, P S Carter
1Department of Pediatrics, Madigan Army Medical Center, Tacoma, Wash, USA.
Insights
Short-course prednisone therapy did not affect the immunogenicity of the influenza virus vaccine in children with asthma exacerbations. Asthmatic children can receive influenza vaccination during prednisone bursts.
Area of Science:
- Pediatric Allergy and Immunology
- Vaccinology
- Respiratory Medicine
Background:
- Asthma exacerbations in children often require short courses of oral prednisone.
- Influenza virus vaccination is crucial for preventing respiratory infections in children with asthma.
- Concerns exist regarding the potential impact of corticosteroids on vaccine immunogenicity.
Purpose of the Study:
- To evaluate the immunogenicity of the influenza virus vaccine in children receiving short-course prednisone therapy for acute asthmatic exacerbations.
- To compare the immune response to influenza vaccination between children on prednisone bursts and a control group.
Main Methods:
- Prospective cohort study conducted in an outpatient pediatric clinic.
- Enrolled children aged 6 months to 18 years receiving the 1996-1997 influenza vaccine.
- Compared antibody titers (4-fold rise and end titers) to influenza antigens between a prednisone group (n=21) and a control group (n=37).
Main Results:
- No significant differences were observed in the proportion of patients achieving at least a 4-fold rise in antibody titers to any of the three influenza antigens (H3N2, H1N1, B).
- End titers of at least 1:40 to all three antigens were comparable between the prednisone and control groups.
- Mean changes in geometric titers to the influenza antigens showed no significant differences between the groups.
Conclusions:
- Short-course prednisone therapy for acute asthmatic exacerbations does not diminish the immunogenicity of the influenza virus vaccine in children.
- Influenza virus vaccination is effective in children with asthma who are undergoing short bursts of prednisone therapy.
Objective:
To evaluate the immunogenicity of the influenza virus vaccine in children receiving short-course (a burst) prednisone therapy for acute asthmatic exacerbations.
Design:
Prospective cohort study.
Setting:
Outpatient pediatric clinic of a military medical center.
Patients:
Children aged 6 months to 18 years requiring the 1996 influenza virus vaccine were eligible for the study. A total of 58 children were enrolled initially. The control group included 37 asthmatic children requiring less than 900 microg/d of inhaled prednisone and their siblings. The prednisone group included 21 children vaccinated at the beginning of a course of prednisone prescribed to treat an asthma exacerbation. Thirty-one control subjects (84%) and 19 patients in the prednisone group (90%) completed the study. Dropout was due to failure to come in for the postvaccination serum sampling.
Interventions:
All study patients underwent immunization with the 1996-1997 trivalent subvirion influenza virus vaccine (FluShield; Wyeth Laboratories Inc, Marietta, Pa) containing 15-microg hemagglutinin antigens each of A/Texas/36/91 (H1N1) (A/H1), A/Wuhan/359/95 (H3N2)(A/H3), and B/Beijing/184/93 (B). The prednisone cohort received a burst of oral prednisone therapy (2 mg/kg per day for 5 days).
Main Outcome Measures:
To assess the immunogenicity of the vaccine between both groups, at least a 4-fold rise in titer and end titers of at least 1:40 to each of the 3 antigens were compared. Mean changes in geometric titers to the 3 antigens were also compared.
Results:
Proportion of patients in each group with at least a 4-fold rise in titer to each of the influenza antigens was as follows: for A/H3N3 antigen, 15 patients (79%) in the prednisone group vs 22 controls (71%) (P = .74); for A/ H1N1 antigen, 16 patients in the prednisone group (84%) vs 20 controls (64%) (P = .20); and for B antigen, 7 patients in the prednisone group (37%) vs 8 controls (26%) (P = .53). Proportion of patients in each group with an end titer of at least 1:40 to each of the antigens was as follows: for A/ H3N2 antigen, 18 patients in the prednisone group (95%) vs 28 controls (90%) (P = .69); for A/H1N1 antigen, 17 patients in the prednisone group (89%) vs 26 controls (84%) (P = .99); and for B antigen, 7 patients in the prednisone group (37%) vs 13 controls (42%) (P = .99). There were also no significant differences between groups in the mean changes in geometric titers to any of the 3 antigens.
Conclusions:
Prednisone bursts did not diminish the response of asthmatic children to the 1996 influenza virus vaccine, compared with controls. Children can be effectively vaccinated against influenza virus while they are receiving prednisone therapy bursts for asthmatic exacerbations.
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