Decreased immune responses to influenza vaccination in patients with heart failure

Abstract

Background: Heart failure (HF) patients are at risk for influenza despite widespread vaccination. Both humoral (antibody) and cytotoxic T-lymphocyte (CTL) responses are important for protection. We explored antibody- and CTL-mediated responses to the influenza vaccine in HF patients compared with healthy controls.

Methods and results: We studied 29 HF patients (9 ischemic, 20 nonischemic) stable on HF therapies and 17 healthy controls. Participants had phlebotomy before and after influenza vaccination. Antibody production was measured in serum by hemagglutination inhibition assay and CTL responses (via interferon [IFN]-gamma and interleukin [IL]-10 production) were measured in isolated peripheral blood mononuclear cells with enzyme-linked immunosorbent assay. CTL responses demonstrated increased IL-10 production in HF patients after vaccination (P = .002), but similar IFN-gamma responses to healthy controls. All participants demonstrated antibody seroprotection; groups had similar rates of seroconversion (P = NS). Antibody-mediated response to the newest vaccine antigen, H3N2, was reduced in HF (P = .009).

Conclusions: Patients with HF had higher vaccine induced IL-10 concentrations, suggesting a different CTL phenotype for vaccine responses. HF patients did not mount as vigorous of an antibody immune response to the newest vaccine viral strain compared with healthy individuals. These data suggest that immunologic memory may be important for vaccine protection in HF patients.

Figures

Figure 1

Absolute changes in IFNgamma and IL-10 production between HF and healthy controls. Values expressed as distribution of differences (pre and post vaccination) of log transformed IFNgamma and IL-10 concentrations. P=0.133, 0.002 for comparison between groups, respectively.

Figure 2

Absolute changes in influenza vaccine-mediated A/H3N2, A/H1N1, and B-Malaysia antibody productions (hemagglutination units) between HF and healthy controls. Values expressed as medians (box plot lines) of differences (pre and post vaccination) of log transformed serum antibody concentrations. P=0.009, 0.9, and 0.08, respectively, for comparison between groups. HF = heart failure, HC = healthy controls, HAU = hemagglutination units.

Figure 3

Absolute changes in influenza vaccine-mediated A/H3N2 antibody productions (hemagglutination units) within the HF group between participants on carvedilol versus metoprolol succinate. Values expressed as medians (box plot lines) of differences (pre and post vaccination) of log transformed serum antibody concentrations. P=0.06, for comparison between beta blocker groups. HAU = hemagglutination units.