Efficacy of influenza A H1N1/2009 vaccine in hemodialysis and kidney transplant patients

Abstract

Background and objectives: Data are needed to assess safety and efficacy of the 2009 pandemic influenza A H1N1 vaccine in renal patients.

Design, setting, participants, & measurements: We prospectively evaluated seroconversion, predictors of response, and vaccine safety in renal patients. Hemagglutination inhibition tests to detect serum antibodies against a new influenza A-H1N1 virus were performed in 79 transplant patients, 48 hemodialysis patients, and 15 healthy workers before and 1 month after vaccination. Healthy controls and 88 of 127 renal patients were vaccinated. Seroconversion was defined as at least 2 dilutions increase in titer.

Results: We excluded 19 individuals seroprotected (≥1/40) against the novel H1N1 in the initial sample. Efficacy rate in the 96 vaccinated individuals was 43.7% (42 of 96 seroconverted versus four of 27 nonvaccinated patients, P = 0.007). For vaccinated subgroups, efficacy was 41.8% in transplant patients (P = 0.039 versus nonvaccinated), 33.3% in hemodialysis patients (P = 0.450), and 81.8% in controls. Healthy controls showed better response to vaccine than transplant (P = 0.021) and dialysis (P = 0.012) patients. For the transplant subgroup, longer time after transplantation (P = 0.028) was associated with seroconversion, but no influence was found for age, gender, renal function, or immunosuppression. In the hemodialysis subgroup, younger age was associated with response (55.7 ± 20.8 versus 71.6 ± 10.1 years, P = 0.042), but other specific variables, including Kt/V or time on dialysis, were not. No serious adverse events were reported, and kidney function was stable.

Conclusion: The novel influenza A 2009 H1N1 vaccine was safe in renal patients, although administration of a single dose of adjuvanted vaccine induced a poor response in these patients.

Figures

Figure 1.

Patient flow in the study.

Figure 2.

(A) Distribution curves for titers of hemagglutination inhibition antibodies before and 8 weeks after the dose of 2009 pandemic influenza vaccine in vaccinated transplant patients not protected before vaccination (initial titers <1:40). (B) Distribution curves for titers of hemagglutination inhibition antibodies before and 8 weeks after the dose of 2009 pandemic influenza vaccine in vaccinated patients on hemodialysis not protected before vaccination (initial titers <1:40).