Humoral and cellular immune responses to influenza vaccine in patients with advanced cirrhosis

doi:10.1016/j.vaccine.2005.11.064

Vaccine

Volume 24, Issue 13, 20 March 2006, Pages 2417-2422

https://doi.org/10.1016/j.vaccine.2005.11.064 Get rights and content

Abstract

Influenza vaccine has been shown to successfully reduce influenza- and pneumonia-associated hospitalizations and deaths. Yet in liver cirrhosis, influenza vaccines have received little attention in determining the potential benefits. Thus, we undertook this study to evaluate the humoral and cellular immune responses to vaccination against influenza in patients with advanced cirrhosis. We measured interferon (IFN)-γ secretion response and hemagglutinin inhibition (HI) of antibody titer from pre- and post-vaccination blood samples in 80 cirrhotic patients (Child–Pugh class B or C) and 80 healthy, age-matched subjects. Although the patients with advanced cirrhosis showed similar humoral immune response against influenza vaccination compared to the healthy controls, cell-mediated immunity showed different results according to the remnant liver function.

Section snippets

Background

The morbidity and mortality associated with influenza are greatly increased in elderly people or patients with underlying chronic diseases. In this perspective, vaccination is the main tool to reduce complications and mortality related to influenza in this population [1].

Center for Disease Control and Prevention (CDC) recommends annual influenza vaccination to people who have long-term health problems such as heart disease, kidney disease, lung disease, metabolic disease (such as diabetes),

Subjects

Eighty patients with advanced cirrhosis, namely Child–Pugh class B or C, were recruited from Korea University Guro Hospital (KUGH) in Seoul, South Korea. Cirrhotic patients with hepatocellular carcinoma were excluded from the study. Eighty healthy, age-matched subjects were enrolled as controls. Informed consent was obtained from all patients and controls participating in this study.

All subjects were vaccinated in October and November 2003 with commercially available, split trivalent influenza

Results

A total of 160 subjects, 80 advanced cirrhotic patients and 80 healthy controls, were assigned to receive trivalent influenza vaccine. Fifty-six subjects were dropped out from the study due to poor compliance to the study protocol. Of the 104 subjects, from whom samples were successfully tested, 50 (48%) were cirrhotic patients and 54 (52%) were healthy controls. The main demographic and clinical data of the patients and controls are shown in Table 1.

Discussion

In order to include chronic liver disease as one of the obligatory indications of influenza vaccination, the effectiveness of vaccination in advanced liver cirrhosis must be studied and studies on immunogenicity of influenza vaccination in patients with liver cirrhosis must be done in advance. In our study, we measured the immunogenicity of commercially available, split trivalent influenza vaccine in patients with advanced liver cirrhosis and proved that the humoral immunity was not inferior to

Acknowledgments

We thank Ms. Ha Seok-Hoon and In-Sook Jang for technical assistance.

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Humoral and cellular immune responses to influenza vaccine in patients with advanced cirrhosis

Abstract

Section snippets

Background

Subjects

Results

Discussion

Acknowledgments

Liver Transpl

Exp Gerontol

Vaccine

Vaccine

Immunol Today

Vaccine

Vaccine

Med Clin North Am

Prevention and Control of Influenza. Recommendations of the Advisory Committee on Immunization Practices (ACIP)

MMWR Morb Mortal Wkly Rep

Prevention and control of influenza: Recommendations of the Advisory Committee on Immunization Practices (ACIP)

MMWR Morb Mortal Wkly Rep

Infections in cirrhosis

Infect Dis Clin North Am

Bacterial infections in liver disease

Sem Liver Dis

Deficient serum bactericidal activity against Escherichia coli in patients with cirrhosis of the liver

J Clin Invest

Hepatic decompensation in patients with cirrhosis during infection with influenza A

Arch Intern Med