Crohn's and Colitis Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA.
Gut. 2012 Mar;61(3):385-91. doi: 10.1136/gutjnl-2011-300256. Epub 2011 Jul 13.
Influenza vaccination is recommended for patients with inflammatory bowel disease (IBD). The 2009 H1N1 influenza vaccine produced seroprotection rates of >85% in the general population but there are no data on the immunogenicity of the vaccine in patients with IBD.
An observational prospective open-label study was conducted to examine the immunogenicity of the 2009 H1N1 influenza vaccine in 108 patients with IBD. Patient details, medications and disease activity were recorded. Pre- and post-vaccination haemagglutinin inhibition titres and geometric mean titres were measured. A functional assay of T lymphocyte activity was measured at vaccination in a subset of patients as an alternative measure of immunosuppression. Subjects were followed for 6 months post-vaccination.
Of 108 patients enrolled, 105 completed the study. The post-vaccination seroprotection rate was 50%. Immunosuppressed subjects had a lower rate of seroprotection than non-immunosuppressed subjects (44% vs 64%, p=0.06). The proportion with seroprotection was significantly lower in subjects on combination immunosuppression than in those receiving no immunosuppression (36% vs 64%, p=0.02). Patients receiving combined immunosuppression had a significantly lower fold increase in geometric mean titres than those on monotherapy immunosuppression (3.5 vs 11.5, p=0.03). An assay of T lymphocyte activity was performed in a subgroup of 48 subjects. Those with intermediate activity had lower seroprotection than those with high activity (28% vs 61%, p=0.02). The vaccine was well tolerated.
Patients with IBD vaccinated with the 2009 H1N1 influenza vaccine had a low rate of seroprotection, particularly among those who were immunosuppressed. Although there is a need for studies of the clinical benefit of vaccines in this population, patients with IBD need to be aware of this reduced immunogenicity.
流感疫苗推荐用于炎症性肠病（IBD）患者。2009 年 H1N1 流感疫苗在普通人群中的血清保护率>85%，但尚无该疫苗在 IBD 患者中免疫原性的数据。
进行了一项观察性前瞻性开放标签研究，以检查 108 例 IBD 患者接种 2009 年 H1N1 流感疫苗的免疫原性。记录患者详细信息、药物和疾病活动情况。测量接种前后的血凝素抑制滴度和几何平均滴度。在一组患者中进行 T 淋巴细胞活性的功能测定，作为免疫抑制替代指标。在接种疫苗后 6 个月对受试者进行随访。
在纳入的 108 例患者中，有 105 例完成了研究。接种后血清保护率为 50%。免疫抑制组的血清保护率低于非免疫抑制组（44%比 64%，p=0.06）。联合免疫抑制组的血清保护率明显低于未接受免疫抑制组（36%比 64%，p=0.02）。联合免疫抑制组的几何平均滴度倍数增加明显低于单药免疫抑制组（3.5 比 11.5，p=0.03）。对 48 例患者进行了 T 淋巴细胞活性测定。中等活性组的血清保护率低于高活性组（28%比 61%，p=0.02）。疫苗耐受性良好。
接种 2009 年 H1N1 流感疫苗的 IBD 患者血清保护率较低，尤其是免疫抑制患者。尽管需要研究该人群疫苗的临床获益，但 IBD 患者需要了解这种免疫原性降低的情况。
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