Division of Rheumatology, University of São Paulo, São Paulo, SP, Brazil.
Scand J Rheumatol. 2013;42(1):34-40. doi: 10.3109/03009742.2012.709272. Epub 2012 Sep 20.
To assess the vaccine response in juvenile idiopathic arthritis (JIA) as an extension of previous observation of immunogenicity and safety of a non-adjuvanted influenza A H1N1/2009 vaccine in a large population of juvenile rheumatic diseases. Moreover, to assess the possible influence of demographic data, disease subtypes, disease activity, and treatment on immunogenicity and the potential deleterious effect of the vaccine in the disease itself, particularly in the number of arthritis and inflammatory markers.
A total of 95 patients with JIA and 91 healthy controls were evaluated before and 21 days after vaccination, and serology for anti-H1N1 was performed by haemagglutination inhibition assay (HIA). Patient and physician visual analogue scales (VAS), Childhood Health Assessment Questionnaire (CHAQ), number of active joints, acute phase reactants, and treatments were evaluated before and after vaccination. Adverse events were also reported.
JIA patients and controls were comparable regarding mean current age (14.9 ± 3.2 vs. 14.6 ± 3.7 years, p = 0.182). After vaccination, the seroconversion rate was significantly lower in JIA patients compared to controls (83.2% vs. 95.6%, p = 0.008), particularly in the polyarticular subtype (80% vs. 95.6%, p = 0.0098). Of note, JIA subtypes, number of active joints, acute phase reactants, CHAQ, patient and physician VAS, and use of disease-modifying anti-rheumatic drugs (DMARDs)/immunosuppressive drugs were similar between seroconverted and non-seroconverted patients (p > 0.05). Regarding vaccine safety, no deterioration was observed in the number of active joints and acute phase reactants during the study period.
Influenza A H1N1/2009 vaccination in JIA induces a lower but effective protective antibody response probably independent of disease parameters and treatment with an adequate disease safety profile.
评估幼年特发性关节炎（JIA）中的疫苗反应，这是对先前观察到的大样本幼年风湿性疾病人群中使用非佐剂甲型 H1N1/2009 流感疫苗的免疫原性和安全性的扩展。此外，评估人口统计学数据、疾病亚型、疾病活动度和治疗对免疫原性的可能影响，以及疫苗在疾病本身中可能产生的有害影响，特别是在关节炎和炎症标志物的数量上。
共评估了 95 例 JIA 患者和 91 例健康对照者接种疫苗前后 21 天的情况，并通过血凝抑制试验（HIA）检测抗 H1N1 抗体。在接种前后评估患者和医生的视觉模拟量表（VAS）、儿童健康评估问卷（CHAQ）、活跃关节数、急性期反应物和治疗情况。还报告了不良事件。
JIA 患者和对照组的平均当前年龄（14.9 ± 3.2 岁 vs. 14.6 ± 3.7 岁，p = 0.182）无显著差异。接种疫苗后，JIA 患者的血清转化率明显低于对照组（83.2% vs. 95.6%，p = 0.008），特别是在多关节型（80% vs. 95.6%，p = 0.0098）。值得注意的是，在血清转化率和非血清转化率患者之间，JIA 亚型、活跃关节数、急性期反应物、CHAQ、患者和医生的 VAS 以及疾病修饰抗风湿药物（DMARDs）/免疫抑制剂的使用无显著差异（p > 0.05）。关于疫苗安全性，在研究期间，活跃关节数和急性期反应物没有恶化。
甲型 H1N1/2009 流感疫苗在 JIA 中诱导的保护性抗体反应较低，但有效，可能独立于疾病参数和使用疾病安全状况良好的治疗药物。
