The Department of Paediatrics and Adolescent Medicine, Juliane Marie Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
Pediatr Rheumatol Online J. 2021 Mar 12;19(1):26. doi: 10.1186/s12969-021-00518-0.
Prevention of illness due to infection by influenza viruses is important for children with rheumatic diseases. Biological disease modifying antirheumatic drugs have become increasingly important in the treatment of juvenile idiopathic arthritis, and combinations of immunosuppressive drugs are used for the treatment of systemic disorders, which increase the risk of secondary immunodeficiency. Therefore, we investigated whether children with rheumatic disease can mount a protective antibody response after influenza immunization.
The prospective multicentre cohort study was conducted in Denmark during the influenza season 2015-2016. Children with rheumatic disease aged six months to 19 years were eligible. Controls were immunologically healthy children. A blood sample was collected before and after vaccination and analysed by haemagglutination inhibition (HI) assay for the 2015-2016 influenza vaccine-strains. In case of flu-like symptoms the child was tested for influenza. For statistical analyses the patients were grouped according to medical treatment or disease.
A total of 226 patients and 15 controls were enrolled. No differences were found for the increase of antibodies from pre-vaccine to post-vaccine between the groups in our primary analyses: A/Cal H1N1pdm09 (p = 0.28), A/Swi H3N2 (p = 0.15) and B/Phu Yamagata (p = 0.08). Only when combining patients across groups a lower increase in antibodies was found compared to controls. Among all patients the pre-vaccine rates for seroprotection using the HI-titer cut-off ≥ 40 were 93.1-97.0 % for all three strains. For seroprotection using the HI-titer cut-off ≥ 110 the pre-vaccine rates for all patients were 14.9-43.6 % for all three strains and an increase in the proportions of patients being seroprotected after vaccination was found for A/Cal H1N1pdm09 and A/Swi H3N2. None of the children with flu-like symptoms tested positive for the vaccine strains.
Children with rheumatic diseases increase in antibody titres after influenza immunization, however, it remains uncertain whether a protective level is achieved.
预防流感病毒感染导致的疾病对患有风湿性疾病的儿童很重要。生物性疾病修饰抗风湿药物在治疗幼年特发性关节炎方面变得越来越重要，免疫抑制剂的组合用于治疗全身性疾病，这会增加继发免疫缺陷的风险。因此，我们研究了患有风湿性疾病的儿童在流感免疫接种后是否能够产生保护性抗体反应。
本前瞻性多中心队列研究于 2015-2016 年流感季节在丹麦进行。年龄在 6 个月至 19 岁之间患有风湿性疾病的儿童符合条件。对照组为免疫健康的儿童。在接种疫苗前后采集血样，并通过血凝抑制（HI）试验分析 2015-2016 年流感疫苗株。如果出现流感样症状，对儿童进行流感检测。为了进行统计学分析，根据治疗方法或疾病对患者进行分组。
共纳入 226 名患者和 15 名对照。在我们的主要分析中，各组之间从疫苗前到疫苗后的抗体增加没有差异：A/Cal H1N1pdm09（p=0.28）、A/Swi H3N2（p=0.15）和 B/Phu Yamagata（p=0.08）。只有当将各组患者合并时，与对照组相比，抗体增加较低。所有患者中，使用 HI 滴度截断值≥40 的三种菌株的血清保护率均为 93.1-97.0%。使用 HI 滴度截断值≥110 的所有患者的三种菌株的血清保护率分别为 14.9-43.6%，且发现接种疫苗后血清保护的患者比例增加了 A/Cal H1N1pdm09 和 A/Swi H3N2。没有出现流感样症状的儿童对疫苗株检测呈阳性。
患有风湿性疾病的儿童在流感免疫接种后抗体滴度增加，但仍不确定是否达到了保护水平。
