Pharmacy Division, Dialysis Clinic, Inc, Nashville, Tennessee.
Clinical Science & Quality Initiatives Division, Dialysis Clinic, Inc, Nashville, Tennessee; Department of Medicine, Nephrology Service, Tufts Medical Center, Boston, Massachusetts.
Am J Kidney Dis. 2022 Sep;80(3):309-318. doi: 10.1053/j.ajkd.2022.01.425. Epub 2022 Mar 12.
RATIONALE & OBJECTIVE: High-dose influenza vaccine provides better protection against influenza infection in older adults than standard-dose vaccine. We compared vaccine seroresponse among hemodialysis patients over a period of 4 months after administration of high-dose trivalent inactivated (HD-IIV3), standard-dose quadrivalent inactivated (SD-IIV4), or quadrivalent recombinant quadrivalent (RIV4) influenza vaccine.
Prospective observational study.
SETTING & PARTICIPANTS: Patients at 4 hemodialysis clinics who received influenza vaccine.
Type of influenza vaccine.
Hemagglutination inhibition (HI) titers were measured at baseline and at 1, 2, 3, and 4 months after vaccination. The primary outcome was seroprotection rates at HI titers of at least 1:40 and at least 1:160 (antibody levels providing protection from infection in approximately 50% and 95% of immunocompetent individuals, respectively) at 1, 2, 3, and 4 months after vaccination.
We calculated geometric mean titer as well as seroprotection and seroconversion rates. Adjusted generalized linear models with additional trend analyses were performed to evaluate the association between vaccine type and outcomes.
254 hemodialysis patients were vaccinated against influenza with HD-IIV3 (n = 141), SD-IIV4 (n = 36), or RIV4 (n = 77). A robust initial seroresponse to influenza A strains was observed after all 3 vaccines. Geometric mean titer and seroprotection (HI titer ≥1:160) rates against influenza A strains were higher and more sustained with HD-IIV3 than SD-IIV4 or RIV4. More than 80% of patients vaccinated with HD-IIV3 were seroprotected (HI titer ≥1:160) at month 4 (P < 0.001), whereas, among patients vaccinated with SD-IIV4 or RIV4, seroprotection rates were similar to those at baseline. Seroprotection rates were lower against B strains for all vaccines.
Because of the use of observational data, bias from unmeasured confounders may exist. Some age subgroups were small in number. Clinical outcome data were not available.
Hemodialysis patients exhibited high seroprotection rates after all 3 influenza vaccines. The seroresponse waned more slowly with HD-IIV3 compared with SD-IIV4 and RIV4 vaccines.
大剂量流感疫苗比标准剂量疫苗能为老年人提供更好的流感感染防护。我们比较了高剂量三价灭活（HD-IIV3）、标准剂量四价灭活（SD-IIV4）和四价重组四价（RIV4）流感疫苗接种后 4 个月内血液透析患者的疫苗血清反应。
前瞻性观察性研究。
在 4 家血液透析诊所接受流感疫苗接种的患者。
流感疫苗类型。
接种后 1、2、3 和 4 个月时测量血凝抑制（HI）滴度。主要结局是接种后 1、2、3 和 4 个月时 HI 滴度至少为 1:40 和至少为 1:160 的血清保护率（分别提供约 50%和 95%免疫功能正常个体免受感染的抗体水平）。
我们计算了几何平均滴度以及血清保护和血清转化率。使用额外趋势分析的调整广义线性模型来评估疫苗类型与结果之间的关联。
254 名血液透析患者接种了 HD-IIV3（n=141）、SD-IIV4（n=36）或 RIV4（n=77）预防流感。所有 3 种疫苗接种后均观察到对甲型流感株的初始血清反应增强。与 SD-IIV4 或 RIV4 相比，接种 HD-IIV3 后甲型流感株的几何平均滴度和血清保护（HI 滴度≥1:160）率更高且更持久。接种 HD-IIV3 的患者中超过 80%在第 4 个月时具有血清保护（HI 滴度≥1:160）（P<0.001），而接种 SD-IIV4 或 RIV4 的患者的血清保护率与基线相似。所有疫苗对乙型流感株的血清保护率均较低。
由于使用观察性数据，可能存在未测量混杂因素的偏倚。一些年龄亚组的数量较少。未获得临床结局数据。
血液透析患者接种所有 3 种流感疫苗后均表现出高血清保护率。与 SD-IIV4 和 RIV4 疫苗相比，HD-IIV3 的血清反应消退较慢。
