Division of Allergy & Immunology, Morsani College of Medicine, University of South Florida, at Johns Hopkins All Children's Hospital, St. Petersburg Florida, FL, United States.
Professor of Microbiology, Scientific Advisor & Emeritus Director, National Influenza Center, Valladolid, Spain.
Front Immunol. 2024 Oct 22;15:1452106. doi: 10.3389/fimmu.2024.1452106. eCollection 2024.
Seasonal and pandemic influenza infection present a potential threat to patients with antibody deficiency. The acceptance and effect of the current recommendation for annual vaccination against influenza for patients with antibody deficiency is not well investigated and due to antigenic drift or shift the protective capacity of regular IgG replacement therapy (IgRT) is considered low. This narrative review considers the effect of influenza vaccination in immunodeficient patients and discusses available information on the effect of immunoglobulin products on seasonal influenza infectivity and severity in antibody deficiency patients receiving IgRT. The humoral immune response to seasonal influenza vaccination is reduced in patients with antibody immune deficiency. However, there is no evidence that the proportion of patients with primary antibody deficiency who develop influenza illness, and the severity of such illness, is increased when compared with the general population. The IgRT that patients receive has been shown to contain neutralizing antibodies as a consequence of past flu infections against both the hemagglutinin and neuraminidase surface proteins and other viral internal proteins of different influenza A virus strains. Studies have demonstrated not only significant levels of specific but also cross-reactive antibodies against seasonal influenza virus strains. Thus, despite the yearly changes in influenza viral antigenicity that occur, IgRT could potentially contribute to the protection of patients against seasonal influenza. Currently, only limited clinical data are available confirming a preventative effect of IgRT with respect to seasonal influenza infection. In conclusion, there is some evidence that IgRT could contribute to protection against seasonal influenza in patients with antibody-related immunodeficiency. However, additional clinical data are needed to confirm the extent and relevance of this protection and identify the main responsible virus targets of that protection.
季节性流感和大流行性流感感染对抗体缺陷患者构成潜在威胁。目前针对抗体缺陷患者推荐每年接种流感疫苗的接受程度和效果尚未得到充分研究，由于抗原漂移或转变，常规 IgG 替代疗法（IgRT）的保护能力被认为较低。本综述性叙述考虑了流感疫苗接种在免疫缺陷患者中的作用，并讨论了关于免疫球蛋白产品对接受 IgRT 的抗体缺陷患者季节性流感感染性和严重程度影响的现有信息。抗体免疫缺陷患者对季节性流感疫苗接种的体液免疫反应降低。然而，没有证据表明原发性抗体缺陷患者中发生流感病的比例以及此类疾病的严重程度与普通人群相比有所增加。患者接受的 IgRT 已经显示出含有中和抗体，这是过去流感感染针对血凝素和神经氨酸酶表面蛋白以及不同流感 A 病毒株的其他病毒内部蛋白的结果。研究不仅证明了针对季节性流感病毒株的特异性抗体而且还证明了交叉反应性抗体的显著水平。因此，尽管每年都会发生流感病毒抗原性的变化，但 IgRT 有可能有助于保护患者免受季节性流感的侵害。目前，只有有限的临床数据证实 IgRT 对季节性流感感染具有预防作用。总之，有一些证据表明 IgRT 可能有助于抗体相关免疫缺陷患者预防季节性流感。然而，需要更多的临床数据来确认这种保护的程度和相关性，并确定该保护的主要病毒靶标。
