Immunologic responses to the annual influenza vaccination in COPD patients

Session 4: Respiratory infections & host defence and oncology

MC Telgen1,2, MGJ Brusse-Keizer1, GT Rijkers6, J van der Palen5, HAM Kerstjens3, MGR Hendrix4,

PDLPM van der Valk1 1Department of Pulmonary Medicine,Medisch Spectrum Twente,Enschede; 2Department of Internal Medicine,Medisch Spectrum Twente,Enschede; 3Department of Pulmonary

Medicine,University Medical Centre Groningen,Groningen; 4Department of Medical

Microbiology,Regional Laboratory of Public Health,Enschede; 5Department of Research Methodology,

Measurement, and Data Analysis,University of Twente, Enschede; 6Department of Surgery,University

Medical Centre Utrecht,Utrecht

Rationale: Infections caused by influenza viruses lead to morbidity and mortality in humans and especially in patients with COPD. To reduce this risk, COPD patients are routinely offered an influenza vaccination. Response to this vaccination is well defined by the EMEA (The European Agency for the Evaluation of Medicinal Products, 1997). A four-fold rise in hemagglutination inhibition (HI) antibody titer is considered to be sufficient and a successful response to vaccination. With the influenza vaccination, the proportion of subjects with a significant increase in antibody titer was greater than 40% in the general population (Fluvirin, official FDA information). Kositanont found in a poorly defined COPD population a protection rate of only 22% for H1N1 and 29% for H3N2. We wanted to investigate the response to the annual influenza vaccination in a well defined cohort of COPD patients.

Methods: Within our patient population a cohort study was of well defined COPD patients with mainly stage II and III COPD was initiated (the COMIC study). At stable state, an influenza vaccination was offered and blood was obtained prior to and 4-6 weeks after vaccination. We measured the HI antibody titers to the influenza A strains in the vaccine.

Results: In 369 COPD patients (see table 1 for baseline characteristics) the proportion of subjects with a fourfold increase in HI antibody titer was 3%, and with a two-fold increase 18%. Table 2 shows the frequency table for vaccination response.

Conclusions: In a cohort of well defined COPD patients an adequate antibody response to the influenza vaccination was present in only 3% which is rather low and not consistent with earlier

studies. A two-fold rise was found in 18% of the patients. The protection offered by this limited two-fold response is currently unclear and should be investigated.