ABSTRACT
BACKGROUND: Influenza A (H1N1) has emerged as a considerable threat for recipients of organ transplants. Vaccination against the novel influenza A (H1N1) virus has generally been advocated. There is limited experience with AS03-adjuvanted A/H1N1 pandemic influenza vaccines in immunosuppressed patients. METHODS: We conducted an observational, nonrandomized single-center study to assess antibody response and vaccine-related adverse effects in 47 heart transplant recipients (44 men; age, 56±13 years). The AS03-adjuvanted, inactivated split-virion A/California/7/2009 H1N1v pandemic vaccine was administered. Antibody titers were measured using hemagglutination inhibition; immunoglobulin G (IgG) response was assessed using a new pandemic influenza A IgG enzyme-linked immunosorbent assay (ELISA) test kit and compared with hemagglutination-inhibition titers. Adverse effects of vaccination were assessed by a questionnaire. RESULTS: Postvaccination antibody titers of greater than or equal to 1:40 were found in only 15 patients, corresponding to a seroprotection rate of 32% (95% confidence interval, 19%-47%). Sensitivity, specificity, positive predictive value, and negative predictive value of ELISA testing were 80.0%, 68.8%, 54.5%, and 88.0%, respectively. Age, time posttransplantation, and immunosuppressive regimen did not impact antibody response. Vaccination was well tolerated. CONCLUSIONS: Single-dose administration of an AS03-adjuvanted vaccine against the novel influenza A (H1N1) virus did not elicit seroprotective antibody concentrations in a substantial proportion of heart transplant recipients; the new pandemic influenza A IgG ELISA test kit proved to be of limited clinical use.
Subject(s)
Adjuvants, Immunologic/administration & dosage , Antibodies, Viral/blood , Heart Transplantation/immunology , Influenza A Virus, H1N1 Subtype/immunology , Influenza Vaccines/administration & dosage , Adult , Aged , Enzyme-Linked Immunosorbent Assay , Female , Hemagglutination Inhibition Tests , Humans , Immunoglobulin G/blood , Influenza Vaccines/adverse effects , Influenza, Human/epidemiology , Influenza, Human/immunology , Influenza, Human/prevention & control , Male , Middle Aged , Pandemics/prevention & controlSubject(s)
Erysipelas/diagnosis , Heart Transplantation/adverse effects , Opportunistic Infections/diagnosis , Tuberculosis, Cutaneous/diagnosis , Antitubercular Agents/therapeutic use , Ethambutol/therapeutic use , Humans , Isoniazid/therapeutic use , Leg , Pyrazinamide/therapeutic use , Tuberculosis, Cutaneous/drug therapyABSTRACT
The spectrum of manifestations and management of the novel influenza A/H1N1 virus in transplanted patients is currently of major concern. Asymptomatic infections are less common yet important for spreading of the virus and thus affect containment measures. To our knowledge, there are no reports of asymptomatic infections with influenza A/H1N1 in immunosuppressed patients. We present the first case of a young heart transplant recipient who remained asymptomatic despite positive polymerase chain reaction (PCR) after exposure to individuals with influenza A/H1N1.
