The Comparison of antibody response to influenza in hemodialysis, CAPD and renal transplanted patients

VII -SUMMARY During influenza epidemics, the increase of the number of acute illness leads to applications to out-patient and emergency services, and it also results in increase of hospitalization for treatment of complications of lower respiratory system. Because of high medical treatment costs and the rate of mortality, the effective protective methods should be applied to infection sensitive groups in communities. Every year immunoprophylaxis with inactivated vaccine is the most effective method in decreasing the effect of influenza. The immune system in Continuous Ambulatory Peritoneal Dialysis ( CAPD ), hemodialysis ( HD ) and renal transplanted ( Tx ) patients have been supressed. Generally these patients give weakly antibody response to vaccination in comparison to healthy adults. The aim of this study is to detect antibody response to influenza vaccine as an indicator of the level of immunity in CAPD, HD and Tx patients and then to investigate the difference of these groups. In this study 48 patients including 17 Tx, 16 CAPD and 15 HD were vaccinated. 10 healthy adults were incorporated to this study as control group. During October - November 1997, a purified, split- virus, commercial trivalent influenza vaccine ( VAXIGRIP - Pasteur Merieux Connaught ) was given to both patients and control group in the dosage of 0.5 mL one times to deltoid muscle intramuscularly. Vaccine contained 15 ug of each hemagglutinin of A/Johannesburg/82/96 ( HıNı ), A/Nachang/933/95 ( H3N2 ) and B/Harbin/07/94 strains. Serum samples were collected before and 1 month after vaccination for antibody determinations. The antibody response against to each strain was detected separately. Determination of antibody response was performed with hemagglutination-inhibition test ( HAI ). Except for determination of antibody response before and after vaccination, the magnitude of antibody rising, the ratio of protective HAI titers and seroconversion were also calculated. While the results of study groups are reported HıNı, H3N2 and B refer to A/Johannesburg/82/96 ( H1N1 ), A/Nachang/933/95 ( H3N2 ) and B/Harbin/07/94, respectively. Wilcoxon paired 2 test ( for comparisons within groups ) and Mann - Whitney U test ( for comparisons between groups ) were used for statistical analysis, p < 0.05 was accepted as statistically significant. Influenza vaccine was tolerated well in Tx, CAPD and HD patients. 40All of the results related with study groups are shown in Table 1. Table 1: The Results of the Study Groups («İ 8§t!jKi>>§ 27,50±4,33 34,00±5,84 46,00±7,92 62,67±8,92* 74,67±12,72* 88,00±16,65* 2,53±0,29 1,93±0,20 2,00±0,26 25,00±5,70 19,67±4,59 28,00±6,63 60,00±12,19* 40,67±5,89* 102,00±28,67* 3,67±1,07 2,23±0,30 3,80±0,76 llj>2( Before) 38,82±4,61 36,25±7,0 32,00±6,91 48,00±13,73 HjN2( Vfter) 67,06±12,33*+ 58,67±12,07*+ 75,33±15,18*+ 204,00*61,81* AHjNz 1,68±0,25+ 2,30±0,51 2,32±0,52 5,00±1,46 * Antibody levels were increased statistically significant after influenza vaccine (p<0. 05) ( Comparison within groups) + Antibody response against to H3N2 was significantly lower in Tx, CAPD and HD patients. (p<0.05) AB, A HjN], A H3N2: The magnitude of antibody rising In conclusion, antibody levels after vaccination in Tx, CAPD and HD patients increased statistically significant; this resulted in increasing the proportion of patients having protective antibody titration however these proportions were found lower than those of control group. Although the ratio of patients having protective antibody titration with vaccination increased in Tx, CAPD and HD patients, the magnitude of antibody rising against to H3N2 and the levels at first month were detected as lower than that of control group. Tx, CAPD and HD patients should be vaccinated every year because of medical complications caused by influenza infection. Trial of high dose vaccination protocols may be useful to increase antibody response. 41