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Risk factors affecting seroconversion after influenza A/H1N1 vaccination in hemodialysis patients.

 Sung Jin Moon  ;  Sang Hun Lee  ;  Young-Ho Byun  ;  Gi Young Yun  ;  Seung Kyu Kim  ;  Baik-Lin Seong  ;  Ah Reum Kim  ;  Eun sun Park  ;  Hyung-Jong Kim  ;  Jung Eun Lee  ;  Sung Kyu Ha  ;  Jae Myun Lee  ;  Hyeong-Cheon Park 
 BMC NEPHROLOGY, Vol.13 : 165, 2012 
Journal Title
Issue Date
Antibodies, Viral/blood* ; Comorbidity ; Female ; Humans ; Influenza A Virus, H1N1 Subtype* ; Influenza Vaccines/therapeutic use* ; Influenza, Human/epidemiology ; Influenza, Human/immunology ; Influenza, Human/prevention & control* ; Kidney Failure, Chronic/epidemiology ; Kidney Failure, Chronic/immunology* ; Kidney Failure, Chronic/rehabilitation* ; Male ; Mass Vaccination/utilization ; Middle Aged ; Prevalence ; Renal Dialysis/utilization* ; Republic of Korea/epidemiology ; Risk Factors ; Treatment Outcome
Hemodialysis ; Pandemic H1N1/2009 influenza ; Vaccine ; Seroconversion
BACKGROUND: Hemodialysis (HD) patients have multiple causes of immune dysfunction and poor immune response to influenza vaccination. We investigated the antibody response rate to a pandemic H1N1/2009 influenza vaccination and clinical parameters influencing the induction of antibody responses in HD patients.

METHODS: A total of 114 HD patients were vaccinated with a monovalent adjuvanted H1N1 inactivated influenza vaccine. Titers of neutralizing antibodies were evaluated by hemagglutination inhibition (HI) assay at pre- and 4 weeks after vaccination. Seroconversion was defined as either a pre-vaccination HI titer < 1:10 and a post vaccination HI titer > 1:40 or a pre-vaccination HI titer ≥ 1:10 and a minimum four-fold rise in post-vaccination HI antibody titer. Seventeen out of 114 HD patients (14.9%) tested positive for antibodies against influenza A/H1N1/2009 before vaccination. The remaining 97 baseline sero-negative patients were included in the analysis.

RESULTS: Only 30 (30.9%) HD patients had seroconversion 4 weeks after vaccination. The elderly patients, those over 65 years of age, showed significantly lower seroconversion rate compared to younger HD patients (20.5% vs. 39.6%, p = 0.042). Furthermore, patients with hemoglobin values less than 10 g/dL had a significantly lower seroconversion rate compared to those with higher hemoglobin values (20.0 vs. 38.6%, p = 0.049). By multivariate logistic regression analysis, only age ≥65 years (OR = 0.336, 95% confidence interval (CI) 0.116-0.971, p = 0.044) and hemoglobin levels <10 g/dL (OR = 0.315, 95% CI 0.106-0.932, p = 0.037) were independently associated with seroconversion after vaccination.

CONCLUSIONS: Our data show that HD patients, especially who are elderly with low hemoglobin levels, are at increased risk for lower seroconversion rate after influenza A/H1N1 vaccination. Further studies are needed to improve the efficacy of vaccination in these high risk patients.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Microbiology (미생물학교실) > 1. Journal Papers
Yonsei Authors
Park, Hyeong Cheon(박형천) ORCID logo https://orcid.org/0000-0002-1550-0812
Lee, Jae Myun(이재면) ORCID logo https://orcid.org/0000-0002-5273-3113
Ha, Sung Kyu(하성규)
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