Immune Response to Influenza Vaccine in Pediatric Patients With Inflammatory Bowel Disease

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doi:10.1016/j.cgh.2007.02.035 Copyright © 2007 AGA Institute Published by Elsevier Ltd.

Original article—alimentary tract

Immune Response to Influenza Vaccine in Pediatric Patients With Inflammatory Bowel Disease

Petar Mamula, , E. Markowitz‡, A. Piccoli, Klimov, Louis Cohen and N. Baldassano§ ‡Children’s Hospital, Greenville Hospital System, University of South Carolina, Greenville, South CarolinaDivision of Gastroenterology, Hepatology and Nutrition, The Children’s Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, PennsylvaniaTufts University School of Medicine, Boston, Massachusetts§Centers for Disease Control and Prevention, Atlanta, Georgia Available online 4 June 2007.

Background & Aims: The aim of this study was to compare response to inactivated influenza vaccine in healthy children and pediatric patients with inflammatory bowel disease (IBD). Methods: A prospective, open-label, controlled clinical trial during influenza seasons of 2002–2004 was performed. Single-dose inactive trivalent influenza vaccine was administered. Immune response to vaccination was measured by pre-immunization and postimmunization hemagglutinin inhibition titers. A postimmunization hemagglutinin inhibition titer of 40 or higher was considered protective against influenza. IBD activity and adverse events were recorded. Results: Eighty subjects were enrolled (29 healthy controls, 51 IBD patients). One patient did not complete the study. Patients were divided into 3 subgroups: infliximab and immunomodulatory (16), immunomodulatory (20), and anti-inflammatory therapy (14). Immunomodulatory therapy included corticosteroids, 6-mercaptopurine, or methotrexate. Overall, there was a statistically significant decrease in immune response in patients compared with healthy controls who received 1 influenza vaccine antigen (B/Hong Kong, P = .0125). Patients receiving infliximab and immunomodulatory therapy were less likely to respond to 2 influenza vaccine antigens (A/New Caledonia/20/99 and B/Hong Kong/330/2001, P = .018 and .0002, respectively). Fifteen subjects (19%) reported 19 mild adverse events: 11 (14%) reported soreness at the site, 4 (5%) reported having a cold, 3 (4%) reported flu-like symptoms, and 1 (1%) reported a headache. The clinical activity of IBD was not affected by vaccination. Conclusions: The serologic conversion rate to influenza vaccine in patients with IBD ranged from 33% to 85%. Patients on concomitant infliximab and immunomodulatory therapy are at risk of inadequate response to vaccination. The vaccine was safe and did not affect IBD activity. Abbreviations: HI, hemagglutinin inhibition; IBD, inflammatory bowel disease

Supported by a grant from the Clinical & Translational Research Center at The Children’s Hospital of Philadelphia (UL1-RR-024134).Address requests for reprints to: Petar Mamula, MD, Division of GI & Nutrition, The Children’s Hospital of Philadelphia, 34th Street and Civic Boulevard, Philadelphia, Pennsylvania 19104. Fax: .

Clinical Gastroenterology and Hepatology Volume 5, Issue 7, July 2007, Pages 851-856