Influenza vaccination in primary and secondary immunodeficiencies

PhD ceremony: Mr. S. van Assen, 16.15 uur, Aula Academiegebouw, Broerstraat 5, Groningen

Dissertation: Influenza vaccination in primary and secondary immunodeficiencies

Promotor(s): prof. C.G.M. Kallenberg

Faculty: Medical Sciences

Patients with immunodeficiencies are at increased risk of contracting common and/or opportunistic infections, that might be prevented or mitigated by vaccination. We investigated the humoral and cell-mediated immune (CMI) responses following influenza vaccination in patients with humoral primary immunodeficiencies (hPID), systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA)-patients treated with rituximab. In patients with hPID humoral responses following influenza vaccination were clearly hampered. Previous vaccination and treatment with intravenous immunoglobulin did not result in higher seroprotection rates. Antibody responses were also decreased in SLE-patients. A second influenza vaccination four weeks later only led to an additional increase in the influenza-specific antibody responses in not previously vaccinated SLE-patients. Influenza vaccination within four to eight weeks after administration of rituximab did not result in a humoral response in rituximab-induced B-cell depleted RA-patients. Six to 10 months following rituximab therapy an antibody response was found although it was still hampered. CMI responses following influenza vaccination were impaired in the hPID, SLE and rituximab-treated RA-patients. In SLE-patients reduced CMI responses were associated with the use of prednisone and/or azathioprine. In conclusion, the patients with primary and secondary immunodeficiencies we investigated demonstrated hampered humoral and CMI responses following influenza vaccination. We developed evidence- and expert-based recommendations for vaccination in adult patients with auto-immune inflammatory rheumatic diseases for the European League Against Rheumatism (EULAR).