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Decreased T‐Cell Responses to Influenza Vaccination in Patients with Heart Failure
Author(s) -
Vardeny Orly,
Moran John J. M.,
Sweitzer Nancy K.,
Johnson Maryl R.,
Hayney Mary S.
Publication year - 2010
Publication title -
pharmacotherapy: the journal of human pharmacology and drug therapy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.227
H-Index - 109
eISSN - 1875-9114
pISSN - 0277-0008
DOI - 10.1592/phco.30.1.10
Subject(s) - medicine , vaccination , peripheral blood mononuclear cell , hemagglutination assay , immunology , immune system , antibody titer , influenza vaccine , antibody , heart failure , t cell , antigen , titer , biology , in vitro , biochemistry
Study Objective. To determine whether T‐cell immune responses to influenza vaccination in patients with chronic heart failure (CHF) are less vigorous than the responses of healthy control subjects. Design. Prospective, single‐center study Setting. University hospital and research laboratory Participants. Eighteen adults with stable CHF receiving optimal treatment and 16 healthy control subjects. Intervention. Participants were immunized with the 2006–2007 trivalent inactivated (killed) influenza vaccine during October‐December of 2006. Measurements and Main Results. Blood samples were taken from the participants before and 2–4 weeks after vaccination to measure antibody titers, which were measured with a hemagglutination inhibition assay, then 3–4 months after vaccination to assess T‐cell responses, measured by using the trans vivo delayed‐type hypersensitivity method. As part of this method, which mimics physiologic conditions, peripheral blood mononuclear cells were isolated from the blood samples. The cells were mixed with influenza vaccine antigens A/H1N1, A/H3N2, and B type and injected into the footpads of SCID mice (mice with severe combined immunodeficiency), as their resulting swelling is an index of human T‐cell sensitization. Median T‐cell‐mediated immune responses to A/H3N2 were less vigorous in patients with CHF than in control subjects (62.5 vs 87.5 μm, unadjusted p=0.031, age‐adjusted p=0.006). Median responses to A/H1N1 were not significantly different between the groups (56.3 vs 75 μm, p=0.11). Median responses to B type were also similar between the groups (62.5 vs 75 μm, p=0.47). All participants mounted an antibody response to the influenza vaccine. Conclusion. Patients with CHF had reduced T‐cell responses to the influenza vaccine compared with healthy control subjects, as demonstrated by a lower response to A/H3N2, the newest antigen in the 2006–2007 vaccine. However, differences in T‐cell immune responses to the A/H1N1 and B type strains were not found to be significant between the two groups, which suggests that patients with CHF can mount an appropriate response to vaccine antigens to which they have been previously exposed, but less so to new antigens. These findings suggest that patients with CHF may be at increased risk for influenza infection, and clinicians may want to investigate other or additional strategies for influenza vaccination.