Vaccine strain affects seroconversion after influenza vaccination in COPD patients and healthy older people

Natale Snape,Tina Collins,Yang Xi,Andrew G. Jarnicki,Aeron C. Hurt,John W. Upham,Louis B. Irving,Gary P. Anderson

doi:10.1038/s41541-021-00422-4

Abstract

Though clinical guidelines recommend influenza vaccination for chronic obstructive pulmonary disease (COPD) patients and other high-risk populations, it is unclear whether current vaccination strategies induce optimal antibody responses. This study aimed to identify key variables associated with strain-specific antibody responses in COPD patients and healthy older people. 76 COPD and 72 healthy participants were recruited from two Australian centres and inoculated with influenza vaccine. Serum strain-specific antibody titres were measured pre- and post-inoculation. Seroconversion rate was the primary endpoint. Antibody responses varied between vaccine strains. The highest rates of seroconversion were seen with novel strains (36–55%), with lesser responses to strains included in the vaccine in more than one consecutive year (27–33%). Vaccine responses were similar in COPD patients and healthy participants. Vaccine strain, hypertension and latitude were independent predictors of seroconversion. Our findings reassure that influenza vaccination is equally immunogenic in COPD patients and healthy older people; however, there is room for improvement. There may be a need to personalise the yearly influenza vaccine, including consideration of pre-existing antibody titres, in order to target gaps in individual antibody repertoires and improve protection.

Highlights

Chronic obstructive pulmonary disease (COPD) is a common, serious lung disease caused by smoking and exposure to air pollutants[1]
Though this study showed that influenza vaccination reduced COPD exacerbations relative to placebo, it is notable that the active intervention group received double the recommended vaccine dose[21]
Influenza vaccine formulations were based on Australian Government recommendations and differed slightly across the study years 2015-2017 (Table 1)

Summary

Introduction

Chronic obstructive pulmonary disease (COPD) is a common, serious lung disease caused by smoking and exposure to air pollutants[1]. COPD is the third leading cause of mortality worldwide[2] with the global disease burden likely to increase substantially in coming years[3,4]. Common respiratory viruses such as rhinoviruses and influenza often trigger COPD exacerbations[5,6], and can lead to secondary bacterial infections, hospitalisations and death[7]. Clinical guidelines recommend influenza vaccination as a priority for COPD patients and other high-risk populations including the elderly and immune compromised[8]. Post-vaccination, influenza antibody titres decline relatively quickly, in the elderly[16,17], so annual vaccination is required. Strain selection for the vaccine each year is usually based on knowledge of strains circulating in the opposite hemisphere’s winter[19]

Objectives

Methods

Results