Clinical Rheumatology

, Volume 29, Issue 6, pp 605–613 | Cite as

Anti-influenza vaccination in systemic lupus erythematosus patients: an analysis of specific humoral response and vaccination safety

  • Ewa Więsik-SzewczykEmail author
  • Magdalena Romanowska
  • Paweł Mielnik
  • Hanna Chwalińska-Sadowska
  • Lidia B. Brydak
  • Marzena Olesińska
  • Jakub Ząbek
Original Article


The objective of this study is to evaluate efficacy and safety of influenza vaccine in systemic lupus erythematosus (SLE) patients. We studied SLE patients and healthy subjects immunised with inactivated influenza vaccine. Efficacy was measured by comparing humoral response to vaccine antigens between groups. Safety was monitored by SLEDAI and serological markers. Subjects attended visits at baseline and on post-vaccination weeks 4 and 12. We enrolled 62 SLE patients and 47 healthy subjects. In post-immunisation week 4, anti-haemagglutinin antibody titres rose in the patient group at least 6.23-fold, compared to 11.90-fold among controls (P ≤ 0.05). The seroconversion rate range was 53-56% among patients and 72-85% among controls (P < 0.05 for strains H1N1 and H3N2, NS for strain type B). The seroprotection rate ranged between 62% and 73% and between 90% and 98% in the patient and control group, respectively (P < 0.05). In post-vaccination week 12, the antibody titre was higher at least 3.86-fold in the patient group and 7.65-fold among controls. The seroconversion rate range was 32-40% among patients and 64-70% among controls, while the seroprotection rate ranged between 43% and 50% and between 79% and 94%, respectively (P < 0.005 for three strains). We identified one severe and six mild to moderate SLE exacerbations by week 12. The anti-nuclear antibodies and anti-double-stranded DNA titres grew by post-immunisation week 4 (P < 0.05). The post-vaccination response was weaker in SLE patients compared to healthy subjects. Immunisation did not change underlying disease activity.


Humoral response Influenza vaccination Lupus erythematosus Safety 





  1. 1.
    Noël V, Lortholary O, Casassus P, Cohen P, Généreau T, André MH, Mouthon L et al (2001) Risk factors and prognostic influence of infection in a single cohort of 87 adults with systemic lupus erythematosus. Ann Rheum Dis 60:1141–1144CrossRefPubMedGoogle Scholar
  2. 2.
    Update: Novel influenza A (H1N1) virus infections worldwide (2009) MMWR 58:453-458Google Scholar
  3. 3.
    Fiore AE, Shay DK, Haber P, Iskander JK, Uyeki TM, Mootrey G et al (2007) Prevention and control of influenza. Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 56:1–54PubMedGoogle Scholar
  4. 4.
    Ciszewski A, Bilinska ZT, Brydak LB, Kepka C, Kruk M, Romanowska M (2008) Influenza vaccination in secondary prevention from coronary ischaemic events in coronary artery disease: FLUCAD study. Eur Heart J 29:1350–1358CrossRefPubMedGoogle Scholar
  5. 5.
    Lanternier F, Henegar C, Mounthon L, Blanche P, Guillevine L, Launay O (2008) Low influenza-vaccination rate among adults receiving immunosuppresive therpy for systemic inflammatory disease. Ann Rheum Dis 67:1047CrossRefPubMedGoogle Scholar
  6. 6.
    Brodman R, Gilfillan R, Glass D, Schur PH (1978) Influenzal vaccine response in systemic lupus erythematosus. Ann Intern Med 88:735–740PubMedGoogle Scholar
  7. 7.
    Ristow SC, Douglas RG, Condemi JJ (1978) Influenza vaccination of patients with systemic lupus erythematosus. Ann Intern Med 88:786–789PubMedGoogle Scholar
  8. 8.
    Louie JS, Nies KM, Shoji KT, Fraback RC, Abrass C, Border W et al (1978) Clinical and antibody responses after influenza immunization in systemic lupus erythematosus. Ann Intern Med 88:790–792PubMedGoogle Scholar
  9. 9.
    Herron A, Dettleff G, Hixon B, Brandwin L, Ortbals D, Hornick R et al (1979) Influenza vaccination in patients with rheumatic diseases. JAMA 242:53–56CrossRefPubMedGoogle Scholar
  10. 10.
    Kanakoudi-Tsakalidou F, Trachana M, Pratsidou-Gertsi P, Tsitsami E, Kyriazopoulou-Dalaina V (2001) Influenza vaccination in children with chronic rheumatic diseases and long term immunosupressive therapy. Clin Exp Rheumatol 19:589–594PubMedGoogle Scholar
  11. 11.
    Abu-Shakra M, Press J, Varsano N, Levy V, Mendelson E, Sukenik S et al (2002) Specific antibody response after influenza immunization in systemic lupus erythematosus. J Rheumatol 29:2555–2557PubMedGoogle Scholar
  12. 12.
    Holvast A, Huckriede A, Wilschut J, Horst G, De Vries JJC, Benne CA et al (2006) Safety and efficacy of influenza vaccination in systemic lupus erythematosus patients with quiescent disease. Ann Rheum Dis 65:913–918CrossRefPubMedGoogle Scholar
  13. 13.
    Del Porto F, Laganà B, Biselli R, Donatelli I, Campitelli L, Nisini R et al (2006) Influenza vaccine administration in patients with systemic lupus erythematosus and rheumatoid arthritis. Safety and immunogenicity. Vaccine 24:3217–3223CrossRefPubMedGoogle Scholar
  14. 14.
    Mercado U, Acosta H, Avendano L (2004) Influenza vaccination of patients with systemic lupus erythematosus. Rev Invest Clin 56:16–20PubMedGoogle Scholar
  15. 15.
    Williams GW, Steinberg AD, Reinertsen JL, Klassen LW, Decker JL, Dolin R (1978) Influenza immunization in systemic lupus erythematosus. Ann Intern Med 88:729–734PubMedGoogle Scholar
  16. 16.
    Davis JR, Grillis EA (1989) Nature or vaccine-induced immunity as a predictor of immunity in the face of natural challenge with influenza virus. Epidemiol Infect 102:325–333CrossRefGoogle Scholar
  17. 17.
    Hobson D, Curry RL, Beare AS, Ward-Gardner A (1972) Role of serum haemgglutination-inhibition antibody in protection against challenge infection with influenza A2 and B viruses. J Hyg (Lond) 70:767–777CrossRefGoogle Scholar
  18. 18.
    Centers for Disease Control and Prevention. WHO Collaborating Center for the Surveillance, Epidemiology and Control of Influenza. Concepts and procedures for laboratory-based influenza surveillance. US Department of Health and Human Services, Public Health Service, July 1982Google Scholar
  19. 19.
    Cook RJ, Gladman DD, Pericek D, Uroviz MB (2000) Prediction of short-term mortality in systemic lupus erythematosus with time-dependent measures of disease activity. J Rheumatol 27:1892–1895PubMedGoogle Scholar
  20. 20.
    Petri M, Buyon J, Kim M (1999) Classification and definition of major flares in SLE clinical trials. Lupus 8:685–691CrossRefPubMedGoogle Scholar
  21. 21.
    Buyon JP, Petri M, Kim MY, Kalunian KC, Grossman J, Hahn BH, OC-SELENA Trial et al (2005) The effect of combined estrogen and progesterone hormonal replacement therapy on disease activity in systemic lupus erythematosus; a randomized trial. Ann Intern Med 142:953–962PubMedGoogle Scholar
  22. 22.
    Commission of the European Communities (1992) The rules governing medicinal products in the European Community. Commission of the European Communities 3:93–98Google Scholar
  23. 23.
    Committee for Proprietary Medicinal Products (CPMP): note for guidance on harmonization of requirements for influenza vaccines. The European Agency for Evaluation of Medicinal Products, Human Medicines Evaluation Unit (EMEA), CPMP/BWP/214/96, 12 March 1997, LondonGoogle Scholar
  24. 24.
    Cate TR, Couch RB, Kasel JA, Six HR (1977) Clinical trials of monovalent influenza A/New Jersey/76virus vaccines in adults: reactogenicity, antibody response, and antibody persistence. J Infect Dis 136:S450–S455PubMedGoogle Scholar
  25. 25.
    Brydak LB, Skwarczynski T, Machala M (2004) Antibody response to influenza vaccination in healthy adults. Viral Immunol 17:609–615CrossRefPubMedGoogle Scholar
  26. 26.
    Martinuc Porobic J, Avcin T, Bozic B, Kuhar M, Cucnik S, Zupancic M et al (2005) Anti-phosholipid antibodies following vaccination with recombinant hepatitis B vaccine. Clin Exp Immunol 142:377–380CrossRefPubMedGoogle Scholar

Copyright information

© Clinical Rheumatology 2010

Authors and Affiliations

  • Ewa Więsik-Szewczyk
    • 1
    Email author
  • Magdalena Romanowska
    • 2
  • Paweł Mielnik
    • 1
  • Hanna Chwalińska-Sadowska
    • 1
  • Lidia B. Brydak
    • 2
  • Marzena Olesińska
    • 1
  • Jakub Ząbek
    • 3
  1. 1.Department of Systemic Connective Tissue DiseasesInstitute of RheumatologyWarsawPoland
  2. 2.National Influenza CenterNational Institute of Public Health, National Institute of HygieneWarsawPoland
  3. 3.Department of Microbiology and SerologyInstitute of RheumatologyWarsawPoland

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