Background:

Vaccination earlier than 3 months post SOT is felt to be safe but data on vaccine efficacy in this setting is lacking. We evaluated HI & CMI response to TIV given at <3 months (mos) from SOT.

Methods:

Consented adults (≥ 18 years) & children (≥ 3 years) still unvaccinated for the 2011-12 flu season & at <3 mos from SOT were included. TIV for season 2011-12 (A/H1N1/2009, A/H2N3/Perth/16/0/09 & B/Brisbane/60/08) was given with baseline blood draw at visit 1.Subsequent tests were done at 3-5 wk (visit 2) & 2-3 mos (visit 3). Booster TIV was offered at visit 3 with repeat blood draws at 3-5 wks (visit 4) & 2-3 mos (visits 5). HI testing was by serum hemagglutination inhibition (HAI) with response defined as >4-fold rise in HAI titer from baseline. CMI was measured by ELISPOT for TIV interferon gamma (IFN-Γ) production with response defined as a >2 fold rise in IFN-Γ spots/200,000 PBL.

Results:

Subjects included 1 pediatric (age 12 years), 5 adults (median age: 60 years, range: 39-70); 3 kidney, 1 heart & 2 liver transplants. Induction therapy consisted of basiliximab (3/6), thymoglobulin (1/6), TOL101 (1/6) & none (1/6). Median time from SOT to TIV was 12.5 days (5-99). Five subjects received boosters. For all, A/H1N1 response was more robust than A/H3N2 or B. A/H1N1 response occurred in 2/6 after primary TIV and 3/5 after booster dose. Seroprotective HAI titers were present for 5/6 subjects. CMI and HI response correlated for only one subject (no induction). No rejection occurred during the study.

Conclusions:

Response to TIV was limited but better than expected when given < 3 mos after SOT. It is unclear whether early vaccination + booster is better than delaying TIV to after 3 mos in SOT recipients. Given small sample size definitive conclusions cannot be made but further study is required.

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