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P521. Cytomegalovirus infection and response to influenza vaccination in inflammatory bowel disease patients on anti-TNF therapy

L. Guidi1, G. Andrisani1, D. Frasca2, P. Cattani3, M. Marzo1, C. Felice1, D. Pugliese1, A. Papa1, G.L. Rapaccini1, B.B. Blomberg2, A. Armuzzi1, 1Catholic University, IBD Unit, Complesso Integrato Columbus, Rome, Italy, 2Miller School of Medicine, Department of Microbiology and Immunology, Miami, United States, 3Catholic University, Clinical Laboratory Unit, Complesso integrato Columbus, Rome, Italy

Background

Cytomegalovirus (CMV) infection has been suggested as a factor affecting the response to influenza vaccine in elderly subjects [1,2] but also in healthy adults [3]. In a previous study [4] we have shown that the antibody response after vaccination was reduced in IBD patients on anti-TNF therapy compared to healthy controls, particularly in those on combined therapy with immunosuppressants (IS). Aim of this study was to evaluate the influence of CMV infection on the response to influenza vaccination in IBD patients on anti-TNF therapy.

Methods

Sixty-two consecutive IBD patients (36 Crohn's disease and 26 ulcerative colitis) on anti-TNF maintenance treatment at our outpatients clinic during the 2009 vaccine campaign for H1N1 influenza were studied. Five healthy controls were also included in the study. After informed consent, they were vaccinated with MF59-adjuvanted vaccine A/California/7/2009 (H1N1), Focetria®, Novartis (monovalent vaccine). Sera were collected at baseline (T0) and at 4 weeks (T1) for hemagglutination inhibition assay (HAI), performed as previously described [4]. T0 sera were also analysed by ELISA for CMV IgG and samples with a titer >8 U/ml were considered as positive (Liaison® CMV IgG II DiaSorin). Statistical analysis was performed by t test for independent samples and Fisher's exact test.

Results

Fifty-four patients (62%) and 4 controls (80%) were positive for CMV infection. Among the CMV negative patients, 2/8 were on combined therapy with IS (25%) while the rate of combined therapy among the CMV positive patients was 24% (13/45). At T0, no difference was detected in pre-vaccination Geometric mean titer of HAI (GMT) among IBD patients with or without CMV infection. The overall rate of seroconvertion (>4-fold increase in HAI titer) was 45% as previously reported (4). The rate of seroconvertion (37.5% for CMV− versus 46% for CMV+) and the GMT (147, 95% CI 39 to 555, for CMV− versus 97, 95% CI 74 to 127, for CMV+) were not different among CMV positive and negative patients.

Conclusion

CMV infection did not affect the impaired response to influenza vaccine observed in patients on anti-TNF therapy.

1. Trzonkowski P et al. Vaccine 2003.

2. Derhovanessian E et al. Vaccine 2013.

3. Wald A et al. J Med. Virol 2013.

4. Andrisani G et al. J Crohns Colitis 2013.