[CIS PIDD] [cis-pidd] High-dose influenza vaccine for PID patients?

[Michael H. Land, MD]

Hi Ida,
At Duke, several of my CVID patients had similar concerns and I offered the Fluzone as well (last year, 4 of my adult patients received it).  My impression with these patients, given the heterogeneity of the disease, is that while there is a likelihood they may have no response (without an an obvious contraindication) there is still a remote possibility they may have some antibody response.  Even a small bit of protection may be better than nothing.  

The only paper I've found is a case discussion by Anne Junker, Francisco Bonilla, and Kate Sullivan in which the recommendation by the group was to vaccinate and provide anti-influenza medications.  Unfortunately, I know of no formal study of flu vaccine response in CVID.

Junker A, Bonilla F, Sullivan K. How to flee the flu. Clinical Immunology 112 (2004) 219-220

Hope this helps.

Michael Land, MD FAAAAI
Department of Allergy & Immunology
Southern California Permanente Medical Group
7060 Clairemont Mesa Blvd
San Diego, CA 92111

--- On Fri, 11/9/12, Hsu, Florence <ida.hsu at yale.edu> wrote:

From: Hsu, Florence <ida.hsu at yale.edu>
Subject: RE:[cis-pidd] High-dose influenza vaccine for PID patients?
To: "CIS-PIDD" <cis-pidd at lists.clinimmsoc.org>
Date: Friday, November 9, 2012, 7:27 AM



 
 




The HD version we have (Fluzone) is 4-fold more concentrated, not 10.  The patients that are requesting it do not appear to have concerns re: flu-like symptoms after an inactivated vaccine; they are more concerned
 about mounting adequate immunity against the “real thing”.  I have given it to 3 CVID patients so far, and two of these had actually received the high-dose vaccine last year (I am not sure why, since they are <65yo and hadn’t been diagnosed with CVID yet),
 without adverse effect.  
   
Does anybody else have any thoughts on this? 
   
Thank you,  Ida 
   


From: Sorensen, Ricardo [mailto:RSoren at lsuhsc.edu]


Sent: Sunday, November 04, 2012 8:09 AM

To: CIS-PIDD

Subject: RE:[cis-pidd] High-dose influenza vaccine for PID patients? 


   
Hi Florence, 
   
This is a question asked frequently  and we  have not found any publication about it. Although it is not a live vaccine, I would not do it. It is not unusual to have patients complaining that they  had flu-like
 symptoms after the regular vaccine; a 10 time higher dose seems risky to me. It would be interesting to know if other have a different opinion. 
   
Ricardo Sorensen  
   


From: Hsu, Florence [mailto:ida.hsu at yale.edu]


Sent: Thursday, November 01, 2012 11:55 AM

To: CIS-PIDD

Subject: [cis-pidd] High-dose influenza vaccine for PID patients? 


   
Hi all, 
   
I’ve had several inquiries from adult patients under the age of 65 with CVID or other IgG/IgA deficiencies regarding whether they should get the high-dose flu vaccine currently approved for >65 yo.  Is there any consensus whether this is
 indicated/good idea or not necessary? 
   
Would love to hear what others are suggesting, 
Ida 
   



F. Ida Hsu, M.D. 
Section of Allergy and Immunology 
Department of Medicine 
Yale University School of Medicine 
Phone:   (203) 785-4143 
Fax:        (203) 785-3229 
   
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