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Lupus. 2014 Nov;23(13):1412-6. doi: 10.1177/0961203314540351. Epub 2014 Jun 24.

Pandemic influenza immunization in primary antiphospholipid syndrome (PAPS): a trigger to thrombosis and autoantibody production?

Author information

1
Division of Rheumatology and.
2
Division of Rheumatology and Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo, São Paulo.
3
Division of Rheumatology, Universidade Federal da Bahia, Bahia, Brazil.
4
Division of Rheumatology and eloisa.bonfa@hc.fm.usp.br.

Abstract

OBJECTIVE:

The objective of this report is to conduct short- and long-term evaluation of a large panel of antiphospholipid (aPL) autoantibodies following pandemic influenza A/H1N1 non-adjuvant vaccine in primary antiphospholipid syndrome (PAPS) patients and healthy controls.

METHODS:

Forty-five PAPS and 33 healthy controls were immunized with H1N1 vaccine. They were prospectively assessed at pre-vaccination, and three weeks and six months after vaccination. aPL autoantibodies were determined by an enzyme-linked immunosorbent assay (ELISA) and included IgG/IgM: anticardiolipin (aCL), anti-beta2glycoprotein I (anti-β2GPI); anti-annexin V, anti-phosphatidyl serine and anti-prothrombin antibodies. Anti-Sm was determined by ELISA and anti-double-stranded DNA (anti-dsDNA) by indirect immunofluorescence. Arterial and venous thrombosis were also clinically assessed.

RESULTS:

Pre-vaccination frequency of at least one aPL antibody was significantly higher in PAPS patients versus controls (58% vs. 24%, p = 0.0052). The overall frequencies of aPL antibody at pre-vaccination, and three weeks and six months after immunization remained unchanged in patients (p = 0.89) and controls (p = 0.83). The frequency of each antibody specificity for patients and controls remained stable in the three evaluated periods (p > 0.05). At three weeks, two PAPS patients developed a new but transient aPL antibody (aCL IgG and IgM), whereas at six months new aPL antibodies were observed in six PAPS patients and none had high titer. Anti-Sm and anti-dsDNA autoantibodies were uniformly negative and no new arterial or venous thrombosis were observed throughout the study.

CONCLUSIONS:

This is the first study to demonstrate that pandemic influenza vaccine in PAPS patients does not trigger short- and long-term thrombosis or a significant production of aPL-related antibodies (ClinicalTrials.gov, #NCT01151644).

KEYWORDS:

H1N1; Vaccine; antiphospholipid antibodies; antiphospholipid syndrome; pandemic influenza A

PMID:
24961747
DOI:
10.1177/0961203314540351
[Indexed for MEDLINE]

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