Alteration of humoral, cellular and cytokine immune response to inactivated influenza vaccine in patients with Sickle Cell Disease

Autoři: Carole Nagant aff001;  Cyril Barbezange aff002;  Laurence Dedeken aff003;  Tatiana Besse-Hammer aff004;  Isabelle Thomas aff002;  Bhavna Mahadeb aff005;  André Efira aff004;  Alice Ferster aff003;  Francis Corazza aff001
Působiště autorů: Immunology Department, LHUB-ULB, Université libre de Bruxelles, Brussels, Belgium aff001;  National Influenza Centre, Sciensano, Brussels, Belgium aff002;  Department of Hematology Oncology, Hôpital Universitaire des Enfants Reine Fabiola, Université libre de Bruxelles, Brussels, Belgium aff003;  Department of Hematology Oncology, Centre Hospitalier Universitaire Brugmann, Brussels, Belgium aff004;  Microbiology Department, LHUB-ULB, Université libre de Bruxelles, Brussels, Belgium aff005
Vyšlo v časopise: PLoS ONE 14(10)
Kategorie: Research Article
doi: 10.1371/journal.pone.0223991



Patients suffering from Sickle Cell Disease (SCD) are at increased risk for complications due to influenza virus. Annual influenza vaccination is strongly recommended but few clinical studies have assessed its immunogenicity in individuals with SCD. The aim of this study was to explore the biological efficacy of annual influenza vaccination in SCD patients by characterizing both their humoral and cell-mediated immunity against influenza antigen. We also aimed to investigate these immunological responses among SCD individuals according to their treatment (hydroxyurea (HU), chronic blood transfusions (CT), both HU and CT or none of them).


Seventy-two SCD patients (49 receiving HU, 9 on CT, 7 with both and 7 without treatment) and 30 healthy controls were included in the study. All subjects received the tetravalent influenza α-RIX-Tetra® vaccine from the 2016–2017 or 2017–2018 season.


Protective anti-influenza HAI titers were obtained for the majority of SCD patients one month after vaccination but seroconversion rates in patient groups were strongly decreased compared to controls. Immune cell counts, particularly cellular memory including memory T and memory B cells, were greatly reduced in SCD individuals. Functional activation assays confirmed a poorer CD8+ T cell memory. We also document an imbalance of cytokines after influenza vaccination in SCD individuals with an INFγ/IL-10 ratio (Th1-type/Treg-type response) significantly lower in the SCD cohort.


SCD patients undergoing CT showed altered immune regulation as compared to other treatment subgroups. Altogether, the cytokine imbalance, the high regulatory T cell levels and the low memory lymphocyte subset levels observed in the SCD cohort, namely for those on CT, suggest a poor ability of SCD patients to fight against influenza infection. Nevertheless, our serological data support current clinical practice for annual influenza vaccination, though immunogenicity to other vaccines involving immunological memory might be hampered in SCD patients and should be further investigated.

Klíčová slova:

Cytokines – Cytotoxic T cells – Influenza – Influenza viruses – Lymphocytes – T cells – Vaccination and immunization – Vaccines


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