A comparison of antibody responses to Admune inactivated influenza vaccine in serum and respiratory secretions of healthy non-smokers, healthy cigarette-smokers and patients with chronic bronchitis

Smoking cessation and influenza vaccination can reduce the healthcare burden of COPD

INTRODUCTION

Influenza vaccination (INV) and smoking cessation (SC) have individual positive effects on COPD, but their synergistic impact has yet to be extensively studied. This retrospective study aimed to assess the combined effect of SC and IV on the medical burden of COPD, including medical visits, hospitalization, medical expenses, and the occurrence of respiratory failure.

METHODS

Patients with COPD who visited our medical center between January and October 2018 were included in the study. The patients were categorized into four groups: Group I (no SC or INV), Group II (INV only), Group III (SC only), and Group IV (both SC and INV). The outcomes analyzed were emergency utilization, hospital utilization, and occurrence of respiratory failure. Airflow limitation was stratified according to GOLD guidelines, and successful smoking cessation was defined as not smoking for at least one year.

RESULTS

A total of 357 patients were included in the study. Group I (119 patients) neither smoking cessation nor influenza vaccination; Group II (66 patients) had only influenza vaccination; Group III (94 patients), had only smoking cessation, Group IV (78 patients), with both smoking cessation and influenza vaccination. Group IV had lower odds of emergency utilization (OR=0.13; 95% CI: 0.07-0.25), hospital utilization (OR=0.13; 95% CI: 0.05-0.30, p<0.001), and occurrence of respiratory failure (OR=0.13; 95% CI: 0.04-0.40, p<0.001).

CONCLUSIONS

Combined smoking cessation and influenza vaccination are more effective in reducing the medical burden of COPD compared to either intervention alone or neither. These findings highlight the importance of promoting both smoking cessation and influenza vaccination in the management of COPD.

Survey of the level of anti-HBs antibody titer in vaccinated Iranian general dentists

Hepatitis B is an infectious disease to which dentists are susceptible. The main aim of this study was to determine the level of antibody titer and immunity in vaccinated Iranian general dentists. A total of 861 general dentists were invited to participate in this study; 598 persons who could recall their history of vaccination and consented to have blood samples taken were recruited. Demographic and work-related data were recorded, and anti-Hepatitis B surface antigen (anti-HBs-Ag) evaluations were measured using the enzyme-linked immunosorbent assay (ELISA). Of the 598 participants, 35 (5.9%) were nonimmune (anti-HBs <10 IU/l), 101 (16.9%) were relatively immune (anti-HBs = 10-99 IU/l), and 462 (77.3%) were completely immune (anti-HBs > or =100 IU/l). Only 218 (36.5%) of the dentists knew their HBs antibody titer. Fourteen (2.3%) persons reported receiving one dose and 65 (10.9%) had received two doses. The number of those who had received the three recommended doses totaled 519 (86.8%), 491 (82.1%) of them receiving their vaccine on schedule. Age, city, pack-years of smoking, years of smoking, and the interval between the last vaccination and the commencement of the study had a significant relationship to the antibody titer level, whereas sex, marital status, place of practice, smoking, and vaccination schedule were not related. Only 36.5% of the general dentists had checked their antibody titer. We, therefore, recommend that dentists, as a potential high-risk group, should know their level of anti-HBs antibody titer so that those who require revaccination can get treatment.

The effect of smoking on influenza, influenza vaccination efficacy and on the antibody response to influenza vaccination

We examined the relation between cigarette smoking and (1) the occurrence of influenza, (2) the efficacy of influenza vaccination and (3) the antibody response to influenza vaccination in fifteen family practices in South-Limburg, the Netherlands, during the influenza season 1991 1992. Data were used from a randomized double-blind placebo-controlled trial into the efficacy of influenza vaccination in which smoking status was measured 10 weeks after the start of the trial. A total of 1838 subjects aged 60 years or older, of whom 1531 subjects (321 smokers, 1152 non-smokers and 58 cigar/pipe smokers) who returned the smoking questionnaire and were not previously vaccinated, were used in the analyses. The main outcome measures were serological influenza (fourfold increase of antibody titre between 3 weeks and 5 months after vaccination); clinical influenza as determined by criteria of the Dutch Sentinel Stations from self reported symptoms in postal questionnaires 10 weeks and 5 months after vaccination; increases after vaccination and decreases after 5 months in logarithmic titres of antibody against the vaccine strains. No relation between smoking and either serological or clinical influenza was found, although the risk for serological influenza was slightly (not significantly) elevated in smokers compared to non-smokers. A statistical interaction was found between smoking and vaccination when serological influenza was the outcome measure indicating that the efficacy of vaccination was greater in smokers than in non-smokers (comparison of model with and without interaction; likelihood ratio test, p < 0.0001). This finding is supported by a greater titre rise 3 weeks after vaccination for two out of four strains, but not by the antibody response after vaccination in previous studies on influenza and other infectious diseases. Also, this possible difference of immunogenicity is not reflected in a better protection for clinical influenza. The rise in antibody titre 3 weeks after vaccination was higher in smokers for A/Singapore/6/86 and B/Beijing/11/87, but not for the other two strains. Decline in titres after 5 months was similar for smokers and non-smokers. We conclude that smoking has no clinical or preventive significance for risk of influenza in the elderly.

Smoking, humoral immunity, and ulcerative colitis

Since ulcerative colitis predominantly affects non-smokers and ex-smokers we have examined the possibility that smoking modifies the humoral immune response to an antigenic challenge from the gut lumen. Gut lavage was used in healthy subjects and patients with ulcerative colitis, including both smokers and non-smokers. Antibodies in the intestinal fluid to Escherichia coli (five pooled serotypes), Candida albicans, gliadin, ovalbumin, and beta lactoglobulin were measured by ELISA to determine specific antibody concentrations of IgG, IgA, and IgM classes. Total IgG, IgA, and IgM were also measured in intestinal secretions and serum. In addition, circulating antibody concentrations of IgG, IgA, and IgM to three gut commensals - E coli (five pooled serotypes) C albicans, and Poroteus mirabilis were measured. There was a significant reduction in the IgA concentration in intestinal fluid of smokers with ulcerative colitis compared with healthy non-smoking controls. No other significant differences were found between the groups. Overall, these data are not consistent with the idea that smoking suppresses immune responses in the gut and suggest that the effect of smoking in colitis is mediated by another mechanism.

The role of infection in asthma

The possible role of bacterial, viral and fungal infections in the development, exacerbation and treatment of asthma are discussed. Although bacterial allergy has in the past been advocated as an important etiologic factor for asthma, the evidence is inconclusive. Hyposensitization with bacterial antigens is no longer an accepted treatment. Bacterial infection of the nasal sinuses and bronchi may exacerbate an asthmatic attack and in some cases patients benefit from antibiotic therapy. However, bacterial infections in asthma and allergic rhinitis do not always require treatment and if treated this is not sufficient alone to reverse symptoms. Opinions vary as to the importance of viral infections. There is evidence that the immunologic consequences of intrabronchial infection with Aspergillus fumigatus may cause exacerbations of asthma.

Lack of clinical exacerbations in adults with chronic asthma after immunization with killed influenza virus

The effects of immunization with killed influenza virus vaccine were assessed by comparison with placebo in a double-blind study of 318 adult patients with chronic asthma. The patients were randomly allocated to active vaccine and placebo. No difference was observed in peak expiratory flow rate or in clinical symptoms of bronchial obstruction between the groups receiving active vaccine and placebo during the first week after immunization. The data were analyzed separately for age, sex, duration of the disease, hypersensitivity to aspirin (acetylsalicylic acid), atopic status, patients with a history of attacks of asthma induced by viral infections, patients with a diurnal variation of baseline peak expiratory flow of 20 percent or more, and patients receiving continuous oral steroid medication, but none of these factors seemed to predict any short-term adverse effects of vaccination. Follow-up for eight months after the vaccination revealed no differences in asthmatic symptoms between the patients treated with active vaccine and those receiving placebo. The antiviral antibody response to vaccination was normal. The possible protection provided by the vaccination against exacerbation of asthma induced by influenza could not be evaluated, since the influenza epidemic expected during the season failed to occur in Finland. It is concluded that immunization with killed influenza vaccine is safe and is not associated with any significant side effects in adult patients with chronic asthma.