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Ann Biol Sci, 2017
ISSN: 2348-1927
August 23-24, 2017 | Toronto, Canada
Annual Conference on
MICROBIAL PATHOGENESIS, INFECTIOUS DISEASE,
ANTIMICROBIALS AND DRUG RESISTANCE
Background:
Considering heavy economic burden of
influenza,variouseffortshavebeendoneforbetterprevention
and different vaccination methods employed for expediting
immune response. Up to our knowledge, no study has been
conducted in patients undergoing routine hemodialysis, so
the goal of this study is to evaluate difference between the
immunogenicity caused by two different routes of influenza
vaccine injection (i.e. intradermal versus intramuscular), and
evaluating whether pretreatment with imiquimod could
augment and expedite the immune response.
Method:
In this prospective randomized, double blind,
controlled trial, 120 patents undergoing routine hemodialysis
(i.e. for more than 1 month, at least 2 times a week) entered
the study and randomly assigned into 3 groups: one
experimental, and two controls. For the experimental group
(INT-I), 250 mg imiquimod 5% cream (Aldara) was rubbed
on deltoid region of right arm, and after 15 minutes, 0.25
cc of trivalent influenza vaccine was injected intradermal.
The individuals in the first control group (INT-A), received
0.25 cc trivalent influenza vaccine via intradermal route after
rubbing 250 mg aqueous cream in the same region with the
same prior interval. For the second control group (IM-A),
0.5 cc trivalent influenza vaccine was injected intramuscular
after using 250 mg aqueous topical cream on the same area.
The immunogenicity was then measured by serum antibody
titers using hemagglutination-inhibition (HI) assays, against
two influenza strains: A (H1N1) and B. For comparing
antibody titers two blood samples were obtained: the
first immediately before and the second 14-21 days after
vaccination. The increase in antibody levels against each
strain then analyzed for significance.
Results:
Among initial 120 participants, 117 persons
completed the study. The antibody titers before and after
vaccination were measured by hemagglutination inhibition
assay. Both increase in antibody titers and means of the
antibody increases in intradermal with imiquimod cream
(INT-I), intradermal with placebo (INT-A) and intramuscular
group (IM-A) were determined. Then the differences
between the mean titers of INT-A and IM groups and
between INT-I and INT-A groups were analyzed by covariance
method (Acova). This study revealed significant response
among strain A (H1N1) in intramuscular group (IM-A)
comparing with the intradermal with aquas cream (INT-A) (P,
0.05). The subsequent immunogenicity in other groups and
for different strains did not show any significant difference
(i.e. INTA and IM-A for B strain and INT-A and INT-I for both
A and B strains).
Conclusion:
Although some previous studies among elderly
and healthy people showed intradermal route of influenza
vaccination more efficacious comparing with intramuscular
route, and imiquimod pretreatment expediting and
augmenting the subsequent immunogenicity comparingwith
non-imiquimod pretreated people, this study did not reveal
the superiority of intradermal injection over intramuscular
route, and also the benefit of imiquimod as premedication.
Finally, regarding the acceptable immunogenicity among
individuals in intradermal groups (both INT-I and INT-A), we
conclude that intradermal route would be an alternative for
intramuscular injections.
Speaker Biography
Sara Abolghasemi is an Infectious Diseases Specialist and completed her Fellowship of
Infectious Diseases in Immunocompromised patients from Shahd Beheshti University
of Medical Sciences, Tehran. She has published few papers about infectious diseases
in ISI and PubMed journals and is currently working as an Assistant Professor in Shahid
Beheshti University of Medical Sciences.
e:
sara.abolghasemi1@gmail.comIntradermal trivalent influenza vaccine with and without imiquimod in hemodialysis patients
Sara Abolghasemi, Shabnam Tehrani
and
Zahra Doosti
Shahid Beheshti University of Medical Sciences, Iran
Sara Abolghasemi et al., Arch Clin Microbiol, 8:5
DOI: 10.4172/1989-8436-C1-003