Comparison of the Immunogenicity of Intramuscular Versus Subcutaneous Administration of Trivalent Inactivated Influenza Vaccine in Individuals With Neuromuscular Diseases
Restricted accessResearch articleFirst published online May, 2013
Comparison of the Immunogenicity of Intramuscular Versus Subcutaneous Administration of Trivalent Inactivated Influenza Vaccine in Individuals With Neuromuscular Diseases
Individuals with neuromuscular disease show a wide spectrum of muscle pathology. To test the hypothesis that the immune response to trivalent inactivated influenza vaccine is potentially inadequate when given intramuscularly into a fibrosed muscle, this prospective randomized study compared the immunogenicity and safety of the standard intramuscular versus subcutaneous administration of the influenza vaccine in 22 nonambulatory subjects, of whom 10 have been on glucocorticoid therapy. Analysis of hemagglutination inhibition antibody titers showed high prevalence of seroprotection (prevaccination of 82% H1N1, 72% H3N2, 31% B; postvaccination of 100% H1N1, 77% H3N2, 59% B). Geometric mean titer ratios for each antigen showed no significant difference (P > .5) between intramuscular and subcutaneous routes. Seroprotection was not adversely affected by glucocorticoid therapy. Local tolerance was better with subcutaneous route. Larger studies are needed to confirm these preliminary results.
MolinariNAOrtega-SanchezIRMessonnierML. The annual impact of seasonal influenza in the US: measuring disease burden and costs. Vaccine. 2007;25:5086–5096.
2.
FioreAEUyekiTMBroderK. Prevention and control of influenza with vaccines: recommendations of the Advisory Committee on Immunization Practices (ACIP), 2010. Centers for Disease Control and Prevention, Advisory Committee on Immunization Practices. MMWR Recomm Rep. 2010 Aug 6;59(RR-8):1–62.
3.
American Academy of Pediatrics. Influenza. In: PickeringLKBakerCJKimberlinDWLongSS, eds. Red Book: 2009 Report of the Committee on Infectious Diseases. 28th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2009:400–412.
4.
American Academy of Pediatrics, Committee on Infectious Diseases. Policy statement—recommendations for the prevention and treatment of influenza in children, 2009-2010. Pediatrics. 2009;124:1216–1226.
5.
OhYOhtaKKuno-SakaiH. Local and systemic influenza hemagglutinin-specific antibody responses following aerosol and subcutaneous administration of inactivated split influenza vaccine. Vaccine. 1992;10:506–511.
6.
The Australian Immunisation Handbook. 9th ed. Commonwealth of Australia; 2008.
MarineWMStuart-HarrisSC. Reactions and serologic responses in young children and infants after administration of inactivated monovalent influenza A vaccine. J Pediatr. 1976;88:26–30.
9.
WrightPFSellSHWThompsonJ. Clinical reactions and serologic response following inactivated monovalent influenza type B vaccine in young children and infants. J Pediatr. 1976;88:31–35.
10.
RubenFLJacksonGG. A new subunit influenza vaccine: acceptability compared with standard vaccines and effect of dose on antigenicity. J Infect Dis. 1972;6:656–664.
11.
CookIFBarrIHartelG. Reactogenicity and immunogenicity of an inactivated influenza vaccine administered by intramuscular or subcutaneous injection in elderly adults. Vaccine. 2006;24:2395–2402.
12.
Centers for Disease Control and Prevention. Seasonal influenza vaccine dosage & administration. Available at: http://www.cdc.gov/flu/about/qa/vaxadmin.htm. Accessed August29, 2010.
13.
DarrasBTMillerDTUrionDK. Dystrophinopathies. In: PagonRABirdTDDolanCRStephensKAdamMP, eds. GeneReviews™ [Internet]. Seattle: University of Washington; 1993-. Available at:http://www.ncbi.nlm.nih.gov/books/NBK1119/.
Food and Drug Administration. Vaccines and Related Biological Products Advisory Committee meeting transcript. Rockville, MD: Food and Drug Administration; 2011.
16.
WilliamsonAHoggartB. Pain: a review of three commonly used pain rating scales. J Clin Nurs. 2005;14:798–804.
17.
BrevikEKBjörnssonGASkovlundE. A comparison of pain rating scales by sampling from clinical trial data. Clin J Pain. 2000;16:22–28.
YatesKFestaMGillisJ. Outcome of children with neuromuscular disease admitted to paediatric intensive care. Arch Dis Child. 2004;89(2):170–175.
20.
BlackSNicolayUVesikariT. Hemagglutination inhibition antibody titers as a correlate of protection for inactivated influenza vaccines in children. Pediatr Infect Dis J. 2011;30(12):1081–1085.
21.
OchiaiHShibataMKamimuraK. Evaluation of the efficacy of split-product trivalent A (H1N1), A (H3N2) and B influenza vaccines: protective efficacy. Microbiol Immunol. 1986;30:1151–1165.
22.
LambkinROxfordJSBinoL. Rapid antibody response to influenza vaccination in an “at risk” group. Vaccine. 2000;18:2307–2311.
23.
ParkCLFrankALSullivanM. Influenza vaccination of children during acute asthma exacerbation and concurrent prednisone therapy. Pediatrics. 1996;98:196–200.
24.
KubietMAGonzalez-RothiRJCotteyR. Serum antibody response to influenza vaccine in pulmonary patients receiving corticosteroids. Chest. 1996;110:367–370.
25.
SugayaNNeromeKIshidaM. Efficacy of inactivated influenza vaccine in preventing antigenically drifted influenza type A and well-matched type B. JAMA. 1994;272:1122–1126.
26.
Safety and Immunogenicity of Fluzone® Influenza Virus Vaccine (2006-2007 Formulation) Among Healthy Children Immunized in Fall2005With Fluzone Vaccine or Placebo. Clinical Trials.gov identifier: NCT00390884. September2008.
27.
Study of Inactivated, Split-Virion Influenza Vaccine Compared With Standard Fluzone Vaccine in Infants and Children. ClinicalTrials.gov identifier: NCT00391391. October2007.
28.
Study of Safety and Immunogenicity of Fluzone® in Healthy Children. ClinicalTrials.gov identifier: NCT00831675. April2006.
29.
CookIF. Evidence based route of administration of vaccines. Hum Vaccin. 2008;4(1):67–73.
30.
DelafuenteJCDavisJAMeulemanJR. Influenza vaccination and warfarin anticoagulation: a comparison of subcutaneous and intramuscular routes of administration in elderly men. Pharmacology. 1998;18:631–636.
31.
JacksonLAAustinGChenRT. Safety and immunogenicity of varying dosages of trivalent inactivated influenza vaccine administered by needle free jet injectors. Vaccine. 2001;19:4703–4709.
32.
Committee for Proprietary Medicinal Products. Note for guidance on harmonisation of requirements for influenza vaccines. CPMP/BWP/214/96. European Agency for the Evaluation of Medicinal Products, March1997.
33.
HannounCMegasFPiercyJ. Immunogenicity and protective efficacy of influenza vaccination. Virus Res. 2004; 103(1-2):133–138.
Petousis-HarrisH. Vaccine injection technique and reactogenicity—evidence for practice. Vaccine. 2008;26(50):6299–6304.
36.
MoxleyRT IIIAshwalSPandyaS. Quality Standards Subcommittee of the American Academy of Neurology; Practice Committee of the Child Neurology Society. Practice parameter: corticosteroid treatment of Duchenne dystrophy: report of the Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society. Neurology. 2005;64(1):13–20.
37.
LuCCWangYCLaiJH. A/H1N1 influenza vaccination in patients with systemic lupus erythematosus: safety and immunity. Vaccine. 2011;29(3):444–450.
38.
HananiaNASockriderMCastroM. American Lung Association Asthma Clinical Research Centers. Immune response to influenza vaccination in children and adults with asthma: effect of corticosteroid therapy. J Allergy Clin Immunol. 2004;113(4):717–724.
