Summary
The antibody response and delayed type hypersensitivity reaction to commercially available trivalent influenza vaccine in 159 patients with diabetes mellitus was compared with response and reaction in 28 healthy volunteers. A correction for prevaccination titres was made. No differences were found between diabetic patients and control subjects with respect to antibody response to the three vaccine strains as measured by the difference between geometric mean titres of post- and prevaccination sera. In Type 1 (insulin-dependent) diabetic patients the incidence of non-responders to two vaccine components was significantly increased (p< 0.05). The delayed type hypersensitivity reaction to influenza antigen was significantly decreased in patients with high concentrations of glycosylated haemoglobin (p<0.01). These findings suggest a role for impaired immune response in the increased influenza morbidity and mortality in patients with diabetes mellitus. Implications for therapy and vaccination strategy are discussed.
Article PDF
Similar content being viewed by others
References
Barker WH, Mullooly JP (1982) Pneumonia and influenza deaths during epidemics. Arch Intern Med 142: 85–89
Housworth J, Langmuir A (1974) Excess mortality from epidemic influenza 1957–1966. Am J Epidemiol 100: 40–47
Watkins PJ, Soler NG, Fitzgerald MG, Malins JM (1970) Diabetic ketoacidosis during the influenza epidemic. Br Med J 4: 89–91
Eickhoff TC, Sherman JL, Serfling RE (1961) Observations on excess mortality associated with epidemic influenza. JAMA 176: 776–782
Khurana RC, Younger D, Ryan JR (1973) Charactersistics of pneumonia in diabetics. Clin Res 21: 629
Casey JL, Heeter BJ, Klyshevich KA (1977) Impaired response of lymphocytes of diabetic subjects to antigen of Staphylococcus aureus. J Infect Dis 136: 495–496
Rayfield EJ, Ault MJ, Keusch GT, Brothers MJ, Nechemias C, Smith H (1982) Infection and diabetes: the case for glucose control. Am J Med 72: 439–450.
Masurel N, Laufer J (1984) A one-year study of trivalent influenza vaccines in primed and unprimed volunteers; immunogenicity, clinical reactions and protection. J Hyg (Lond) 92: 263–276
Ennis A (1982) Some newly recognized aspects of resistance against and recovery from influenza. Arch Virol 73: 207–217
Versluis DJ, Beyer WEP, Masurel N, Wenting GJ, Weimar W (1986) Impairment of the immune response to influenza vaccination in renal transplant recipients by cyclosporine A, but not by azathioprine. Transplantation 42: 376–379
Ortbals DW, Liebhaber H, Presant CA, Van Amburg A, Lee JY (1977) Influenza immunisation of adult patients with malignant diseases. Ann Intern Med 87: 552–557
Gross PA, Lee H, Wolff JA, Hall CB, Minnefore AB, Lazicki ME (1978) Influenza immunization in immunosuppressed children. J Pediatr 92: 30–35
Phair J, Kaufman CA, Bjornson A, Adams L, Linneman C (1978) Failure to respond to influenca vaccine in the aged; correlation with B-cell number and function. J Lab Clin Med 92: 822–828
Berlin BS, McQueen JL, Minuse E, Davenport FM (1963) A method for increasing the sensitivity of the haemagglutination inhibition test with equine influenza virus. Virology 21: 665–666
Masurel N, Ophof P, De Jong P (1981) Antibody response to immunization with influenza A/USSR/77 (H1N1) virus in young individuals primed or unprimed for A/New Jersey/76 (H1N1) virus. J Hyg (Lond) 87: 201–209
Van der Logt JTM, Van Loon AM, Van der Veen J (1981) Hemadsorption immunosorbent technique for determination of rubella immunoglobulin M antibody. J Clin Microbiol 13: 410–415
Sokal JE (1975) Measurement of delayed skin test tesponses. N Engl J Med 293: 501–502
Feery BJ, Hartman LJ, Hampson AW, Proietto J (1983) Influenza immunisation in adults with diabetes mellitus. Diabetes Care 6: 475–478
Virelizier J-L, Postlethwaite R, Schild GC, Allison AC (1974) Antibody responses to antigenic determinants of influenza virus hemagglutinin. I. Thymus dependence of antibody formation and thymus independence of immunological memory. J Exp Med 140: 1559–1570
Quinion-Debrie MC, Debray-Sachs M, Dardenne M, Chernichow P, Assan R, Bach JF (1985) Anti-islet cellular and humoral immunity, T-cell subsets, and thymic function in type 1 diabetes. Diabetes 34: 373–379
Lederman MM, Schifman G, Rodman HM (1981) Pneumococcal immunization in adult diabetics. Diabetes 30: 119–121
Versluis DJ, Beyer WEP, Masurel N, Weimar W (1985) Influenza vaccination in dialysis and transplant patients. Antiviral Res Suppl. 1: 289–292
Plouffe JE, Silva J, Fekety R, Allen JL (1978) Cell mediated immunity in diabetes mellitus. Infect Immun 21: 425–429
Mahmoud AAF, Rodman HM, Mandel MA, Warren KS (1976) Induced and spontaneous diabetes mellitus and suppression of cell-mediated immunologic responses. J Clin Invest 57: 362–367
Leung KN, Ada GL (1980) Cells mediating delayed type hypersensitivity in the lungs of mice infected with an influenza A virus. Scand J Immunol 12: 393–400
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Diepersloot, R.J.A., Bouter, K.P., Beyer, W.E.P. et al. Humoral immune response and delayed type hypersensitivity to influenza vaccine in patients with diabetes mellitus. Diabetologia 30, 397–401 (1987). https://doi.org/10.1007/BF00292541
Received:
Revised:
Issue Date:
DOI: https://doi.org/10.1007/BF00292541