Double-Dose plus Booster of Influenza Vaccine in Patients on Hemodialysis

Patients with end-stage kidney disease receiving maintenance hemodialysis may be at increased of illness and death from influenza. There are few data available on the efficacy of increased dose of influenza vaccine among dialysis patients. Ekapol Ritveeradej and colleagues in Bangkok, Thailand, conducted a prospective, open-label, randomized study to examine the efficacy of double-dose and booster influenza vaccines compared with standard-dose vaccine in patients on hemodialysis.

The researchers reported results of the study during a virtual poster session at ASN Kidney Week 2020. The poster was titled Efficacy of Double-Dose Influenza Vaccine with a Booster Compared with Standard Dose in Hemodialysis Patients: Randomized Controlled Trial.

The study enrolled 100 hemodialysis patients who were randomized to receive double-dose and booster of intramuscular inactivated seasonal quadrivalent influenza vaccine and a booster in the following 2 weeks (double-dose group, n=50) or one dose of the vaccine (standard-dose group, n=50). Demographics and comorbidity data were collected at baseline. Hemagglutination inhibition (HAI) titers were assessed prior to vaccination and at 14 and 28 days post-vaccination.

The two groups were similar in baseline laboratory measurements and comorbidities. Mean age was 61 years. The double-dose group had a higher rate of seroprotection  than the standard group (100% vs 86%; P=.006) and seroconversion (84% vs 60%, P=.008) measured using HAI against H3N2. Further, those in the double-dose group had higher rates of sustained antibody level at 4 weeks after the initial vaccination compared with the standard-dose group, measured by HAI against H1N1 (88% vs 52%, P=.006) and against H3N2 (84% vs 72%, P=.003).

There were no differences in HAI against B strains. At 4 weeks after the initial vaccination, HAI against H1N1, H3N2, B/Colorado, and B/Yamagata were similar in the two groups.

In conclusion, the researchers said, “The double dose with booster influenza vaccine can provide higher seroprotection and seroconversion rates of HAI against H3N2 but no difference in other strains compared with standard dose.”

Source: Ritveeradej E, Boonnak K, Yoowannakul S. Efficacy of double-dose influenza vaccine with a booster compared with standard dose in hemodialysis patients: Randomized controlled trial. Abstract of a poster presented at the American Society of Nephrology virtual Kidney Week 2020 (PO1067), October 22, 2020.