RT Journal Article SR Electronic T1 Prime-boost, double-dose influenza vaccine immunity in COPD: a pilot observational study JF ERJ Open Research JO erjor FD European Respiratory Society SP 00641-2021 DO 10.1183/23120541.00641-2021 VO 9 IS 2 A1 Gary P. Anderson A1 Louis B. Irving A1 Andrew Jarnicki A1 Katherine Kedzierska A1 Marios Koutsakos A1 Stephen Kent A1 Aeron C. Hurt A1 Adam K. Wheatley A1 Thi H.O. Nguyen A1 Natale Snape A1 John W. Upham YR 2023 UL http://openres.ersjournals.com/content/9/2/00641-2021.abstract AB Background COPD patients are more susceptible to viral respiratory infections and their sequelae, and have intrinsically weaker immune responses to vaccinations against influenza and other pathogens. Prime-boost, double-dose immunisation has been suggested as a general strategy to overcome weak humoral response to vaccines, such as seasonal influenza vaccination, in susceptible populations with weak immunity. However, this strategy, which may also provide fundamental insights into the nature of weakened immunity, has not been formally studied in COPD.Methods We conducted an open-label study of seasonal influenza vaccination in 33 vaccine-experienced COPD patients recruited from established cohorts (mean age 70 (95% CI 66.9–73.2) years; mean forced expiratory volume in 1 s/forced vital capacity ratio 53.4% (95% CI 48.0–58.8%)). Patients received two sequential standard doses of the 2018 quadrivalent influenza vaccine (15 μg haemagglutinin per strain) in a prime-boost schedule 28 days apart. We measured strain-specific antibody titres, an accepted surrogate of likely efficacy, and induction of strain-specific B-cell responses following the prime and boost immunisations.Results Whereas priming immunisation induced the expected increase in strain-specific antibody titres, a second booster dose was strikingly ineffective at further increasing antibody titres. Similarly, priming immunisation induced strain-specific B-cells, but a second booster dose did not further enhance the B-cell response. Poor antibody responses were associated with male gender and cumulative cigarette exposure.Conclusions Prime-boost, double-dose immunisation does not further improve influenza vaccine immunogenicity in previously vaccinated COPD patients. These findings underscore the need to design more effective vaccine strategies for COPD patients for influenza.Prime-boost, double-dose influenza immunisation does not further improve vaccine response in COPD patients, underscoring the need to design more effective vaccine strategies to overcome immune hyporesponsiveness https://bit.ly/3pd2Zas