The Journal of Heart and Lung Transplantation
International Society for Heart and Lung Transplantation.
Original clinical science| Volume 30, ISSUE 6, P685-690, June 2011

Download started.


Pandemic 2009 H1N1 influenza virus vaccination in lung transplant recipients: Coverage, safety and clinical effectiveness in the Zurich cohort


      Pandemic 2009 H1N1 influenza virus (H1N1) infection is considered harmful to lung transplant recipients (LTRs). Vaccination against this virus is recommended for LTRs, but little is known about associated benefits and risks. Our aim in this study is to document the safety and clinical effectiveness of the H1N1 vaccine in LTRs.


      All LTRs received an informational letter on the H1N1 pandemic that included hygiene and vaccination recommendations. After completing a questionnaire, volunteering LTRs received Pandemrix (H1N1 2009 Monovalent AS03-Adjuvanted Vaccine; GSK). Adverse events (AEs) were documented at short-term follow-up visits and by telephone. Any flu-like symptoms were reported and a low threshold for performing nasal/pharyngeal swabs for virus detection was maintained.


      Of 168 eligible LTRs (107 already vaccinated for 2009 seasonal influenza), 148 (88%) received at least one vaccination with the H1N1 vaccine and 115 received a second dose. After the first vaccination, 44% had no AEs. Six self-limiting, severe AEs occurred, and the remainder were minor to moderate, predominantly injection-site reactions. After the second vaccination, AEs were clearly less frequent. All AEs resolved completely. Documented H1N1 infection occurred in 2 of 148 vaccinated LTRs, in contrast to 5 infections in 20 non-vaccinated LTRs.


      H1N1 vaccination is generally well tolerated with mild to moderate, predominantly local AEs in most LTRs and few self-limiting severe events. Clinical effectiveness is good.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to The Journal of Heart and Lung Transplantation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Kunisaki K.M.
        • Janoff E.N.
        Influenza in immunosuppressed populations: a review of infection frequency, morbidity, mortality, and vaccine responses.
        Lancet Infect Dis. 2009; 9: 493-504
        • Danziger-Isakov L.A.
        • Husain S.
        • Mooney M.L.
        • et al.
        The novel 2009 H1N1 influenza virus pandemic: unique considerations for programs in cardiothoracic transplantation.
        J Heart Lung Transplant. 2009; 28: 1341-1347
        • Kumar D.
        • Morris M.I.
        • Kotton C.N.
        • et al.
        Guidance on novel influenza A/H1N1 in solid organ transplant recipients.
        Am J Transplant. 2010; 10: 18-25
        • Stark K.
        • Günther M.
        • Schönfeld C.
        • et al.
        Immunisations in solid-organ transplant recipients.
        Lancet. 2002; 359: 957-965
        • Mazzone P.J.
        • Mossad S.B.
        • Mawhorter S.D.
        • et al.
        The humoral immune response to influenza vaccination in lung transplant patients.
        Eur Respir J. 2001; 18: 971-976
        • Hayney M.S.
        • Welter D.L.
        • Francois M.
        • et al.
        Influenza vaccine antibody responses in lung transplant recipients.
        Prog Transplant. 2004; 14: 346-351
        • Mazzone P.J.
        • Mossad S.B.
        • Mawhorter S.D.
        • et al.
        Cell-mediated immune response to influenza vaccination in lung transplant recipients.
        J Heart Lung Transplant. 2004; 23: 1175-1181
        • Dopp J.M.
        • Wiegert N.A.
        • Moran J.J.
        • et al.
        Effect of annual influenza immunization on antibody response in lung transplant patients.
        Prog Transplant. 2009; 19: 153-159
        • Harris K.
        • Baggs J.
        • Davis R.L.
        • et al.
        Influenza vaccination coverage among adult solid organ transplant recipients at three health maintenance organizations, 1995–2005.
        Vaccine. 2009; 27: 2335-2341
        • Duesberg C.
        • Schreder T.
        • Knuth C.
        • et al.
        2009 pandemic influenza A (H1H1) in lung transplant recipients (poster).
        Eur Respir J. 2010; 36: 893s
        • Benden C.
        • Danziger-Isakov L.A.
        • Astor T.
        • et al.
        Variability in immunization guidelines in children before and after lung transplantation.
        Pediatr Transplant. 2007; 11: 882-887
        • Roman F.
        • Vaman T.
        • Gerlach B.
        • et al.
        Immunogenicity and safety in adults of one dose of influenza A H1N1v 2009 vaccine formulated with and without AS03A-adjuvant: preliminary report of an observer-blind, randomised trial.
        Vaccine. 2010; 28: 1740-1745
      1. Common Terminology Criteria for Adverse Events v4.O2 (CTCAE), May 28, 2009.

        • Giezeman K.M.
        • Nauta J.
        • de Bruijn I.A.
        • et al.
        Trivalent inactivated subunit influenza vaccine Influvac®: 25-year experience of safety and immunogenicity.
        Vaccine. 2009; 27: 2414-2417
        • Schuurmans M.M.
        • Dalar L.
        • Benden C.
        • et al.
        Influenza A/H1N1 vaccination in a lung transplant program: coverage, safety and clinical effectiveness during the pandemic 2009/2010.
        Eur Respir J. 2010; 36: 628s
        • Fox B.D.
        • Raviv Y.
        • Rozengarten D.
        • et al.
        Pandemic influenza (H1N1): impact on lung transplant recipients and candidates.
        J Heart Lung Transplant. 2010; 29: 1034-1038

      Linked Article

      • Erratum
        The Journal of Heart and Lung TransplantationVol. 30Issue 10
        • Preview
          Schuurmans MM, Tini GM, Dalar L, Fretz G, Benden C, Boehler A. Pandemic 2009 H1N1 influenza virus vaccination in lung transplant recipients: coverage, safety and clinical effectiveness in the Zurich cohort. J Heart Lung Transplant 2011 Jun;30(6):685–90.
        • Full-Text
        • PDF