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Reply to Ikegame et al.

Bone Marrow Transplantation volume 38, pages 324–325 (2006)Cite this article

Ikegame et al. reported a case of idiopathic thrombocytopenic purpura (ITP) in a BMT recipient and attributed this complication to influenza vaccination. However, this association should be interpreted with caution since several factors, as mentioned by the authors, have been linked to the occurrence of ITP, which is still called ‘idiopathic’ because the cause remains uncertain.

In the normal population and in other high-risk groups, side effects of influenza vaccination are generally mild and observed up to 48 h of vaccination. Local reactions (soreness at the vaccination site) can affect 10–64% of the subjects but rarely interfere with daily activities.1 Systemic reactions like fever, malaise, myalgia, headache, etc, are less frequent. Recent placebo-controlled studies including persons with asthma,2 the elderly3 and healthy young adults4 did not show higher rates of systemic reactions among vaccinated in comparison to the placebo group. Non-controlled studies have reported systemic reactions in 10–25% of the patients.1 With regard to late complications (those occurring between 10 and 14 days after vaccination), more attention has been paid to the occurrence of Guillain-Barre Syndrome (GBS) that was associated to the 1976 swine influenza vaccine.1 Evidence for a causal relation of GBS with the following influenza vaccines is unclear and the rarity of the disease (10–20 annual cases of GBS/1 million adults) further limits epidemiological studies due to the huge number of subjects that should be included. In BMT recipients, influenza vaccination has been recommended annually, and widely used. The vaccine is recommended to patients transplanted longer than 6 months due to poor serological responses before this period, and not for safety reasons.5 As 1993, when the reimmunization program after BMT was started, we have not observed any severe side effect that could be attributed to influenza vaccination. This observation includes the patients enrolled in our study of clinical efficacy of influenza vaccine,6 mentioned by the Ikegame et al. Similarly, in a prospective cohort study of 75 renal transplant recipients vaccinated against influenza in 2005, only mild side effects were reported and no decrease in platelet counts was observed during a 4-month follow-up (Salles et al. personal communication).

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References

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  1. Virology Laboratory, Institute of Tropical Medicine, University of São Paulo, São Paulo, Brazil

    C M Machado

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Machado, C. Reply to Ikegame et al.. Bone Marrow Transplant 38, 324–325 (2006). https://doi.org/10.1038/sj.bmt.1705443

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