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Abstract
Patients that are immunosuppressed might be at risk of serious influenza-associated
complications. As a result, multiple guidelines recommend influenza vaccination for
patients infected with HIV, who have received solid-organ transplants, who have received
haemopoietic stem-cell transplants, and patients on haemodialysis. However, immunosuppression
might also limit vaccine responses. To better inform policy, we reviewed the published
work relevant to incidence, outcomes, and prevention of influenza infection in these
patients, and in patients being treated chemotherapy and with systemic corticosteroids.
Available data suggest that most immunosuppressed populations are indeed at higher
risk of influenza-associated complications, have a general trend toward impaired humoral
vaccine responses (although these data are mixed), and can be safely vaccinated--although
longitudinal data are largely lacking. Randomised clinical trial data were limited
to one study of HIV-infected patients with high vaccine efficacy. Better trial data
would inform vaccination recommendations on the basis of efficacy and cost in these
at-risk populations.