Response to: Larger Dose of Intradermal Influenza Vaccination May Be More Immunogenic in Transplant Recipients
Bibliographic record
Abstract
To the Editor: We appreciate the insightful comments by Mossad (1Mossad SB Larger dose of intradermal influenza vaccination may be more immunogenic in transplant recipients.Am J Transplant. 2008; Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar). We were encouraged by the safety profile of intradermal vaccination in our lung transplant cohort (2Manuel O Humar A Chen MH et al.Immunogenicity and safety of an intradermal boosting strategy for vaccination against influenza in lung transplant recipients.Am J Transplant. 2007; 7: 2567-2572Abstract Full Text Full Text PDF PubMed Scopus (57) Google Scholar). Although no direct comparison of adverse events versus healthy controls was performed, rates of local reactions as high as 96% have been reported in the latter population (3Belshe RB Newman FK Cannon J et al.Serum antibody responses after intradermal vaccination against influenza.N Engl J Med. 2004; 351: 2286-2294Crossref PubMed Scopus (293) Google Scholar,4Kenney RT Frech SA Muenz LR Villar CP Glenn GM Dose sparing with intradermal injection of influenza vaccine.N Engl J Med. 2004; 351: 2295-2301Crossref PubMed Scopus (366) Google Scholar). An intradermal vaccine utilizes the dendritic cell population which are potent inducers of cell-mediated immunity. Thus, a lower antigen dose may suffice. Since our primary concern was safety of the intradermal injection, we used 3 μg (one-fifth of the standard intramuscular dose of 15 μg). While it is possible that a greater dose of intradermal vaccine may increase the proportion of responders, the volume of injection that can be technically administered intradermally may be an issue. The study by Belshe et al. used an unlicensed vaccine preparation that contained 6 μg antigen in 0.1 mL volume (3Belshe RB Newman FK Cannon J et al.Serum antibody responses after intradermal vaccination against influenza.N Engl J Med. 2004; 351: 2286-2294Crossref PubMed Scopus (293) Google Scholar). The study by Kenney et al., however, used 3 μg antigen (similar to our study), also in 0.1 mL volume, and found similar immunogenicity to the intramuscular injection in healthy adults (4Kenney RT Frech SA Muenz LR Villar CP Glenn GM Dose sparing with intradermal injection of influenza vaccine.N Engl J Med. 2004; 351: 2295-2301Crossref PubMed Scopus (366) Google Scholar). Therefore, one could evaluate a higher dose in transplant patients using a special vaccine preparation with a higher concentration of antigen. Alternatively, two injections of 0.1 mL each of the standard vaccine preparation could also be used (5Belshe RB Newman FK Wilkins K et al.Comparative immunogenicity of trivalent influenza vaccine administered by intradermal or intramuscular route in healthy adults.Vaccine. 2007; 25: 6755-6763Crossref PubMed Scopus (92) Google Scholar). Therefore, we agree that given the safety of the single intradermal dose in the transplant population, our study sets the stage for future trials of higher doses.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.004 | 0.025 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.002 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.002 | 0.000 |
| Research integrity | 0.007 | 0.008 |
| Insufficient payload (model declined to judge) | 0.005 | 0.003 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".