human
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: To assess the efficacy and safety of vaccination against p and emic H1N1 virus in patients with rheumatoid arthritis ( RA ) , systemic lupus erythematosus ( SLE ) , psoriatic arthritis ( PsA ) , and ankylosing spondylitis ( AS ) compared with healthy controls Twenty-eight patients with low-moderate , stable rheumatoid arthritis ( RA ) , under treatment with tumor necrosis factor ( TNF ) alpha blockers  , were immunized at least once with non-adjuvanted trivalent influenza vaccine during three consecutive influenza seasons . Antibodies toward A influenza antigens significantly increased and reached protective levels , still detectable 6 months after vaccination , both in RA patients and healthy controls . Response to B antigen instead was only observed from the second year for healthy controls and in the third year for patients . No significant difference in disease activity and anti-nuclear antibodies was observed as a consequence of vaccine administration , whereas T regulatory cells showed a significant increase 30 days after immunization in RA patients . This study confirms safety of influenza vaccine administration in RA patients treated with TNFalpha blockers . The cohort follow-up revealed the overcoming of poor B vaccine antigen immunogenicity via repeated vaccinations . Finally , protective antibody response was still observed 6 months after vaccination Objective : To assess the effect of rituximab on the efficacy and safety of influenza virus vaccine in patients with rheumatoid arthritis ( RA ) . Methods : The study group comprised patients with RA treated with conventional disease-modifying drugs with or without rituximab . Split-virion inactivated vaccine containing 15 μg haemagglutinin/dose of B/Shanghai/361/02 ( SHAN ) , A/New Caledonian/20/99 ( NC ) ( H1N1 ) and A/California/7/04 ( CAL ) ( H3N2 ) was used . Disease activity was assessed by the number of tender and swollen joints , duration of morning stiffness and evaluation of pain on the day of vaccination and 4 weeks later . CD19-positive cell levels were assessed in rituximab-treated patients . Haemagglutination inhibition ( HI ) antibodies were tested and response was defined as a greater than fourfold rise 4 weeks after vaccination or seroconversion in patients with a non-protective baseline level of antibodies ( < 1/40 ) . Geometric mean titres ( GMT ) were calculated in all subjects . Results : The participants were divided into three groups : RA ( n = 29 , aged 64 ( 12 ) years ) , rituximab-treated RA ( n = 14 , aged 53 ( 15 ) years ) and healthy controls ( n = 21 , aged 58 ( 15 ) years ) . All baseline protective levels of HI antibodies and GMT were similar . Four weeks after vaccination , there was a significant increase in GMT for NC and CAL antigens in all subjects , but not for the SHAN antigen in the rituximab group . In rituximab-treated patients , the percentage of responders was low for all three antigens tested , achieving statistical significance for the CAL antigen . Measures of disease activity remained unchanged . Conclusion : Influenza virus vaccine generated a humoral response in all study patients with RA and controls . Although the response was significantly lower among rituximab-treated patients , treatment with rituximab does not preclude administration of vaccination against influenza Vaccines have undoubtedly brought overwhelming benefits to mankind and are considered safe and effective . Nevertheless , they can occasionally stimulate autoantibody production or even a recently defined syndrome known as autoimmune/inflammatory syndrome induced by adjuvants ( ASIA ) . There is scarce data regarding autoimmune response after seasonal/influenza A ( H1N1 ) vaccine in patients with autoimmune inflammatory rheumatic disease ( AIRD ) . The objective of our study was therefore to determine autoimmune response in a large group of AIRD patients vaccinated against seasonal and /or H1N1 influenza .  We conducted a prospect i ve cohort study with a 6-month follow-up . Two-hundred and eighteen patients with AIRD ( 50 vaccinated against seasonal influenza , six against H1N1 , 104 against both , 58 non-vaccinated controls ) and 41 apparently healthy controls ( nine vaccinated against seasonal influenza , three against H1N1 , 18 against both , 11 non-vaccinated controls ) were included . Blood sample s were taken and screened for autoantibodies [ antinuclear antibody ( ANA ) , anti-extractable nuclear antigen ( anti-ENA ) , anticardiolipin ( aCL ) IgG/IgM antibodies , anti-beta 2-glycoprotein I ( anti-β2GPI ) ] at inclusion in the study , before each vaccination , 1 month after the last vaccination and 6 months after inclusion . For non-vaccinated participants ( patients and healthy controls ) blood sample s were taken at the time of inclusion in the study and 6 months later . We report that after the administration of seasonal/H1N1 vaccine there were mostly transient changes in autoantibody production in AIRD patients and in healthy participants . However , a small subset of patients , especially ANA-positive patients , had a tendency towards anti-ENA development . Although no convincing differences between the seasonal and H1N1 vaccines were observed , our results imply that there might be a slight tendency of the H1N1 vaccine towards aCL induction . Although seasonal and H1N1 vaccines are safe and effective , they also have the potential to induce autoantibodies in selected AIRD patients and healthy adults . Follow-up of such individuals is proposed and further research is needed OBJECTIVES To assess the 2009 influenza vaccine A/H1N1 on antibody response , side effects and disease activity in patients with immune-mediated diseases . METHODS Patients with RA , SpA , vasculitis ( VAS ) or CTD ( n = 149 ) and healthy individuals ( n = 40 ) received a single dose of adjuvanted A/H1N1 influenza vaccine . Sera were obtained before vaccination , and 3 weeks , 6 weeks and 6 months thereafter . A/H1N1 antibody titres were measured by haemagglutination inhibition ( HAI ) assay . Seroprotection was defined as specific antibody titre ≥ 1 : 40 , seroconversion as 4-fold increase in antibody titre . RESULTS Titres increased significantly in patients and controls with a maximum at Week 3 , declining to levels below protection at Month 6 ( P < 0.001 ) . Seroprotection was more frequently reached in SpA and CTD than in RA and VAS ( 80 and 82 % and 57 and 47 % , respectively ) . There was a significantly negative impact by MTX ( P < 0.001 ) , rituximab ( P = 0.0031 ) and abatacept ( P = 0.045 ) . Other DMARDs , glucocorticoids and TNF blockers did not significantly suppress response ( P = 0.06 , 0.11 and 0.81 , respectively ) . A linear decline in response was noted in patients with increasing age ( P < 0.001 ) . Disease reactivation possibly related to vaccination was suspected in 8/149 patients .  No prolonged side effects or A/H1N1 infections were noted . CONCLUSIONS The results show that vaccination response is a function of disease type , intensity and character of medication and age . A single injection of adjuvanted influenza vaccine is sufficient to protect a high percentage of patients . Therefore , differential vaccination recommendations might in the future reduce costs and increase vaccination acceptance OBJECTIVE To address the issues of immunogenicity and local and systemic reactions to vaccination with influenza vaccine in patients with rheumatoid arthritis ( RA ) . METHODS One hundred and twenty-six patients with RA were stratified into 3 groups : ( 1 ) those with a history of vaccination with influenza vaccine within 24 months who were receiving usual therapy for RA  , ( 2 ) those receiving usual therapy for RA but without prior vaccine  , and ( 3 ) those receiving immunosuppressive medication or prednisone > or = 7.5 mg/day  , irrespective of their prior immunization status . Within each group , patients were r and omized to receive vaccine or placebo . A group of age matched , healthy controls were also vaccinated . RESULTS During a one month followup period , adverse reactions occurred with equal frequency among patients with RA and healthy controls . Similar significant increases in titers to the vaccine were seen in all groups of patients with arthritis and in the controls . CONCLUSION The potential increase in susceptibility to influenza and death from respiratory illness in patients with RA and the demonstrated safety and immunogenicity of influenza vaccine should require the inclusion of patients with RA in st and ard immunization programs 
    Output:
    
agent
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: To assess the efficacy and safety of vaccination against p and emic H1N1 virus in patients with rheumatoid arthritis ( RA ) , systemic lupus erythematosus ( SLE ) , psoriatic arthritis ( PsA ) , and ankylosing spondylitis ( AS ) compared with healthy controls Twenty-eight patients with low-moderate , stable rheumatoid arthritis ( RA ) , under treatment with tumor necrosis factor ( TNF ) alpha blockers  , were immunized at least once with non-adjuvanted trivalent influenza vaccine during three consecutive influenza seasons . Antibodies toward A influenza antigens significantly increased and reached protective levels , still detectable 6 months after vaccination , both in RA patients and healthy controls . Response to B antigen instead was only observed from the second year for healthy controls and in the third year for patients . No significant difference in disease activity and anti-nuclear antibodies was observed as a consequence of vaccine administration , whereas T regulatory cells showed a significant increase 30 days after immunization in RA patients . This study confirms safety of influenza vaccine administration in RA patients treated with TNFalpha blockers . The cohort follow-up revealed the overcoming of poor B vaccine antigen immunogenicity via repeated vaccinations . Finally , protective antibody response was still observed 6 months after vaccination Objective : To assess the effect of rituximab on the efficacy and safety of influenza virus vaccine in patients with rheumatoid arthritis ( RA ) . Methods : The study group comprised patients with RA treated with conventional disease-modifying drugs with or without rituximab . Split-virion inactivated vaccine containing 15 μg haemagglutinin/dose of B/Shanghai/361/02 ( SHAN ) , A/New Caledonian/20/99 ( NC ) ( H1N1 ) and A/California/7/04 ( CAL ) ( H3N2 ) was used . Disease activity was assessed by the number of tender and swollen joints , duration of morning stiffness and evaluation of pain on the day of vaccination and 4 weeks later . CD19-positive cell levels were assessed in rituximab-treated patients . Haemagglutination inhibition ( HI ) antibodies were tested and response was defined as a greater than fourfold rise 4 weeks after vaccination or seroconversion in patients with a non-protective baseline level of antibodies ( < 1/40 ) . Geometric mean titres ( GMT ) were calculated in all subjects . Results : The participants were divided into three groups : RA ( n = 29 , aged 64 ( 12 ) years ) , rituximab-treated RA ( n = 14 , aged 53 ( 15 ) years ) and healthy controls ( n = 21 , aged 58 ( 15 ) years ) . All baseline protective levels of HI antibodies and GMT were similar . Four weeks after vaccination , there was a significant increase in GMT for NC and CAL antigens in all subjects , but not for the SHAN antigen in the rituximab group . In rituximab-treated patients , the percentage of responders was low for all three antigens tested , achieving statistical significance for the CAL antigen . Measures of disease activity remained unchanged . Conclusion : Influenza virus vaccine generated a humoral response in all study patients with RA and controls . Although the response was significantly lower among rituximab-treated patients , treatment with rituximab does not preclude administration of vaccination against influenza Vaccines have undoubtedly brought overwhelming benefits to mankind and are considered safe and effective . Nevertheless , they can occasionally stimulate autoantibody production or even a recently defined syndrome known as autoimmune/inflammatory syndrome induced by adjuvants ( ASIA ) . There is scarce data regarding autoimmune response after seasonal/influenza A ( H1N1 ) vaccine in patients with autoimmune inflammatory rheumatic disease ( AIRD ) . The objective of our study was therefore to determine autoimmune response in a large group of AIRD patients vaccinated against seasonal and /or H1N1 influenza .  We conducted a prospect i ve cohort study with a 6-month follow-up . Two-hundred and eighteen patients with AIRD ( 50 vaccinated against seasonal influenza , six against H1N1 , 104 against both , 58 non-vaccinated controls ) and 41 apparently healthy controls ( nine vaccinated against seasonal influenza , three against H1N1 , 18 against both , 11 non-vaccinated controls ) were included . Blood sample s were taken and screened for autoantibodies [ antinuclear antibody ( ANA ) , anti-extractable nuclear antigen ( anti-ENA ) , anticardiolipin ( aCL ) IgG/IgM antibodies , anti-beta 2-glycoprotein I ( anti-β2GPI ) ] at inclusion in the study , before each vaccination , 1 month after the last vaccination and 6 months after inclusion . For non-vaccinated participants ( patients and healthy controls ) blood sample s were taken at the time of inclusion in the study and 6 months later . We report that after the administration of seasonal/H1N1 vaccine there were mostly transient changes in autoantibody production in AIRD patients and in healthy participants . However , a small subset of patients , especially ANA-positive patients , had a tendency towards anti-ENA development . Although no convincing differences between the seasonal and H1N1 vaccines were observed , our results imply that there might be a slight tendency of the H1N1 vaccine towards aCL induction . Although seasonal and H1N1 vaccines are safe and effective , they also have the potential to induce autoantibodies in selected AIRD patients and healthy adults . Follow-up of such individuals is proposed and further research is needed OBJECTIVES To assess the 2009 influenza vaccine A/H1N1 on antibody response , side effects and disease activity in patients with immune-mediated diseases . METHODS Patients with RA , SpA , vasculitis ( VAS ) or CTD ( n = 149 ) and healthy individuals ( n = 40 ) received a single dose of adjuvanted A/H1N1 influenza vaccine . Sera were obtained before vaccination , and 3 weeks , 6 weeks and 6 months thereafter . A/H1N1 antibody titres were measured by haemagglutination inhibition ( HAI ) assay . Seroprotection was defined as specific antibody titre ≥ 1 : 40 , seroconversion as 4-fold increase in antibody titre . RESULTS Titres increased significantly in patients and controls with a maximum at Week 3 , declining to levels below protection at Month 6 ( P < 0.001 ) . Seroprotection was more frequently reached in SpA and CTD than in RA and VAS ( 80 and 82 % and 57 and 47 % , respectively ) . There was a significantly negative impact by MTX ( P < 0.001 ) , rituximab ( P = 0.0031 ) and abatacept ( P = 0.045 ) . Other DMARDs , glucocorticoids and TNF blockers did not significantly suppress response ( P = 0.06 , 0.11 and 0.81 , respectively ) . A linear decline in response was noted in patients with increasing age ( P < 0.001 ) . Disease reactivation possibly related to vaccination was suspected in 8/149 patients .  No prolonged side effects or A/H1N1 infections were noted . CONCLUSIONS The results show that vaccination response is a function of disease type , intensity and character of medication and age . A single injection of adjuvanted influenza vaccine is sufficient to protect a high percentage of patients . Therefore , differential vaccination recommendations might in the future reduce costs and increase vaccination acceptance OBJECTIVE To address the issues of immunogenicity and local and systemic reactions to vaccination with influenza vaccine in patients with rheumatoid arthritis ( RA ) . METHODS One hundred and twenty-six patients with RA were stratified into 3 groups : ( 1 ) those with a history of vaccination with influenza vaccine within 24 months who were receiving usual therapy for RA  , ( 2 ) those receiving usual therapy for RA but without prior vaccine  , and ( 3 ) those receiving immunosuppressive medication or prednisone > or = 7.5 mg/day  , irrespective of their prior immunization status . Within each group , patients were r and omized to receive vaccine or placebo . A group of age matched , healthy controls were also vaccinated . RESULTS During a one month followup period , adverse reactions occurred with equal frequency among patients with RA and healthy controls . Similar significant increases in titers to the vaccine were seen in all groups of patients with arthritis and in the controls . CONCLUSION The potential increase in susceptibility to influenza and death from respiratory illness in patients with RA and the demonstrated safety and immunogenicity of influenza vaccine should require the inclusion of patients with RA in st and ard immunization programs 
    Output:
    