Should patients with CVID be immunized with inactivated (killed) influenza vaccine?

The answer to the questions is "probably yes".

The usefulness of vaccinating patients with CVID has not been well studied.

Vaccine Efficacy

Most patients with CVID have impaired responses to vaccination but there is a range of immunologic capacity which depends on how much the immune system is affected and to what extent the T-lymphocytes are involved.

A key problem that faces patients with CVID is the fact that they cannot recognize vaccines sufficiently well to mount a useful immune response on subsequent exposure. This property is used as part of the criteria for diagnosis of CVID.

In CVID, there is a poor antibody response to carbohydrate antigens (measured using pneumococcal antibodies) but the protein antigen response is also impaired.

Safety

In addition, the safety of live vaccines in patients with CVID and significantly impaired T cell function has not been examined.

Recommendations

Recommendations:
- Family members and household contacts of patients with CVID may receive live vaccines
- Patients with CVID who are planning to travel should receive vaccines against infectious diseases endemic to that area

Influenza vaccine is not routinely administered in patients with CVID. Influenza immunization is unlikely to be useful in CVID, since T cell help is unlikely to be effective following immunization. However, many immunology experts administer influenza vaccine to their CVID patients considering the risk/benefit ratio. Live intranasal vaccine must not be administered to patients with CVID or their household contacts.

CVID patients have to rely on influenza-specific antibodies in their IVIG, anti-viral drugs, and herd immunity by immunization of their household contacts.

CVID patients with an exposure to influenza are typically treated with antiviral agents.

References:
CVID patients may not respond to influenza immunization. William A.C. Sewell. Clinical Immunology, Volume 114, Issue 2, February 2005, Page 210.
How to flee the flu. Anne K. Junkera, Francisco A. Bonillab and Kathleen E. Sullivan. Clinical Immunology, Volume 112, Issue 3, September 2004, Pages 219-220.
Treatment of common variable immunodeficiency. Sam Ahn, MD, Lloyd Mayer, MD, Charlotte Cunningham-Rundles, MD. UpToDate 16.2.
Should common variable immunedeficiency patients receive chemoprophylaxis for influenza? Ask the Expert. AAAAI, 2009.

Influenza Vaccines for the Future - NEJM, 2010 http://goo.gl/cPIgz
Stem Cells Show Promise in Common Variable Immunodeficiency (CVID) - selected patient could be cured. Medscape and JACI, 2011.
Image source: Influenza virus, Wikipedia, public domain.