Inated population was very low. Several factors may affect immune response including concurrent use of medications, in particular drugs influencing immune function such as immunosuppression and interferon based therapies [7,31]. However, in our study even CHC patients under treatment with pegylated-interferon and ribavirin showed responses comparable to those seen in non-treated CHC patients and healthy controls. This is in keeping with the results obtained in a small cohort of heterogeneous hepatitis C patients [32]. In contrast, IBD patients with immunosuppression had lower immune response to pandemic (H1N1) influenza A vaccine, in agreement with other recent studies in Pentagastrin web pediatric and adult populations [8,33,34]. This is not surprising as data derived from seasonal 
influenza Pentagastrin vaccination indicate that antibody response is diminished in immunosuppressed transplant recipients [32,35], patients receiving chemotherapy [36] 1326631 and human immunodeficiency virus infected adults [37]. We did not find differences between subjects receiving monotherapy immunosuppression and those receiving combined immunosuppression, although the study was not powered to find differences [34]. Finally, we investigated the tolerance of the influenza vaccine. Despite the fact that subjects receiving adjuvanted vaccines tended to show more adverse effects [19,38], even in the worst-case scenario like ours, tolerance of our overall study population to the vaccine can be considered to be satisfactory, as VAPI questionnaire items scored low. Although in this study CHC patients with ongoing treatment had the highest scores concerning injection site reactions with statistically significant differences, we cannot rule out a bias due to the well known local effects that pegylatedinterferon cause in nearly two-thirds of treated patients [39]. This limitation is difficult to overcome. However, the clinical relevance of these differences is likely to be minimal. In fact, considering the VAPI questionnaire questions specifically evaluating this issue, overall acceptance was satisfactory. As a further illustration of this,the willingness to be vaccinated the following year was not affected by the local reactions. This is of interest as these patients appeared to have optimal immune response to the vaccine, achieving in our limited sample size the three immunologic thresholds approved by 
the European Medicines Agency [30]. Vaccination was well tolerated by IBD patients, in agreement with recent data [40]. No deaths or serious vaccine-related adverse events, including neurological and autoimmune disorders in accordance with a recent published study [41], were reported during follow-up of all subjects included. Influenza vaccination apparently did not influence the CHC therapy response. Both groups had similar prognostic factors of favorable outcome after treatment, although caution should again be exercised considering our small sample size. CHC and influenza has aroused interest because of T cell response cross reactivity of a hepatitis C virus epitope (NS3-1073) and influenza A epitope (NA-231), which may theoretically contribute to viral clearance [42]. However, this specific effect of the vaccine on CHC response was not an objective of our study and definite conclusions cannot be drawn due to our small sample size. In conclusion, in our cohort there appeared to be no differences between CHC patients and healthy controls in serological response and acceptance of (H1N1) influenza v.Inated population was very low. Several factors may affect immune response including concurrent use of medications, in particular drugs influencing immune function such as immunosuppression and interferon based therapies [7,31]. However, in our study even CHC patients under treatment with pegylated-interferon and ribavirin showed responses comparable to those seen in non-treated CHC patients and healthy controls. This is in keeping with the results obtained in a small cohort of heterogeneous hepatitis C patients [32]. In contrast, IBD patients with immunosuppression had lower immune response to pandemic (H1N1) influenza A vaccine, in agreement with other recent studies in pediatric and adult populations [8,33,34]. This is not surprising as data derived from seasonal influenza vaccination indicate that antibody response is diminished in immunosuppressed transplant recipients [32,35], patients receiving chemotherapy [36] 1326631 and human immunodeficiency virus infected adults [37]. We did not find differences between subjects receiving monotherapy immunosuppression and those receiving combined immunosuppression, although the study was not powered to find differences [34]. Finally, we investigated the tolerance of the influenza vaccine. Despite the fact that subjects receiving adjuvanted vaccines tended to show more adverse effects [19,38], even in the worst-case scenario like ours, tolerance of our overall study population to the vaccine can be considered to be satisfactory, as VAPI questionnaire items scored low. Although in this study CHC patients with ongoing treatment had the highest scores concerning injection site reactions with statistically significant differences, we cannot rule out a bias due to the well known local effects that pegylatedinterferon cause in nearly two-thirds of treated patients [39]. This limitation is difficult to overcome. However, the clinical relevance of these differences is likely to be minimal. In fact, considering the VAPI questionnaire questions specifically evaluating this issue, overall acceptance was satisfactory. As a further illustration of this,the willingness to be vaccinated the following year was not affected by the local reactions. This is of interest as these patients appeared to have optimal immune response to the vaccine, achieving in our limited sample size the three immunologic thresholds approved by the European Medicines Agency [30]. Vaccination was well tolerated by IBD patients, in agreement with recent data [40]. No deaths or serious vaccine-related adverse events, including neurological and autoimmune disorders in accordance with a recent published study [41], were reported during follow-up of all subjects included. Influenza vaccination apparently did not influence the CHC therapy response. Both groups had similar prognostic factors of favorable outcome after treatment, although caution should again be exercised considering our small sample size. CHC and influenza has aroused interest because of T cell response cross reactivity of a hepatitis C virus epitope (NS3-1073) and influenza A epitope (NA-231), which may theoretically contribute to viral clearance [42]. However, this specific effect of the vaccine on CHC response was not an objective of our study and definite conclusions cannot be drawn due to our small sample size. In conclusion, in our cohort there appeared to be no differences between CHC patients and healthy controls in serological response and acceptance of (H1N1) influenza v.
