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Rapid decline of influenza vaccine-induced antibody in the elderly: is it real, or is it relevant?
J Infect Dis 2008; 197(4):490-502JI

Abstract

Advisory committees have cautioned that influenza vaccine-induced antibody declines more rapidly in the elderly, falling below seroprotective levels within 4 months. We conducted a literature review to assess this assertion. The articles that were included in this review reported antibody levels > or =4 months after influenza immunization in persons > or =60 years old, interpretable in the context of annual influenza vaccine-approval criteria (seroprotection/seroconversion) specified by the Committee for Proprietary Medicinal Products (CPMP) for the elderly. The final review included 14 studies; 8 of which reported seroprotection rates. Seroprotection exceeding CPMP criteria was maintained > or =4 months after influenza immunization in all 8 of the studies reporting this for the H3N2 component and in 5 of the 7 studies reporting this for the H1N1 and B components. In determining whether CPMP criteria were met at season's end, primary antibody response appeared to be more relevant than secondary antibody decline. Both studies reporting seroprotection rates that failed CPMP criteria > or =4 months after influenza immunization for each of the H1N1 and B components had also reported failed seroprotection at 1 month after immunization. If initially achieved after immunization, seroprotection rates of 70%-100% were maintained not just at 4 months (2 studies) but also at 5 months (2 studies) and even at >6 months (4 studies), for the H3N2 and H1N1 vaccine components. Seroprotection rates appeared less consistent for the B vaccine component, throughout the postimmunization period. Seroconversion appears to vary substantially and inversely with preimmunization titers but not with age. In 2 of 6 studies reporting seroconversion alone, CPMP criteria were still met at 4 months. In the other 4 studies, the main reason for failure at 4 months was primary failure at 1 month. A total of 6 studies compared antibody persistence by age, and no consistent differences were found on that basis. The historic concern that the influenza vaccine-induced antibody response in the elderly declines more rapidly and below seroprotective levels within 4 months of immunization should be reconsidered.

Authors+Show Affiliations

British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada. danuta.skowrinski@bccdc.caNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

18275271

Citation

Skowronski, Danuta M., et al. "Rapid Decline of Influenza Vaccine-induced Antibody in the Elderly: Is It Real, or Is It Relevant?" The Journal of Infectious Diseases, vol. 197, no. 4, 2008, pp. 490-502.
Skowronski DM, Tweed SA, De Serres G. Rapid decline of influenza vaccine-induced antibody in the elderly: is it real, or is it relevant? J Infect Dis. 2008;197(4):490-502.
Skowronski, D. M., Tweed, S. A., & De Serres, G. (2008). Rapid decline of influenza vaccine-induced antibody in the elderly: is it real, or is it relevant? The Journal of Infectious Diseases, 197(4), pp. 490-502. doi:10.1086/524146.
Skowronski DM, Tweed SA, De Serres G. Rapid Decline of Influenza Vaccine-induced Antibody in the Elderly: Is It Real, or Is It Relevant. J Infect Dis. 2008 Feb 15;197(4):490-502. PubMed PMID: 18275271.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Rapid decline of influenza vaccine-induced antibody in the elderly: is it real, or is it relevant? AU - Skowronski,Danuta M, AU - Tweed,S Aleina, AU - De Serres,Gaston, PY - 2008/2/16/pubmed PY - 2008/4/9/medline PY - 2008/2/16/entrez SP - 490 EP - 502 JF - The Journal of infectious diseases JO - J. Infect. Dis. VL - 197 IS - 4 N2 - Advisory committees have cautioned that influenza vaccine-induced antibody declines more rapidly in the elderly, falling below seroprotective levels within 4 months. We conducted a literature review to assess this assertion. The articles that were included in this review reported antibody levels > or =4 months after influenza immunization in persons > or =60 years old, interpretable in the context of annual influenza vaccine-approval criteria (seroprotection/seroconversion) specified by the Committee for Proprietary Medicinal Products (CPMP) for the elderly. The final review included 14 studies; 8 of which reported seroprotection rates. Seroprotection exceeding CPMP criteria was maintained > or =4 months after influenza immunization in all 8 of the studies reporting this for the H3N2 component and in 5 of the 7 studies reporting this for the H1N1 and B components. In determining whether CPMP criteria were met at season's end, primary antibody response appeared to be more relevant than secondary antibody decline. Both studies reporting seroprotection rates that failed CPMP criteria > or =4 months after influenza immunization for each of the H1N1 and B components had also reported failed seroprotection at 1 month after immunization. If initially achieved after immunization, seroprotection rates of 70%-100% were maintained not just at 4 months (2 studies) but also at 5 months (2 studies) and even at >6 months (4 studies), for the H3N2 and H1N1 vaccine components. Seroprotection rates appeared less consistent for the B vaccine component, throughout the postimmunization period. Seroconversion appears to vary substantially and inversely with preimmunization titers but not with age. In 2 of 6 studies reporting seroconversion alone, CPMP criteria were still met at 4 months. In the other 4 studies, the main reason for failure at 4 months was primary failure at 1 month. A total of 6 studies compared antibody persistence by age, and no consistent differences were found on that basis. The historic concern that the influenza vaccine-induced antibody response in the elderly declines more rapidly and below seroprotective levels within 4 months of immunization should be reconsidered. SN - 0022-1899 UR - https://www.unboundmedicine.com/medline/citation/18275271/Rapid_decline_of_influenza_vaccine_induced_antibody_in_the_elderly:_is_it_real_or_is_it_relevant L2 - https://academic.oup.com/jid/article-lookup/doi/10.1086/524146 DB - PRIME DP - Unbound Medicine ER -