Rapid decline of influenza vaccine-induced antibody in the elderly: Is it real, or is it relevant?
Rapid decline of influenza vaccine-induced antibody in the elderly: Is it real, or is it relevant?
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DOI：
10.1086/524146
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发表时间：
2008-02-15
影响因子：
6.4
通讯作者：
De Serres, Gaston
中科院分区：
文献类型：
--
作者：
Skowronski, Danuta M.;Tweed, S. Aleina;De Serres, Gaston
咨询委员会警告说，流感疫苗诱导的抗体在老年人中下降得更快，在4个月内降至血清保护水平以下。我们进行了文献综述来评估这一论断。纳入本综述的文章报告了≥ 60岁人群流感疫苗接种后≥ 4个月的抗体水平，可在专利药品委员会（CPMP）规定的老年人年度流感疫苗批准标准（血清保护/血清转换）的背景下进行解释。最终审查包括14项研究;其中8项报告了血清保护率。在所有8项报告H3 N2组分的研究中，以及在7项报告H1N1和B组分的研究中，超过CPMP标准的血清保护在流感免疫后维持≥ 4个月。在确定是否符合CPMP标准，在赛季结束时，第一抗体反应似乎比第二抗体下降更相关。两项研究报告了在流感疫苗接种后≥ 4个月，H1N1和B组分的血清保护率不符合CPMP标准，也报告了疫苗接种后1个月的血清保护失败。如果最初在免疫后达到，H3 N2和H1N1疫苗组分的血清保护率不仅在4个月（2项研究），而且在5个月（2项研究）甚至在> 6个月（4项研究）时都保持在70%-100%。在整个免疫后阶段，B疫苗组分的血清保护率似乎不太一致。血清转化率与免疫前滴度呈显著负相关，但与年龄无关。在仅报告血清转化的6项研究中，有2项在4个月时仍符合CPMP标准。在其他4项研究中，4个月时失败的主要原因是1个月时的原发性失败。共有6项研究比较了不同年龄的抗体持久性，在此基础上没有发现一致的差异。应重新考虑老年人流感疫苗诱导的抗体应答在免疫后4个月内下降更快并低于血清保护水平的历史性问题。
Advisory committees have cautioned that influenza vaccine-induced antibody declines more rapidly in the elderly, falling below seroprotective levels within 4 months. Weconducted a literature review to assess this assertion. The articles that were included in this review reported antibody levels >= 4 months after influenza immunization in persons >= 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 >= 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 >= 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.