1
|
Andrew MK. Commentary on: Cost-effectiveness of pneumococcal vaccination and of programs to increase its uptake in U.S. older adults. J Am Geriatr Soc 2024; 72:2299-2302. [PMID: 39007431 DOI: 10.1111/jgs.19079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2024] [Accepted: 06/11/2024] [Indexed: 07/16/2024]
Abstract
See related articles by Wateska et al.
Collapse
Affiliation(s)
- Melissa K Andrew
- Department of Medicine (Geriatrics), Dalhousie University, Halifax, Nova Scotia, Canada
| |
Collapse
|
2
|
Nguyen TN, Ahmad F, Lindley RI. Frailty in clinical drug trials: Frailty assessments, subgroup analyses and outcomes. Br J Clin Pharmacol 2024. [PMID: 38509766 DOI: 10.1111/bcp.16034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 12/23/2023] [Accepted: 01/18/2024] [Indexed: 03/22/2024] Open
Abstract
With population ageing, drug trials are increasingly turning their attention to including older, frailer people. This review aimed to provide an overview of how frailty was assessed in published studies related to clinical pharmacological trials, and on the interaction of frailty on the efficacy of the treatments. We searched MEDLINE, EMBASE and Cochrane for clinical drug trials in older people. A total of 4031 abstracts were screened and 17 relevant studies were included in this review. We summarized the findings of these 17 trials into five main clinical areas: cardiovascular (eight studies), cognition (one study), vaccination (two studies), cancer (four studies) and other (two studies). Frailty was assessed retrospectively in most of the studies. Frailty was treated as an ordinal variable (with different levels of frailty) or binary variable (frail/non-frail) using cut-offs in some studies, and as a continuous in some other studies. The effect of frailty on the treatment efficacy was not consistent among the studies. While several trials, such as the Action in Diabetes and Vascular Disease-Preterax and Diamicron Modified Release Controlled Evaluation trials, the Systolic Blood Pressure Intervention Trial and the Aspirin in Reducing Events in the Elderly trial, showed some reduced effects of the treatment in frail patients, most of the trials showed that the benefits of the treatment are not affected by frailty. Some trials even showed that the benefits of the treatment were more significant in frailer patients (the Dapagliflozin and Prevention of Adverse Outcomes in Heart Failure and the Dapagliflozin Evaluation to Improve the Lives of Patients with Preserved Ejection Fraction Heart Failure trials). The results of this review suggest that routine measurement of frailty in participants in clinical drug trials would improve our knowledge of the effect of treatment in the frail and identify those who have more or least to gain from treatment.
Collapse
Affiliation(s)
- Tu N Nguyen
- Westmead Applied Research Centre, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Fahed Ahmad
- Westmead Applied Research Centre, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Richard I Lindley
- Westmead Applied Research Centre, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- George Institute for Global Health, Sydney, New South Wales, Australia
| |
Collapse
|
3
|
Zhou S, Lv M, Bai S, Chen W, Zhao W, Wang J, Zhang A, Li J, Xie H, Gao Y, Li D, Wu J. Baseline Pneumococcal IgG Levels and Response to 23-Valent Pneumococcal Polysaccharide Vaccine among Adults from Beijing, China. Vaccines (Basel) 2023; 11:1780. [PMID: 38140184 PMCID: PMC10748153 DOI: 10.3390/vaccines11121780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 11/19/2023] [Accepted: 11/23/2023] [Indexed: 12/24/2023] Open
Abstract
PURPOSE To investigate the baseline levels of serotype-specific IgG antibodies to Streptococcus pneumoniae (S. pneumoniae) and assess their impact on the assessment of vaccine immunogenicity. METHODS We used a subset of serum samples from a randomized controlled trial. The blood of 584 healthy participants was collected on day 0 before and day 28 after the 23-valent pneumococcal polysaccharide vaccine (PPSV23) vaccination. Serotype-specific IgG against PPSV23-covered serotypes were measured by the World Health Organization (WHO) reference enzyme-linked immunosorbent assay (ELISA). Vaccine immunogenicity was compared using conversion rates (proportion of participants with IgG levels following immunization that are 2-fold greater than the baseline) and geometric mean fold rises (GMFRs) between the two groups, which were grouped according to pre-vaccination (baseline) IgG antibody levels. RESULTS Our data showed that over half of individuals have baseline IgG levels for 15 out of 23 serotypes above 1.3 µg/mL, and geometric mean concentrations (GMCs) were generally higher in the elderly group and the female group; significant differences were found in 15 serotypes for vaccine immunogenicity based on the seroconversion rate or GMFRs between individuals with baseline IgG ≥ 1.3 µg/mL and individuals with baseline IgG < 1.3 µg/mL. The seroconversion rate decreased with the increase of baseline IgG levels according to a linear regression model. CONCLUSIONS The assessment of vaccine immunogenicity could be impacted by the fact that many adults had high baseline antibody levels. This study is registered in the Chinese Clinical Trial Registry, number NCT05298800.
Collapse
Affiliation(s)
- Shanshan Zhou
- Beijing Center for Disease Prevention and Control, No. 16, Hepingli Middle Street, Dongcheng District, Beijing 100013, China
| | - Min Lv
- Beijing Center for Disease Prevention and Control, No. 16, Hepingli Middle Street, Dongcheng District, Beijing 100013, China
| | - Shuang Bai
- Beijing Center for Disease Prevention and Control, No. 16, Hepingli Middle Street, Dongcheng District, Beijing 100013, China
| | - Weixin Chen
- Beijing Center for Disease Prevention and Control, No. 16, Hepingli Middle Street, Dongcheng District, Beijing 100013, China
| | - Wei Zhao
- Beijing Center for Disease Prevention and Control, No. 16, Hepingli Middle Street, Dongcheng District, Beijing 100013, China
| | - Jian Wang
- Beijing Center for Disease Prevention and Control, No. 16, Hepingli Middle Street, Dongcheng District, Beijing 100013, China
| | - Ao Zhang
- Beijing Center for Disease Prevention and Control, No. 16, Hepingli Middle Street, Dongcheng District, Beijing 100013, China
| | - Jing Li
- Beijing Center for Disease Prevention and Control, No. 16, Hepingli Middle Street, Dongcheng District, Beijing 100013, China
| | - Hui Xie
- Beijing Center for Disease Prevention and Control, No. 16, Hepingli Middle Street, Dongcheng District, Beijing 100013, China
| | - Yanqing Gao
- Daxing District Center for Disease Control and Prevention of Beijing, Beijing 102600, China
| | - Dongmei Li
- Daxing District Center for Disease Control and Prevention of Beijing, Beijing 102600, China
| | - Jiang Wu
- Beijing Center for Disease Prevention and Control, No. 16, Hepingli Middle Street, Dongcheng District, Beijing 100013, China
| |
Collapse
|
4
|
See KC. Pneumococcal Vaccination in Adults: A Narrative Review of Considerations for Individualized Decision-Making. Vaccines (Basel) 2023; 11:vaccines11050908. [PMID: 37243012 DOI: 10.3390/vaccines11050908] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 04/22/2023] [Accepted: 04/25/2023] [Indexed: 05/28/2023] Open
Abstract
Pneumococcal disease remains one of the major causes of severe disease in both children and adults. Severe disease may be prevented by pneumococcal polysaccharide and conjugate vaccines, which currently cover more than 20 serotypes. However, unlike routine pneumococcal vaccination in children, guidelines promote only limited pneumococcal vaccination in adults, and do not cater for decision-making for individual patients. In this narrative review, considerations for individualized decision-making are identified and discussed. This review identifies and discusses considerations for individualized decision-making, including the risk of severe disease, immunogenicity, clinical efficacy, mucosal immunity, herd immunity, concomitant administration with other vaccines, waning immunity, and replacement strains.
Collapse
Affiliation(s)
- Kay Choong See
- Department of Medicine, National University Hospital, Singapore 119228, Singapore
| |
Collapse
|
5
|
Hafızoğlu M, Bas AO, Tavukçuoğlu E, Sahiner Z, Oytun MG, Ulutürk S, Yanık H, Doğu BB, Cankurtaran M, Esendağlı G, Akbıyık F, Çakır B, Ünal S, Halil MG. Memory T cell responses in seronegative older adults following SARS-CoV-2 vaccination. CLINICAL IMMUNOLOGY COMMUNICATIONS 2022; 2:154-158. [PMID: 38013969 PMCID: PMC9529214 DOI: 10.1016/j.clicom.2022.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 09/28/2022] [Accepted: 09/28/2022] [Indexed: 11/05/2022]
Abstract
Generating memory T cell responses besides humoral immune responses is essential when it comes to the efficacy of a vaccine. In this study, the presence of memory T cell responses after aluminum-adjuvanted inactivated whole-virion SARS-CoV-2 vaccine (CoronaVac) in seronegative and seropositive elderly individuals were examined. CD4+ and CD8+ memory T cell proliferation and IFN-γ production capacities were evaluated. Additionally, clinical frailty scale (CFS) and FRAIL scales of the individuals were scored. CD4+ memory T cell responses more prominent than CD8+ memory T cells. In seronegative individuals, 80% of them had memory CD4+ and IFN-γ, whereas 50% of them had memory CD4+ and all of them had IFN-γ responses. Additionally, 40% of seronegative patients and 50% of seropositive patients had memory CD8+ responses. To sum up, humoral immune responses are not associated with memory T cell responses, and in seronegative individuals, memory T cell responses can be detected.
Collapse
Affiliation(s)
- Merve Hafızoğlu
- Department of Internal Medicine, Division of Geriatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Arzu Okyar Bas
- Department of Internal Medicine, Division of Geriatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ece Tavukçuoğlu
- Department of Basic Oncology, Hacettepe University Cancer Institute, Ankara, Turkey
| | - Zeynep Sahiner
- Department of Internal Medicine, Division of Geriatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Merve Güner Oytun
- Department of Internal Medicine, Division of Geriatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Sıla Ulutürk
- Department of Basic Oncology, Hacettepe University Cancer Institute, Ankara, Turkey
| | - Hamdullah Yanık
- Department of Basic Oncology, Hacettepe University Cancer Institute, Ankara, Turkey
| | - Burcu Balam Doğu
- Department of Internal Medicine, Division of Geriatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Mustafa Cankurtaran
- Department of Internal Medicine, Division of Geriatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Güneş Esendağlı
- Department of Basic Oncology, Hacettepe University Cancer Institute, Ankara, Turkey
| | - Filiz Akbıyık
- Ankara City Hospital Siemens Healthineers Laboratory, Enterprise Services & Solutions, Ankara, Turkey
| | - Banu Çakır
- Department of Public Health, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Serhat Ünal
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Meltem Gülhan Halil
- Department of Internal Medicine, Division of Geriatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| |
Collapse
|
6
|
Meyers E, De Rop L, Deschepper E, Duysburgh E, De Burghgraeve T, Van Ngoc P, Digregorio M, Delogne S, Coen A, De Clercq N, Buret L, Coenen S, De Sutter A, Scholtes B, Verbakel JY, Cools P, Heytens S. Prevalence of SARS-CoV-2 antibodies among Belgian nursing home residents and staff during the primary COVID-19 vaccination campaign. Eur J Gen Pract 2022:1-9. [DOI: 10.1080/13814788.2022.2149732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Eline Meyers
- Department of Diagnostic Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Liselore De Rop
- Department of Public Health and Primary Care, EPI-Centre, ACHG, Leuven, Belgium
| | - Ellen Deschepper
- Faculty of Medicine and Health Sciences, Biostatistics Unit, Ghent University, Ghent, Belgium
| | - Els Duysburgh
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
| | - Tine De Burghgraeve
- Department of Public Health and Primary Care, EPI-Centre, ACHG, Leuven, Belgium
| | - Pauline Van Ngoc
- Department of General Medicine, Faculty of Medicine, Research Unit of Primary Care and Health, University of Liège, Liège, Belgium
| | - Marina Digregorio
- Department of General Medicine, Faculty of Medicine, Research Unit of Primary Care and Health, University of Liège, Liège, Belgium
| | - Simon Delogne
- Department of General Medicine, Faculty of Medicine, Research Unit of Primary Care and Health, University of Liège, Liège, Belgium
| | - Anja Coen
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Nele De Clercq
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Laëtitia Buret
- Department of General Medicine, Faculty of Medicine, Research Unit of Primary Care and Health, University of Liège, Liège, Belgium
| | - Samuel Coenen
- Department of Family Medicine and Population Health (FAMPOP) and Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium
| | - An De Sutter
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Beatrice Scholtes
- Department of General Medicine, Faculty of Medicine, Research Unit of Primary Care and Health, University of Liège, Liège, Belgium
| | - Jan Y. Verbakel
- Department of Public Health and Primary Care, EPI-Centre, ACHG, Leuven, Belgium
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Piet Cools
- Department of Diagnostic Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Stefan Heytens
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| |
Collapse
|
7
|
Declining Prevalence of SARS-CoV-2 Antibodies among Vaccinated Nursing Home Residents and Staff Six Months after the Primary BNT162b2 Vaccination Campaign in Belgium: A Prospective Cohort Study. Viruses 2022; 14:v14112361. [PMID: 36366456 PMCID: PMC9696089 DOI: 10.3390/v14112361] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 10/21/2022] [Accepted: 10/24/2022] [Indexed: 02/01/2023] Open
Abstract
In the SCOPE study, we monitored SARS-CoV-2 antibodies in a national sample of residents and staff from Belgian nursing homes. Here, we report the seroprevalence among infected and infection-naive residents and staff after the primary COVID-19 vaccination campaign. Among 1554 vaccinated nursing home residents and 1082 vaccinated staff from 69 nursing homes in Belgium, we assessed the proportion having SARS-CoV-2 antibodies approximately two (April 2021), four (June 2021), and six months (August 2021) after a two-dose regimen of the BNT162b2 vaccine. We measured the seroprevalence using SARS-CoV-2 antibody rapid tests and collected socio-demographic and COVID-19 medical data using an online questionnaire. Two months after vaccination (baseline), we found a seroprevalence of 91% (95% CI: 89-93) among vaccinated residents and 99% (95% CI: 98-99) among vaccinated staff. Six months after vaccination, the seroprevalence significantly decreased to 68% (95% CI: 64-72) among residents and to 89% (95% CI; 86-91) among staff (p < 0.001). The seroprevalence was more likely to decrease among infection-naive residents, older residents, or residents with a high care dependency level. These findings emphasize the need for close monitoring of nursing home residents, as a substantial part of this population fails to mount a persistent antibody response after BNT162b2 vaccination.
Collapse
|
8
|
Humoral immunity induced by mRNA COVID-19 vaccines in Nursing Home Residents previously infected with SARS-CoV-2. Aging Clin Exp Res 2022; 34:2577-2584. [PMID: 36127623 PMCID: PMC9489481 DOI: 10.1007/s40520-022-02239-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 08/25/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Nursing home (NH) residents suffered the greatest impact of the COVID-19 pandemic. Limited data are available on vaccine-induced immunity and on the protection ensured by a prior infection in this population. AIMS The present study aims to monitor antibody levels and their persistence over a 6-month period in NH residents according to the history of prior SARS-CoV-2 infection. METHODS We measured anti-trimeric Spike IgG antibody levels in a sample of 395 residents from 25 NHs in 6 Italian Regions at study enrolment (prior to the first dose of vaccine, T0) and then after 2 (T1) and 6 months (T2) following the first vaccine dose. All participants received mRNA vaccines (BNT162b2 or mRNA-1273). Analyses were performed using log-transformed values of antibody concentrations and geometric means (GM) were calculated. RESULTS Superior humoral immunity was induced in NH residents with previous SARS-CoV-2 infection. (T0: GM 186.6 vs. 6.1 BAU/ml, p < 0.001; T1: GM 5264.1 vs. 944.4 BAU/ml, p < 0.001; T2: GM 1473.6 vs. 128.7 BAU/ml, p < 0.001). Residents with prior SARS-CoV-2 infection receiving two vaccine doses presented significantly higher antibody concentration at T1 and T2. A longer interval between previous infection and vaccination was associated with a better antibody response over time. DISCUSSION In a frail sample of NH residents, prior SARS-CoV-2 infection was associated with a higher humoral response to vaccination. Number of vaccine doses and the interval between infection and vaccination are relevant parameters in determining humoral immunity. CONCLUSIONS These findings provide important information to plan future immunization policies and disease prevention strategies in a highly vulnerable population.
Collapse
|
9
|
Okyar Baş A, Hafizoğlu M, Akbiyik F, Güner Oytun M, Şahiner Z, Ceylan S, Ünsal P, Doğu BB, Cankurtaran M, Çakir B, Ünal S, Halil MG. Antibody response with SARS-CoV-2 inactivated vaccine (CoronaVac) in Turkish geriatric population. Age Ageing 2022; 51:6564409. [PMID: 35524745 PMCID: PMC9129137 DOI: 10.1093/ageing/afac088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Indexed: 01/07/2023] Open
Abstract
Background Sars-CoV-2 infection influences older individuals at the forefront, and there is still limited data on the COVID-19 vaccine response in the geriatric population. This study aimed to assess antibody response after vaccination with SARS-CoV-2 inactivated vaccine and examine possible factors affecting this response in a geriatric population. Methods individuals who have been on at least the 28th day after the second dose of the COVID-19 vaccine were included. Comprehensive geriatric assessment tools and the Clinical Frailty Scale were performed. SARS-CoV-2 spike-specific IgG antibodies were detected and, levels ≥1 U/ml were defined as seropositive, <1 U/ml were defined as seronegative. Results a total of 497 patients were included and divided into three groups according to the days past after the second dose of the vaccine (Group 1: 28–59 days, Group 2: 60–89 days and Group 3: 90 days and more). Groups included 188, 148 and 171 patients, respectively. Seropositivity rate in each group was 80.9,73.2 and 57.3%, respectively. In Groups 1 and 2, Charlson Comorbidity Index score was higher in the seronegative group (P = 0.023 and P = 0.011, respectively). In Group 3, the prevalence of frailty was significantly higher in the seronegative group (P = 0.002). Conclusion to the best of our knowledge, this is the first study assessing the antibody response after vaccination with Sars-CoV 2 inactivated vaccine in the Turkish geriatric population. Moreover, this is the first study revealing the relationship between antibody response and frailty. Larger studies are needed to confirm the antibody response duration and the association between frailty and COVID-19 vaccine response.
Collapse
Affiliation(s)
- Arzu Okyar Baş
- Department of Internal Medicine, Division of Geriatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Merve Hafizoğlu
- Department of Internal Medicine, Division of Geriatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Filiz Akbiyik
- Ankara City Hospital Laboratory, Siemens Healthineers, Ankara, Turkey
| | - Merve Güner Oytun
- Department of Internal Medicine, Division of Geriatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Zeynep Şahiner
- Department of Internal Medicine, Division of Geriatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Serdar Ceylan
- Department of Internal Medicine, Division of Geriatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Pelin Ünsal
- Department of Internal Medicine, Division of Geriatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Burcu Balam Doğu
- Department of Internal Medicine, Division of Geriatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Mustafa Cankurtaran
- Department of Internal Medicine, Division of Geriatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Banu Çakir
- Department of Public Health, Hacettepe University Faculty of Medicine, Ankara 06230, Turkey
| | - Serhat Ünal
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Meltem Gülhan Halil
- Department of Internal Medicine, Division of Geriatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| |
Collapse
|
10
|
Luong R, Ribeiro RV, Rangan A, Naganathan V, Blyth F, Waite LM, Handelsman DJ, Cumming RG, Le Couteur DG, Hirani V. Changes in dietary total and non-haem iron intake is associated with incident frailty in older men: The Concord Health and Ageing in Men Project. J Gerontol A Biol Sci Med Sci 2022; 77:1853-1865. [PMID: 35352124 PMCID: PMC9434472 DOI: 10.1093/gerona/glac077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Indexed: 11/29/2022] Open
Abstract
Background Nutritional intake could influence the development of frailty. The aim was to evaluate the associations between dietary iron intakes and changes in dietary iron intakes with frailty. Methods Cross-sectional analyses involved 785 men with Fried frailty phenotype (FP) and 758 men with Rockwood frailty index (FI) data aged 75 years and older at nutrition assessment from the Concord Health and Ageing in Men Project prospective cohort study. Of these, 563 men who were FP robust or prefrail, and 432 men who were FI nonfrail were included in the longitudinal analyses for more than 3 years. Dietary intake was assessed at both timepoints using a validated diet history questionnaire. The dietary calculation was used to derive heme iron and nonheme iron intakes from total iron intakes. The associations were evaluated through binary logistic regression. Results Incidence of FP frailty was 15.3% (n = 86). In longitudinal analyses, maintaining total iron intakes (medium tertile −2.61–0.81 mg/d), increases in total iron and nonheme iron intakes (high tertiles ≥0.82 mg/d and ≥0.80 mg/d), and changes in nonheme iron intake (1 mg increment) were associated with reduced risks of incident FP frailty (OR: 0.47 [95% confindence interval (CI): 0.24, 0.93, p = .031], OR 0.48 [95% CI: 0.23, 0.99, p = .048], OR 0.41 [95% CI: 0.20, 0.88, p = .022], and OR 0.89 [95% CI: 0.82, 0.98, p = .017]). Conclusion Maintaining or increases in total dietary iron and increases or changes in dietary nonheme iron intakes more than 3 years were associated with reduced incidence of FP frailty in older men.
Collapse
Affiliation(s)
- Rebecca Luong
- Charles Perkins Centre, The University of Sydney, NSW, Australia.,Nutrition and Dietetics Group, Sydney Nursing School, Faculty of Medicine and Health, The University of Sydney, NSW, Australia.,ARC Centre of Excellence in Population Ageing Research (CEPAR), The University of Sydney, NSW, Australia
| | - Rosilene V Ribeiro
- Charles Perkins Centre, The University of Sydney, NSW, Australia.,School of Life and Environmental Sciences, Faculty of Science, The University of Sydney, NSW, Australia
| | - Anna Rangan
- Charles Perkins Centre, The University of Sydney, NSW, Australia.,Nutrition and Dietetics Group, Sydney Nursing School, Faculty of Medicine and Health, The University of Sydney, NSW, Australia
| | - Vasi Naganathan
- Centre for Education and Research on Ageing, Concord Hospital, The University of Sydney, Concord, NSW, Australia.,Concord Clinical School, Faculty of Medicine and Health, The University of Sydney, Concord, NSW, Australia
| | - Fiona Blyth
- ARC Centre of Excellence in Population Ageing Research (CEPAR), The University of Sydney, NSW, Australia.,School of Public Health, The University of Sydney, NSW, Australia
| | - Louise M Waite
- Centre for Education and Research on Ageing, Concord Hospital, The University of Sydney, Concord, NSW, Australia.,Concord Clinical School, Faculty of Medicine and Health, The University of Sydney, Concord, NSW, Australia
| | - David J Handelsman
- ANZAC Research Institute, The University of Sydney and Concord Hospital, Concord, NSW, Australia
| | - Robert G Cumming
- ARC Centre of Excellence in Population Ageing Research (CEPAR), The University of Sydney, NSW, Australia.,School of Public Health, The University of Sydney, NSW, Australia
| | - David G Le Couteur
- Charles Perkins Centre, The University of Sydney, NSW, Australia.,ANZAC Research Institute, The University of Sydney and Concord Hospital, Concord, NSW, Australia
| | - Vasant Hirani
- Charles Perkins Centre, The University of Sydney, NSW, Australia.,Nutrition and Dietetics Group, Sydney Nursing School, Faculty of Medicine and Health, The University of Sydney, NSW, Australia.,Centre for Education and Research on Ageing, Concord Hospital, The University of Sydney, Concord, NSW, Australia.,ANZAC Research Institute, The University of Sydney and Concord Hospital, Concord, NSW, Australia
| |
Collapse
|
11
|
Affiliation(s)
- Melissa K Andrew
- Department of Medicine (Geriatrics) and Canadian Center for Vaccinology, Dalhousie University, Halifax, B3H 2E1, NS, Canada.
| | | |
Collapse
|
12
|
Sinclair DR, Maharani A, Stow D, Welsh CE, Matthews FE. Can vaccination roll-out be more equitable if population risk is taken into account? PLoS One 2021; 16:e0259990. [PMID: 34780553 PMCID: PMC8592495 DOI: 10.1371/journal.pone.0259990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 10/29/2021] [Indexed: 11/18/2022] Open
Abstract
Background COVID-19 vaccination in many countries, including England, has been prioritised primarily by age. However, people of the same age can have very different health statuses. Frailty is a commonly used metric of health and has been found to be more strongly associated with mortality than age among COVID-19 inpatients. Methods We compared the number of first vaccine doses administered across the 135 NHS Clinical Commissioning Groups (CCGs) of England to both the over 50 population and the estimated frail population in each area. Area-based frailty estimates were generated using the English Longitudinal Survey of Ageing (ELSA), a national survey of older people. We also compared the number of doses to the number of people with other risk factors associated with COVID-19: atrial fibrillation, chronic kidney disease, diabetes, learning disabilities, obesity and smoking status. Results We estimate that after 79 days of the vaccine program, across all Clinical Commissioning Group areas, the number of people who received a first vaccine per frail person ranged from 4.4 (95% CI 4.0-4.8) and 20.1 (95% CI 18.3-21.9). The prevalences of other risk factors were also poorly associated with the prevalence of vaccination across England. Conclusions Vaccination with age-based priority created area-based inequities in the number of doses administered relative to the number of people who are frail or have other risk factors associated with COVID-19. As frailty has previously been found to be more strongly associated with mortality than age for COVID-19 inpatients, an age-based priority system may increase the risk of mortality in some areas during the vaccine roll-out period. Authorities planning COVID-19 vaccination programmes should consider the disadvantages of an age-based priority system.
Collapse
Affiliation(s)
- David R. Sinclair
- Population Health Sciences Institute, Newcastle University, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle upon Tyne, United Kingdom
- * E-mail:
| | - Asri Maharani
- Division of Nursing, Midwifery and Social Work, University of Manchester, Manchester, United Kingdom
| | - Daniel Stow
- Population Health Sciences Institute, Newcastle University, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle upon Tyne, United Kingdom
| | - Claire E. Welsh
- Population Health Sciences Institute, Newcastle University, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle upon Tyne, United Kingdom
| | - Fiona E. Matthews
- Population Health Sciences Institute, Newcastle University, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle upon Tyne, United Kingdom
| |
Collapse
|
13
|
Weinberger B. Vaccination of older adults: Influenza, pneumococcal disease, herpes zoster, COVID-19 and beyond. Immun Ageing 2021; 18:38. [PMID: 34627326 PMCID: PMC8501352 DOI: 10.1186/s12979-021-00249-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 09/21/2021] [Indexed: 12/11/2022]
Abstract
Preserving good health in old age is of utmost importance to alleviate societal, economic and health care-related challenges caused by an aging society. The prevalence and severity of many infectious diseases is higher in older adults, and in addition to the acute disease, long-term sequelae, such as exacerbation of underlying chronic disease, onset of frailty or increased long-term care dependency, are frequent. Prevention of infections e.g. by vaccination is therefore an important measure to ensure healthy aging and preserve quality of life. Several vaccines are specifically recommended for older adults in many countries, and in the current SARS-CoV-2 pandemic older adults were among the first target groups for vaccination due to their high risk for severe disease. This review highlights clinical data on the influenza, Streptococcus pneumoniae and herpes zoster vaccines, summarizes recent developments to improve vaccine efficacy, such as the use of adjuvants or higher antigen dose for influenza, and gives an overview of SARS-CoV-2 vaccine development for older adults. Substantial research is ongoing to further improve vaccines, e.g. by developing universal influenza and pneumococcal vaccines to overcome the limitations of the current strain-specific vaccines, and to develop novel vaccines against pathogens, which cause considerable morbidity and mortality in older adults, but for which no vaccines are currently available. In addition, we need to improve uptake of the existing vaccines and increase awareness for life-long vaccination in order to provide optimal protection for the vulnerable older age group.
Collapse
Affiliation(s)
- Birgit Weinberger
- Institute for Biomedical Aging Research, Universität Innsbruck, Rennweg 10, 6020, Innsbruck, Austria.
| |
Collapse
|
14
|
Vetrano DL, Triolo F, Maggi S, Malley R, Jackson TA, Poscia A, Bernabei R, Ferrucci L, Fratiglioni L. Fostering healthy aging: The interdependency of infections, immunity and frailty. Ageing Res Rev 2021; 69:101351. [PMID: 33971332 PMCID: PMC9588151 DOI: 10.1016/j.arr.2021.101351] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 04/16/2021] [Accepted: 05/03/2021] [Indexed: 12/20/2022]
Abstract
Untangling the interdependency of infections, immunity and frailty may help to clarify their roles in the maintenance of health in aging individuals, and the recent COVID-19 pandemic has further highlighted such priority. In this scoping review we aimed to systematically collect the evidence on 1) the impact of common infections such as influenza, pneumonia and varicella zoster on frailty development, and 2) the role played by frailty in the response to immunization of older adults. Findings are discussed under a unifying framework to identify knowledge gaps and outline their clinical and public health implications to foster a healthier aging. Twenty-nine studies (113,863 participants) selected to answer the first question provided a moderately strong evidence of an association between infections and physical as well as cognitive decline - two essential dimensions of frailty. Thirteen studies (34,520 participants) investigating the second aim, showed that frailty was associated with an impaired immune response in older ages, likely due to immunosenescence. However, the paucity of studies, the absence of tools to predict vaccine efficacy, and the lack of studies investigating the efficacy of newer vaccines in presence of frailty, strongly limit the formulation of more personalized immunization strategies for older adults. The current evidence suggests that infections and frailty repeatedly cross each other pathophysiological paths and accelerate the aging process in a vicious circle. Such evidence opens to several considerations. First, the prevention of both conditions pass through a life course approach, which includes several individual and societal aspects. Second, the maintenance of a well-functioning immune system may be accomplished by preventing frailty, and vice versa. Third, increasing the adherence to immunization may delay the onset of frailty and maintain the immune system homeostasis, beyond preventing infections.
Collapse
Affiliation(s)
- Davide L Vetrano
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Centro Medicina dell'Invecchiamento, Fondazione Policlinico "A- Gemelli" IRCCS and Catholic University of Rome, Italy.
| | - Federico Triolo
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Stefania Maggi
- National Research Council, Neuroscience Institute, Padua, Italy
| | - Richard Malley
- Division of Infectious Diseases, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Thomas A Jackson
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK; Department of Geriatrics, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | - Roberto Bernabei
- Centro Medicina dell'Invecchiamento, Fondazione Policlinico "A- Gemelli" IRCCS and Catholic University of Rome, Italy
| | - Luigi Ferrucci
- Longitudinal Studies Section, Translational Gerontology Branch, National Institute on Aging, National Institutes of Health, Baltimore, USA
| | - Laura Fratiglioni
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Stockholm Gerontology Research Center, Stockholm, Sweden
| |
Collapse
|
15
|
Nguyen TN, Harris K, Woodward M, Chalmers J, Cooper M, Hamet P, Harrap S, Heller S, MacMahon S, Mancia G, Marre M, Poulter N, Rogers A, Williams B, Zoungas S, Chow CK, Lindley RI. The Impact of Frailty on the Effectiveness and Safety of Intensive Glucose Control and Blood Pressure-Lowering Therapy for People With Type 2 Diabetes: Results From the ADVANCE Trial. Diabetes Care 2021; 44:1622-1629. [PMID: 34035077 PMCID: PMC8323181 DOI: 10.2337/dc20-2664] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 04/23/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To develop a frailty index (FI) and explore the relationship of frailty to subsequent adverse outcomes on the effectiveness and safety of more intensive control of both blood glucose and blood pressure (BP), among participants with type 2 diabetes in the Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation (ADVANCE) trial. RESEARCH DESIGN AND METHODS Cox proportional hazard models were used to estimate the effectiveness and safety of intensive glucose control and BP intervention according to frailty (defined as FI >0.21) status. The primary outcomes were macro- and microvascular events. The secondary outcomes were all-cause mortality, cardiovascular mortality, severe hypoglycemia, and discontinuation of BP treatment due to hypotension/dizziness. RESULTS There were 11,140 participants (mean age, 65.8 years; 42.5% women, 25.7% frail). Frailty was an independent predictor of all primary outcomes and secondary outcomes. The effect of intensive glucose treatment on primary outcomes showed some evidence of attenuation in the frail: hazard ratios for combined major macro- and microvascular events 1.03 (95% CI 0.90-1.19) in the frail versus 0.84 (95% CI 0.74-0.94) in the nonfrail (P = 0.02). A similar trend was observed with BP intervention. Severe hypoglycemia rates (per 1,000 person-years) were higher in the frail: 8.39 (6.15-10.63) vs. 4.80 (3.84-5.76) in nonfrail (P < 0.001). There was no significant difference in discontinuation of BP treatment between frailty groups. CONCLUSIONS It was possible to retrospectively estimate frailty in a trial population, and this FI identified those at higher risk of poor outcomes. Participants with frailty had some attenuation of benefit from intensive glucose-lowering and BP-lowering treatments.
Collapse
Affiliation(s)
- Tu N Nguyen
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Katie Harris
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Mark Woodward
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia.,The George Institute for Global Health, Department of Epidemiology and Biostatistics, Imperial College, London, U.K.,Department of Epidemiology, Johns Hopkins University, Baltimore, MD
| | - John Chalmers
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Mark Cooper
- Department of Diabetes, Monash University, Melbourne, Victoria, Australia
| | - Pavel Hamet
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Stephen Harrap
- Department of Physiology, Royal Melbourne Hospital, University of Melbourne, Victoria, Australia
| | - Simon Heller
- Academic Unit of Diabetes, Oncology & Metabolism, University of Sheffield, Sheffield, U.K
| | - Stephen MacMahon
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia.,The George Institute for Global Health, Department of Epidemiology and Biostatistics, Imperial College, London, U.K
| | - Giuseppe Mancia
- Istituto Auxologico Italiano, University of Milan-Bicocca, Milan, Italy
| | - Michel Marre
- Department of Endocrinology, Hôpital Bichat-Claude Bernard, University of Paris, Paris, France
| | - Neil Poulter
- Imperial Clinical Trials Unit, Imperial College London, London, U.K
| | - Anthony Rogers
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Bryan Williams
- National Institute for Health Research, University College London, Hospitals Biomedical Research Centre, London, U.K
| | - Sophia Zoungas
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Clara K Chow
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.,Department of Cardiology, Westmead Hospital, Sydney, New South Wales, Australia.,The George Institute for Global Health, Sydney, New South Wales, Australia
| | - Richard I Lindley
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia .,The George Institute for Global Health, Sydney, New South Wales, Australia
| |
Collapse
|
16
|
Walkowski W, Bassett J, Bhalla M, Pfeifer BA, Ghanem ENB. Intranasal Vaccine Delivery Technology for Respiratory Tract Disease Application with a Special Emphasis on Pneumococcal Disease. Vaccines (Basel) 2021; 9:vaccines9060589. [PMID: 34199398 PMCID: PMC8230341 DOI: 10.3390/vaccines9060589] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 05/17/2021] [Accepted: 05/22/2021] [Indexed: 12/17/2022] Open
Abstract
This mini-review will cover recent trends in intranasal (IN) vaccine delivery as it relates to applications for respiratory tract diseases. The logic and rationale for IN vaccine delivery will be compared to methods and applications accompanying this particular administration route. In addition, we will focus extended discussion on the potential role of IN vaccination in the context of respiratory tract diseases, with a special emphasis on pneumococcal disease. Here, elements of this disease, including its prevalence and impact upon the elderly population, will be viewed from the standpoint of improving health outcomes through vaccine design and delivery technology and how IN administration can play a role in such efforts.
Collapse
Affiliation(s)
- William Walkowski
- Department of Chemical and Biological Engineering, University at Buffalo, The State University of New York, Buffalo, NY 14260, USA; (W.W.); (J.B.); (B.A.P.)
| | - Justin Bassett
- Department of Chemical and Biological Engineering, University at Buffalo, The State University of New York, Buffalo, NY 14260, USA; (W.W.); (J.B.); (B.A.P.)
| | - Manmeet Bhalla
- Department of Microbiology and Immunology, University at Buffalo, The State University of New York, Buffalo, NY 14203, USA;
| | - Blaine A. Pfeifer
- Department of Chemical and Biological Engineering, University at Buffalo, The State University of New York, Buffalo, NY 14260, USA; (W.W.); (J.B.); (B.A.P.)
| | - Elsa N. Bou Ghanem
- Department of Microbiology and Immunology, University at Buffalo, The State University of New York, Buffalo, NY 14203, USA;
- Correspondence:
| |
Collapse
|
17
|
Older but Not Wiser: the Age-Driven Changes in Neutrophil Responses during Pulmonary Infections. Infect Immun 2021; 89:IAI.00653-20. [PMID: 33495271 DOI: 10.1128/iai.00653-20] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Elderly individuals are at increased risk of life-threatening pulmonary infections. Neutrophils are a key determinant of the disease course of pathogen-induced pneumonia. Optimal host defense balances initial robust pulmonary neutrophil responses to control pathogen numbers, ultimately followed by the resolution of inflammation to prevent pulmonary damage. Recent evidence suggests that phenotypic and functional heterogeneity in neutrophils impacts host resistance to pulmonary pathogens. Apart from their apparent role in innate immunity, neutrophils also orchestrate subsequent adaptive immune responses during infection. Thus, the outcome of pulmonary infections can be shaped by neutrophils. This review summarizes the age-driven impairment of neutrophil responses and the contribution of these cells to the susceptibility of the elderly to pneumonia. We describe how aging is accompanied by changes in neutrophil recruitment, resolution, and function. We discuss how systemic and local changes alter the neutrophil phenotype in aged hosts. We highlight the gap in knowledge of whether these changes in neutrophils also contribute to the decline in adaptive immunity seen with age. We further detail the factors that drive dysregulated neutrophil responses in the elderly and the pathways that may be targeted to rebalance neutrophil activity and boost host resistance to pulmonary infections.
Collapse
|
18
|
Koval L, Zemskaya N, Aliper A, Zhavoronkov A, Moskalev A. Evaluation of the geroprotective effects of withaferin A in Drosophila melanogaster. Aging (Albany NY) 2021; 13:1817-1841. [PMID: 33498013 PMCID: PMC7880378 DOI: 10.18632/aging.202572] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 01/04/2021] [Indexed: 01/15/2023]
Abstract
Withanolides are a class of compounds usually found in plant extracts which are an attractive geroprotective drug design starting point. We evaluated the geroprotective properties of Withaferin A (WA) in vivo using the Drosophila model. Flies were supplemented by nutrient medium with WA (at a concentration of 1, 10, or 100 μM dissolved in ethanol) for the experiment group and 30 μM of ethanol for the control group. WA treatment at 10 and 100 μM concentrations prolong the median life span of D. melanogaster's male by 7.7, 9.6% (respectively) and the maximum life span (the age of death 90% of individuals) by 11.1% both. Also WA treatment at 1, 10 and 100 μM improved the intestinal barrier permeability in older flies and affected an expression of genes involved in antioxidant defense (PrxV), recognition of DNA damage (Gadd45), heat shock proteins (Hsp68, Hsp83), and repair of double-strand breaks (Ku80). WA was also shown to have a multidirectional effect on the resistance of flies to the prooxidant paraquat (oxidative stress) and 33° C hyperthermia (heat shock). WA treatment increased the resistance to oxidative stress in males at 4 and 7 week old and decreased it at 6 weeks old. It increased the male's resistance to hyperthermia at 2, 4 and 7 weeks old and decreased it at 3, 5 and 8 weeks old. WA treatment decreased the resistance to hyperthermia in females at 1, 2 and 3 weeks old and not affected on their resistance to oxidative stress.
Collapse
Affiliation(s)
- Liubov Koval
- Institute of Biology, Komi Science Centre, the Ural Branch of the Russian Academy of Sciences, Syktyvkar, Komi Republic, Russia
| | - Nadezhda Zemskaya
- Institute of Biology, Komi Science Centre, the Ural Branch of the Russian Academy of Sciences, Syktyvkar, Komi Republic, Russia
| | - Alexander Aliper
- Deep Longevity Ltd, Hong Kong Science and Technology Park, Hong Kong, China
| | - Alex Zhavoronkov
- Deep Longevity Ltd, Hong Kong Science and Technology Park, Hong Kong, China
| | - Alexey Moskalev
- Institute of Biology, Komi Science Centre, the Ural Branch of the Russian Academy of Sciences, Syktyvkar, Komi Republic, Russia
| |
Collapse
|
19
|
Bhalla M, Nayerhoda R, Tchalla EYI, Abamonte A, Park D, Simmons SR, Pfeifer BA, Bou Ghanem EN. Liposomal Encapsulation of Polysaccharides (LEPS) as an Effective Vaccine Strategy to Protect Aged Hosts Against S. pneumoniae Infection. FRONTIERS IN AGING 2021; 2. [PMID: 35291600 PMCID: PMC8920316 DOI: 10.3389/fragi.2021.798868] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Despite the availability of licensed vaccines, pneumococcal disease caused by the bacteria Streptococcus pneumoniae (pneumococcus), remains a serious infectious disease threat globally. Disease manifestations include pneumonia, bacteremia, and meningitis, resulting in over a million deaths annually. Pneumococcal disease disproportionally impacts older adults aged ≥65 years. Interventions are complicated through a combination of complex disease progression and 100 different bacterial capsular polysaccharide serotypes. This has made it challenging to develop a broad vaccine against S. pneumoniae, with current options utilizing capsular polysaccharides as the primary antigenic content. However, current vaccines are substantially less effective in protecting the elderly. We previously developed a Liposomal Encapsulation of Polysaccharides (LEPS) vaccine platform, designed around limitations of current pneumococcal vaccines, that allowed the noncovalent coupling of polysaccharide and protein antigen content and protected young hosts against pneumococcal infection in murine models. In this study, we modified the formulation to make it more economical and tested the novel LEPS vaccine in aged hosts. We found that in young mice (2-3 months), LEPS elicited comparable responses to the pneumococcal conjugate vaccine Prevnar-13. Further, LEPS immunization of old mice (18-22 months) induced comparable antibody levels and improved antibody function compared to Prevnar-13. Importantly, LEPS protected old mice against both invasive and lung localized pneumococcal infections. In summary, LEPS is an alternative and effective vaccine strategy that protects aged hosts against different manifestations of pneumococcal disease.
Collapse
Affiliation(s)
- Manmeet Bhalla
- Department of Microbiology and Immunology, University at Buffalo, The State University of New York, Buffalo, NY, United States
| | - Roozbeh Nayerhoda
- Department of Biomedical Engineering, University at Buffalo, The State University of New York, Buffalo, NY, United States
| | - Essi Y I Tchalla
- Department of Microbiology and Immunology, University at Buffalo, The State University of New York, Buffalo, NY, United States
| | - Alexsandra Abamonte
- Department of Microbiology and Immunology, University at Buffalo, The State University of New York, Buffalo, NY, United States
| | - Dongwon Park
- Department of Chemical and Biological Engineering, University at Buffalo, The State University of New York, Buffalo, NY, United States
| | - Shaunna R Simmons
- Department of Microbiology and Immunology, University at Buffalo, The State University of New York, Buffalo, NY, United States
| | - Blaine A Pfeifer
- Department of Chemical and Biological Engineering, University at Buffalo, The State University of New York, Buffalo, NY, United States.,Gene and Tissue Engineering Center, University at Buffalo, The State University of New York, Buffalo, NY, United States
| | - Elsa N Bou Ghanem
- Department of Microbiology and Immunology, University at Buffalo, The State University of New York, Buffalo, NY, United States
| |
Collapse
|
20
|
Curran D, Kim JH, Matthews S, Dessart C, Levin MJ, Oostvogels L, Riley ME, Schmader KE, Cunningham AL, McNeil SA, Schuind AE, Andrew MK. Recombinant Zoster Vaccine Is Efficacious and Safe in Frail Individuals. J Am Geriatr Soc 2020; 69:744-752. [PMID: 33197294 PMCID: PMC7984267 DOI: 10.1111/jgs.16917] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 10/05/2020] [Accepted: 10/07/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND/OBJECTIVES Frail participants are often under-represented in randomized trials, raising questions about outcomes of interventions in real-world settings. Frailty is strongly associated with vulnerability to illness and adverse health outcomes. We studied the impact of frailty on recombinant zoster vaccine (RZV) clinical outcomes. DESIGN/SETTING Data from two previously conducted phase III randomized trials of RZV were pooled. These two parent trials were conducted concurrently at the same study sites using the same methods. PARTICIPANTS/INTERVENTION In the two parent studies, participants aged ≥50 years (ZOE-50 study) and ≥70 years (ZOE-70 study), respectively, were randomized 1:1 to receive two doses of RZV or placebo. MEASUREMENTS In the current ZOE-Frailty study (NCT03563183), a frailty index was created using previously validated methods. Clinical outcomes assessed by frailty status included vaccine efficacy, immunogenicity, reactogenicity, and safety. RESULTS Of 29,305 participants from the pooled ZOE-50 and ZOE-70 total vaccinated cohort, 92% were included in this study. Mean age was 68.8 years; 58.1% were women; 45.6% were pre-frail and 11.3% frail. The percentage of frail participants increased with age from 5.7% aged 50-59 years to 22.7% aged ≥80 years. RZV vaccine efficacy against herpes zoster was >90% for all frailty subgroups (non-frail: 95.8% (95% confidence interval = 91.6-98.2), pre-frail: 90.4% (84.4-94.4), frail: 90.2% (75.4-97.0)). The RZV group demonstrated robust anti-gE antibody and gE-specific CD42+ responses, with mean concentrations remaining above pre-vaccination levels at least 3 years post-dose two, in all frailty subgroups. In the RZV group, the percentage of participants reporting solicited adverse events tended to decrease with increasing frailty. CONCLUSION The relatively nonrestrictive inclusion/exclusion criteria in the parent ZOE studies resulted in a range of participants that included frail and pre-frail older adults. RZV significantly reduced the risk of herpes zoster across all frailty subgroups.
Collapse
Affiliation(s)
| | | | | | | | - Myron J Levin
- Departments of Pediatrics and Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | | | | | - Kenneth E Schmader
- Division of Geriatrics, Duke University Medical Center and GRECC, Durham Veterans Affairs Medical Center, Durham, North Carolina, USA
| | - Anthony L Cunningham
- The Westmead Institute for Medical Research, Westmead, University of Sydney, Sydney, Australia
| | - Shelly A McNeil
- Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, Halifax, Canada
| | | | - Melissa K Andrew
- Division of Geriatric Medicine, Department of Medicine, Dalhousie University, Halifax, Canada
| | | |
Collapse
|
21
|
Reich J, Thompson MG, Cowling BJ, Iuliano AD, Greene C, Chen Y, Phadnis R, Leung NHL, Song Y, Fang VJ, Xu C, Dai Q, Zhang J, Zhang H, Havers F. Comparison of alternative full and brief versions of functional status scales among older adults in China. PLoS One 2020; 15:e0234698. [PMID: 32780744 PMCID: PMC7418957 DOI: 10.1371/journal.pone.0234698] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 06/01/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Brief assessments of functional status for community-dwelling older adults are needed given expanded interest in the measurement of functional decline. METHODS As part of a 2015 prospective cohort study of older adults aged 60-89 years in Jiangsu Province, China, 1506 participants were randomly assigned to two groups; each group was administered one of two alternative 20-item versions of a scale to assess activities of daily living (ADL) and instrumental activities of daily living (IADL) drawn from multiple commonly-used scales. One version asked if they required help to perform activities (ADL-IADL-HELP-20), while the other version provided additional response options if activities could be done alone but with difficulty (ADL-IADL-DIFFICULTY-20). Item responses to both versions were compared using the binomial test for differences in proportion (with Wald 95% confidence interval [CI]). A brief 9-item scale (ADL-IADL-DIFFICULTY-9) was developed favoring items identified as difficult or requiring help by ≥4%, with low redundancy and/or residual correlations, and with significant correlations with age and other health indicators. We repeated assessment of the measurement properties of the brief scale in two subsequent samples of older adults in Hong Kong in 2016 (aged 70-79 years; n = 404) and 2017 (aged 65-82 years; n = 1854). RESULTS Asking if an activity can be done alone but with difficulty increased the proportion of participants reporting restriction on 9 of 20 items, for which 95% CI for difference scores did not overlap with zero; the proportion with at least one limitation increased from 28.6% to 34.2% or an absolute increase of 5.6% (95% CI = 0.9-10.3%), which was a relative increase of 19.6%. The brief ADL-IADL-DIFFICULTY-9 maintained excellent internal consistency (α = 0.93) and had similar ceiling effect (68.1%), invariant item ordering (H trans = .41; medium), and correlations with age and other health measures compared with the 20-item version. The brief scale performed similarly when subsequently administered to older adults in Hong Kong. CONCLUSIONS Asking if tasks can be done alone but with difficulty can modestly reduce ceiling effects. It's possible that the length of commonly-used scales can be reduced by over half if researchers are primarily interested in a summed indicator rather than an inventory of specific types of deficits.
Collapse
Affiliation(s)
- Jeremy Reich
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Mark G. Thompson
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Benjamin J. Cowling
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - A. Danielle Iuliano
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Carolyn Greene
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Yuyun Chen
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Rachael Phadnis
- Abt Associates, Cambridge, Massachusetts, United States of America
| | - Nancy H. L. Leung
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Ying Song
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Vicky J. Fang
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Cuiling Xu
- Chinese National Influenza Center, National Institute for Viral Disease Control and Prevention, Collaboration Innovation Center for Diagnosis and Treatment of Infectious Diseases, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Qigang Dai
- Department of Acute Infectious Disease Control and Prevention, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Jun Zhang
- Suzhou Center for Disease Prevention and Control, Suzhou, China
| | - Hongjun Zhang
- Yancheng Center for Disease Prevention and Control, Yancheng, China
| | - Fiona Havers
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | | |
Collapse
|
22
|
Wagner A, Weinberger B. Vaccines to Prevent Infectious Diseases in the Older Population: Immunological Challenges and Future Perspectives. Front Immunol 2020; 11:717. [PMID: 32391017 PMCID: PMC7190794 DOI: 10.3389/fimmu.2020.00717] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 03/30/2020] [Indexed: 12/15/2022] Open
Abstract
Infectious diseases are a major cause for morbidity and mortality in the older population. Demographic changes will lead to increasing numbers of older persons over the next decades. Prevention of infections becomes increasingly important to ensure healthy aging for the individual, and to alleviate the socio-economic burden for societies. Undoubtedly, vaccines are the most efficient health care measure to prevent infections. Age-associated changes of the immune system are responsible for decreased immunogenicity and clinical efficacy of most currently used vaccines in older age. Efficacy of standard influenza vaccines is only 30-50% in the older population. Several approaches, such as higher antigen dose, use of MF59 as adjuvant and intradermal administration have been implemented in order to specifically target the aged immune system. The use of a 23-valent polysaccharide vaccine against Streptococcus pneumoniae has been amended by a 13-valent conjugated pneumococcal vaccine originally developed for young children several years ago to overcome at least some of the limitations of the T cell-independent polysaccharide antigens, but still is only approximately 50% protective against pneumonia. A live-attenuated vaccine against herpes zoster, which has been available for several years, demonstrated efficacy of 51% against herpes zoster and 67% against post-herpetic neuralgia. Protection was lower in the very old and decreased several years after vaccination. Recently, a recombinant vaccine containing the viral glycoprotein gE and the novel adjuvant AS01B has been licensed. Phase III studies demonstrated efficacy against herpes zoster of approx. 90% even in the oldest age groups after administration of two doses and many countries now recommend the preferential use of this vaccine. There are still many infectious diseases causing substantial morbidity in the older population, for which no vaccines are available so far. Extensive research is ongoing to develop vaccines against novel targets with several vaccine candidates already being clinically tested, which have the potential to substantially reduce health care costs and to save many lives. In addition to the development of novel and improved vaccines, which specifically target the aged immune system, it is also important to improve uptake of the existing vaccines in order to protect the vulnerable, older population.
Collapse
Affiliation(s)
- Angelika Wagner
- Department of Pathophysiology, Infectiology, and Immunology, Institute of Specific Prophylaxis and Tropical Medicine, Medical University of Vienna, Vienna, Austria
| | - Birgit Weinberger
- Institute for Biomedical Aging Research, Universität Innsbruck, Innsbruck, Austria
| |
Collapse
|
23
|
Hsu B, Hirani V, Cumming RG, Naganathan V, Blyth FM, Wright FC, Waite LM, Seibel MJ, Handelsman DJ, Le Couteur DG. Cross-Sectional and Longitudinal Relationships Between Inflammatory Biomarkers and Frailty in Community-dwelling Older Men: The Concord Health and Ageing in Men Project. J Gerontol A Biol Sci Med Sci 2020; 74:835-841. [PMID: 28977375 DOI: 10.1093/gerona/glx142] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 07/17/2017] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Previous studies demonstrated associations between IL-6 and frailty, but associations between a wide range of cytokines, chemokines, and growth factors with prevalent and incident frailty has not been studied. METHODS Community-dwelling men aged more than 75 enrolled in the 5-year and 8-year follow-up of the CHAMP study were assessed. Twenty-seven inflammatory biomarkers were measured using the Bio-Plex Pro Human Cytokine 27-plex Assay kit at 5-year follow-up. Frailty was determined using the Fried frailty phenotype (FP) and Rockwood frailty index (FI) at both time-points. Age, body mass index, smoking, alcohol, and comorbidity were also assessed. RESULTS In cross-sectional analysis of the 5-year follow-up, the unadjusted odds ratio (OR) for frail versus robust evaluated by the FP showed significant associations for IL-6 (OR: 1.56, 95% confidence interval [CI]: 1.23-1.98) and IL-8 (OR: 1.28, 95% CI: 1.00-1.63). IL-6 remained significantly associated in the age-adjusted (OR: 1.58, 95% CI: 1.21-2.05) and multivariable-adjusted model (OR: 1.54, 95% CI: 1.16-2.05). No associations were observed between pre-frail versus robust. In longitudinal unadjusted analysis, IL-8 (OR: 1.32, 95% CI: 1.03-1.70) and IP-10 (OR: 1.32, 95% CI: 1.03-1.70) at 5-year predicted incident frailty at 8-year follow-up. IL-8 remained longitudinally associated with incident frailty after age (OR: 1.34, 95% CI: 1.03-1.75) but not multivariable (OR: 1.20, 95% CI: 0.98-1.70) adjustment. Similar results were seen using the FI. None of the other biomarkers had significant associations with incident frailty. CONCLUSIONS Our findings suggest that IL-6 and IL-8 may be cross-sectionally associated with frailty and that all measured inflammatory biomarkers were not causally related to frailty. Together with previous studies, the results suggest that frailty is specifically linked to IL-6 and IL-8 rather than simply representing a nonspecific pan-inflammatory condition.
Collapse
Affiliation(s)
- Benjumin Hsu
- ANZAC Research Institute, University of Sydney and Concord Hospital, New South Wales, Australia.,Centre of Education and Research on Ageing, University of Sydney and Concord Hospital, New South Wales, Australia.,ARC Centre of Excellence in Population Ageing Research, University of Sydney, New South Wales, Australia
| | - Vasant Hirani
- Centre of Education and Research on Ageing, University of Sydney and Concord Hospital, New South Wales, Australia.,ARC Centre of Excellence in Population Ageing Research, University of Sydney, New South Wales, Australia.,Charles Perkins Centre, University of Sydney, New South Wales, Australia
| | - Robert G Cumming
- ANZAC Research Institute, University of Sydney and Concord Hospital, New South Wales, Australia.,Centre of Education and Research on Ageing, University of Sydney and Concord Hospital, New South Wales, Australia.,ARC Centre of Excellence in Population Ageing Research, University of Sydney, New South Wales, Australia.,School of Public Health, University of Sydney, New South Wales, Australia
| | - Vasi Naganathan
- Centre of Education and Research on Ageing, University of Sydney and Concord Hospital, New South Wales, Australia
| | - Fiona M Blyth
- Centre of Education and Research on Ageing, University of Sydney and Concord Hospital, New South Wales, Australia
| | - Fredrick C Wright
- Centre of Education and Research on Ageing, University of Sydney and Concord Hospital, New South Wales, Australia
| | - Louise M Waite
- Centre of Education and Research on Ageing, University of Sydney and Concord Hospital, New South Wales, Australia
| | - Markus J Seibel
- ANZAC Research Institute, University of Sydney and Concord Hospital, New South Wales, Australia
| | - David J Handelsman
- ANZAC Research Institute, University of Sydney and Concord Hospital, New South Wales, Australia
| | - David G Le Couteur
- ANZAC Research Institute, University of Sydney and Concord Hospital, New South Wales, Australia.,Centre of Education and Research on Ageing, University of Sydney and Concord Hospital, New South Wales, Australia.,Charles Perkins Centre, University of Sydney, New South Wales, Australia
| |
Collapse
|
24
|
Hsu B, Naganathan V, Blyth FM, Hirani V, Le Couteur DG, Waite LM, Seibel MJ, Handelsman DJ, Cumming RG. Frailty and Cause-Specific Hospitalizations in Community-Dwelling Older Men. J Nutr Health Aging 2020; 24:563-569. [PMID: 32510107 DOI: 10.1007/s12603-020-1352-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The types of medical conditions leading to hospitalization in frail older people have not been investigated. The objectives were to evaluate associations between frailty and (a) risk of all-cause and cause-specific hospitalization, and (b) rate of all-cause and cause-specific hospitalizations. DESIGN, SETTING AND PARTICIPANTS Community-dwelling men aged 70+ years in the Concord Health and Ageing in Men Project (CHAMP) were assessed for frailty at baseline (2005-2007, n=1705). MEASUREMENTS Frailty was determined by both the Fried frailty phenotype (FP) and the Rockwood frailty index (FI). Non-elective and elective hospitalization data were accessed from the New South Wales (NSW) Admitted Patient Data Collection and mortality from the NSW Deaths Registry for the period 2005-2017. Causes of hospitalization were categorized using ICD-10 classification of principal diagnoses based on organ system involved into 14 major categories. RESULTS Nearly 80% of CHAMP men had at least one non-elective hospitalization and 63% had an elective hospitalization over a 9-year follow-up. Men with FP frailty were twice as likely to have a non-elective hospitalization (HR: 1.98, 95%CI: 1.61-2.44) and a greater number of non-elective hospitalizations (IRR: 1.44, 95%CI: 1.22-1.70). Similar relationships were found between FI frailty and non-elective hospitalizations. Men with frailty (either FP or FI) were more likely to have at least one non-elective hospitalization for 13 of the 14 cause-related admissions. In contrast, frailty was only associated with 3 cause-related elective hospitalizations. Men with frailty were also more likely to have an increased number of non-elective hospitalizations for all 14 causes, but only for 6 causes of elective hospitalizations. CONCLUSIONS Our findings suggest frailty increases the risk and number of non-elective hospitalizations in older men for a wide range of cause. Strategies on early identification of frailty, followed by appropriate preventative strategies to lower the risk of non-elective hospital admissions are warranted.
Collapse
Affiliation(s)
- B Hsu
- Benjumin Hsu, Centre for Big Data Research in Health, UNSW Sydney, New South Wales, Australia 2052. E-mail:
| | | | | | | | | | | | | | | | | |
Collapse
|
25
|
Nguyen TV, Le D, Tran KD, Bui KX, Nguyen TN. Frailty in Older Patients with Acute Coronary Syndrome in Vietnam. Clin Interv Aging 2019; 14:2213-2222. [PMID: 31908432 PMCID: PMC6925543 DOI: 10.2147/cia.s234597] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 11/27/2019] [Indexed: 12/26/2022] Open
Abstract
Background There has been limited evidence about frailty in older patients with acute coronary syndrome (ACS) in Vietnam. Aim (1) To investigate the prevalence of frailty in older patients hospitalised with ACS and its associated factors; (2) To investigate the impact of frailty on percutaneous coronary intervention (PCI) and adverse outcomes in this population. Methods Patients aged ≥60 with ACS admitted to two teaching hospitals in Vietnam were recruited from 9/2017 to 4/2018. Frailty was defined by the Reported Edmonton Frail Scale. Multivariate logistic regression was applied to investigate the associated factors of frailty and the impact of frailty on PCI and adverse outcomes. Results There were 324 participants, mean age 73.5±8.3, 39.2% female. The prevalence of frailty was 48.1%. Advanced age, female gender, history of hypertension, heart failure, stroke and chronic kidney disease were significantly associated with a frailty status. Overall, 50.3% of the participants received PCI (58.3% in the non-frail vs 41.7% in the frail, p=0.003). However, frailty did not have an independent impact on PCI (adjusted OR 0.66, 95% CI 0.41–1.08). Frailty was significantly associated with increased risk of having arrhythmia during hospitalisation (adjusted OR 2.24, 95% CI 1.32–3.80), hospital-acquired pneumonia (adjusted OR 2.27, 95% CI 1.24–4.17), in-hospital mortality (adjusted OR 3.02, 95% CI 1.35–6.75), 30-day mortality (adjusted OR 3.28, 95% CI 1.59–6.76), and 30-day readmission (adjusted OR 2.53, 95% CI 1.38–4.63). Conclusion In this study, frailty was present in nearly half of older patients with ACS and was associated with increased adverse outcomes. These findings suggest that frailty screening should be performed in older patients with ACS in Vietnam.
Collapse
Affiliation(s)
- Tan Van Nguyen
- Department of Geriatrics & Gerontology, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam.,Department of Interventional Cardiology, Thong Nhat Hospital, Ho Chi Minh City, Vietnam
| | - Duong Le
- Department of Geriatrics & Gerontology, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam.,Department of Interventional Cardiology, Thong Nhat Hospital, Ho Chi Minh City, Vietnam
| | - Khuong Dang Tran
- Department of Geriatrics & Gerontology, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
| | - Khai Xuan Bui
- Department of Geriatrics & Gerontology, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
| | - Tu Ngoc Nguyen
- Westmead Applied Research Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| |
Collapse
|
26
|
Grudzinska FS, Brodlie M, Scholefield BR, Jackson T, Scott A, Thickett DR, Sapey E. Neutrophils in community-acquired pneumonia: parallels in dysfunction at the extremes of age. Thorax 2019; 75:164-171. [PMID: 31732687 PMCID: PMC7029227 DOI: 10.1136/thoraxjnl-2018-212826] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Revised: 09/16/2019] [Accepted: 09/25/2019] [Indexed: 12/15/2022]
Abstract
"Science means constantly walking a tight rope" Heinrich Rohrer, physicist, 1933. Community-acquired pneumonia (CAP) is the leading cause of death from infectious disease worldwide and disproportionately affects older adults and children. In high-income countries, pneumonia is one of the most common reasons for hospitalisation and (when recurrent) is associated with a risk of developing chronic pulmonary conditions in adulthood. Pneumococcal pneumonia is particularly prevalent in older adults, and here, pneumonia is still associated with significant mortality despite the widespread use of pneumococcal vaccination in middleand high-income countries and a low prevalence of resistant organisms. In older adults, 11% of pneumonia survivors are readmitted within months of discharge, often with a further pneumonia episode and with worse outcomes. In children, recurrent pneumonia occurs in approximately 10% of survivors and therefore is a significant cause of healthcare use. Current antibiotic trials focus on short-term outcomes and increasingly shorter courses of antibiotic therapy. However, the high requirement for further treatment for recurrent pneumonia questions the effectiveness of current strategies, and there is increasing global concern about our reliance on antibiotics to treat infections. Novel therapeutic targets and approaches are needed to improve outcomes. Neutrophils are the most abundant immune cell and among the first responders to infection. Appropriate neutrophil responses are crucial to host defence, as evidenced by the poor outcomes seen in neutropenia. Neutrophils from older adults appear to be dysfunctional, displaying a reduced ability to target infected or inflamed tissue, poor phagocytic responses and a reduced capacity to release neutrophil extracellular traps (NETs); this occurs in health, but responses are further diminished during infection and particularly during sepsis, where a reduced response to granulocyte colony-stimulating factor (G-CSF) inhibits the release of immature neutrophils from the bone marrow. Of note, neutrophil responses are similar in preterm infants. Here, the storage pool is decreased, neutrophils are less able to degranulate, have a reduced migratory capacity and are less able to release NETs. Less is known about neutrophil function from older children, but theoretically, impaired functions might increase susceptibility to infections. Targeting these blunted responses may offer a new paradigm for treating CAP, but modifying neutrophil behaviour is challenging; reducing their numbers or inhibiting their function is associated with poor clinical outcomes from infection. Uncontrolled activation and degranulation can cause significant host tissue damage. Any neutrophil-based intervention must walk the tightrope described by Heinrich Rohrer, facilitating necessary phagocytic functions while preventing bystander host damage, and this is a significant challenge which this review will explore.
Collapse
Affiliation(s)
- Frances Susanna Grudzinska
- Institute of Inflammation and Ageing, University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Malcolm Brodlie
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Barnaby R Scholefield
- Institute of Inflammation and Ageing, University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Thomas Jackson
- Institute of Inflammation and Ageing, University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Aaron Scott
- Institute of Inflammation and Ageing, University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - David R Thickett
- Institute of Inflammation and Ageing, University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Elizabeth Sapey
- Institute of Inflammation and Ageing, University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| |
Collapse
|
27
|
Pansarasa O, Pistono C, Davin A, Bordoni M, Mimmi MC, Guaita A, Cereda C. Altered immune system in frailty: Genetics and diet may influence inflammation. Ageing Res Rev 2019; 54:100935. [PMID: 31326616 DOI: 10.1016/j.arr.2019.100935] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Revised: 07/11/2019] [Accepted: 07/15/2019] [Indexed: 12/22/2022]
Abstract
Frailty is a complex geriatric syndrome associated with biological vulnerability to stressors and decreased physiological reserve. Its etiology and pathogenesis are not completely understood, although various causes and complex pathways have been proposed. Immune system alterations (immunosenescence and "InflammAging") have been suggested to contribute to frailty, but a precise causative role of such alterations remains to be determined. Genetic studies support the suggestion of immune system involvement in frailty: genetic variants in genes involved in immune system function have been associated with the syndrome. Interestingly, nutritional status, through its effects on cellular metabolism, may also influence the immune system, i.e. hormone and cytokine (mainly adipocytokine) levels, and immune cell populations and function, increasing inflammation and contributing to frailty. This review aims to discuss the role of immune system alterations in frailty, analyzing the role of genetic factors in frailty onset and the impact of diet on inflammation and, in turn, on frailty.
Collapse
|
28
|
Pamukcuoglu M, Bhatia S, Weisdorf DJ, DeFor TE, Ustun C, Nayar M, Holtan SG, Jurdi NE, Thyagarajan B, Brunstein CG, Bachanova V, Warlick ED, Severseike B, Te HS, Lund T, Arora M. Hematopoietic Cell Transplant-Related Toxicities and Mortality in Frail Recipients. Biol Blood Marrow Transplant 2019; 25:2454-2460. [PMID: 31394273 DOI: 10.1016/j.bbmt.2019.07.030] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 07/07/2019] [Accepted: 07/23/2019] [Indexed: 01/23/2023]
Abstract
Frailty is a state characterized by diminished physiologic reserve and increased vulnerability to stress and adversely affects outcomes in older patients. We aimed to determine the relationship between pre-hematopoietic cell transplant (HCT) frailty and grades 3 to 4 nonhematologic toxicities (Common Terminology Criteria for Adverse Events, version 5.0) and mortality in HCT recipients within 1 year after HCT and also examined whether age at HCT moderated that association. In a prospective longitudinal study of 117 patients aged ≥ 40 years undergoing HCT, we performed formal pre-HCT geriatric assessments. Frailty was assessed using Fried's criteria. Post-HCT toxicities were abstracted through medical record reviews. The prevalence of pre-HCT frailty was 21% and was not different in younger (40 to 59 years) versus older (≥60 years) HCT recipients. Overall, frail recipients (versus nonfrail) had a higher cumulative incidence of any grades 3 to 4 nonhematologic toxicity (86% [95% confidence interval {CI}, 62% to 100%] versus 70% [95% CI, 57% to 83%), P = .03) and more organ-specific grades 3 to 4 toxicities, such as non-neutropenic infections (38% [95% CI, 17% to 59%] versus 13% [95% CI, 6% to 20%], P < .01), nervous system disorders (19% [95% CI, 3% to 35%] versus 4% [95% CI, 0 to 8%], P = .02), and pneumonia (38% [95% CI, 17% to 59%] versus 10% [95% CI, 4% to 17%], P < .01). Frail recipients were 1.9-fold (95% CI, 1.1 to 3.4) more likely to develop any grades 3 to 4 toxicities (P = .03), 4-fold more likely to suffer non-neutropenic infections (95% CI, 1.4 to 11) and pneumonia (95% CI, 1.4 to 12; both P = .01), and 8.6-fold (95% CI, 1.6 to 45.3) more likely to suffer nervous system disorders (P = .01). Frail allogeneic HCT recipients also had a 3.1 times (95% CI, .9 to 9.7; P = .06) higher risk of overall mortality as compared with nonfrail allogeneic HCT recipients. The higher toxicity and mortality observed in frail allogeneic recipients needs to be monitored with high attention. Studies focusing on interventions to reduce frailty and manage morbidities are needed.
Collapse
Affiliation(s)
- Merve Pamukcuoglu
- Division of Hematology, Oncology and Transplant, University of Minnesota, Minneapolis, Minnesota
| | - Smita Bhatia
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, Alabama
| | - Daniel J Weisdorf
- Division of Hematology, Oncology and Transplant, University of Minnesota, Minneapolis, Minnesota
| | - Todd E DeFor
- Division of Biostatistics, Clinical Translational Science Institute, University of Minnesota, Minneapolis, Minnesota
| | - Celalettin Ustun
- Division of Hematology Oncology and Transplant, Rush University Medical Center, Chicago, Illinois
| | - Manju Nayar
- Division of Hematology, Oncology and Transplant, University of Minnesota, Minneapolis, Minnesota
| | - Shernan G Holtan
- Division of Hematology, Oncology and Transplant, University of Minnesota, Minneapolis, Minnesota
| | - Najla-El Jurdi
- Division of Hematology, Oncology and Transplant, University of Minnesota, Minneapolis, Minnesota
| | - Bharat Thyagarajan
- Lab Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota
| | - Claudio G Brunstein
- Division of Hematology, Oncology and Transplant, University of Minnesota, Minneapolis, Minnesota
| | - Veronika Bachanova
- Division of Hematology, Oncology and Transplant, University of Minnesota, Minneapolis, Minnesota
| | - Erica D Warlick
- Division of Hematology, Oncology and Transplant, University of Minnesota, Minneapolis, Minnesota
| | - Ben Severseike
- Department of Pediatrics, Division of Hematology, Oncology and Transplantation, University of Minnesota, Minneapolis, Minnesota
| | - Hok Sreng Te
- Division of Hematology, Oncology and Transplant, University of Minnesota, Minneapolis, Minnesota
| | - Troy Lund
- Department of Pediatrics, Division of Hematology, Oncology and Transplantation, University of Minnesota, Minneapolis, Minnesota
| | - Mukta Arora
- Division of Hematology, Oncology and Transplant, University of Minnesota, Minneapolis, Minnesota.
| |
Collapse
|
29
|
Weinberg A, Lambert SL, Canniff J, Yu L, Lang N, Esser MT, Falloon J, Levin MJ. Antibody and B cell responses to an investigational adjuvanted RSV vaccine for older adults. Hum Vaccin Immunother 2019; 15:2466-2474. [PMID: 30852939 DOI: 10.1080/21645515.2019.1589282] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background: Infections with respiratory syncytial virus (RSV) cause significant morbidity and hospitalization in older adults. We studied the humoral, mucosal and B cell responses of an investigational adjuvanted RSV sF vaccine, MEDI7510, in older adults. Methods: In a substudy of a randomized (1:1), double-blind, placebo-controlled study of MEDI7510 in adults ≥60 years of age, we collected blood and nasal secretions at days 0, 8, 29, 91 and 180 post-vaccination to measure F-specific IgG and IgA antibodies by ELISA, and plasmablasts and memory B cells by IgA/IgG dual-color fluorospot. Results: The 27 vaccine- and 18 placebo-recipients had a mean age of 73 years and included 24 women. Among vaccinees, 93% had significant increases in F-specific plasma IgG 85% had increased plasma IgA; 74% had increased nasal IgG and 26% nasal IgA; 93% had IgG and 89% IgA plasmablasts on Day 8 post-immunization; and 82% had IgG and 7.4% IgA memory B cell responses to the vaccine. Vaccinees <70 years of age and women had the highest responses to the vaccine. Conclusions: This adjuvanted vaccine generated robust humoral immune responses in older adults, including RSV F-specific systemic and mucosal antibodies and memory B cells. Nevertheless, age ≥70 years was associated with decreased immunogenicity of the adjuvanted vaccine.
Collapse
Affiliation(s)
- Adriana Weinberg
- Departments of Pediatrics, University of Colorado Denver School of Medicine, Anschutz Medical Center , Aurora, CO , USA.,Medicine, University of Colorado Denver School of Medicine, Anschutz Medical Center , Aurora, CO , USA.,Pathology of the University of Colorado Denver School of Medicine, Anschutz Medical Center , Aurora , CO , USA
| | | | - Jennifer Canniff
- Departments of Pediatrics, University of Colorado Denver School of Medicine, Anschutz Medical Center , Aurora, CO , USA
| | - Li Yu
- Statistical Sciences, MedImmune , Gaithersburg , MD , USA
| | - Nancy Lang
- Departments of Pediatrics, University of Colorado Denver School of Medicine, Anschutz Medical Center , Aurora, CO , USA
| | - Mark T Esser
- Translational Medicine, MedImmune , Gaithersburg , MD , USA
| | - Judith Falloon
- Clinical Development, MedImmune , Gaithersburg , MD , USA
| | - Myron J Levin
- Departments of Pediatrics, University of Colorado Denver School of Medicine, Anschutz Medical Center , Aurora, CO , USA.,Medicine, University of Colorado Denver School of Medicine, Anschutz Medical Center , Aurora, CO , USA
| |
Collapse
|
30
|
Gehrig AC, Hartmann K, Günther F, Klima A, Habacher G, Bergmann M. A survey of vaccine history in German cats and owners' attitudes to vaccination. J Feline Med Surg 2019; 21:73-83. [PMID: 29529958 PMCID: PMC10814604 DOI: 10.1177/1098612x18759838] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Vaccination is the most important measure for prevention of feline infectious diseases. Cat owner compliance with vaccination recommendations has been investigated in the UK but not in other European countries. The aim of the present study was to determine cat owners' attitudes towards vaccination in cats in Germany, to identify factors that are associated with the vaccination status of their cats and to compare the results with those of the UK survey. METHODS The survey was conducted using an online questionnaire and was aimed at respondents throughout Germany. Respondents under 16 years of age, cats that were less than 9 weeks old and veterinarians were excluded. A total of 920 questionnaires were evaluated, and information about cats and respondents was assessed with respect to the current vaccination status of the cats using a linear logistic regression model. RESULTS The majority of cats (77.9%; n = 717) were vaccinated according to current guidelines; only 5.4% (n = 50; 95% confidence interval [CI] 5.00-9.00) of cats had never received a vaccine. Having visited a cattery, a cat show or travelled abroad in the past 12 months (n = 96/773; odds ratio [OR] 6.95; 95% CI 1.65-52.19) had the highest positive impact on the vaccination status of cats. In addition, detailed veterinary advice about vaccination had a positive impact (n = 275/773; OR 2.09; 95% CI 0.67-6.25) on the attitude of owners towards vaccinating their cats. CONCLUSIONS AND RELEVANCE A history of travelling abroad or visiting cat shows or a cattery, and thus regulatory requirements, had the greatest positive impact on the current vaccination status of the cats. Veterinary consultation on preventive measures, including vaccination, is crucial for protecting the cat population against infectious diseases.
Collapse
Affiliation(s)
- Anne-Claire Gehrig
- Clinic of Small Animal Medicine, Centre of Clinical Veterinary Medicine, LMU Munich, Munich, Germany
| | - Katrin Hartmann
- Clinic of Small Animal Medicine, Centre of Clinical Veterinary Medicine, LMU Munich, Munich, Germany
| | - Felix Günther
- Department of Statistics, LMU Munich, Munich, Germany
| | - André Klima
- Department of Statistics, LMU Munich, Munich, Germany
| | | | - Michèle Bergmann
- Clinic of Small Animal Medicine, Centre of Clinical Veterinary Medicine, LMU Munich, Munich, Germany
| |
Collapse
|
31
|
Camous X, Visan L, Ying CTT, Abel B, Nyunt MSZ, Narang V, Poidinger M, Carre C, Sesay S, Bosco N, Burdin N, Tambyah PA, Pin NT, Larbi A. Healthy elderly Singaporeans show no age-related humoral hyporesponsiveness nor diminished plasmablast generation in response to influenza vaccine. IMMUNITY & AGEING 2018; 15:28. [PMID: 30455722 PMCID: PMC6231250 DOI: 10.1186/s12979-018-0137-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 11/02/2018] [Indexed: 11/10/2022]
Abstract
Abstract Improving influenza vaccine efficacy is a priority to reduce the burden of influenza-associated morbidity and mortality. By careful selection of individuals based on health we show sustained response to influenza vaccination in older adults. Sustaining health in aging could be an important player in maintaining immune responses to influenza vaccination. Trial registration NCT03266237. Registered 30 August 2017, https://clinicaltrials.gov/ct2/show/NCT03266237.
Collapse
Affiliation(s)
- Xavier Camous
- 1Biology of Aging Laboratory, Singapore Immunology Network, Agency for Science Technology and Research, Singapore, Singapore
| | - Lucian Visan
- 2Sanofi Pasteur, Research and Non-Clinical safety, Marcy L'Etoile, France
| | - Crystal Tan Tze Ying
- 1Biology of Aging Laboratory, Singapore Immunology Network, Agency for Science Technology and Research, Singapore, Singapore
| | - Brian Abel
- 3Immunomonitoring Platform, Singapore Immunology Network, Agency for Science Technology and Research, 8A Biomedical Grove, Singapore, 138648 Singapore
| | - Ma Shwe Zin Nyunt
- 4Gerontology Research Programme, Department of Psychological Medicine, National University of Singapore, Singapore, Singapore
| | - Vipin Narang
- 3Immunomonitoring Platform, Singapore Immunology Network, Agency for Science Technology and Research, 8A Biomedical Grove, Singapore, 138648 Singapore
| | - Michael Poidinger
- 3Immunomonitoring Platform, Singapore Immunology Network, Agency for Science Technology and Research, 8A Biomedical Grove, Singapore, 138648 Singapore
| | - Christophe Carre
- 2Sanofi Pasteur, Research and Non-Clinical safety, Marcy L'Etoile, France
| | - Sanie Sesay
- 5Sanofi Pasteur, Clinical Sciences, Marcy L'Etoile, France
| | - Nabil Bosco
- Nestle Research Center Asia, 21 Biopolis Road, Singapore, Singapore
| | - Nicolas Burdin
- 2Sanofi Pasteur, Research and Non-Clinical safety, Marcy L'Etoile, France
| | | | - Ng Tze Pin
- 4Gerontology Research Programme, Department of Psychological Medicine, National University of Singapore, Singapore, Singapore
| | - Anis Larbi
- 1Biology of Aging Laboratory, Singapore Immunology Network, Agency for Science Technology and Research, Singapore, Singapore.,3Immunomonitoring Platform, Singapore Immunology Network, Agency for Science Technology and Research, 8A Biomedical Grove, Singapore, 138648 Singapore
| |
Collapse
|
32
|
Narang V, Lu Y, Tan C, Camous XFN, Nyunt SZ, Carre C, Mok EWH, Wong G, Maurer-Stroh S, Abel B, Burdin N, Poidinger M, Tambyah PA, Bosco N, Visan L, Ng TP, Larbi A. Influenza Vaccine-Induced Antibody Responses Are Not Impaired by Frailty in the Community-Dwelling Elderly With Natural Influenza Exposure. Front Immunol 2018; 9:2465. [PMID: 30405641 PMCID: PMC6207627 DOI: 10.3389/fimmu.2018.02465] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 10/04/2018] [Indexed: 12/22/2022] Open
Abstract
Background: Elderly adults over 65 years of age are recommended to receive seasonal influenza vaccination as they are at a higher risk of infection and its complications than the younger community. The elderly are often stratified according to frailty status where frail individuals are more susceptible to adverse health outcomes than their non-frail counterparts, however, it is not known whether immunity induced by influenza vaccination is impaired in the frail elderly. Study Design: Two hundred and five elderly subjects of Chinese ethnicity in Singapore (mean age 73.3 ± 5.3 years, 128 females and 77 males) were administered the recommended trivalent inactivated 2013–14 seasonal influenza vaccine (Vaxigrip™) containing A/H1N1, A/H3N2, and B strains. The elderly subjects were stratified into three groups according to Fried's frailty criteria (59 frail, 85 pre-frail, 61 robust) and were also ranked by Rockwood's frailty index (RFI). Statistical associations were evaluated between frailty status and pre- and post-vaccination antibody titres in sera measured by Hemagglutination inhibition (HAI) and microneutralization (MN) assays. Immunological responses across frailty strata were also studied in terms of leukocyte cellular distribution, cytokine levels and gene expression. Results: Post-vaccination, 83.4% of the subjects seroconverted for A/H1N1, 80.5% for A/H3N2, and 81% for the B strain. The seroconversion rates were comparable across frailty groups (A/H1N1, ANOVA, p = 0.7910; A/H3N2, ANOVA, p = 0.8356, B, ANOVA, p = 0.9741). Geometric mean titres of HAI and MN as well as seroprotection rates were also similar in all three frailty groups and uncorrelated with RFI (Spearman, r = 0.023, p = 0.738). No statistically significant differences were observed between the frailty groups in vaccine-induced modulation of leukocyte populations, cytokine responses, and gene expression profiles of peripheral blood mononuclear cells (PBMCs). Whereas, post- and pre-vaccination HAI titres were positively correlated after adjusting for age and gender (A/H1N1, R2 = 0.216, p = 9.1e−11; A/H3N2, R2 = 0.166, p = 3.4e−8; B, R2 = 0.104, p = 3.1e−5). With most subjects lacking previous history of influenza vaccination, the pre-vaccination titres were likely due to natural exposure and seen to match the pattern of influenza subtype prevalence in the time period of vaccination. Conclusion: The majority of the elderly subjects seroconverted for seasonal influenza upon vaccination, and importantly, influenza vaccination-induced humoral immune responses and seroprotection were similar across the frailty strata, indicating that frail individuals may also benefit from influenza vaccination. Pre-existing antibodies due to natural exposure appeared to positively influence vaccine-induced antibody responses.
Collapse
Affiliation(s)
- Vipin Narang
- Singapore Immunology Network, Singapore, Singapore
| | - Yanxia Lu
- Singapore Immunology Network, Singapore, Singapore
| | - Crystal Tan
- Singapore Immunology Network, Singapore, Singapore
| | | | - Shwe Zin Nyunt
- Department of Psychological Medicine, National University Hospital, Singapore, Singapore
| | | | | | - Glenn Wong
- Singapore Immunology Network, Singapore, Singapore
| | | | - Brian Abel
- Singapore Immunology Network, Singapore, Singapore
| | | | | | | | - Nabil Bosco
- Nestlé Research Singapore Hub, Singapore, Singapore
| | | | - Tze Pin Ng
- Department of Psychological Medicine, National University Hospital, Singapore, Singapore
| | - Anis Larbi
- Singapore Immunology Network, Singapore, Singapore
| |
Collapse
|
33
|
El Chakhtoura NG, Bonomo RA, Jump RLP. Influence of Aging and Environment on Presentation of Infection in Older Adults. Infect Dis Clin North Am 2018; 31:593-608. [PMID: 29079150 DOI: 10.1016/j.idc.2017.07.017] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
In older adults, pathophysiologic, clinical, and environmental factors all affect the presentation of infections. We explore how age-related changes influence the manifestation and evaluation of infections in this population. Specific topics include immunosenescence, age-related organ-specific physiologic changes, and frailty. We also describe clinical factors influencing infection risk and presentation in older adults, including temperature regulation, cognitive decline, and malnutrition. Finally, we discuss the influence of the setting in which older adults reside on the clinical evaluation of infection. Understanding the influence of all these changes may facilitate the prevention, early recognition, and treatment of infections in older adults.
Collapse
Affiliation(s)
- Nadim G El Chakhtoura
- Geriatric Research Education and Clinical Center (GRECC), Louis Stokes Cleveland Department of Veterans Affairs Medical Center (LSCVAMC), 10701 East Boulevard, Cleveland, OH 44106, USA; Division of Infectious Diseases and HIV Medicine, Department of Medicine, Case Western Reserve University, 11100 Euclid Avenue, Cleveland, OH 44195-5029, USA
| | - Robert A Bonomo
- Geriatric Research Education and Clinical Center (GRECC), Louis Stokes Cleveland Department of Veterans Affairs Medical Center (LSCVAMC), 10701 East Boulevard, Cleveland, OH 44106, USA; Division of Infectious Diseases and HIV Medicine, Department of Medicine, Case Western Reserve University, 11100 Euclid Avenue, Cleveland, OH 44195-5029, USA; Specialty Care Center of Innovation, LSCVAMC, 10701 East Boulevard, Cleveland, OH 44106, USA; Research Services, LSCVAMC, 10701 East Boulevard, Cleveland, OH 44106, USA; Department of Pathology, Case Western Reserve University School of Medicine, 11100 Euclid Avenue, Cleveland, OH 44195-5029, USA; Department of Pharmacology, Case Western Reserve University School of Medicine, 11100 Euclid Avenue, Cleveland, OH 44195-5029, USA; Department of Molecular Biology and Microbiology, Case Western Reserve University School of Medicine, 11100 Euclid Avenue, Cleveland, OH 44195-5029, USA; Department of Biochemistry, Case Western Reserve University School of Medicine, 11100 Euclid Avenue, Cleveland, OH 44195-5029, USA
| | - Robin L P Jump
- Geriatric Research Education and Clinical Center (GRECC), Louis Stokes Cleveland Department of Veterans Affairs Medical Center (LSCVAMC), 10701 East Boulevard, Cleveland, OH 44106, USA; Division of Infectious Diseases and HIV Medicine, Department of Medicine, Case Western Reserve University, 11100 Euclid Avenue, Cleveland, OH 44195-5029, USA; Specialty Care Center of Innovation, LSCVAMC, 10701 East Boulevard, Cleveland, OH 44106, USA; Research Services, LSCVAMC, 10701 East Boulevard, Cleveland, OH 44106, USA.
| |
Collapse
|
34
|
Bou Ghanem EN, Maung NHT, Siwapornchai N, Goodwin AE, Clark S, Muñoz-Elías EJ, Camilli A, Gerstein RM, Leong JM. Nasopharyngeal Exposure to Streptococcus pneumoniae Induces Extended Age-Dependent Protection against Pulmonary Infection Mediated by Antibodies and CD138 + Cells. THE JOURNAL OF IMMUNOLOGY 2018; 200:3739-3751. [PMID: 29661828 DOI: 10.4049/jimmunol.1701065] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 03/22/2018] [Indexed: 11/19/2022]
Abstract
Streptococcus pneumoniae commonly resides asymptomatically in the nasopharyngeal (NP) cavity of healthy individuals but can cause life-threatening pulmonary and systemic infections, particularly in the elderly. NP colonization results in a robust immune response that protects against invasive infections. However, the duration, mechanism, and cellular component of such responses are poorly understood. In this study, we found that repeated NP exposure of mice to S. pneumoniae TIGR4 strain results in pneumococcal-specific Ab responses that protect against lethal lung challenge. Abs were necessary and sufficient for protection because Ab-deficient μMT mice did not develop postexposure protection, only becoming resistant to lung infection after transfer of immune sera from NP-exposed mice. T cells contributed to immunity at the time of NP exposure, but neither CD4+ nor CD8+ T cells were required. The protective activity was detectable 20 wk after exposure and was maintained in irradiated mice, suggesting involvement of long-lived Ab-secreting cells (ASC), which are radioresistant and secrete Abs for extended periods of time in the absence of T cells or persistent Ag. CD138+ bone marrow cells, likely corresponding to long-lived ASC, were sufficient to confer protection. NP exposure of aged mice failed to protect against subsequent lung infection despite eliciting a robust Ab response. Furthermore, transfer of CD138+ bone marrow cells or sera from NP-exposed old mice failed to protect naive young mice. These findings suggest that NP exposure elicits extended protection against pneumococcal lung infection by generating long-lived CD138+ ASC and that the protective efficacy of these responses declines with age.
Collapse
Affiliation(s)
- Elsa N Bou Ghanem
- Department of Microbiology and Immunology, University at Buffalo School of Medicine, Buffalo, NY 14203
| | - Nang H Tin Maung
- Department of Microbiology and Physiological Systems, University of Massachusetts Medical School, Worcester, MA 01655
| | - Nalat Siwapornchai
- Department of Molecular Biology and Microbiology, Tufts University School of Medicine, Boston, MA 02111
| | - Aaron E Goodwin
- Department of Microbiology and Physiological Systems, University of Massachusetts Medical School, Worcester, MA 01655
| | - Stacie Clark
- Department of Molecular Biology and Microbiology, Tufts University School of Medicine, Boston, MA 02111.,Graduate Program in Molecular Microbiology, Sackler School of Graduate Biomedical Sciences, Tufts University School of Medicine, Boston, MA 02111
| | | | - Andrew Camilli
- Department of Molecular Biology and Microbiology, Tufts University School of Medicine, Boston, MA 02111.,Howard Hughes Medical Institute, Boston, MA 02111
| | - Rachel M Gerstein
- Department of Microbiology and Physiological Systems, University of Massachusetts Medical School, Worcester, MA 01655
| | - John M Leong
- Department of Molecular Biology and Microbiology, Tufts University School of Medicine, Boston, MA 02111;
| |
Collapse
|
35
|
Bahuaud M, Beaudouin-Bazire C, Husson M, Molto A, Launay O, Batteux F, Dougados M. Immunogenicity and persistence of a prime-boost re-vaccination strategy for pneumococcal vaccines in patients with rheumatoid arthritis. Hum Vaccin Immunother 2018; 14:1464-1470. [PMID: 29432051 DOI: 10.1080/21645515.2018.1438091] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVES Patients with rheumatoid arthritis (RA) are at an increased risk of Pneumococcal infections. Immunogenicity and persistence of a prime-boost revaccination strategy using 13-valent/23-valent anti-pneumococcal vaccines was evaluated in patients with RA treated by Methotrexate (MTX) and anti-TNF. METHOD Twenty-four patients with RA received one dose of PCV13 (Prevenar13®; Pfizer) followed two months later by one dose of PPV23 (Pneumovax®, Merck). Concentrations of IgG specific for 7 serotypes common to both vaccines and 3 uncommon serotypes, included only in the PPV23 were measured by ELISA and Opsonophagocytic Assay (OPA) at baseline and after 4, 12 and 24 months post-vaccine. RESULTS Similar percentages of protection were found at 4 months (63% vs. 55%), 12 months (54% vs. 50%) and 24 months (52% vs. 55%) for the 7 common and 3 uncommon serotypes when antibody titers were assayed by ELISA. Based on functional antibody measurements by OPA, a decrease of protected patients was observed 24 months after vaccine with only 19% of patients protected compared to 29% at baseline. CONCLUSION Although the combined pneumococcal revaccination strategy induces good protection in the short term in RA patients, this protection does not persist beyond two years with levels of functional antibody decreasing below pre-vaccine levels. We did not observe a higher efficacy of the conjugate vaccine compared to the polysaccharide vaccine. Our results clearly question the advantage of the prime-boost strategy as it highlight the possible hyporesponse induced by PPV23 against the immune response elicited by the primo-injection of the PCV13 vaccine.
Collapse
Affiliation(s)
- Mathilde Bahuaud
- a Plateforme d'Immunomonotoring Vaccinal, Laboratoire d'Immunologie , Groupe hospitalier Cochin-Broca-Hôtel Dieu, AP-HP , Paris , France
| | | | - Marine Husson
- a Plateforme d'Immunomonotoring Vaccinal, Laboratoire d'Immunologie , Groupe hospitalier Cochin-Broca-Hôtel Dieu, AP-HP , Paris , France
| | - Anna Molto
- b Service de Rhumatologie B , Groupe hospitalier Cochin-Broca-Hôtel Dieu, APHP , Paris , France
| | - Odile Launay
- c Centre d'Investigation Clinique Cochin-Pasteur (CIC1417) , Groupe hospitalier Cochin-Broca-Hôtel Dieu, AP-HP , Paris , France
| | - Frédéric Batteux
- a Plateforme d'Immunomonotoring Vaccinal, Laboratoire d'Immunologie , Groupe hospitalier Cochin-Broca-Hôtel Dieu, AP-HP , Paris , France
| | - Maxime Dougados
- b Service de Rhumatologie B , Groupe hospitalier Cochin-Broca-Hôtel Dieu, APHP , Paris , France
| |
Collapse
|
36
|
Pneumococcal conjugate vaccination response in patients after community-acquired pneumonia, differences in patients with S. pneumoniae versus other pathogens. Vaccine 2017; 35:4886-4895. [DOI: 10.1016/j.vaccine.2017.07.088] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Revised: 07/15/2017] [Accepted: 07/25/2017] [Indexed: 11/19/2022]
|
37
|
Delgado-Arce JC, García-Lara JMA, Pérez-Zepeda MU, Avila-Funes JA. La fragilidad no se asocia con una baja frecuencia de vacunación en adultos mayores. SALUD PUBLICA DE MEXICO 2017; 59:493. [DOI: 10.21149/8394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Señor editor: Los adultos mayores son particularmente susceptibles a infecciones respiratorias, por lo que la prevención de éstas es fundamental para disminuir complicaciones. Por otra parte, en geriatría, “fragilidad”describe un estado de gran vulnerabilidad y pobre resiliencia, el cual no debería excluir a las personas frágiles del beneficio de intervenciones tales como la vacunación, bajo el argumento infundado de que ésta es inútil.
Collapse
|
38
|
Bauer JM, De Castro A, Bosco N, Romagny C, Diekmann R, Benyacoub J, Vidal K. Influenza vaccine response in community-dwelling German prefrail and frail individuals. IMMUNITY & AGEING 2017; 14:17. [PMID: 28694834 PMCID: PMC5501346 DOI: 10.1186/s12979-017-0098-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 06/12/2017] [Indexed: 01/01/2023]
Abstract
Background The age-related dysregulation of the immune system in older persons results in reduced responses to vaccination and greater susceptibility to infection, especially in frail individuals who suffer the greatest of morbidity and mortality due to infection. Recently, significantly reduced anti-influenza antibody titers and increased rates of influenza infection after vaccination were reported in community-dwelling American frail older adults. The aim of our study was to further assess the relative impact of frailty and of each individual Fried frailty criterion on influenza vaccine response. Prefrail and frail community-dwelling German persons aged ≥70 years were recruited for a nutritional randomized double-blind placebo-controlled clinical trial conducted during the 2014–2015 influenza season. Herein, we present a sub-analysis study of the placebo group to compare 76 prefrail and frail participants. Results Previous seasonal influenza vaccination rate was relatively high (77.6%) in the 76 volunteers aged from 70 to 93 years. Of these participants, 65.8% were diagnosed as prefrail and 34.2% as frail according to the Fried frailty criteria. In both prefrail and frail groups, elevated levels of pre-vaccination seroprotection were observed to all vaccine strains (H1N1: 54% and 32%, H3N2: 60% and 72%, B: 10% and 16%). Post-vaccination, similar increases in haemagglutination-inhibiting antibody titers were observed for the three vaccine strains in both prefrail and frail groups. No significant difference in geometric mean titer (GMT) ratios and in rates of seroconversion or seroprotection were observed between prefrail and frail groups. Regarding the five Fried frailty criteria, only participants with low physical activity had significantly lower GMT to the strains H3N2 (55.4 vs 103.7, p = 0.001) and B (13.9 vs 20.0, p = 0.06), as compared to those having normal physical activity. Conclusions Influenza vaccine response was not significantly affected by the frail phenotype, as defined by Fried frailty criteria, in community-dwelling German individuals. However, low physical activity may be a relevant predictor of lower serological response in vaccinated older individuals. Trial registration Clinicaltrials.govNCT02262091 (October 8, 2013).
Collapse
Affiliation(s)
- Jürgen M Bauer
- Department of Geriatric Medicine, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany.,Present address: Center for Geriatric Medicine, University of Heidelberg and Agaplesion Bethanien Hospital, Heidelberg, Germany
| | - Antonio De Castro
- Nestlé Research Center, Route du Jorat 57, 1000 Lausanne, Switzerland.,Present address: Nestlé Research Center Asia, 21 Biopolis Road, Singapore, 138567 Singapore
| | - Nabil Bosco
- Nestlé Research Center, Route du Jorat 57, 1000 Lausanne, Switzerland.,Present address: Nestlé Research Center Asia, 21 Biopolis Road, Singapore, 138567 Singapore
| | - Celine Romagny
- Nestlé Research Center, Route du Jorat 57, 1000 Lausanne, Switzerland
| | - Rebecca Diekmann
- Department of Geriatric Medicine, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany
| | - Jalil Benyacoub
- Nestlé Research Center, Route du Jorat 57, 1000 Lausanne, Switzerland
| | - Karine Vidal
- Nestlé Research Center, Route du Jorat 57, 1000 Lausanne, Switzerland
| |
Collapse
|
39
|
van Deursen AMM, van Houten MA, Webber C, Patton M, Scott DA, Patterson S, Sidhu M, Drews W, Gruber WC, Emini EA, Grobbee DE, Bonten MJM, Sanders EAM. Immunogenicity of the 13-Valent Pneumococcal Conjugate Vaccine in Older Adults With and Without Comorbidities in the Community-Acquired Pneumonia Immunization Trial in Adults (CAPiTA). Clin Infect Dis 2017; 65:787-795. [DOI: 10.1093/cid/cix419] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 05/03/2017] [Indexed: 01/10/2023] Open
|
40
|
Laratta CR, Williams K, Vethanayagam D, Ulanova M, Vliagoftis H. A case series evaluating the serological response of adult asthma patients to the 23-valent pneumococcal polysaccharide vaccine. Allergy Asthma Clin Immunol 2017; 13:27. [PMID: 28596792 PMCID: PMC5463404 DOI: 10.1186/s13223-017-0200-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2016] [Accepted: 05/23/2017] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Asthma is an independent risk factor for invasive pneumococcal disease; however, the immune response of adult asthma patients to pneumococcal vaccination is unknown. We explore the serologic response of patients with moderate to severe asthma to the 23-valent pneumococcal polysaccharide vaccine (PPSV23). METHODS Seventeen moderate to severe adult asthma patients that had not been vaccinated against pneumococcus over the 5 previous years were prospectively recruited from a tertiary care asthma clinic. Serum was analyzed for the presence of antibodies to five capsular polysaccharide (CP) antigens (6B, 9V, 19A, 19F, 23F) before and 4 weeks after PPSV23 vaccination. RESULTS There was a wide variability in baseline anti-CP antibody concentrations. Other than for serotype 19A, our patients frequently have baseline anti-CP antibody concentrations below 1 µg/mL (35% for serotype 19F, 41% for serotypes 9V and 23F, and 59% for serotype 6B). All post-vaccination geometric mean antibody concentrations were significantly higher than baseline. In the 31 tests where the baseline antibody concentration was <1 µg/mL, 77.4% had at least a twofold increase post-vaccination. Despite this, a large proportion of post-vaccination anti-CP antibody concentrations remained <1 µg/mL (51.6% of tests). Nine patients had at least one anti-CP antibody concentration <1 µg/mL post-vaccination. There was no difference between these patients and the remaining eight patients in demographic or clinical variables. CONCLUSIONS Patients with moderate to severe asthma have variable baseline and low post-vaccination antibody concentrations to common CP antigens included in the PPSV23 vaccine. The clinical relevance of these observations remains to be determined since the threshold concentration in adults required for clinical protection from invasive pneumococcal disease is uncertain.
Collapse
Affiliation(s)
- C R Laratta
- Pulmonary Research Group, Department of Medicine, University of Alberta, Edmonton, AB Canada
| | - K Williams
- Medical Sciences Division, Northern Ontario School of Medicine, Lakehead University Campus, Thunder Bay, ON Canada
| | - D Vethanayagam
- Pulmonary Research Group, Department of Medicine, University of Alberta, Edmonton, AB Canada
| | - M Ulanova
- Medical Sciences Division, Northern Ontario School of Medicine, Lakehead University Campus, Thunder Bay, ON Canada
| | - H Vliagoftis
- Pulmonary Research Group, Department of Medicine, University of Alberta, Edmonton, AB Canada.,Division of Pulmonary Medicine, Department of Medicine, University of Alberta, Room 3-105 Clinical Sciences Building, 11350 83 Avenue, Edmonton, AB T6G 2G3 Canada
| |
Collapse
|
41
|
Preexisting Immunity, Not Frailty Phenotype, Predicts Influenza Postvaccination Titers among Older Veterans. CLINICAL AND VACCINE IMMUNOLOGY : CVI 2017; 24:CVI.00498-16. [PMID: 28100496 DOI: 10.1128/cvi.00498-16] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Accepted: 01/10/2017] [Indexed: 01/08/2023]
Abstract
Both preexisting immunity to influenza and age have been shown to be correlates of influenza vaccine responses. Frailty, an indicator of functional impairment in older adults, was also shown in one study to predict lower influenza vaccine responses among nonveterans. In the current study, we aimed to determine the associations between frailty, preexisting immunity, and immune responses to influenza vaccine among older veterans. We studied 117 subjects (age range, 62 to 95 years [median age, 81 years]), divided into three cohorts based on the Fried frailty test, i.e., nonfrail (NF) (n = 23 [median age, 68 years]), prefrail (n = 50 [median age, 80 years]), and frail (n = 44 [median age, 82 years]), during the 2010-2011 and 2011-2012 influenza seasons. Subjects received the seasonal trivalent inactivated influenza vaccine, and baseline and postvaccination samples were obtained. Anti-influenza humoral immunity, as measured by hemagglutination inhibition (HI) and microneutralization assays, was measured for influenza B, A(H1N1)pdm09, and A(H3N2) viruses. Postvaccination titers were not different between frail and NF subjects overall in this older subset of veterans. However, preexisting HI titers were strongly correlated with postvaccination titers among all functional status groups. When microneutralization titers were compared, the association between preexisting immunity and vaccine responses varied by frailty status, with the strongest correlation being observed for the NF group. In conclusion, preexisting immunity rather than frailty appeared to predict postvaccination titers in this older veteran cohort.
Collapse
|
42
|
Edwards K, Creech C. Vaccine Development in Special Populations. HUMAN VACCINES 2017. [DOI: 10.1016/b978-0-12-802302-0.00007-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
43
|
Schaffner W, Gravenstein S, Hopkins RH, Jernigan DB. Reinvigorating Influenza Prevention in US Adults Aged 65 Years and Older. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2016. [DOI: 10.1097/ipc.0000000000000462] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
44
|
|
45
|
Dirmesropian S, Wood JG, MacIntyre CR, Beutels P, Newall AT. Economic Evaluation of Vaccination Programmes in Older Adults and the Elderly: Important Issues and Challenges. PHARMACOECONOMICS 2016; 34:723-731. [PMID: 26914091 DOI: 10.1007/s40273-016-0393-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
High-income countries are undergoing demographic transitions towards populations with substantial larger proportions of older adults. Due to the increased susceptibility of older adults to infectious diseases and their consequences, vaccination programmes are an important health intervention to help maintain healthy ageing. While much of the existing literature suggests that current vaccination programmes targeted at older adults and the elderly are likely to be cost effective in high-income countries, we argue that it is important to more fully consider some important issues and challenges. Since the majority of vaccines have been developed for children, economic evaluations of vaccination programmes have consequentially tended to focus on this age group and on how to incorporate herd-immunity effects. While programmes targeted at older adults and the elderly may also induce some herd effects, there are other important challenges to consider in these economic evaluations. For example, age and time effects in relation to vaccine efficacy and duration of immunity, as well as heterogeneity between targeted individuals in terms of risk of infection, severity of disease and response to vaccination. For some pathogens, there is also the potential for interactions with childhood programmes in the form of herd-immunity effects.
Collapse
Affiliation(s)
- Sevan Dirmesropian
- Samuels Building, School of Public Health and Community Medicine, UNSW Australia, Sydney, NSW, 2052, Australia
| | - James G Wood
- Samuels Building, School of Public Health and Community Medicine, UNSW Australia, Sydney, NSW, 2052, Australia
| | - C Raina MacIntyre
- Samuels Building, School of Public Health and Community Medicine, UNSW Australia, Sydney, NSW, 2052, Australia
| | - Philippe Beutels
- Samuels Building, School of Public Health and Community Medicine, UNSW Australia, Sydney, NSW, 2052, Australia
- Centre for Health Economics Research and Modelling Infectious Diseases (CHERMID) and Centre for the Evaluation of Vaccination (CEV), Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
| | - Anthony T Newall
- Samuels Building, School of Public Health and Community Medicine, UNSW Australia, Sydney, NSW, 2052, Australia.
| |
Collapse
|
46
|
Musher DM. Should Committees That Write Guidelines and Recommendations Publish Dissenting Opinions? Mayo Clin Proc 2016; 91:634-9. [PMID: 27061767 DOI: 10.1016/j.mayocp.2016.01.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 01/20/2016] [Accepted: 01/22/2016] [Indexed: 11/30/2022]
Abstract
Medical guidelines tend to convey a sense of unanimity of opinion that may not reflect the deliberations of the experts who wrote them. Using, as an example, an analysis of the recently published recommendations on administering pneumococcal conjugate vaccine to adults, the present article raises the question of whether official recommendations and guidelines should include dissenting opinions, analogous to decisions issued by the US Supreme Court. The argument that such a policy would lead to confusion in our profession is addressed in 2 ways: (1) the current system, in which different professional societies publish conflicting recommendations, as in the case of breast or prostate cancer screening, can be far more confusing, and (2) in the long run, greater transparency will lead to more thoughtful and higher-quality medical care. Perhaps the most important point of this paper is the suggestion that it is far better to bring dissent into the recommendation process than to act as if it is not there.
Collapse
Affiliation(s)
- Daniel M Musher
- Departments of Medicine and Molecular Virology and Microbiology, Baylor College of Medicine; and Medical Care Line (Infectious Disease Section), Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX.
| |
Collapse
|
47
|
Noguchi N, Blyth FM, Waite LM, Naganathan V, Cumming RG, Handelsman DJ, Seibel MJ, Le Couteur DG. Prevalence of the geriatric syndromes and frailty in older men living in the community: The Concord Health and Ageing in Men Project. Australas J Ageing 2016; 35:255-261. [DOI: 10.1111/ajag.12310] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Naomi Noguchi
- Centre for Education and Research on Ageing and Ageing and Alzheimer's Institute; Concord Hospital; University of Sydney; Sydney New South Wales Australia
| | - Fiona M Blyth
- Centre for Education and Research on Ageing and Ageing and Alzheimer's Institute; Concord Hospital; University of Sydney; Sydney New South Wales Australia
| | - Louise M Waite
- Centre for Education and Research on Ageing and Ageing and Alzheimer's Institute; Concord Hospital; University of Sydney; Sydney New South Wales Australia
| | - Vasi Naganathan
- Centre for Education and Research on Ageing and Ageing and Alzheimer's Institute; Concord Hospital; University of Sydney; Sydney New South Wales Australia
| | - Robert G Cumming
- Centre for Education and Research on Ageing and Ageing and Alzheimer's Institute; Concord Hospital; University of Sydney; Sydney New South Wales Australia
- School of Public Health; University of Sydney; Sydney New South Wales Australia
- ANZAC Research Institute; Concord Hospital; University of Sydney; Sydney New South Wales Australia
| | - David J Handelsman
- ANZAC Research Institute; Concord Hospital; University of Sydney; Sydney New South Wales Australia
| | - Markus J Seibel
- ANZAC Research Institute; Concord Hospital; University of Sydney; Sydney New South Wales Australia
| | - David G Le Couteur
- Centre for Education and Research on Ageing and Ageing and Alzheimer's Institute; Concord Hospital; University of Sydney; Sydney New South Wales Australia
- ANZAC Research Institute; Concord Hospital; University of Sydney; Sydney New South Wales Australia
| |
Collapse
|
48
|
Talbot HK, Nian H, Chen Q, Zhu Y, Edwards KM, Griffin MR. Evaluating the case-positive, control test-negative study design for influenza vaccine effectiveness for the frailty bias. Vaccine 2016; 34:1806-9. [PMID: 26930368 DOI: 10.1016/j.vaccine.2016.02.037] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Revised: 01/15/2016] [Accepted: 02/12/2016] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Previous influenza vaccine effectiveness studies were criticized for their failure to control for frailty. This study was designed to see if the test-negative study design overcomes this bias. METHODS Adults ≥ 50 years of age with respiratory symptoms were enrolled from November 2006 through May 2012 during the influenza season (excluding the 2009-2010 H1N1 pandemic season) to perform yearly test-negative control influenza vaccine effectiveness studies in Nashville, TN. At enrollment, both a nasal and throat swab sample were obtained and tested for influenza by RT-PCR. Frailty was calculated using a modified Rockwood Index that included 60 variables ascertained in a retrospective chart review giving a score of 0 to 1. Subjects were divided into three strata: non frail (≤ 0.08), pre-frail (> 0.08 to < 0.25), and frail (≥ 0.25). Vaccine effectiveness was calculated using the formula [1-adjusted odds ratio (OR)] × 100%. Adjusted ORs for individual years and all years combined were estimated by penalized multivariable logistic regression. RESULTS Of 1023 hospitalized adults enrolled, 866 (84.7%) participants had complete immunization status, molecular influenza testing and covariates to calculate frailty. There were 83 influenza-positive cases and 783 test-negative controls overall, who were 74% white, 25% black, and 59% female. The median frailty index was 0.167 (Interquartile: 0.117, 0.267). The frailty index was 0.167 (0.100, 0.233) for the influenza positive cases compared to 0.183 (0.133, 0.267) for influenza negative controls (p = 0.07). Vaccine effectiveness estimates were 55.2% (95%CI: 30.5, 74.2), 60.4% (95%CI: 29.5, 74.4), and 54.3% (95%CI: 28.8, 74.0) without the frailty variable, including frailty as a continuous variable, and including frailty as a categorical variable, respectively. CONCLUSIONS Using the case positive test negative study design to assess vaccine effectiveness, our measure of frailty was not a significant confounder as inclusion of this measure did not significantly change vaccine effectiveness estimates.
Collapse
Affiliation(s)
- H Keipp Talbot
- Departments of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States.
| | - Hui Nian
- Departments of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Qingxia Chen
- Departments of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Yuwei Zhu
- Departments of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Kathryn M Edwards
- Departments of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Marie R Griffin
- Departments of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States; Departments of Health Policy, Vanderbilt University Medical Center, Nashville, TN, United States; Mid-South Geriatric Research Education and Clinical Center and Clinical Research Center of Excellence, VA TN Valley Health Care System, Nashville, TN, United States
| |
Collapse
|
49
|
Dirmesropian S, Wood JG, MacIntyre CR, Newall AT. A review of economic evaluations of 13-valent pneumococcal conjugate vaccine (PCV13) in adults and the elderly. Hum Vaccin Immunother 2016; 11:818-25. [PMID: 25933180 PMCID: PMC4514194 DOI: 10.1080/21645515.2015.1011954] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
The 13-valent pneumococcal conjugated vaccine (PCV13) is already recommended for some adult groups and is being considered for wider use in many countries. In order to identify the strengths and limitations of the existing economic evaluation studies of PCV13 in adults and the elderly a literature review was conducted. The majority of the studies identified (9 out of 10) found that PCV13 was cost-effective in adults and/or the elderly. However, these results were based on assumptions that could not always be informed by robust evidence. Key uncertainties included the efficacy of PCV13 against non-invasive pneumonia and the herd immunity effect of childhood vaccination programs. Emerging trial evidence on PCV13 in adults from the Netherlands offers the ability to parameterize future economic evaluations with empirical efficacy data. However, it is important that these estimates are used thoughtfully when they are transferred to other settings.
Collapse
Affiliation(s)
- S Dirmesropian
- a School of Public Health and Community Medicine; UNSW Australia ; Sydney , NSW Australia
| | | | | | | |
Collapse
|
50
|
Musher DM, Rodriguez-Barradas MB. Why the recent ACIP recommendations regarding conjugate pneumococcal vaccine in adults may be irrelevant. Hum Vaccin Immunother 2016; 12:331-5. [PMID: 26606172 PMCID: PMC5049714 DOI: 10.1080/21645515.2015.1098794] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 09/18/2015] [Indexed: 10/22/2022] Open
Abstract
The Advisory Committee on Immunization Practices of the US Centers for Disease Control (ACIP) has recently recommended the 13-valent protein-conjugate pneumococcal vaccine (PCV13) for routine use in adults age 18-65 who have immunocompromising conditions as well as in all adults over the age of 65. By comparison to 23-valent pneumococcal polysaccharide vaccine (PPSV23), antibody responses to PCV13 are similar or modestly better one month after vaccination. The implication that PCV13 will provide more persistent immunity has been disproven; 12 months later, recipients of PPSV23 or PCV13 have identical anti-pneumococcal activity. The theoretical concept that a protein-based vaccine will be followed by a booster effect when pure polysaccharide antigens are administered is based on remarkably little evidence. The strongest objection to the current recommendations is that, since PCVs stimulate mucosal antibodies, the widespread use of these PCVs has led to a near-disappearance of vaccine serotypes from the population. This phenomenon has been amply documented for PCV7, and PCV13 is well on its way to doing the same. Thus, as US physicians are convincing their adult patients to receive 2 "pneumonia shots" instead of one, the use of PCV13 in the USA is rapidly becoming irrelevant.
Collapse
Affiliation(s)
- Daniel M. Musher
- Medical Care Line (Infectious Disease Section); Michael E. DeBakey Veterans Affairs Medical Center; Houston, TX USA
- Department of Medicine (Infectious Disease Section); Baylor College of Medicine; Houston, TX USA
- Department of Molecular Virology and Microbiology; Baylor College of Medicine; Houston, TX USA
| | - Maria B. Rodriguez-Barradas
- Medical Care Line (Infectious Disease Section); Michael E. DeBakey Veterans Affairs Medical Center; Houston, TX USA
- Department of Medicine (Infectious Disease Section); Baylor College of Medicine; Houston, TX USA
| |
Collapse
|