The intersection of biological sex and gender in adverse events following seasonal influenza vaccination in older adults

Factors determining first influenza vaccination among individuals with type 2 diabetes in the CONSTANCES cohort by age group (younger than 65 years or 65 and older)

Vaccine coverage against influenza is suboptimal among people with diabetes. Our principal objective was to study and compare the factors related to a first influenza vaccination in individuals with type 2 diabetes according to age group (<65 years and ≥ 65 years) and then to compare the older age group with diabetes to the general population of that age. This is a descriptive cross-sectional study within the French Constances cohort. The study populations were composed of people with type 2 diabetes and individuals without diabetes 65 years and older. Our variable of interest was the first reimbursement for a vaccine against influenza over the period from 2009 to 2019. We identified 2540 cohort members with type 2 diabetes (<65 years n = 1583; ≥65 years n = 957). The population without diabetes (≥65 years) comprised 18,364 individuals. The factors related to the first influenza vaccination differed significantly between the persons with diabetes younger than 65 years and those aged at least 65 years: age (OR = 1.01/OR = 0.89-P-interaction<0.001), poor perceived health (OR = 1.24/OR = 0.79-P-interaction = 0.048), and indicators of diabetes treatment quality [at least 2 hbA1c assays/year (OR = 1.91/0 R = 0.90-P-interaction<0.001), and blood pressure < 140/90 (OR = 1.24/OR = 0.90-P-interaction = 0.059)]. The only factor related to first influenza vaccination significantly different between individuals aged at least 65 years with and without diabetes was age (OR = 0.83/OR = 1.05-P-interaction<0.001). This study shows that trials are now needed to test the effectiveness of age- and sex-specific messages to increase influenza vaccination coverage among people with diabetes.

New-onset anesthesia/paresthesia following the administration of COVID-19 vaccines in Quebec, Canada

INTRODUCTION

In Canada, anesthesia/paresthesia were the most frequently reported adverse events following immunization (AEFI) against SARS-CoV-2. This study aims to describe the frequency and characteristics of anesthesia/paresthesia cases temporally associated with a first or second dose of COVID-19 vaccines administered in Quebec, Canada.

METHODS

Cases were extracted among AEFI reports submitted to the passive surveillance system. Sociodemographic, vaccination and AEFI information were obtained from the immunization registry. Signs, symptoms and anatomical location were manually extracted from clinical narratives.

RESULTS

From December 13, 2020 to December 31, 2022, 15.2 million doses of vaccines were administered in Quebec. By July 1, 2022, 1024 cases of anesthesia/paresthesia following COVID-19 vaccination had been reported. The global reporting rate was 7.7 per 100,000 doses administered. Rates were higher with the first than the second dose (11.4 vs. 3.8 per 100,000 doses), and higher with ChAdOx1 than with mRNA vaccines Comirnaty™ (BNT-162b2, Pfizer BioNTech) or Spikevax™ (mRNA-1273, Moderna) (28.7 vs. 6.1 and 7.9, respectively). Rates were 3- to 4-times higher in women, with the highest rate ratios among those 18-49 years of age. Median time to onset was 24 h (IQR: 3-96). Paresthesia, hypoesthesia/anesthesia (83 %) were more common than dysesthesias (13 %). Symptoms were reported mostly in upper limbs (62 %), but also frequently in lower limbs (47 %) or the face (42 %). Most reported mild (41 %) or moderate (48 %) symptoms, with a median duration of 5 days (IQR: 2-15), although symptoms lasting 1-5 months (12 %) or over 6 months (1 %) were also reported.

CONCLUSION

Symptoms of anesthesia/paresthesia are commonly reported following the administration of several vaccines, including those against COVID-19. In most instances, symptoms occur shortly after vaccination, have a limited impact on daily activities, and resolve spontaneously within a month of onset. A small proportion of cases report sensory and/or motor symptom of longer duration, which remain undiagnosed following neurological investigations. Despite being a common occurrence, post-vaccination sensory disturbances remain a poorly understood phenomenon that warrants further study.

Applicability of Retrospective and Prospective Gender Scores for Clinical and Health Data: Protocol for a Scoping Review

BACKGROUND

Gender is known to have a strong influence on human health and disease. Despite its relevance to treatment and outcome, gender is insufficiently considered in current health research. One hindering factor is the poor representation of gender information in clinical and health (meta) data.

OBJECTIVE

We aim to conduct a scoping review of the literature describing gender scores. The review will provide insights into the current application of gender scores in clinical and health settings. The protocol describes how relevant literature will be identified and how gender scores will be evaluated concerning applicability and usability in scientific investigations.

METHODS

Our scoping review follows the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. A title and abstract screening was conducted on PubMed, followed by a full-text screening. The inclusion and exclusion criteria were discussed by a team of 5 domain experts, and a data-charting form was developed. The charted data will be categorized, summarized, and analyzed based on the research questions during the scoping review.

RESULTS

We will report our research results according to the PRISMA-ScR guidelines. The literature retrieval was carried out on June 13, 2024, and resulted in 1202 matches. As of July 2024, the scoping review is in the data extraction phase and we expect to complete and publish the results in the first quarter of 2025.

CONCLUSIONS

The scoping review lays the foundation for a retrospective gender assessment by identifying scores that can be applied to existing large-scale datasets. Moreover, it will help to formulate recommendations for standardized gender scores in future investigations.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/57669.

Reconsidering tools for measuring gender dimensions in biomedical research

Sex and gender play important roles in contributing to disease and health outcomes and represent essential, but often overlooked, measures in biomedical research. The context-specific, multifaceted, and relational nature of gender norms, roles, and relations (i.e., gender dimensions) make their incorporation into biomedical research challenging. Gender scores-measures of gender dimensions-can help researchers incorporate gender into quantitative methodologies. These measures enable researchers to quantify the gendered dimensions of interest using data collected from survey respondents. To highlight the complexities of using gender scores within biomedical research, we used the application of the Bem Sex Role Inventory (BSRI) scale, a commonly used gender score, to explore gender differences in adverse events to the influenza vaccine among older adults (75+). Within this paper, we focus on the findings from our longitudinal gender score data collected over three influenza seasons (2019-20, 2020-21, and 2021-22), irrespective of adverse event data, to provide commentary on the reliability of gender scores, such as the BSRI, and the complexities of their application. Of the 162 total study participants included within the study, 69 were enrolled in all three consecutive seasons and 35 participants were enrolled in two consecutive seasons. The majority of participants had a different gender score in at least one of the years, demonstrating the nuances and fluidity of gender identity. Interpretations of BSRI data (or other gender score data) when measured against outcome data must, therefore, be time and context specific, as results are unlikely to be replicated across years.

Sex and gender differences in adverse events following influenza and COVID-19 vaccination

INTRODUCTION

Active and passive surveillance studies have found that a greater proportion of females report adverse events (AE) following receipt of either the COVID-19 or seasonal influenza vaccine compared to males. In a predominately young adult female population of healthcare workers, we sought to determine the intersection of biological sex and sociocultural gender differences in prospective active reporting of vaccine outcomes, which remains poorly characterized.

METHODS

This cohort study enrolled Johns Hopkins Health System healthcare workers (HCWs) who were recruited from the mandatory annual fall 2019-2022 influenza vaccine and the fall 2022 COVID-19 bivalent vaccine campaigns. Vaccine recipients were enrolled the day of vaccination and AE surveys were administered two days post-vaccination for bivalent COVID-19 and influenza vaccine recipients. Data were collected regarding the presence of a series of solicited local and systemic AEs. Open-ended answers about participants' experiences with AEs also were collected for the COVID-19 vaccine recipients.

RESULTS

Females were more likely to report local AEs after either influenza (OR = 2.28, p = 0.001) or COVID-19 (OR = 2.57, p = 0.008) vaccination compared to males, regardless of age or race. Males and females had comparable probabilities of reporting systemic AEs after either influenza (OR = 1.18, p = 0.552) or COVID-19 (OR = 0.96, p = 0.907) vaccination. Hormonal birth control use did not impact the rates of reported AEs following influenza vaccination among reproductive-aged female HCWs. Women reported more interruptions in their daily routine following COVID-19 vaccination than men and were more likely to seek out self-treatment. More women than men scheduled their COVID-19 vaccination before their days off in anticipation of AEs.

CONCLUSIONS

Our findings highlight the need for sex- and gender-inclusive policies to inform more effective mandatory occupational health vaccination strategies. Further research is needed to evaluate the potential disruption of AEs on occupational responsibilities following mandated vaccination for healthcare workers, a predominately female population, and to more fully characterize the post-vaccination behavioral differences between men and women.

Immune Cells, Gut Microbiota, and Vaccines: A Gender Perspective

The development of preventive and therapeutic vaccines has played a crucial role in preventing infections and treating chronic and non-communicable diseases, respectively. For a long time, the influence of sex differences on modifying health and disease has not been addressed in clinical and preclinical studies. The interaction of genetic, epigenetic, and hormonal factors plays a role in the sex-related differences in the epidemiology of diseases, clinical manifestations, and the response to treatment. Moreover, sex is one of the leading factors influencing the gut microbiota composition, which could further explain the different predisposition to diseases in men and women. In the same way, differences between sexes occur also in the immune response to vaccines. This narrative review aims to highlight these differences, focusing on the immune response to vaccines. Comparative data about immune responses, vaccine effectiveness, and side effects are reviewed. Hence, the intricate interplay between sex, immunity, and the gut microbiota will be discussed for its potential role in the response to vaccination. Embracing a sex-oriented perspective in research may improve the efficacy of the immune response and allow the design of tailored vaccine schedules.

Sex and gender differences in adverse events following receipt of influenza and COVID-19 vaccination among healthcare workers

Introduction

Active and passive surveillance studies have found that a greater proportion of females report adverse events (AE) following receipt of either the COVID-19 or seasonal influenza vaccine compared to males. We sought to determine the intersection of biological sex and sociocultural gender differences in prospective active reporting of vaccine outcomes, which remains poorly characterized.

Methods

This cohort study enrolled Johns Hopkins Health System healthcare workers (HCWs) who were recruited from the annual fall 2019-2022 influenza vaccine and the fall 2022 COVID-19 bivalent vaccine campaigns. Vaccine recipients were enrolled the day of vaccination and AE surveys were administered two days post-vaccination (DPV) for bivalent COVID-19 and Influenza vaccine recipients. Data were collected regarding the presence of a series of solicited local and systemic AEs. Open-ended answers about participants' experiences with AEs also were collected for the COVID-19 vaccine recipients.

Results

Females were more likely to report local AEs after influenza (OR=2.28, p=0.001) or COVID-19 (OR=2.57, p=0.008) vaccination compared to males, regardless of age or race. Males and females had comparable probabilities of reporting systemic AEs after influenza (OR=1.18, p=0.552) or COVID-19 (OR=0.96, p=0.907) vaccination. Exogenous hormones from birth control use did not impact the rates of reported AEs following COVID-19 vaccination among reproductive-aged female HCWs. Women reported more interruptions in their daily routine following COVID-19 vaccination than men and were more likely to seek out self-treatment. More women than men scheduled their COVID-19 vaccination before their days off in anticipation of AEs.

Conclusions

Our findings highlight the need for sex- and gender-inclusive policies to inform more effective occupational health vaccination strategies. Further research is needed to evaluate the potential disruption of AEs on occupational responsibilities following mandated vaccination for healthcare workers and to more fully characterize the post-vaccination behavioral differences between men and women.

KEY MESSAGE

What is already known on this topic: ⇒ Among diversely aged adults 18-64 years, females report more AEs to vaccines, including the influenza and COVID-19 vaccines, than males.⇒ Vaccine AEs play a role in shaping vaccine hesitancy and uptake.⇒ Vaccine uptake related to influenza and COVID-19 are higher among men than women.⇒ Research that addresses both the sex and gender disparities of vaccine outcomes and behaviors is lacking.What this study adds: ⇒ This prospective active reporting study uses both quantitative and qualitative survey data to examine sex and gender differences in AEs following influenza or COVID-19 vaccination among a cohort of reproductive-aged healthcare workers.How this study might affect research, practice, or policy: ⇒ Sex and gender differences in AEs and perceptions relating to vaccination should drive the development of more equitable and effective vaccine strategies and policies in occupational health settings.

SARS-CoV-2 mucosal vaccine protects against clinical disease with sex bias in efficacy

Intranasal mucosal vaccines can more effectively induce mucosal immune responses against SARS-CoV-2. Here, we show in hamsters that an intranasal subunit mucosal vaccine boost with the beta variant S1 can prevent weight loss, in addition to reducing viral load, which cannot be studied in macaques that don't develop COVID-like disease. Protective efficacy against both viral load and weight loss correlated with serum antibody titers. A sex bias was detected in that immune responses and protection against viral load were greater in females than males. We also found that priming with S1 from the Wuhan strain elicited lower humoral immune responses against beta variant and led to less protection against beta viral challenge, suggesting the importance of matched antigens. The greater efficacy of mucosal vaccines in the upper respiratory tract and the need to consider sex differences in vaccine protection are important in the development of future improved COVID-19 vaccines.