Comorbidities in the Elderly and Their Possible Influence on Vaccine Response

Kwetkat, Anja; Heppner, Hans Jürgen

doi:10.1159/000504491

Cited by 37 publications

(40 citation statements)

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“…Therefore, this could explain the lack of reproducible vaccine efficacy reported from the highly controlled clinical research settings compared to the real-world settings since these individuals with comorbidities mainly constituted the real-world study population. Indeed, elderly individuals with comorbidities often have diminished immune responses to vaccines (Kwetkat and Heppner 2020).…”

Section: Discussionmentioning

confidence: 99%

Real-world effectiveness of BNT162b2 mRNA vaccine: a meta-analysis of large observational studies

Kow

Hasan

2021

Inflammopharmacol

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This paper aims to summarize through meta-analyses the overall vaccine effectiveness of the BNT162b2 mRNA vaccine from observational studies. A systematic literature search with no language restriction was performed in electronic databases to identify eligible observational studies which reported the adjusted effectiveness of the BNT162b2 mRNA vaccine to prevent RT-PCR confirmed COVID-19. Meta-analyses with the random-effects model were used to calculate the pooled hazard ratio (HR) and pooled incidence rate ratio (IRR) at 95% confidence intervals, and the vaccine effectiveness was indicated as (pooled HR − 1)/HR or (pooled IRR − 1)/IRR. Nineteen studies were included for this meta-analysis. The meta-analysis revealed significant protective effect against RT-PCR confirmed COVID-19 ≥ 14 days after the first dose, with vaccine effectiveness of 53% (95% confidence interval 32-68%), and ≥ 7 days after the second dose, with vaccine effectiveness of 95% (95% confidence interval: 96-97%). Despite its effectiveness, reporting vaccine safety data by relevant stakeholders should be encouraged as BNT162b2 mRNA is a new vaccine that has not gained full approval. There have been limited data about vaccine effectiveness among immunocompromised patients; thus, the vaccine should be used cautiously in this patient population.

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Section: Discussionmentioning

confidence: 99%

Real-world effectiveness of BNT162b2 mRNA vaccine: a meta-analysis of large observational studies

Kow

Hasan

2021

Inflammopharmacol

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“…Nonseroconverters were older and had a higher frequency of comorbidities. Although not probably the most relevant, both factors might have partially contributed to the undetectable antibody titers, as a decline in the humoral response has been described with age and comorbidities [ 20 , 21 ]. An alternative explanation for the seronegative status in COVID-19 patients might be the earlier intervention of the innate immune cells like neutrophils, interferon, or natural killer cells for viral clearance [ 1 ], before the adaptive immune response reached a significant level.…”

Section: Discussionmentioning

confidence: 99%

SARS-CoV-2 Seroconversion and Viral Clearance in Patients Hospitalized With COVID-19: Viral Load Predicts Antibody Response

Masiá

Telenti

Fernández

et al. 2021

Open Forum Infectious Diseases

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Objectives The interdependencies of viral replication and the host immune response in patients with COVID-19 remain to be defined. We investigated the viral determinants of antibody response, the predictors of non-seroconversion, and the role of antibodies on viral dynamics. Methods Prospective study in patients hospitalized with microbiologically confirmed COVID-19 by real-time polymerase-chain-reaction (RT-PCR). Serial nasopharyngeal and oropharyngeal swabs and plasma samples were obtained for measuring SARS-CoV-2 RNA and antibodies (total and S-IgG/N-IgG), respectively. Results Of 132 patients included, 99 (75%) showed positive antibody titers after a median (Q1-Q3) of 11 (8-14) days. Median (Q1-Q3) follow-up was 74.5 (63.0-87.0) days. In adjusted linear regression model, time to seropositivity was inversely associated with peak log SARS-CoV-2 viral load (p=0.009) and positively with time to viral clearance (p=0.004). Adjusted predictors of S-IgG levels were time to viral clearance (p<0.001), bilateral lung infiltrates on admission (p=0.011), and the time-dependent SARS-CoV-2 RNA (p<0.001) and SARS-CoV-2 RNA area under the curve (p=0.001). Thirty-three (25%) patients showed undetectable antibody titers. Patients who did not seroconvert had higher cycle threshold values of RT-PCR (38.0 vs 28.0; p<0.001), shorter time to viral clearance (3.0 vs 41.0; p<0.001) and were more likely to have SARS-CoV-2 only detected on fecal samples (p<0.001). Non-seroconvertors had also lower levels of blood inflammatory biomarkers on admission and lower disease severity. Conclusions Viral replication determines the magnitude of antibody response to SARS-CoV-2 that, in turn, contributes to viral clearance. COVID-19 patients who do not seroconvert exhibit a differential virological and clinical profile.

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“…These considerations suggest that the relatively higher functioning residential older adults do respond to COVID-19 vaccines, but the strength and duration of response may be shortened by sex, age, and other well-documented comorbidities (eg, cardiovascular disease, renal disease, dementia, chronic inflammatory disease). 24 , 25 Thus, we expect that residents in this population are more vaccine responsive and protected than residents in nursing homes. This is supported by findings of Canaday and colleagues who found vaccine responses absent in a significant fraction of residents in nursing homes.…”

Section: Discussionmentioning

confidence: 99%

Antibody Responses After mRNA-Based COVID-19 Vaccination in Residential Older Adults: Implications for Reopening

Nace

Kip

Mellors

et al. 2021

Journal of the American Medical Directors Association

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Objective COVID-19 disproportionately impacts residents in long-term care facilities. Our objective was to quantify the presence and magnitude of antibody response in vaccinated, older adult residents at assisted living, personal care, and independent living communities. Design A cross-sectional quality improvement study was conducted March 15 – April 1, 2021 in the greater Pittsburgh region. Setting and Population: Participants were older adult residents at assisted living, personal care, and independent living communities, who received mRNA-based COVID-19 vaccine. Conditions that impair immune responses were exclusionary criteria. Methods Sera were collected to measure IgG anti-SARS-CoV-2 antibody level with reflex to total anti-SARS-CoV-2 immunoglobulin levels, and blinded evaluation of SARS-CoV-2 pseudovirus neutralization titers. Descriptive statistics, Pearson correlation coefficients, and multiple linear regression analysis evaluated relationships between factors potentially associated with antibody levels. Spearman correlations were calculated between antibody levels and neutralization titers. Results All participants (N = 70) had received two rounds of vaccination and were found to have antibodies with wide variation in relative levels. Antibody levels trended lower in males, advanced age, current use of steroids, and longer length of time from vaccination. Pseudovirus neutralization titer levels were strongly correlated ( P < .001) with Beckman Coulter antibody levels (D614 G NT50, r s = 0.91; B.1.1.7 [UK] NT50, r s = 0.91). Conclusions and Implications Higher functioning, healthier, residential older adults mounted detectable antibody responses when vaccinated with mRNA-based COVID-19 vaccines. Data suggests some degree of immunity is present during the immediate period following vaccination. However, protective effects remain to be determined in larger studies as clinical protection is afforded by ongoing adaptive immunity, which is known to be decreased in older adults. This study provides important preliminary results on level of population risk in older adult residents at assisted living, personal care, and independent living communities to inform reopening strategies, but are not likely to be translatable for residents in nursing homes.

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Comorbidities in the Elderly and Their Possible Influence on Vaccine Response

Cited by 37 publications

References 0 publications

Real-world effectiveness of BNT162b2 mRNA vaccine: a meta-analysis of large observational studies

Real-world effectiveness of BNT162b2 mRNA vaccine: a meta-analysis of large observational studies

SARS-CoV-2 Seroconversion and Viral Clearance in Patients Hospitalized With COVID-19: Viral Load Predicts Antibody Response

Antibody Responses After mRNA-Based COVID-19 Vaccination in Residential Older Adults: Implications for Reopening

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