Predictors of the antibody response to influenza vaccination in older adults with type 2 diabetes

Abstract

ObjectiveType 2 diabetes mellitus (T2DM) is one of the most prevalent chronic inflammatory diseases of the elderly. Its development is related to the alteration of the immune system with aging characterized by immunosenescence and inflamm-aging. In turn, T2DM also alters the immune response. As a consequence, older people with T2DM are more susceptible to influenza and to its complications as compared with healthy controls. Vaccination against influenza has shown poor efficacy in the older population and even less efficacy in patients with diabetes. We studied here the antibody response to vaccination in healthy and diabetic elderly participants.Research design and methodsIn 2 groups of elderly participants (healthy N=119 and T2DM N=102), we measured the immunogenicity of influenza vaccine by hemagglutination inhibition assays. We assessed several blood and functional parameters as potential predictors of the vaccine efficacy.ResultsWe found no difference between antibody responses in diabetic elderly compared with healthy elderly. Among the biological and functional determinants, the cytomegalovirus (CMV) serostatus played a more prominent role in determining the magnitude of response. We concluded that in addition to age and diabetic status, immunological history such as CMV status should be taken into account. None of the other biological or functional parameters studied could be reliably linked to the vaccine antibody response in older adults who are not frail including those with well-controlled diabetes.ConclusionsOur data strongly suggest that influenza vaccine should be administered to elderly patients with T2DM; however, the immune determinants of the antibody response to influenza vaccination should be further investigated.

How does cytomegalovirus factor into diseases of aging and vaccine responses, and by what mechanisms?

“…The influenza vaccine response was measured in T2D elderly individuals and compared to healthy age-matched controls (McElhaney et al 2015). Results showed no differences between T2D elderly and healthy elderly in the antibody response to the vaccine.…”

“…In this cohort, CMV did not determine per se any functional alteration in clinical and functional parameters of participating elderly individuals. In the same study (McElhaney et al 2015), the antibody response to the vaccine was compared between CMV-seropositive and CMV-seronegative elderly participants. Results showed that both healthy and T2D CMV-seropositive individuals had a significant higher response, which was unexpected, suggesting that in addition to age and diabetic status, immunological history such as CMV status should be taken into account.…”

Influenza vaccine-mediated protection in older adults: Impact of influenza infection, cytomegalovirus serostatus and vaccine dosage

“…Inconsistent findings of the impact of CMV on antibody responses to vaccination have been reported (Wald et al, 2013; Frasca et al, 2015; Furman et al, 2015; McElhaney et al, 2015; Haq et al, 2016). While the influenza B GMT was higher pre-vaccination in CMV − subjects, there was no difference in GMT fold increase (Fig.…”

“…The majority of older adults are seropositive for cytomegalovirus (CMV) (Staras et al, 2006) which may be a confounding factor in evaluating the immune response to influenza vaccination (Frasca et al, 2015; Furman et al, 2015; McElhaney et al, 2015; Haq et al, 2016). Persistent CMV infection has been shown to be a major driver of terminal differentiation of CD8 + T-cells (Derhovanessian et al, 2009; McElhaney et al, 2009).…”

Seasonal influenza vaccination of high-risk adults

“…Three clinical trials evaluating antibody responses to influenza vaccination in patients with diabetes were published in 2015 [65][66][67]. Overall, the data showed no difference in immunological efficacy across several groups varying in age and in the type of diabetes.…”