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Cited by 144Pneumonia and Respiratory InfectionsBacterial Infections and VaccinesImmunodeficiency and Autoimmune Disorders

Immunological responses to pneumococcal vaccine in frail older people

Ridda, I., MacIntyre, C.R., Lindley, R., Gao, Z., Sullivan, J.S., Yuan, F.F., McIntyre, P.B.·2009·Vaccine
DOI 10.1016/j.vaccine.2008.11.098
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Abstract

Unlabelled Advanced age has been associated with a wide range of defects in both the innate and adaptive immune systems including diminished specific antibody responses that increase the risk of invasive pneumococcal disease (IPD) and limit the effectiveness of vaccines. However, the elderly are a heterogeneous group and measures of overall frailty may be a better indicator of disease susceptibility (or vaccine response) than chronological age alone.Aim To evaluate the immunogenicity of the 7-valent conjugated pneumococcal vaccine (PCV7) versus 23-valent polysaccharide vaccine (23vPPV) and compare the immune response to four serotypes (4, 6B, 18C and 19F), with respect to age or frailty in an elderly population of previously unvaccinated hospitalized patients.Method 241 patients aged 60 years and over, recruited between 16 May 2005 and 20 February 2006, were randomised to 23PPV or PCV7 vaccine. We measured Frailty Index (FI), Barthel index and the MiniMental State. Serotype-specific IgG was measured by ELISA at base line and 6 months after vaccination. Antibody responses were defined by the ratio of post-vaccination to pre-vaccination IgG antibody concentration (poor < 2-fold increase, acceptable > or = 2.0 to 3.99-fold and strong > or = 4.0-fold increase).Results Pre-immunization IgG was generally low and did not differ significantly by age or frailty. Post-immunization, IgG increased to all four serotypes; acceptable or strong response ranged between 29% for (6B) and 57% for (18C). There was no significant difference between the two vaccine types (23PPV versus PCV7). At 6 months post-vaccination, the highest geometric mean IgG concentrations (GMCs) were seen for serotype 19F and the lowest for serotype 4. Although there was some variation by serotype, responses after vaccination were lowest in the most frail or aged subjects.Conclusions Pneumococcal vaccines are perceived to offer low protection in the frail elderly, but our study showed that the proportion of this vulnerable population with acceptable responses is encouraging. Frailty, as measured by the Frailty Index, appears to be a better predictor of immune response to pneumococcal vaccines than age alone.

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  • Frailty is linked to weaker antibody responses to influenza and pneumococcal vaccines, which may explain why vaccination benefits older people only modestly.

    “Furthermore, frailty is associated with an impaired antibody response to influenza (63) and pneumococcal vaccine (64), which helps explain the observation that vaccination in older people is associated with only relatively modest clinical effectiveness (65).”

    From Frailty in elderly people (2013) · cites this paper as [64]

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Authors
Ridda, I., MacIntyre, C. R., Lindley, R., Gao, Z., Sullivan, J. S., Yuan, F. F., & McIntyre, P. B.
Affiliations
  • The University of Sydney (AU)
  • UNSW Sydney (AU)
  • National Centre for Immunisation Research & Surveillance (AU)
Corresponding author
Ridda, I.
ORCID
Venue
Vaccine
Publisher
Elsevier BV
Published
2009-03
Volume
27
Issue
10
Pages
1628-1636
ISSN
0264-410X (ISSN-L)
DOI
10.1016/j.vaccine.2008.11.098
OpenAlex
W1997721806
Cited by
144
References
38
Citations by year
2026: 3 · 2025: 3 · 2024: 5 · 2023: 3 · 2022: 8 · 2021: 9 · 2020: 5 · 2019: 8 · 2018: 5 · 2017: 11 · 2016: 8 · 2015: 6 · 2014: 7 · 2013: 13 · 2012: 18
FWCI
7.92
Type
journal article
Language
en
Open access
closed
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • Vaccine (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Epidemiology › Pneumonia and Respiratory Infections
  • Life Sciences › Immunology and Microbiology › Microbiology › Bacterial Infections and Vaccines
  • Life Sciences › Immunology and Microbiology › Immunology › Immunodeficiency and Autoimmune Disorders
Keywords
pneumococcal vaccine, immunogenicity, frailty, older adults, 7-valent conjugate vaccine, 23-valent pneumococcal polysaccharide vaccine, serotype-specific IgG, frailty index, serotype 19F, serotype 4, serotype 6B, serotype 18C, hospitalized older adults, vaccine response
MeSH terms
Heptavalent Pneumococcal Conjugate Vaccine, Aged, Aged, 80 and over, Antibodies, Bacterial, Female, Humans, Immunoglobulin G, Male, Middle Aged, Pneumococcal Infections, Streptococcus pneumoniae, Frail Elderly, Pneumococcal Vaccines

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