title: Immune response to influenza vaccine in the elderly: association with nutritional and physical status.
abstract: OBJECTIVE
  To investigate the distribution of hemagglutination inhibition (HI) titers before and after influenza vaccination and to examine the relationship between physical and nutritional factors and the change in HI titer after influenza vaccination in the elderly.
  
  
  METHODS
  Pre-post-vaccination HI titers were determined from 203 individuals aged 65 years or older residing in a nursing home. For the assessment of physical and nutritional status, information was retrieved from care records.
  
  
  RESULTS
  The immune response to vaccination was assessed as good in 122 subjects based on a fourfold rise or more in HI titer after vaccination for at least one of three vaccine strains. In univariate logistic regression analysis with poor versus good immune response as the dependent variable, factors found to be significantly associated with a poor immune response were disability, a combination of body mass index less than 18.5 and bodyweight loss in 6 months or 5% or more, mid-upper-arm circumference of less than 80%, arm muscle circumference of less than 80% and total protein of less than 6.5 g/dL. Physical and nutritional indicators might be useful in identifying individuals who are unlikely to have a good immune response to influenza vaccination. In a multivariate analysis, the association remained significant for a low level of activities of daily living and a combination of body mass index of less than 18.5 and bodyweight loss in 6 months of 5% or more.
  
  
  CONCLUSIONS
  Elderly individuals with poor physical and nutritional status tended to respond poorly to influenza vaccination. A low level of activities of daily living and a combination of being underweight and having had recent bodyweight loss are good indicators of a poor immune response.
authors.affiliation: Department of Public Health, Graduate School of Medicine, Tokyo Women's Medical University, Ome Keiyu Hospital, Tokyo, Japan.
authors.forename: Masano
authors.initials: M
authors.lastname: Sagawa
authors.forename: Noriko
authors.initials: N
authors.lastname: Kojimahara
authors.forename: Nobuo
authors.initials: N
authors.lastname: Otsuka
authors.forename: Mitsuru
authors.initials: M
authors.lastname: Kimura
authors.forename: Naohito
authors.initials: N
authors.lastname: Yamaguchi
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007109:Immunity / Q000187:drug effects*; D007252:Influenza Vaccines / Q000494:pharmacology*; D007251:Influenza, Human / Q000276:immunology / Q000517:prevention & control*; D008297:Male; D009752:Nutritional Status / Q000276:immunology*; D014611:Vaccination
chemical_list: D007252:Influenza Vaccines