title: Preexisting Immunity, Not Frailty Phenotype, Predicts Influenza Postvaccination Titers among Older Veterans.
abstract: Both preexisting immunity to influenza and age have been shown to be correlates of influenza vaccine responses. Frailty, an indicator of functional impairment in older adults, was also shown in one study to predict lower influenza vaccine responses among nonveterans. In the current study, we aimed to determine the associations between frailty, preexisting immunity, and immune responses to influenza vaccine among older veterans. We studied 117 subjects (age range, 62 to 95 years [median age, 81 years]), divided into three cohorts based on the Fried frailty test, i.e., nonfrail (NF) (n= 23 [median age, 68 years]), prefrail (n= 50 [median age, 80 years]), and frail (n= 44 [median age, 82 years]), during the 2010-2011 and 2011-2012 influenza seasons. Subjects received the seasonal trivalent inactivated influenza vaccine, and baseline and postvaccination samples were obtained. Anti-influenza humoral immunity, as measured by hemagglutination inhibition (HI) and microneutralization assays, was measured for influenza B, A(H1N1)pdm09, and A(H3N2) viruses. Postvaccination titers were not different between frail and NF subjects overall in this older subset of veterans. However, preexisting HI titers were strongly correlated with postvaccination titers among all functional status groups. When microneutralization titers were compared, the association between preexisting immunity and vaccine responses varied by frailty status, with the strongest correlation being observed for the NF group. In conclusion, preexisting immunity rather than frailty appeared to predict postvaccination titers in this older veteran cohort.
authors.affiliation: Geriatric Research, Education, and Clinical Center, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio, USA puja.vanepps@va.gov.|Department of Internal Medicine, Case Western Reserve University, Cleveland, Ohio, USA.
authors.forename: Puja
authors.initials: P
authors.lastname: Van Epps
authors.affiliation: Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
authors.forename: Terrence
authors.initials: T
authors.lastname: Tumpey
authors.affiliation: Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
authors.forename: Melissa B
authors.initials: MB
authors.lastname: Pearce
authors.affiliation: Division of Viral Products, Center for Biologics Evaluation & Research (CBER), FDA, Silver Spring, Maryland, USA.
authors.forename: Hana
authors.initials: H
authors.lastname: Golding
authors.affiliation: Geriatric Research, Education, and Clinical Center, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio, USA.|School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA.
authors.forename: Patricia
authors.initials: P
authors.lastname: Higgins
authors.affiliation: Geriatric Research, Education, and Clinical Center, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio, USA.|Department of Internal Medicine, Case Western Reserve University, Cleveland, Ohio, USA.
authors.forename: Thomas
authors.initials: T
authors.lastname: Hornick
authors.affiliation: Geriatric Research, Education, and Clinical Center, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio, USA.|School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA.
authors.forename: Christopher
authors.initials: C
authors.lastname: Burant
authors.affiliation: Geriatric Research, Education, and Clinical Center, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio, USA.
authors.forename: Brigid M
authors.initials: BM
authors.lastname: Wilson
authors.affiliation: Geriatric Research, Education, and Clinical Center, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio, USA.
authors.forename: Richard
authors.initials: R
authors.lastname: Banks
authors.affiliation: Division of Geriatrics, Department of Medicine, Case Western Reserve University, Cleveland, Ohio, USA.
authors.forename: Stefan
authors.initials: S
authors.lastname: Gravenstein
authors.affiliation: Geriatric Research, Education, and Clinical Center, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio, USA.|Department of Internal Medicine, Case Western Reserve University, Cleveland, Ohio, USA.
authors.forename: David H
authors.initials: DH
authors.lastname: Canaday
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000914:Antibodies, Viral / Q000097:blood*; D005260:Female; D006385:Hemagglutination Inhibition Tests; D006801:Humans; D053118:Influenza A Virus, H1N1 Subtype / Q000276:immunology; D053122:Influenza A Virus, H3N2 Subtype / Q000276:immunology; D009981:Influenza B virus / Q000276:immunology; D007252:Influenza Vaccines / Q000008:administration & dosage / Q000276:immunology*; D007251:Influenza, Human / Q000276:immunology* / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D009500:Neutralization Tests; D015164:Vaccines, Inactivated / Q000008:administration & dosage / Q000276:immunology; D014728:Veterans
chemical_list: D000914:Antibodies, Viral; D007252:Influenza Vaccines; D015164:Vaccines, Inactivated
keywords: Frailty; influenza vaccines