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Danuta M. Skowronski, S. Aleina Tweed, S. Aleina Tweed, Gaston De Serres, Rapid Decline of Influenza Vaccine—Induced Antibody in the Elderly: Is It Real, or Is It Relevant?, The Journal of Infectious Diseases, Volume 197, Issue 4, 15 February 2008, Pages 490–502, https://doi.org/10.1086/524146
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Abstract
Advisory committees have cautioned that influenza vaccine-induced antibody declines more rapidly in the elderly, falling below seroprotective levels within 4 months.Weconducted a literature review to assess this assertion. The articles that were included in this review reported antibody levels ⩾4 months after influenza immunization in persons ⩾60 years old, interpretable in the Medicinal Products (CPMP) for the elderly. The final review included 14 studies; 8 of which reported seroprotection rates. Seroprotection exceedingCPMPcriteria was maintained ⩾4 months after influenza immunization in all 8 of the studies reporting this for the H3N2 component and in 5 of the 7 studies reporting this for the H1N1 and B components. In determining whether CPMP criteria were met at season's end, primary antibody response appeared to be more relevant than secondary antibody decline. Both studies reporting seroprotection rates that failed CPMP criteria ⩾4 months after influenza immunization for each of the H1N1 and B components had also reported failed seroprotection at 1 month after immunization. If initially achieved after immunization, seroprotection rates of 70%–100% were maintained not just at 4 months (2 studies) but also at 5 months (2 studies) and even at >6 months (4 studies), for the H3N2 and H1N1 vaccine components. Seroprotection rates appeared less consistent for the B vaccine component, throughout the postimmunization period. Seroconversion appears to vary substantially and inversely with preimmunization titers but not with age. In 2 of 6 studies reporting seroconversion alone,CPMPcriteria were still met at 4 months. In the other 4 studies, the main reason for failure at 4 months was primary failure at 1 month. A total of 6 studies compared antibody persistence by age, and no consistent differences were found on that basis. The historic concern that the influenza vaccine-induced antibody response in the elderly declines more rapidly and below seroprotective levels within 4 months of immunization should be reconsidered.
