Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands.
Vaccine. 2011 Jun 24;29(29-30):4869-74. doi: 10.1016/j.vaccine.2011.03.086. Epub 2011 Apr 15.
Ample evidence suggests that infection with cytomegalovirus (CMV) leads to accelerated aging of the immune system and may contribute to poor responsiveness to influenza vaccination in older persons. The objective of this study was to investigate whether CMV infection, acquired earlier in life, affects the response to influenza vaccination in a randomized controlled trial among older persons in long-term care facilities. During the 1997-1998 influenza season, 731 residents (median age 83 [interquartile range 78-88], 75.4% female) in 14 long-term care facilities in the Netherlands were randomly assigned to receive 15 or 30 μg of inactivated influenza vaccine, followed by a 15 μg booster vaccine or a placebo vaccine at day 84. Blood samples were collected at day 0, day 25, day 84 and day 109. Seroresponses to influenza vaccination were measured by hemagglutination-inhibition tests to the A/H3N2 strain at all time points. Subsequently, baseline levels of IgG anti-CMV antibodies were measured using an automated chemiluminescent microparticle immunoassay. Participants with CMV antibody level≥6 AU/mL were considered to harbor CMV infection. At baseline, no differences in pre-vaccination geometric mean antibody titers (GMT) were observed between participants with (n=571, 78.1%) or without CMV infection (n=160, 21.9%). During follow-up, participants with and without CMV infection had similar responses to influenza vaccination as measured with changes in GMT (linear mixed model, adjusted for gender, age, pre-vaccination GMT and vaccination strategy, p=0.46). Analogously, no association was found between CMV infection and a more than 4-fold increase in antibody titer (Generalized Estimating Equations, adjusted OR 1.14 [95%CI 0.80;1.64]) or an antibody titer≥40 (adjusted OR 1.24 [95%CI 0.86;1.80]). In conclusion, CMV infection did not explain poor responsiveness to influenza vaccination in residents of long-term care facilities.
大量证据表明，巨细胞病毒（CMV）感染会导致免疫系统加速衰老，并可能导致老年人对流感疫苗的反应不佳。本研究旨在探讨生命早期获得的 CMV 感染是否会影响长期护理机构中老年人的流感疫苗接种反应，并进行了一项随机对照试验。在 1997-1998 年流感季节期间，荷兰 14 家长期护理机构的 731 名居民（中位年龄 83 [四分位间距 78-88]，75.4%为女性）被随机分配接受 15 或 30μg 灭活流感疫苗，随后在第 84 天和第 109 天接受 15μg 加强疫苗或安慰剂疫苗。在第 0 天、第 25 天、第 84 天和第 109 天采集血样。通过血凝抑制试验测量接种流感疫苗后的血清反应，所有时间点均针对 A/H3N2 株进行测量。随后，使用自动化化学发光微粒子免疫测定法测量 IgG 抗 CMV 抗体的基线水平。CMV 抗体水平≥6 AU/mL 的参与者被认为感染了 CMV。在基线时，在接种疫苗前几何平均抗体滴度（GMT）方面，CMV 感染参与者（n=571，78.1%）和无 CMV 感染参与者（n=160，21.9%）之间没有差异。在随访期间，CMV 感染参与者和无 CMV 感染参与者的流感疫苗接种反应相似，GMT 变化（线性混合模型，性别、年龄、接种前 GMT 和接种策略调整，p=0.46）。同样，CMV 感染与抗体滴度增加 4 倍以上（广义估计方程，调整后的 OR 1.14 [95%CI 0.80；1.64]）或抗体滴度≥40（调整后的 OR 1.24 [95%CI 0.86；1.80]）之间没有关联。综上所述，CMV 感染并不能解释长期护理机构居民对流感疫苗的反应不佳。
