Tübingen Ageing and Tumour Immunology Group, Center for Medical Research, University of Tübingen Medical School, Waldhörnlestr. 22, D-72072 Tübingen, Germany.
Microb Biotechnol. 2012 Mar;5(2):226-32. doi: 10.1111/j.1751-7915.2011.00283.x. Epub 2011 Aug 31.
There is a general consensus that the elderly do not respond as well to vaccination as the young, but robust studies are few and far between. Most refer to influenza vaccination, but even here, adequate immunological and clinical data are surprisingly thin on the ground. The meta-analysis by Goodwin et al. from 2006 is still the most comprehensive that we have. They reviewed 31 antibody response studies comparing influenza vaccination efficacy in groups of elderly and younger adults. They reported that the adjusted odds ratio (OR) of responses in elderly versus young adults ranged from 0.24 to 0.59 for the three influenza antigens used in the vaccines. They concluded that rather than the estimated 70-90% clinical vaccine efficacy in younger adults, this figure was only 17-53% in the elderly, depending on which viruses were prevalent that year. They stated that 'this highlights the need for more immunogenic vaccine formulations for the elderly'. How to achieve this? There are three areas where we may consider alterations to increase vaccine efficacy: (i) make the vaccine more potent; (ii) use adjuvants to enhance immunity; and (iii) apply immune modulators or other interventions to alter host immunity generally. We will consider these three options, focusing on influenza vaccination, in this mini-review.
人们普遍认为，老年人对疫苗的反应不如年轻人好，但强有力的研究却很少。大多数研究都涉及流感疫苗，但即使在这里，足够的免疫学和临床数据也非常缺乏。Goodwin 等人于 2006 年进行的荟萃分析仍然是我们拥有的最全面的分析。他们回顾了 31 项抗体反应研究，比较了老年组和年轻组接种流感疫苗的效果。他们报告说，在三种流感疫苗抗原中，老年人相对于年轻人的反应调整后比值比（OR）范围为 0.24 至 0.59。他们的结论是，老年人的临床疫苗有效率估计为 70-90%，而这一数字在当年流行哪种病毒时仅为 17-53%。他们指出，“这凸显了需要为老年人开发更具免疫原性的疫苗制剂”。如何实现这一目标？我们可以考虑在以下三个方面改变以提高疫苗的效果：（i）使疫苗更有效；（ii）使用佐剂增强免疫力；（iii）应用免疫调节剂或其他干预措施来改变宿主的一般免疫。在这篇小综述中，我们将重点讨论流感疫苗接种的这三种选择。
