Kwetkat Anja, Heppner Hans Jürgen
Department of Geriatric Medicine, Jena University Hospital, Jena, Germany,
Faculty of Health, Witten/Herdecke University, Witten, Germany.
Interdiscip Top Gerontol Geriatr. 2020;43:73-85. doi: 10.1159/000504491. Epub 2020 Apr 9.
The following chapter is focused on the impact of comorbidities on the effectiveness of vaccination in older persons. Relevant comorbidities are cardiovascular diseases like hypertension, coronary artery disease or congestive heart failure, which lead to reduction of vaccine immunogenicity; or chronic obstructive pulmonary disease with a decline in lung function and a higher risk for pneumonia or infections due to influenza. End-stage renal disease has a high impact on developing infections and causes immune dysfunction over all parts of the immune system. Depression and dementia as well as psychological stress are associated with poor antibody response and a higher range of inflammation markers. Chronic inflammatory processes like rheumatoid arthritis also alter the immune system. In addition, geriatric syndromes and lowered functional status have implications for the vaccination response. Malnutrition is characterized by depletion of structural and functional proteins. This leads to a low antibody response. Negative immunomodulatory effects are also observed in vitamin D insufficiency. Frailty as well is associated with immunological changes and lowered performance in the activities of daily living, but moderate physical activity improves immune function.
以下章节重点关注合并症对老年人疫苗接种效果的影响。相关合并症包括心血管疾病，如高血压、冠状动脉疾病或充血性心力衰竭，这些疾病会导致疫苗免疫原性降低；或慢性阻塞性肺疾病，其肺功能下降，患肺炎或因流感感染的风险更高。终末期肾病对感染的发生有很大影响，并导致整个免疫系统的免疫功能障碍。抑郁症、痴呆症以及心理压力与抗体反应不佳和炎症标志物范围升高有关。类风湿性关节炎等慢性炎症过程也会改变免疫系统。此外，老年综合征和功能状态下降对接种反应也有影响。营养不良的特征是结构和功能蛋白的消耗。这导致抗体反应低下。维生素D不足也会观察到负性免疫调节作用。虚弱也与免疫变化和日常生活活动能力下降有关，但适度的体育活动可改善免疫功能。
