Section on Geriatric Medicine, Department of Internal Medicine, Wake Forest University School of Medicine, Winston Salem, North Carolina, USA.
Section on Infectious Diseases, Department of Internal Medicine, Wake Forest University School of Medicine, Winston Salem, North Carolina, USA.
J Gerontol A Biol Sci Med Sci. 2022 Jul 5;77(7):1366-1370. doi: 10.1093/gerona/glac095.
COVID-19 has disproportionately affected older adults. Frailty has been associated with impaired vaccine response in other vaccine types, but the impact of frailty on mRNA vaccine response is undefined.
Observational study of adults aged 55 and older from 1 U.S. health care system between January 22, 2021 and September 16, 2021 with self-reported Moderna or Pfizer COVID-19 mRNA vaccine and an electronic frailty index (eFI) score from their medical record (n = 1 677). Participants' frailty status was compared with positive antibody detection (seroconversion) following full vaccination and subsequent loss of positive antibody detection (seroreversion) using logistic regression models.
Of 1 677 older adults with median (interquartile range) age, 67 (62 and 72) years, and frailty status (nonfrail: 879 [52%], prefrail: 678 [40%], and frail: 120 [7.2%]), seroconversion was not detected in 23 (1.4%) over 60 days following full vaccination. Frail individuals were less likely to seroconvert than nonfrail individuals, adjusted odds ratio (OR) 3.75, 95% confidence interval (CI; 1.04, 13.5). Seroreversion was detected in 50/1 631 individuals (3.1%) over 6 months of median follow-up antibody testing. Frail individuals were more likely to serorevert than nonfrail individuals, adjusted OR 3.02, 95% CI (1.17, 7.33).
Overall antibody response to COVID-19 mRNA vaccination was high across age and frailty categories. While antibody detection is an incomplete descriptor of vaccine response, the high sensitivity of this antibody combined with health-system data reinforce our conclusions that frailty is an independent predictor of impaired antibody response to the COVID-19 mRNA vaccines. Frailty should be considered in vaccine studies and prevention strategies.
COVID-19 对老年人的影响不成比例。在其他类型的疫苗中，衰弱与疫苗反应受损有关，但衰弱对 mRNA 疫苗反应的影响尚不清楚。
对 2021 年 1 月 22 日至 2021 年 9 月 16 日期间，1 家美国医疗保健系统中年龄在 55 岁及以上、自我报告接种 Moderna 或 Pfizer COVID-19 mRNA 疫苗且病历中有电子衰弱指数（eFI）评分的成年人（n=1677）进行观察性研究。使用逻辑回归模型比较参与者的衰弱状态与完全接种疫苗后的抗体检测阳性（血清转化）以及随后的抗体检测阳性丧失（血清逆转）。
在 1677 名年龄中位数（四分位距）为 67（62 和 72）岁且衰弱状态（非衰弱：879[52%]，衰弱前期：678[40%]，衰弱：120[7.2%]）的老年人中，完全接种疫苗后 60 天内未检测到 23 例（1.4%）血清转化。与非衰弱者相比，衰弱者血清转化率较低，调整后的优势比（OR）为 3.75，95%置信区间（CI）为 1.04~13.5。在中位随访抗体检测 6 个月期间，检测到 50/1631 名个体（3.1%）血清逆转。与非衰弱者相比，衰弱者血清逆转率更高，调整后的 OR 为 3.02，95%CI（1.17，7.33）。
在年龄和衰弱类别中，COVID-19 mRNA 疫苗接种的总体抗体反应较高。虽然抗体检测是疫苗反应的不完全描述符，但这种抗体的高灵敏度以及基于健康系统的数据均强化了我们的结论，即衰弱是 COVID-19 mRNA 疫苗抗体反应受损的独立预测因子。在疫苗研究和预防策略中应考虑衰弱。
