Effect of Medication Usage on Immune Response to Inactivated Influenza Vaccine among Residents of a Virginia Life Care Facility, 1995-96 Open Access
Gallagher, Patrick Francis (2012)
Abstract
Abstract
Effect of Medication Usage on Immune Response to Inactivated
Influenza Vaccine
among Residents of a Virginia Life Care Facility, 1995-96
Background: It is widely recognized that the immune response to
influenza vaccination
in the elderly may be influenced by medication usage. Previous
studies point to
immunosuppresants, including steroids, as medications which hinder
immune response
to influenza vaccination.
Objective: To determine if medication use is associated with the
height and persistence
of immune response to influenza vaccination in the elderly.
Methods: In 1995, in a life care facility for the elderly in
Virginia, 64 subjects received an
inactivated, trivalent influenza vaccine. In 1996, 68 subjects
received a similar vaccine at
the same facility. The majority of subjects were self-sufficient
and living in independent
apartments. Both vaccines contained A(H1N1), A(H3N2), and B
components. Blood
sera samples were collected at the time of vaccination, and 1, 2,
3, 4, 12, 20, and 28
weeks post vaccination. Hemagglutination inhibition antibody titers
were determined
from blood sera. A prospective cohort study design was employed.
All of the subjects'
medications were categorized according to their medicinal purpose
into four categories:
1) cardiac anti-hypertensives, 2) anti-inflammatory analgesics, 3)
steroids, and 4)
bronchodilators. The outcomes of interest were seroprotection and
seroconversion.
Kruskal-Wallis tests were used to examine HI antibody titers in
users of specific
medication categories compared to non-users. Chi-square tests were
used to examine
seroprotection and seroconversion in users compared to non-users.
Logistic regression
was used to determine which predictors best explained
seroprotection and
seroconversion.
Results: In both vaccine years, subjects were mostly female, over
80 years old, possessed
a normal BMI, and had received influenza vaccine each of the
previous five years. In
1995, at at least one point during the four weeks after
vaccination, 67.2% were
seroprotected against A(H1N1), 43.8% against A(H3N2), and 68.8%
against influenza B.
In 1996, at at least one point during the four weeks after
vaccination, 72.1% were
seroprotected against A(H1N1), 44.1% against A(H3N2), and 77.9%
against B. No
medications demonstrated a conclusive effect on seroprotection or
seroconversion.
Conclusions: There was no clear evidence that any medication
category examined led to a
consistent, discernible effect on immune response to the influenza
vaccine.
Table of Contents
Table of Contents
Background 1
Methods 6
Results 13
Discussion 18
References 25
Tables 29
Figures 49
Appendix I: Medication Categorization 57
Appendix II: Data Collection Form 60
Appendix III: Study Consent Agreement 64
Appendix IV: Example of Logistic Regression Procedure 67
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