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Trombetta CM, Accardi G, Aiello A, Calabrò A, Caruso C, Ligotti ME, Marchi S, Montomoli E, Neto MM, Temperton N, Candore G. Centenarians, semi and supercentenarians, COVID-19 and Spanish flu: a serological assessment to gain insight into the resilience of older centenarians to COVID-19. Immun Ageing 2024; 21:44. [PMID: 38937774 PMCID: PMC11210044 DOI: 10.1186/s12979-024-00450-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Accepted: 06/21/2024] [Indexed: 06/29/2024]
Abstract
BACKGROUND Although it is well known that the older people have been the most susceptible to COVID-19, there are conflicting data on the susceptibility of centenarians. Two epidemiological study have shown that older centenarians (> 101 years old at the time of the 2020 pandemic peak) are more resilient than the remaining centenarians, suggesting that this resilience might be linked to the 1918 Spanish Flu pandemic. To gain insight into this matter, specifically whether the resilience of older centenarians to SARS-CoV-2 infection is linked to the Spanish Flu they had been affected by, we conducted a retrospective serological study. This study examined serum samples from 33 centenarians, encompassing semi- (aged > 104 < 110 years, N = 7) and supercentenarians (aged > 109 years, N = 4), born between 1905 and 1922, against both SARS-CoV-2 and 1918 H1N1 pseudotype virus. RESULTS Anamnestic and laboratory data suggest that SARS-CoV-2 infection occurred in 8 centenarians. The infection appeared to have been asymptomatic or mild, and hospitalization was not required, despite 3 out of 8 being between 109 and 110 years old. The levels of anti-spike antibodies in centenarians infected and/or vaccinated were higher, although not significantly, than those produced by a random sample of seventy-year-old individuals used as controls. All centenarians had antibody levels against the 1918 H1N1 virus significantly higher (almost 50 times) than those observed in the quoted group of seventy-year-old subjects, confirming the key role in maintaining immunological memory from a priming that occurred over 100 years ago. Centenarians whose blood was collected prior to the pandemic outbreak demonstrated neutralising antibodies against the 1918 H1N1 virus, but all these subjects tested negative for SARS-CoV-2. CONCLUSION This retrospective study shows that older centenarians are quite resilient to COVID-19, as they are capable of producing good levels of neutralising antibodies and experiencing mild or asymptomatic disease. This could be attributed to the 1918 Spanish flu pandemic through mechanisms other than the presence of cross-reactive antibodies between the 1918 H1N1 virus and SARS-CoV-2. Another possibility is that the association is purely temporal, solely correlated with the advanced age of resilient centenarians compared to those born after 1918, since older centenarians are known to have better control of immune-inflammatory responses.
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Affiliation(s)
- Claudia Maria Trombetta
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
- VisMederi Research srl, Siena, Italy
| | - Giulia Accardi
- Laboratory of Immunopathology and Immunosenescence, Department of Biomedicine, Neurosciences and Advanced Diagnostics, University of Palermo, Palermo, Italy
| | - Anna Aiello
- Laboratory of Immunopathology and Immunosenescence, Department of Biomedicine, Neurosciences and Advanced Diagnostics, University of Palermo, Palermo, Italy
| | - Anna Calabrò
- Laboratory of Immunopathology and Immunosenescence, Department of Biomedicine, Neurosciences and Advanced Diagnostics, University of Palermo, Palermo, Italy
| | - Calogero Caruso
- Laboratory of Immunopathology and Immunosenescence, Department of Biomedicine, Neurosciences and Advanced Diagnostics, University of Palermo, Palermo, Italy.
| | - Mattia Emanuela Ligotti
- Laboratory of Immunopathology and Immunosenescence, Department of Biomedicine, Neurosciences and Advanced Diagnostics, University of Palermo, Palermo, Italy
- Department of Research, ISMETT-IRCCS Mediterranean Institute forTransplants and Highly Specialized Therapies, Palermo, Italy
| | - Serena Marchi
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - Emanuele Montomoli
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
- VisMederi Research srl, Siena, Italy
- VisMederi srl, Siena, Italy
| | - Martin Mayora Neto
- Viral Pseudotype Unit, Medway School of Pharmacy, University of Kent, Kent, UK
| | - Nigel Temperton
- Viral Pseudotype Unit, Medway School of Pharmacy, University of Kent, Kent, UK
| | - Giuseppina Candore
- Laboratory of Immunopathology and Immunosenescence, Department of Biomedicine, Neurosciences and Advanced Diagnostics, University of Palermo, Palermo, Italy
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Espinar-Buitrago MS, Tarancon-Diez L, Vazquez-Alejo E, Magro-Lopez E, Genebat M, Romero-Candau F, Leal M, Muñoz-Fernandez MA. The use of alpha 1 thymosin as an immunomodulator of the response against SARS-Cov2. Immun Ageing 2023; 20:32. [PMID: 37408063 DOI: 10.1186/s12979-023-00351-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 06/06/2023] [Indexed: 07/07/2023]
Abstract
BACKGROUND Since the beginning of SARS-CoV2 pandemic, the mortality rate among elderly patients (60-90 years) has been around 50%, so age has been a determining factor of a worse COVID-19 prognosis. Associated with age, the thymic function involution and depletion plays an important role, that could be related to a dysregulated and ineffective innate and adaptive immune response against SARS-CoV2. Our study aims to further in vitro effect of human Thymosin-alpha-1 (α1Thy) treatment on the immune system in population groups with different thymic function levels in the scenario of SARS-CoV2 infection. RESULTS Activation markers such as CD40, CD80 and TIM-3 were upregulated in α1Thy presence, especially in plasmacytoid dendritic cells (pDCs) and, with increased TNFα production was observed compared to untreated condition. Co-cultures of CD4 + and CD8 + T cells with DCs treated with α1Thy in response to SARS-CoV2 peptides showed a decrease in the cytokine production compared to the condition without α1Thy pre-treated. A decrease in CD40L activation co-receptor expression in CD8 + LTs was also observed, as well as an increase in PD1 in CD4 + TLs expression in both age groups. In fact, there are no age-related differences in the immunomodulatory effect of the hormone, and it seems that effector memory and terminally differentiated memory T lymphocyte subsets were the most actively influenced by the immunomodulatory α1Thy effect. Finally, the polyfunctionality measured in SARS-CoV2 Specific-T cells response was maintained in α1Thy presence in total and memory subpopulations CD4 + and CD8 + T-cells, despite decreased proinflammatory cytokines production. CONCLUSION The hormone α1Thy could reduce, through the modulation of DCs, the amount of proinflammatory cytokines produced by T cells. Moreover, α1Thy improve lymphocyte functionality and could become a beneficial therapeutic alternative as an adjuvant in SARS-CoV2 treatment either in the acute phase after infection or reinfection. In addition, the effect on the T immune response means that α1Thy can be incorporated into the vaccination regimen, especially in the most immunologically vulnerable individuals such as the elderly. SUBJECTS Thymosin alpha 1, Dendritic cells, SARS-CoV2-specific T cells response, Immunomodulation.
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Affiliation(s)
- M S Espinar-Buitrago
- Immunology Section, Laboratorio Inmuno-Biología Molecular (LIBM), Hospital General Universitario Gregorio Marañón (HGUGM), Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), 28009, Madrid, Spain
- Centro de Investigación Biomédica en Red Bioingeniería, Biomateriales y Nanotecnología (CIBER-BBN), Madrid, Spain
| | - L Tarancon-Diez
- Immunology Section, Laboratorio Inmuno-Biología Molecular (LIBM), Hospital General Universitario Gregorio Marañón (HGUGM), Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), 28009, Madrid, Spain
- Centro de Investigación Biomédica en Red Bioingeniería, Biomateriales y Nanotecnología (CIBER-BBN), Madrid, Spain
| | - E Vazquez-Alejo
- Immunology Section, Laboratorio Inmuno-Biología Molecular (LIBM), Hospital General Universitario Gregorio Marañón (HGUGM), Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), 28009, Madrid, Spain
- Centro de Investigación Biomédica en Red Bioingeniería, Biomateriales y Nanotecnología (CIBER-BBN), Madrid, Spain
| | - E Magro-Lopez
- Immunology Section, Laboratorio Inmuno-Biología Molecular (LIBM), Hospital General Universitario Gregorio Marañón (HGUGM), Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), 28009, Madrid, Spain
- Centro de Investigación Biomédica en Red Bioingeniería, Biomateriales y Nanotecnología (CIBER-BBN), Madrid, Spain
| | - M Genebat
- Department of Internal Medicine, Hospital Fátima, 41012, Sevilla, Spain
| | - F Romero-Candau
- Department of Internal Medicine, Hospital Viamed Santa Ángela de la Cruz, 41014, Seville, Spain
| | - M Leal
- Department of Internal Medicine, Hospital Viamed Santa Ángela de la Cruz, 41014, Seville, Spain
- Home Residencia de la Santa Caridad, 41001, Seville, Spain
| | - M A Muñoz-Fernandez
- Immunology Section, Laboratorio Inmuno-Biología Molecular (LIBM), Hospital General Universitario Gregorio Marañón (HGUGM), Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), 28009, Madrid, Spain.
- Centro de Investigación Biomédica en Red Bioingeniería, Biomateriales y Nanotecnología (CIBER-BBN), Madrid, Spain.
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Caruso C, Marcon G, Accardi G, Aiello A, Calabrò A, Ligotti ME, Tettamanti M, Franceschi C, Candore G. Role of Sex and Age in Fatal Outcomes of COVID-19: Women and Older Centenarians Are More Resilient. Int J Mol Sci 2023; 24:2638. [PMID: 36768959 PMCID: PMC9916733 DOI: 10.3390/ijms24032638] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Revised: 01/25/2023] [Accepted: 01/28/2023] [Indexed: 02/03/2023] Open
Abstract
In the present paper, we have analysed the role of age and sex in the fatal outcome of COVID-19, as there are conflicting results in the literature. As such, we have answered three controversial questions regarding this aspect of the COVID-19 pandemic: (1) Have women been more resilient than men? (2) Did centenarians die less than the remaining older people? (3) Were older centenarians more resistant to SARS-CoV-2 than younger centenarians? The literature review demonstrated that: (1) it is women who are more resilient, in agreement with data showing that women live longer than men even during severe famines and epidemics; however, there are conflicting data regarding centenarian men; (2) centenarians overall did not die less than remaining older people, likely linked to their frailty; (3) in the first pandemic wave of 2020, centenarians > 101 years old (i.e., born before 1919), but not "younger centenarians", have been more resilient to COVID-19 and this may be related to the 1918 Spanish flu epidemic, although it is unclear what the mechanisms might be involved.
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Affiliation(s)
- Calogero Caruso
- Laboratorio di Immunopatologia e Immunosenescenza, Dipartimento di Biomedicina, Neuroscienze e Diagnostica Avanzata, Università di Palermo, 90134 Palermo, Italy
| | - Gabriella Marcon
- Dipartimento di Scienze Medico Chirurgiche e della Salute, Università di Trieste, 34149 Trieste, Italy
- Dipartinento di Area Medica, Università di Udine, 33100 Udine, Italy
| | - Giulia Accardi
- Laboratorio di Immunopatologia e Immunosenescenza, Dipartimento di Biomedicina, Neuroscienze e Diagnostica Avanzata, Università di Palermo, 90134 Palermo, Italy
| | - Anna Aiello
- Laboratorio di Immunopatologia e Immunosenescenza, Dipartimento di Biomedicina, Neuroscienze e Diagnostica Avanzata, Università di Palermo, 90134 Palermo, Italy
| | - Anna Calabrò
- Laboratorio di Immunopatologia e Immunosenescenza, Dipartimento di Biomedicina, Neuroscienze e Diagnostica Avanzata, Università di Palermo, 90134 Palermo, Italy
| | - Mattia Emanuela Ligotti
- Laboratorio di Immunopatologia e Immunosenescenza, Dipartimento di Biomedicina, Neuroscienze e Diagnostica Avanzata, Università di Palermo, 90134 Palermo, Italy
| | - Mauro Tettamanti
- Laboratorio di Epidemiologia Geriatrica, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, 20156 Milano, Italy
| | - Claudio Franceschi
- Dipartimento di Scienze Mediche e Chirurgiche, Alma Mater Studiorum, Università di Bologna, 40126 Bologna, Italy
| | - Giuseppina Candore
- Laboratorio di Immunopatologia e Immunosenescenza, Dipartimento di Biomedicina, Neuroscienze e Diagnostica Avanzata, Università di Palermo, 90134 Palermo, Italy
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Caruso C, Accardi G, Aiello A, Calabrò A, Ligotti ME, Candore G. Centenarians born before 1919 are resistant to COVID-19. Aging Clin Exp Res 2023; 35:217-220. [PMID: 36319938 PMCID: PMC9628492 DOI: 10.1007/s40520-022-02287-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 10/17/2022] [Indexed: 11/05/2022]
Abstract
Although mortality from COVID-19 progressively increases with age, there are controversial data in the literature on the probability of centenarians dying from COVID-19. Moreover, it has been claimed that men in their 90s and 100s are more resilient than women. To gain insight into this matter, we analysed, according to gender, mortality data during the first year of pandemic of Sicilian nonagenarians and centenarians. We used mortality data from the 2019 as a control. The crude excess mortality between the two years was calculated. Data on deaths of Sicilian 90 + years show that, in line with what is known about the different response to infections between the two genders, oldest females are more resilient to COVID-19 than males. Moreover, centenarians born before 1919, but not "younger centenarians", are resilient to COVID-19. This latter datum should be related to the 1918 Spanish flu epidemic, although the mechanisms involved are not clear.
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Affiliation(s)
- Calogero Caruso
- grid.10776.370000 0004 1762 5517Laboratorio di Immunopatologia e Immunosenescenza, Dipartimento di Biomedicina, Neuroscienze e Diagnostica Avanzata, Università di Palermo, Palermo, Italy
| | - Giulia Accardi
- grid.10776.370000 0004 1762 5517Laboratorio di Immunopatologia e Immunosenescenza, Dipartimento di Biomedicina, Neuroscienze e Diagnostica Avanzata, Università di Palermo, Palermo, Italy
| | - Anna Aiello
- grid.10776.370000 0004 1762 5517Laboratorio di Immunopatologia e Immunosenescenza, Dipartimento di Biomedicina, Neuroscienze e Diagnostica Avanzata, Università di Palermo, Palermo, Italy
| | - Anna Calabrò
- grid.10776.370000 0004 1762 5517Laboratorio di Immunopatologia e Immunosenescenza, Dipartimento di Biomedicina, Neuroscienze e Diagnostica Avanzata, Università di Palermo, Palermo, Italy
| | - Mattia Emanuela Ligotti
- grid.10776.370000 0004 1762 5517Laboratorio di Immunopatologia e Immunosenescenza, Dipartimento di Biomedicina, Neuroscienze e Diagnostica Avanzata, Università di Palermo, Palermo, Italy
| | - Giuseppina Candore
- grid.10776.370000 0004 1762 5517Laboratorio di Immunopatologia e Immunosenescenza, Dipartimento di Biomedicina, Neuroscienze e Diagnostica Avanzata, Università di Palermo, Palermo, Italy
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5
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Caruso C, Ligotti ME, Accardi G, Aiello A, Candore G. An immunologist's guide to immunosenescence and its treatment. Expert Rev Clin Immunol 2022; 18:961-981. [PMID: 35876758 DOI: 10.1080/1744666x.2022.2106217] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION : The ageing process causes several changes in the immune system, although immune ageing is strongly influenced by individual immunological history, as well as genetic and environmental factors leading to inter-individual variability. AREAS COVERED : Here, we focused on the biological and clinical meaning of immunosenescence. Data on SARS-CoV-2 and Yellow Fever vaccine have demonstrated the clinical relevance of immunosenescence, while inconsistent results, obtained from longitudinal studies aimed at looking for immune risk phenotypes, have revealed that the immunosenescence process is highly context-dependent. Large projects have allowed the delineation of the drivers of immune system variance, including genetic and environmental factors, sex, smoking, and co-habitation. Therefore, it is difficult to identify the interventions that can be envisaged to maintain or improve immune function in older people. That suggests that drug treatment of immunosenescence should require personalized intervention. Regarding this, we discussed the role of changes in lifestyle as a potential therapeutic approach. EXPERT OPINION : Our review points out that age is only part of the problem of immunosenescence. Everyone ages differently because he/she is unique in genetics and experience of life and this applies even more to the immune system (immunobiography). Finally, the present review shows how appreciable results in the modification of immunosenescence biomarkers can be achieved with lifestyle modification.
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Affiliation(s)
- Calogero Caruso
- Laboratorio di Immunopatologia e Immunosenescenza, Dipartimento di Biomedicina, Neuroscienze e Diagnostica Avanzata, Università di Palermo, Palermo, Italy
| | - Mattia Emanuela Ligotti
- Laboratorio di Immunopatologia e Immunosenescenza, Dipartimento di Biomedicina, Neuroscienze e Diagnostica Avanzata, Università di Palermo, Palermo, Italy
| | - Giulia Accardi
- Laboratorio di Immunopatologia e Immunosenescenza, Dipartimento di Biomedicina, Neuroscienze e Diagnostica Avanzata, Università di Palermo, Palermo, Italy
| | - Anna Aiello
- Laboratorio di Immunopatologia e Immunosenescenza, Dipartimento di Biomedicina, Neuroscienze e Diagnostica Avanzata, Università di Palermo, Palermo, Italy
| | - Giuseppina Candore
- Laboratorio di Immunopatologia e Immunosenescenza, Dipartimento di Biomedicina, Neuroscienze e Diagnostica Avanzata, Università di Palermo, Palermo, Italy
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Trevisan C, Remelli F, Fumagalli S, Mossello E, Okoye C, Bellelli G, Coin A, Malara A, Gareri P, Monzani F, Del Signore S, Zia G, Antonelli Incalzi R, Volpato S. Covid-19 as a paradigmatic model of the heterogeneous disease presentation in older people: data from the GeroCovid Observational study. Rejuvenation Res 2022; 25:129-140. [DOI: 10.1089/rej.2021.0063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Caterina Trevisan
- Università degli Studi di Padova Dipartimento di Medicina, 172921, Geriatrics, Padova, Italy
- Università degli Studi di Ferrara Dipartimento di Scienze Mediche, 165478, Ferrara, Emilia-Romagna, Italy
| | - Francesca Remelli
- Università degli Studi di Ferrara Dipartimento di Scienze Mediche, 165478, Ferrara, Emilia-Romagna, Italy
| | | | | | | | - Giuseppe Bellelli
- University of Milano-Bicocca , Department of Clinical and Preventive Medicine , via Cadore 48, Monza, Italy, 20900, ,
- Geriatric Research Group, GRG, Brescia, Italy, 25100
| | - Alessandra Coin
- University of Padova, Department of Medicine- DIMED, Padova, Italy
| | | | - Pietro Gareri
- Azienda Sanitaria Provinciale di Catanzaro, 154819, Catanzaro, Calabria, Italy
| | - Fabio Monzani
- Pisa University Hospital, 9257, Pisa, Toscana, Italy
| | - Susanna Del Signore
- Bluecompanion Ltd, London, United Kingdom of Great Britain and Northern Ireland
| | - Gianluca Zia
- Bluecompanion Ltd, London, United Kingdom of Great Britain and Northern Ireland
| | | | - Stefano Volpato
- Università degli Studi di Ferrara Dipartimento di Scienze Mediche, 165478, Ferrara, Emilia-Romagna, Italy
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Gadó K, Kovács AK, Domján G, Nagy ZZ, Bednárik GD. COVID-19 and the elderly. Physiol Int 2022; 109:177-185. [PMID: 35575987 DOI: 10.1556/2060.2022.00203] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 02/14/2022] [Accepted: 03/01/2022] [Indexed: 02/18/2024]
Abstract
COVID-19 has become a great burden of the world in respect of health care, social, and economical reason. Several million people died worldwide so far and more and more mutants are generated and spread. Older people with co-morbidities and frailty syndrome have a significantly higher risk to get the infection and also higher the risk of a more serious disease process. Mortality of COVID-19 is also higher in case of geriatric patients. In this review we attempted to summarize the factors of the higher susceptibility for more serious disease, what actions need to be taken for defending older patients and also special aspects of clinical presentation including ophthalmic symptoms.
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Affiliation(s)
- Klara Gadó
- 1 Department of Clinical Studies, Faculty of Health Sciences, Semmelweis University, Budapest, Hungary
- 2 Department of Geriatrics and Center of Nursing Sciences, Faculty of Health Sciences, Semmelweis University, Budapest, Hungary
| | - Aranka Katalin Kovács
- 1 Department of Clinical Studies, Faculty of Health Sciences, Semmelweis University, Budapest, Hungary
| | - Gyula Domján
- 1 Department of Clinical Studies, Faculty of Health Sciences, Semmelweis University, Budapest, Hungary
| | - Zoltán Zsolt Nagy
- 3 Department of Ophthalmology, Faculty of Medicine, Semmelweis University, Budapest, Hungary
- 4 Department of Clinical Ophthalmology, Faculty of Health Sciences, Semmelweis University, Budapest, Hungary
| | - Gabriella Dörnyei Bednárik
- 5 Department of Morphology and Physiotherapy, Faculty of Health Sciences, Semmelweis University, Budapest, Hungary
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8
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Salmerón Ríos S, Cortés Zamora EB, Avendaño Céspedes A, Romero Rizos L, Sánchez-Jurado PM, Sánchez-Nievas G, Mas Romero M, Tabernero Sahuquillo MT, Blas Señalada JJ, Murillo Romero A, García Nogueras I, Estrella Cazalla JDD, Andrés-Pretel F, Lauschke VM, Stebbing J, Abizanda P. Immunogenicity after 6 months of BNT162b2 vaccination in frail or disabled nursing home residents: The COVID-A Study. J Am Geriatr Soc 2021; 70:650-658. [PMID: 34894403 DOI: 10.1111/jgs.17620] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 12/02/2021] [Accepted: 12/05/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND There is incomplete information regarding evolution of antibody titers against SARS-CoV-2 after a two-dose strategy vaccination with BNT162b2 in older adults in long-term care facilities (LTCFs) with frailty, disability, or cognitive impairment. We aimed to determine IgG antibody titer loss in older adults in LTCFs. METHODS This is a multicenter longitudinal cohort study including 127 residents (90 females and 37 males) with a mean age of 82.7 years (range 65-99) with different frailty and disability profiles in two LTCFs in Albacete, Spain. Residents received two doses of BNT162b2 as per label, and antibody levels were determined 1 and 6 months after the second dose. Age, sex, previous history of coronavirus disease 2019 (COVID-19), comorbidity (Charlson Index), performance in activities of daily living (Barthel Index), frailty (FRAIL instrument), and cognitive status were assessed. RESULTS The mean antibody titers 1 and 6 months after the second vaccine dose were 32,145 AU/ml (SD 41,206) and 6182 AU/ml (SD 13,316), respectively. Across all participants, the median antibody titer loss measured 77.6% (interquartile range [IQR] 23.8%). Notably, the decline of titers in individuals with pre-vaccination COVID-19 infection was significantly lower than in those without a history of SARS-CoV-2 infection (72.2% vs. 85.3%; p < 0.001). The median titer decrease per follow-up day was 0.47% (IQR 0.14%) and only pre-vaccination COVID-19 was associated with lower rate of antibody decline at 6 months (hazard ratio 0.17; 95% confidence interval 0.07-0.41; p < 0.001). Frailty, disability, older age, cognitive impairment, or comorbidity were not associated with the extent of antibody loss. CONCLUSIONS Older adults in LTCFs experience a rapid loss of antibodies over the first 6 months after the second dose of BNT162b2 vaccine. Only pre-vaccination COVID-19 is associated with a slower rate of antibody decrease. Our data support immunization with a third dose in this vulnerable, high-risk population.
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Affiliation(s)
- Sergio Salmerón Ríos
- Residencia de Mayores San Vicente de Paúl, Diputación de Albacete, Albacete, Spain
| | - Elisa Belén Cortés Zamora
- Department of Geriatrics, Complejo Hospitalario Universitario de Albacete, Albacete, Spain.,CIBERFES, Ministerio de Economía y Competitividad, Madrid, Spain
| | - Almudena Avendaño Céspedes
- Department of Geriatrics, Complejo Hospitalario Universitario de Albacete, Albacete, Spain.,CIBERFES, Ministerio de Economía y Competitividad, Madrid, Spain.,Facultad de Medicina, Universidad de Castilla-La Mancha, Albacete, Spain
| | - Luis Romero Rizos
- Department of Geriatrics, Complejo Hospitalario Universitario de Albacete, Albacete, Spain.,CIBERFES, Ministerio de Economía y Competitividad, Madrid, Spain.,Facultad de Medicina, Universidad de Castilla-La Mancha, Albacete, Spain
| | - Pedro Manuel Sánchez-Jurado
- Department of Geriatrics, Complejo Hospitalario Universitario de Albacete, Albacete, Spain.,CIBERFES, Ministerio de Economía y Competitividad, Madrid, Spain.,Facultad de Medicina, Universidad de Castilla-La Mancha, Albacete, Spain
| | - Ginés Sánchez-Nievas
- Department of Rheumatology, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | - Marta Mas Romero
- Department of Geriatrics, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | | | | | | | | | - Juan de Dios Estrella Cazalla
- Department of Geriatrics, Complejo Hospitalario Universitario de Albacete, Albacete, Spain.,CIBERFES, Ministerio de Economía y Competitividad, Madrid, Spain.,Residencia de Mayores Núñez de Balboa, Albacete, Spain
| | - Fernando Andrés-Pretel
- Department of Statistics, Foundation of the National Paraplegics Hospital of Toledo, Toledo, Spain
| | - Volker Martin Lauschke
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.,Dr Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart, Germany
| | - Justin Stebbing
- Department of Surgery and Cancer, Imperial College, Hammersmith Hospital, London, UK
| | - Pedro Abizanda
- Department of Geriatrics, Complejo Hospitalario Universitario de Albacete, Albacete, Spain.,CIBERFES, Ministerio de Economía y Competitividad, Madrid, Spain.,Facultad de Medicina, Universidad de Castilla-La Mancha, Albacete, Spain
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