Fading Immune Protection in Old Age: Vaccination in the Elderly

https://doi.org/10.1016/j.jcpa.2009.10.002Get rights and content

Summary

The function of the immune system declines with age, leading to an increased occurrence and severity of infectious diseases and a decreased response to vaccines. As the thymus gradually loses its ability to replenish the population of naïve T cells, the memory and effector T cells increase in number and dominate the repertoire. The changes in the naïve and memory T cell pool that occur with ageing in man are discussed here, along with a brief update of the knowledge of B cell populations in the elderly.

Section snippets

Naïve T Cells in Elderly People

Upon presentation of a specific antigen, naïve T cells (defined phenotypically by expression of CD8, CD45RA and CD28) will be stimulated and will differentiate into an effector or a memory T cell. Studies have shown that the number of naïve T cells is extremely small in elderly people (over 65 years of age), as compared with younger persons (below 30 years old) (Fagnoni et al., 2000). This is true for the peripheral blood, but has also recently been confirmed for lymph node tissue (Lazuardi

Memory T Cells: Two Types of Elderly Person

A striking observation is that the memory to effector CD8+ T cell ratio varies in elderly people, allowing two types of subjects to be differentiated. So-called type 1 elderly people have a relatively large number of CD28+CD25+ central memory T cells (defined phenotypically by expression of CD8, CD25 and CD28 and production of interleukin [IL]-4, but absence of expression of CD45RA) and relatively few CD28 (effector) T cells (defined phenotypically as either CD8+CD25CD28CD45RA or CD8+CD25

Effector CD28 T Cells Accumulate in Elderly Non-responders

When purified, the effector (CD8+CD28) T cells from the blood of non-responders produce no IL-2 or IL-4, but secrete high quantities of IFN-γ. They are highly proinflammatory and probably contribute to both the ‘inflammageing’ phenomenon and to immune senescence, inhibiting antibody production. They are also very restricted and dominated by a few large clones. A large proportion of these effector T cells is specific to the cytomegalovirus (CMV) and in particular to one CMV protein, pp65 (

Age-related Impairment of B Cells

B cells are generated in the bone marrow and, after being transported to lymphatic tissues, they can return to the bone marrow either as plasma cells or as naïve or memory cells. The decrease of B lymphocyte production begins early in adult life, but is more marked in the elderly (Signer et al., 2007). This occurs through a blockage of early hematopoietic progenitors and B cell precursor maturation, leading to an age-dependent decrease of mature B2 cells (naïve cells) (Signer et al., 2007). The

Problematic Response to Vaccination in Aged People

The limited response to vaccination is not restricted to seasonal influenza vaccination (Grubeck-Loebenstein et al., 2009). A previous study related to tetanus toxoid vaccine (administered to 300 young and 300 old persons) revealed that the time of the last vaccination, as well as age, had highly significant effects on tetanus protection (P < 0.001; Hainz et al., 2005). A strong decline in post-vaccination antibody concentrations is observed in relation to age, with an onset at the age of 40

Conclusions

The immune response to vaccination appears to decrease throughout adult life and vaccination strategies in the elderly need to be improved. One of the options might be to carry out regular booster vaccinations in order to elicit a good memory lymphocyte pool throughout life. Shorter vaccination intervals might also be considered with advancing age. Post-vaccination antibody levels should also be checked on a more regular basis. However, the most important of all is an urgent need to develop new

Conflict of Interest

The author was an invited speaker at the Merial European Comparative Vaccinology Symposium and received travel expenses and an honorarium for this presentation.

References (13)

There are more references available in the full text version of this article.

Cited by (28)

  • Importance and value of adjuvanted influenza vaccine in the care of older adults from a European perspective – A systematic review of recently published literature on real-world data

    2022, Vaccine
    Citation Excerpt :

    Unlike genetically relatively stable pathogens such as pneumococci, influenza viruses are subject to antigenic drift and shift [6,7], and seasonal variations in influenza strain circulation together with host factors can significantly affect the translation of influenza vaccine efficacy to effectiveness in the real world, particularly in high-risk groups. In older adults, influenza vaccine effectiveness is generally reduced due to immunosenescence [8–12]. Enhanced influenza vaccines have been developed to strengthen the immune response, including inactivated influenza vaccines (cell-based, high-dose and adjuvanted), recombinant influenza vaccines and live-attenuated influenza vaccines (LAIV) [13].

  • Physiological Aspects of Aging and Their Clinical Ramifications

    2022, Comprehensive Clinical Psychology, Second Edition
  • Canine parvovirus vaccination and immunisation failures: Are we far from disease eradication?

    2020, Veterinary Microbiology
    Citation Excerpt :

    Primary immunisation failure, occurring in 2–10 % of vaccinated healthy humans, is due to failure to develop detectable antibodies, while secondary immunisation failure is associated with loss of previously acquired protection faster than expected (waning immunity) (Wiedermann et al., 2016). Age-related immunosenescence, a well-documented phenomenon in humans, is associated with both primary and secondary immunisation failure (Grubeck-Loebenstein, 2010). A low CPV seroprevalence of 81 % detected among sick dogs admitted to an intensive care unit may, in part, have been due to secondary immunisation failure (Mahon et al., 2017).

  • The importance of tetanus risk assessment during wound management

    2015, IDCases
    Citation Excerpt :

    Most cases of tetanus occurred in susceptible individuals who were either unimmunized or partially immunized and did not have protective levels of antibodies at the time of exposure to C. tetani [7,8]. Adults born prior to 1961, who are more likely to have missed out on childhood vaccinations, are over-represented in this population [6,9]. Sporadic clusters of tetanus in the UK have also been reported among people who inject drugs (PWID) [10].

View all citing articles on Scopus
View full text