New research from the University of Birmingham,
funded by the Lifelong Health and Wellbeing
Cross-Council programme, has shown that flu
vaccinations are more effective when administered in
the morning.
The findings, published in the journal Vaccine,
suggest administering vaccinations in the morning,
rather than the afternoon, could induce greater, and
thus more protective, immune responses.
A total of 24 general practices in the West
Midlands, UK, were analysed between 2011 and 2013 in
a cluster-randomised trial during the annual UK
influenza vaccination programme.
The study involved 276 adults aged over 65 who were
vaccinated against three strains of influenza,
either in morning surgeries (9-11am) or afternoon
surgeries (3-5pm).
In two of the three given influenza virus strains,
those in the morning cohort saw a significantly
larger increase in antibody concentration one month
following vaccination, when compared with those in
the afternoon cohort. In the third strain, there was
no significant difference between morning and
afternoon.
Dr Anna Phillips, a co-investigator on the study
from the School of Sport, Exercise and
Rehabilitation Sciences at the University of
Birmingham explained: “We know that there are
fluctuations in immune responses throughout the day
and wanted to examine whether this would extend to
the antibody response to vaccination. Being able to
see that morning vaccinations yield a more efficient
response will not only help in strategies for flu
vaccination, but might provide clues to improve
vaccination strategies more generally.”
The influenza vaccination is part of the seasonal
vaccination programme carried out by general
practices across the UK, and in many other
countries, with a particular focus on patients over
65 years old.
Despite this, the influenza virus is responsible for
between 250,000 and 500,000 deaths each year
worldwide. The age-related decline in immunity
reduces the ability of older adults to produce
adequate antibody responses following vaccination,
compromising the given protection.
Other interventions to improve outcomes of
vaccination have been attempted with limited
success, including exercise routines and additives
to the vaccine itself.
Professor Janet Lord, co-investigator on the study
from the Institute of Inflammation and Ageing at the
University of Birmingham who is also Director of the
MRC- Arthritis Research UK Centre for
Musculoskeletal Ageing Research, said: “A
significant amount of resource is used to try and
prevent flu infection each year, particularly in
older adults, but less than half make enough
antibody to be fully protected. Our results suggest
that by shifting the time of those vaccinations to
the morning we can improve their efficiency with no
extra cost to the health service.”
The team, led by Dr Kai-Michael Toellner, will now
look to investigate this further in a large scale
study, to see if the morning vaccination strategy
benefits a wide range of over 65s including those
with conditions like diabetes, liver and kidney
disease that impair immunity. The team will also
investigate whether the morning vaccination strategy
is effective for the pneumococcal vaccine that
protects against pneumonia; a vaccine recommended to
all individuals aged 65years in the UK.
For more information
Vaccine
"Morning vaccination enhances antibody response over
afternoon vaccination: a cluster-randomised trial,"
Joanna E Long, Mark T Drayson, Angela E Taylor, Kai
M Toellner, Janet M Lord, and Anna C Phillips
DOI:10.1016/j.vaccine.2016.04.032
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University of Birmingham
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Medical Research Council
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