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Elderly people with few antibodies may need an extra dose of vaccine

The new mRNA vaccines have just as good a protective effect against COVID-19 for the very oldest as for younger people. This is evident in a study at Umeå University, Sweden, where researchers have followed individuals in special housing around Sweden. However, the study shows that elderly people with a low antibody response after vaccination were at increased risk of dying in the omicron variants of the disease.

“The result suggests that we should be able to identify in advance which people have the greatest risk of being seriously affected and may need extra efforts in the form of, for example, additional vaccine doses”, says Linnea Vikström, PhD student at the Department of Clinical Microbiology at Umeå University and joint first author of the study.

Starting in September 2021, the researchers have followed 114 different special housing units with a total of just over 3,000 people in Skåne, Stockholm, Örebro, Jämtland-Härjedalen and Västerbotten Counties. Finger prick blood samples have been taken every three months from the residents and compared with data on illness and death. The average age in special housing for the elderly is 86 years.

By October 2021, almost all residents had received the third dose of the covid vaccine. The researchers could then see a 96-fold increase in the amount of antibodies in the blood. The fourth dose in March 2022 only gave a fourfold increase in the antibodies, which can be explained by the fact that the level was already high then. The researchers were also able to establish that the amount of antibodies was largely the same for people over and under 65 years of age. This suggests that the mRNA vaccines given in doses three and four worked just as well for the elderly as for the younger.

The researchers continued with studies on a smaller group of how vaccination protects against the different omicron variants of COVID-19. With supplementary blood samples, the ability of the antibodies to neutralize the virus variants was analysed. It was then possible to see that the antibodies did not protect against contracting the disease in themselves. In contrast, the antibodies greatly reduced the risk of dying from the disease.

People with lower levels of antibodies had increased mortality within 30 days of infection. When the researchers performed statistical analyses on test results of all the elderly who participated in the study, they saw that the people with the ten percent lowest levels of antibodies in their blood were three to four times as likely to die within 30 days of being diagnosed with the virus.

The lower level of antibodies in some elderly people is probably related to the fact that there may be individual differences in how different people's immune systems react to vaccines.

“The study can help us and other researchers understand how the different variants of the virus get past the immune system among the elderly and how the vaccine needs to be developed to protect against serious illness and death”, says Linnea Vikström.

The research will continue in 2023. It is supported by the Swedish Public Health Agency, Vinnova and Scilifelab via the Knut and Alice Wallenberg Foundation. The study is published in the scientific journal The Lancet Regional Health – Europe.

About the scientific article
Vaccine-induced correlate of protection against fatal COVID-19 in older and frail adults during waves of neutralization-resistant variants of concern: an observational study
Linnea Vikström, Peter Fjällström, Yong-Dae Gwon, Daniel J. Sheward, Julia Wigren-Byström, Magnus Evander, Oscar Bladh, Micael Widerström, Christian Molnar, Gunlög Rasmussen, Louise Bennet, Mikael Åberg, Jonas Björk, Staffan Tevell, Charlotte Thålin, Kim Blom, Jonas Klingström, Ben Murrell, Clas Ahlm, Johan Normark, Anders F Johansson, Mattias NE Forsell
https://doi.org/10.1016/j.lanepe.2023.100646

För more information, please contact

Linnea Vikström
T+46 70 226 54 43
linnea.vikstrom@umu.se

Mattias Forsell
+ 46 90 785 32 08
mattias.forsell@umu.se

Anders Johansson
+46 90 785 17 32
+46 70 359 08 30
anders.f.johansson@umu.se

Peter Fjällström
+46 90 785 32 08
peter.fjallstrom@umu.se

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Umeå University
Umeå University is one of Sweden’s largest institutions of higher education with over 37,000 students and 4,300 faculty and staff. The university is home to a wide range of high-quality education programmes and world-class research in a number of fields. Umeå University was also where the revolutionary gene-editing tool CRISPR-Cas9 was discovered that has been awarded the Nobel Prize in Chemistry.

At Umeå University, distances are short. The university's unified campus encourages academic meetings, an exchange of ideas and interdisciplinary co-operation, and promotes a dynamic and open culture in which students and staff rejoice in the success of others.

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Ola Nilsson

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Umeå University

Umeå University is a comprehensive university and one of Sweden’s largest higher education institutions with around 38,000 students and 4,600 staff. We have a diverse range of high-quality educational programmes and research within all disciplinary domains and the arts. Umeå University is also where the groundbreaking CRISPR-Cas9 gene-editing tool was discovered, starting a revolution in genetic engineering that led to the Nobel Prize in Chemistry.

The University has an international atmosphere and centres its work around core academic values. Our tightly knit campus makes it easy to meet, collaborate and share knowledge, something that encourages a dynamic and open culture where we celebrate each other’s successes. Umeå University prides itself in offering a world-class educational and research environment and expanding knowledge of global significance, where the sustainable development goals of Agenda 2030 inspire and motivate. We have creative and innovative research environments that offer the best potential for taking on the challenges facing society. Through long-term collaborations with organisations, industry and other higher education institutions, the University is helping northern Sweden become a knowledge region. The societal transformation and the massive investments currently occurring in northern Sweden create complex challenges but also opportunities. Umeå University is focused on conducting research about and within a society in transition and continuing to offer academic programmes for regions that need to expand quickly and sustainably.

Campus Umeå and the Umeå Arts Campus are close to the city centre and next to one of Sweden’s largest and most renown university hospitals. Education is also provided in several other towns, including Skellefteå, Örnsköldsvik, Lycksele and Kiruna. Umeå University is home to the highly ranked Umeå Institute of Design, the environmentally certified School of Business, Economics and Law, and the School of Architecture, the only one in Sweden with an artistic profile. Next door is Bildmuseet, which is Umeå’s contemporary art museum, and Curiosum, Umeå’s science centre. Umeå University is one of Sweden’s five national sports universities, has an internationally leading Arctic Research Centre, and has Várdduo, which is Sweden’s only research unit for Sámi research and indigenous research.