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flu shotApril 27 2016

Patients’ immunological responses to flu vaccination may be stronger if the vaccine is given in the morning rather than the afternoon, a study has found. However, the effect may not apply to all flu strains.

The study looked at antibody responses in 276 adults aged over 65 from 24 general practices in the West Midlands who were vaccinated between 2011 and 2013. Each adult was vaccinated against three influenza strains, either in morning surgeries between 9am and 11am or in afternoon surgeries between 3pm and 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,” said the Medicines Research Council, which funded the study via the Lifelong Health & Wellbeing programme.

The research was conducted by a team from the School of Sport, Exercise and Rehabilitation Sciences at the University of Birmingham. Co-investigator Dr Anna Phillips said: “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.”

Previous work undertaking by the research team included a pilot study which found that “men vaccinated in the morning had a greater antibody response to hepatitis A and the A/Panama influenza strain.” With regards the flu vaccine outcome, the researchers suggest that diurnal rhythms in hormonal steroid levels may have a role in mediating the response to the vaccine.

Co-investigator Professor Janet Lord, a Director of the MRC-Arthritis Research UK Centre for Musculoskeletal Ageing Research, commented: “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 research programme is now looking to scale up the study, and will hope to investigate the impact of patients’ existing health conditions, such as diabetes, liver and kidney disease, which can impair immunity. It will also investigate whether the morning vaccination strategy is effective for the pneumococcal vaccine which is recommended to all individuals aged 65 years across the UK, said the MRC. It pointed out that the age-related decline in immunity reduces the ability of older adults to produce an adequate immunological response following a vaccination, and this can compromise the level of protection.

Links:

MRC announcement

University of Birmingham announcement

JE Long et al. ‘Morning vaccination enhances antibody response over afternoon vaccination: a cluster-randomised trial Vaccine’. Published online April 26 2016

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