Zoster Vaccine Response in the Frail Elderly

• Change from Baseline in T-cell response to the VZV vaccine in the frail elderly [ Time Frame: 6 weeks ] [ Designated as safety issue: No ]
  As the primary phenotype, we will compare change in responder cell frequency (RCF) and Enzyme-linked immunosorbent spot (ELISPOT) from baseline (i.e., pre and post vaccination). A high baseline T cell response will be defined as RCF = >5.0 and ELISPOT = >50 spots and a low baseline response will be RCF = <1.0 and ELISPOT = <10 spots.
• Assessment of immune parameters compatible with inflammaging: CD4+/CD8+ ratio [ Time Frame: Baseline ] [ Designated as safety issue: No ]
  Characterization of T-cell populations will be conducted on whole blood using multi-parametric flow cytometry prior to immunization to characterize the immunological function of circulating T-cells in each participant.
• Assessment of immune parameters compatible with inflammaging: high CD8+CD28-CD45RA+ T cells [ Time Frame: Baseline ] [ Designated as safety issue: No ]
  Characterization of T-cell populations will be conducted on whole blood using multi-parametric flow cytometry prior to immunization to characterize the immunological function of circulating T-cells in each participant.
• Assessment of immune parameters compatible with inflammaging: TEMRA Cells [ Time Frame: Baseline ] [ Designated as safety issue: No ]
  Characterization of T-cell populations will be conducted on whole blood using multi-parametric flow cytometry prior to immunization to characterize the immunological function of circulating T-cells in each participant.
• Assessment of immune parameters compatible with inflammaging: high T regulatory cells [ Time Frame: Baseline ] [ Designated as safety issue: No ]
  Characterization of T-cell populations will be conducted on whole blood using multi-parametric flow cytometry prior to immunization to characterize the immunological function of circulating T-cells in each participant.
• Testing 150 candidate immune response genes for SNP analysis [ Time Frame: Baseline ] [ Designated as safety issue: No ]

  These will include Toll-like receptors, cytokines, chemokines, chemokine receptors, interferons and interferon receptors.

  Toll-like receptors: TLR1-TLR9 Cytokines: ILI1A, ILI1B, IL1RN, IL4, IL5, IL12B, IL13, CSF2 Chemokines: CCL1-CCL3, CCL3L1, CCL4-CCL8, CCL11, CCL13, CCL15-CCL28, CXCL1-CXCL14, CXCL16, CX3CL1 Chemokine receptors: CCR1-CCR10, CXCR1-CXCR6, CX3CR1, XCR1-XCR2 Interferons: IFNA1-IFNA2, IFNA4-IFNA8, IFNA10, IFNA13, IFNA14, IFNA16-IFNA17, IFNA21, IFNB1, IFNB3, IFNG, IFNK, IFNW1 Interferon receptors: IFNAR1, IFNAR2, IFNGR1, IFNGR2

This study is being done to evaluate the zoster vaccine response in the nursing home elderly (80 years or older). As the immune system ages, the response to vaccines is not always as strong as in younger people. Previous zoster vaccine studies have excluded nursing home residents so the vaccine effect in this population is not known. Furthermore, the immune and genetic reasons as to why the vaccine works well in some people but not in others are also unknown. The goal of this study is to evaluate why some immune systems respond well to the vaccine and why others do not.

Deleterious changes in immunity that occur with aging are known as immunosenescence. Such changes, particularly in adaptive immunity, may lead to an impaired vaccine response in the elderly. Characterizing the immune determinants and the genetic basis for vaccine response in the frail elderly is a practical approach to better our understanding of immunosenescence. Data on genetic determinants to immunization are sparse, furthermore, to the best of our knowledge, none exist in the elderly. In this pilot study, we propose studying the immune response to the herpes zoster vaccine and the underlying genetic determinants of the immune response in elderly residents of nursing homes.

The three specific aims of this study are to generate data in order to 1) assess the T-cell response to the varicella-zoster virus (VZV) vaccine in the frail elderly; 2) assess whether immune (T-cell) phenotypes are associated with a response; 3) test the association between immune response genotype sets and T-cell response. We hypothesize that response to the VZV vaccine in elderly nonambulatory nursing home residents is a function of characteristic T-cell immune phenotypes prior to vaccination and that there are immune genetic polymorphisms associated with the response. This study will allow us to generate preliminary data and establish feasibility in order to address these questions fully in a larger population in a subsequent grant application.

Elderly, non-ambulatory residents of nursing homes.

• Nursing Home Elderly Cases
  Non-ambulatory nursing home residents <= 80 years old will be vaccinated with the zoster vaccine and provide baseline and post-vaccination blood samples. We will assess differences in genotype frequencies between participants with high and low RCF and ELISPOT responses using a candidate gene approach with SNPs. A case will be considered failure to mount a high response.
• Nursing Home Elderly Controls
  Non-ambulatory nursing home residents <= 80 years old will be vaccinated with the zoster vaccine and provide baseline and post-vaccination blood samples. We will assess differences in genotype frequencies between participants with high and low RCF and ELISPOT responses using a candidate gene approach with SNPs. A control will be a participant who mounted an adequate response as defined in primary outcomes.
• Community dwelling seniors
  Community dwelling seniors ages 60-75 will be enrolled as a control group for the laboratory testing. They will be vaccinated and will provide pre- and post-vaccination blood. If nursing home residents do not show a response it is important to know that it is not a failure of the laboratory's measurement of immunogenicity.

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Inclusion Criteria:

• nursing home resident
• greater than or equal to 80 years old
• non-ambulatory

Exclusion Criteria:

• less than 80 years old
• ambulatory
• taking immunosuppressive medication
• history of primary or acquired immuno-deficiency states including leukemia, other malignant neoplasms affecting the bone marrow or lymphatic system, and AIDS
• active untreated tuberculosis
• previous receipt of varicella vaccine
• residents expected to expire within 30 days, in the opinion of the most responsible physician
• residents planning to move nursing homes within the year
• temporary residents