Influenza vaccination for elderly patients with neurological disease

Elderly people have a high risk for influenza and the existence of central neurological disease is also considered to be a high risk factor for to causing pulmonary complications because of misswallowing. One hundred and forty one elderly patients (60 years or older) were observed. As control 243 cases were also inoculated with one dose of the same vaccine. Thirty-five out of the 243 control received a 2nd dose. After one vaccination the rise of HI titer (percentage of cases with > 40 and GMT) was good enough to be effective in both elderly patients and controls. No significant differences between elderly patients and the control group were observed. Booster effects by 2nd vaccination were not revealed. No serious side effects were noted in all cases throughout the study. In conclusion, influenza vaccine was well treated among the patients with neurological diseases.     

Efficacy of influenza vaccine among geriatric inpatients: effect of previous vaccination and antibody induction by single and twice injections

To investigate the effect of previous influenza vaccination and the difference in antibody induction by single and twice injection of influenza vaccine in the elderly, hemagglutination inhibition (HI) antibody titers of the three types of influenza viruses were measured. Influenza vaccination was done for 217 inpatients. For the patients who had influenza vaccination in the year prior to the study, influenza vaccine was administered once to 77 patients and twice to another 70 patients. Influenza vaccine was injected twice to 70 patients who had not received influenza vaccine in the previous years. The influenza vaccine induced an increase in HI titer in almost all patients. The geometric mean of the HI titer and the frequency of patients with HI titers over 128x were similar after vaccination in the groups of patients who were injected twice, irrespective of whether or not influenza vaccination was given in the year prior to the study. The geometric means of the HI titers for influenzas A/H3N2 and B and the frequency of HI titers over 128x for influenza A/H3N2 after vaccination were lower in the patients who received vaccine once than in the patients vaccinated twice. These results suggest that prior vaccination does not diminish antibody response to influenza vaccine significantly in the elderly when influenza vaccine is injected twice. Although single injection is inferior to twice injection in antibody induction with some vaccine virus strains, induction of HI titers over 128x is found in more than 70% of elderly. Single injection of influenza vaccine may be practically effective and useful for protection of influenza infection in the elderly.     

Influenza revaccination of elderly travelers: antibody response to single influenza vaccination and revaccination at 12 weeks.

The antibody response to a single influenza vaccination and the effect of influenza revaccination was assessed in healthy elderly persons. Travelers > or =65 years old who had received influenza vaccine before travel were enrolled in the study and were offered a second vaccination after 12 weeks. Geographic and age-matched control subjects received a single vaccination. A second influenza vaccination was not associated with increased adverse effects. There was no significant difference between log(10) hemagglutinin-inhibiting (HI) antibody titers or an HI antibody titer > or =1:40 (considered to be protective) in 28 control subjects and 28 revaccinated travelers for any antigen. Probable protection for influenza A antigens remained high 24 weeks after a single immunization and revaccination (A/Sydney/05/97 [H3N2], 92% and 96%, and A/Beijing/262/95 [H1N1], 80% and 96%, respectively). Response to B/Harbin was less throughout the study. A/Sydney antibody titer was lower with more times vaccinated in the previous 5 years. Therefore, a second vaccine did not enhance the immune response.     

Yearly licensing studies from 1997 to 2007 of the inactivated whole virus seasonal influenza vaccine fluval – a useful approach to pandemic vaccine development even in less well developed countries?

Objective Seasonal vaccination has been consistently shown to significantly reduce morbidity and mortality because of influenza epidemics, even in healthy, working adults. Here we report the results of the yearly licensing studies of the past 11 influenza seasons (1997–2007) with a trivalent, inactivated whole virus vaccine with an aluminum phosphate adjuvant system. Methods Sixty healthy volunteers per age group (18–60 years and 60 years and older) were enrolled to receive vaccination each year, thus, a total of 1080 subjects were studied. Serum antibody titers were measured by hemagglutination inhibition (HI). Results: The vaccine met the criteria for licensing each year, meaning seroprotection (achievement of an HI titer of >1:40 in >70% of subjects); seroconversion, i.e. a >4‐fold increase in HI antibody titer, or reaching a titer of >1:40, in >40% of subjects; and an increase in geometric mean titers by >2·5‐fold. Side effects were rare and mild. The same method was used to produce a pre‐pandemic vaccine against influenza A (H5N1), which has been shown to be safe and immunogenic in humans. Conclusions We conclude that the method presented is safe, effective and may serve as a useful approach to seasonal and pandemic vaccine production even in less well‐developed countries by means of technological transfer.     

Cardiovascular Exercise Training Extends Influenza Vaccine Seroprotection in Sedentary Older Adults: The Immune Function Intervention Trial

OBJECTIVES: To determine whether cardiovascular exercise training resulted in improved antibody responses to influenza vaccination in sedentary elderly people who exhibited poor vaccine responses. DESIGN: Single‐site randomized parallel‐arm 10‐month controlled trial. SETTING: University of Illinois at Urbana‐Champaign. PARTICIPANTS: One hundred forty‐four sedentary, healthy older (69.9 ± 0.4) adults. INTERVENTIONS: Moderate (60–70% maximal oxygen uptake) cardiovascular exercise was compared with flexibility and balance training. MEASUREMENTS: The primary outcome was influenza vaccine response, as measured according to hemagglutination inhibition (HI) anti‐influenza antibody titer and seroprotective responses (HI titer ≥40). Secondary measures included cardiovascular fitness and body composition. RESULTS: Of the 160 participants enrolled, 144 (90%) completed the 10‐month intervention with excellent compliance (～83%). Cardiovascular, but not flexibility, exercise intervention resulted in improvements in indices of cardiovascular fitness, including maximal oxygen uptake. Although not affecting peak (e.g., 3 and 6 weeks) postvaccine anti‐influenza HI titers, cardiovascular exercise resulted in a significant increase in seroprotection 24 weeks after vaccination (30–100% dependent on vaccine variant), whereas flexibility training did not. CONCLUSION: Participants randomized to cardiovascular exercise experienced improvements in influenza seroprotection throughout the entire influenza season, whereas those in the balance and flexibility intervention did not. Although there were no differences in reported respiratory tract infections, the exercise group exhibited reduced overall illness severity and sleep disturbance. These data support the hypothesis that regular endurance exercise improves influenza vaccine responses.     

The efficacy of influenza vaccine among geriatric inpatients

To investigate the efficacy of influenza vaccine in the elderly, hemagglutination inhibition (HI) antibody titer for the three types of influenza viruses were measured and the influenza infection rate was determined serologically in geriatric inpatients. Influenza vaccination was done for inpatients. For patients who had influenza vaccination in the year prior to the study, influenza vaccine was administered once or twice, and the number of injections were determined randomly. Influenza vaccine was injected twice to those had not received influenza vaccine in the previous year. Serum samples were collected from 166 vaccinated and 104 unvaccinated patients before and after 1996/1997 influenza season. In the vaccinees who had been vaccinated the previous year, 56 patients were injected once and 58 patient were injected twice. Fifty-two patients had not been vaccinated the previous year. Serologically diagnosed influenza infection rate in the 104 unvaccinated patients was 16.3% for influenza A/H3N2 and 8.7% for influenza B. The infection rate was 3.0% for influenza A/H3N2 and 0.6% for influenza B in the 166 vaccinated patients. The infection rates were significantly lower in the vaccinees than in the unvaccinated patients (p < 0.001 with A/H3N2 and p < 0.01 with B). There was no significant difference in the infection rate among the three vaccinated groups. These results suggest that the influenza vaccination had significant protective efficacy for influenza infection in the elderly. Prior vaccination did not diminish the efficacy of the influenza vaccine. The efficacy of a single influenza vaccine injection was equivalent to that of two injection.     

Co‐administration of l‐cystine and l‐theanine enhances efficacy of influenza vaccination in elderly persons: Nutritional status‐dependent immunogenicity

Aim: The immune response to influenza vaccine is attenuated in elderly persons, though they are at greatest risk for morbidity and mortality by influenza virus infection. Experimental studies demonstrate that co‐administration of l ‐cystine and l ‐theanine enhanced antigen‐specific production of immunoglobulin in aged mice infected with influenza virus. We thus investigated the effect of l ‐cystine and l ‐theanine on antibody induction by influenza vaccines in elderly persons. Methods: Residents in a nursing home were randomly allocated to l ‐cystine and l ‐theanine (n = 32) or placebo (n = 33). The test substances were administered p.o. for 14 days before immunization. Serum influenza virus antibody titers were measured before and 4 weeks after vaccination. Results: Vaccination significantly elevated hemagglutination inhibition (HI) titers for all the three strains of influenza viruses (A/New Caledonia [H1N1], A/New York [H3N2] and B/Shanghai) in both groups. HI titers after vaccination were not significantly different between the two groups for either strain. Also, the seroconversion rate was not significantly different between the two groups in the aggregate. A stratified analysis showed that the rate of seroconversion was significantly greater in the l ‐cystine and l ‐theanine group compared with the placebo group for influenza virus A (H1N1) among subjects with low serum total protein (63% vs 10%, P < 0.05) or low hemoglobin (71% vs 9%, P < 0.05). Conclusion: Co‐administration of l ‐cystine and l ‐theanine before vaccination may enhance the immune response to influenza vaccine in elderly subjects with low serum total protein or hemoglobin.     

Immunogenicity of trivalent-inactivated influenza vaccine among children less than 4 years old

We studied the immunogenicity of trivalent-inactivated influenza vaccine. Subjects were 259 children under 4 years old who visited six pediatric clinics to undergo influenza vaccination. Age distribution was 64 aged <1.0, 65 aged 1.0-1.9, 64 aged 2.0-2.9, and 66 aged 3.0-3.9 years, including subjects who had been previously vaccinated within the last three years, 0% (0/64) aged <1.0, 26% (17/65) aged 1.0-1.9, 72% (46/64) aged 2.0-2.9, and 77% (51/66) aged 3.0-3.9 years old. Two doses of vaccine were given subcutaneously four weeks apart. Dosage was 0.l mL for children under 1 year old, while for children aged one year or older, dosage was 0.2mL, based on standard Japanese recommendations. To measure hemagglutination inhibition (HI) antibody titer, triplet sera were obtained before vaccination (S0), 4 weeks after the first vaccination (S1), and 4 weeks after the second vaccination (S2). The geometric mean of HI antibody titer, the response proportion (titer rise > or =4-fold), and the achievement proportion (postvaccination titer > or =1 : 40) were calculated by age group. Analysis of variance was used to estimate the independent effect of age and prevaccination titer on antibody increase. The geometric means of HI antibody titer were lower among the two younger age groups than among the two older age groups, regardless of vaccine strain or when blood samples were collected. The achievement proportion after 2 doses of vaccine in the <1.0, 1.0-1.9, 2.0-2.9, 3.0-3.9 year age groups were 38%, 58%, 89%, and 85% against A (HI) ; 52%, 54%, 81%, and 73% against A (H3) ; and 23%, 49%, 67%, and 71% against B. Regarding the analysis of variance, prevaccination titer consistently indicated strong effects on antibody increase, regardless of vaccine strain or combination of paired sera. After two doses of vaccine (S2/S0), significant effects of age on antibody induction were shown against A (H1) and B (p = 0.000 and 0.002). Thus, the immunogenicity of trivalent-inactivated influenza vaccine was strongly influenced by prevaccination titer and age. Even two doses of vaccine did not induce a protective antibody level in about 50 to 80% of subjects among infants aged <1.0 year, and 40 to 50% among children 1.0-1.9 year old.     

Relation between influenza vaccination and outpatient visits, hospitalization, and mortality in elderly persons with chronic lung disease

BACKGROUND: Influenza vaccine is underused in groups targeted for vaccination. OBJECTIVE: To define the effects of influenza and the benefits of influenza vaccination in elderly persons with chronic lung disease. DESIGN: Retrospective, multiseason cohort study. SETTING: Large managed care organization. PATIENTS: All elderly members of a managed care organization who had a previous diagnosis of chronic lung disease. MEASUREMENTS: Outcomes in vaccinated and unvaccinated persons for the 1993-1994, 1994-1995, and 1995-1996 influenza seasons were compared after adjustment for baseline demographic and health characteristics. All data were obtained from administrative databases. RESULTS: Vaccination rates were greater than 70% for each season. Among unvaccinated persons, hospitalization rates for pneumonia and influenza were twice as high in the influenza seasons as they were in the interim (noninfluenza) periods. Influenza vaccination was associated with fewer hospitalizations for pneumonia and influenza (adjusted risk ratio, 0.48 [95% CI, 0.28 to 0.82]) and with lower risk for death (adjusted odds ratio, 0.30 [CI, 0.21 to 0.43]) during the influenza seasons. It was also associated with fewer outpatient visits for pneumonia and influenza and for all respiratory conditions. CONCLUSIONS: For elderly persons with chronic lung disease, influenza is associated with significant adverse health effects and influenza vaccination is associated with substantial health benefits, including fewer outpatient visits, fewer hospitalizations, and fewer deaths. Health care providers should take advantage of all opportunities to immunize these high-risk patients.     

Effect of a complete nutritional supplement on antibody response to influenza vaccine in elderly people

BACKGROUND: The impact of influenza infection on morbidity and mortality in the elderly population can be severe. Influenza vaccination is not very effective in this age group, which is potentially related to impaired nutritional status. We investigated the effect of a 7-month nutritional supplementation on antibody response to influenza vaccine in elderly people. METHODS: Nineteen subjects aged 65 years and older with a body mass index of 25 kg/m(2) or less were studied. Subjects received a complete liquid nutrition supplement containing energy, vitamins, and minerals, including enhanced levels of antioxidants or noncaloric placebo drink for 7 months. Antibody titers to influenza strains A/Sydney/5/97 (SY), A/Beijing/262/95 (BE), and B/Yamanashi/166/98 (YA) before and 28 days after vaccination were measured. Age, gender, weight, height, serum albumin, serum prealbumin, hemoglobin, and serum vitamin E at baseline were registered. RESULTS: Mean fold increase upon vaccination for SY was significantly larger in the supplement group (2.76 +/- 0.66) compared to the placebo group (1.91 +/- 0.66). These differences were not observed for YA (1.73 +/- 0.31 vs 1.19 +/- 0.18) and BE (4.40 +/- 2.63 vs 5.76 +/- 3.34). For all three strains, there was no significant difference between groups in protective antibody levels (HI titer > or =40) after vaccination. CONCLUSIONS: We conclude that provision of a complete liquid nutrition supplement including enhanced levels of antioxidants may have a beneficial effect on antibody response to influenza vaccination in the elderly population. Further confirmation of these findings and their clinical consequences should be the subject of a larger study.     

Influenza vaccination as secondary prevention for cardiovascular disease: a science advisory from the American Heart Association/American College of Cardiology

Evidence from cohort studies and a randomized clinical trial indicates that annual vaccination against seasonal influenza prevents cardiovascular morbidity and all-cause mortality in patients with cardiovascular conditions. The American Heart Association and American College of Cardiology recommend influenza immunization with inactivated vaccine (administered intramuscularly) as part of comprehensive secondary prevention in persons with coronary and other atherosclerotic vascular disease (Class I, Level B). Immunization with live, attenuated vaccine (administered intranasally) is not currently recommended [corrected] for persons with cardiovascular conditions. It is important to note that influenza vaccination coverage levels overall and in this population remain well below national goals and are marked by disparities across different age and ethnic groups. One of the barriers to vaccination for patients with cardiovascular disease is that cardiology practices frequently do not stock and administer influenza vaccine. Healthcare providers who treat individuals with cardiovascular disease can help improve influenza vaccination coverage rates by providing and strongly recommending vaccination to their patients before and throughout the influenza season.     

Influenza vaccination as secondary prevention for cardiovascular disease: a science advisory from the American Heart Association/American College of Cardiology.

Evidence from cohort studies and a randomized clinical trial indicates that annual vaccination against seasonal influenza prevents cardiovascular morbidity and all-cause mortality in patients with cardiovascular conditions. The American Heart Association and American College of Cardiology recommend influenza immunization with inactivated vaccine (administered intramuscularly) as part of comprehensive secondary prevention in persons with coronary and other atherosclerotic vascular disease (Class I, Level B). Immunization with live, attenuated vaccine (administered intranasally) is not currently recommended [corrected] for persons with cardiovascular conditions. It is important to note that influenza vaccination coverage levels overall and in this population remain well below national goals and are marked by disparities across different age and ethnic groups. One of the barriers to vaccination for patients with cardiovascular disease is that cardiology practices frequently do not stock and administer influenza vaccine. Healthcare providers who treat individuals with cardiovascular disease can help improve influenza vaccination coverage rates by providing and strongly recommending vaccination to their patients before and throughout the influenza season.     

Influenza vaccination as secondary prevention for cardiovascular disease: a science advisory from the American Heart Association/American College of Cardiology

Evidence from cohort studies and a randomized clinical trial indicates that annual vaccination against seasonal influenza prevents cardiovascular morbidity and all-cause mortality in patients with cardiovascular conditions. The American Heart Association and American College of Cardiology recommend influenza immunization with inactivated vaccine (administered intramuscularly) as part of comprehensive secondary prevention in persons with coronary and other atherosclerotic vascular disease (Class I, Level B). Immunization with live, attenuated vaccine (administered intranasally) is not currently recommended [corrected] for persons with cardiovascular conditions. It is important to note that influenza vaccination coverage levels overall and in this population remain well below national goals and are marked by disparities across different age and ethnic groups. One of the barriers to vaccination for patients with cardiovascular disease is that cardiology practices frequently do not stock and administer influenza vaccine. Healthcare providers who treat individuals with cardiovascular disease can help improve influenza vaccination coverage rates by providing and strongly recommending vaccination to their patients before and throughout the influenza season.     

A comparison of antibody responses to admune inactivated influenza vaccin in serum and respiratory secretions of healthy non-smokers,healthy cigarette-smokers and patients with chronic bronchitis

Admune inactivated influenza vaccine was administered intramuscularly to 31 healthy subjects (18 non-smokers and 13 cigarette smokers) and 30 patients with chronic bronchitis. Homologous haemagglutination inhibition (HI) antibody titres were measured in serum and respiratory secretions over a three-month post-vaccination period. Clinical reactions to the vaccine were recorded during the week following vaccination.Among healthy subjects cigarette smoking did not influence HI antibody responses in serum and nasal secretion following vaccination. Chronic bronchitics produced at least as much serum and nasal antibody as healthy subjects and their sputum and nasal secretion antibody responses were comparable. Clinical reactions to the vaccine were mild and well tolerated in all groups but seven patients with chronic bronchitis (23%) experienced increased respiratory symptoms during the week following vaccination.     

Universal influenza vaccination in the United States: are we ready? Report of a meeting

Universal influenza vaccination has been proposed as one strategy to improve vaccination coverage and disease prevention. In October 2005, influenza and vaccination experts, public health practitioners, representatives from medical professional societies, influenza vaccine manufacturers, and managed care organizations met to assess whether current data were sufficient to support an expansion of universal influenza vaccination and to define information gaps and potential barriers to implementation. Presenters at the meeting documented the substantial burden of influenza disease among all age groups, the major role of children in transmission, and the effectiveness of vaccine, especially in healthy children and adults. Observational studies and a mathematical model suggested that indirect protection, or "herd immunity," resulting from vaccination of school-age children would substantially reduce the incidence of disease in other age groups. Economic analyses generally showed that vaccination of healthy children and adults is cost-effective and is sensitive to vaccine cost, population group, and season. Influenza vaccination received annually over several years is safe and effective, but data on long-term use are limited. Challenges to expanded recommendations include maintenance of the vaccine supply, implementation of a feasible and effective strategy for vaccine delivery, the burden on the public health infrastructure, public acceptability, and financing. Overall, meeting attendees favored incremental expansion of recommendations, potentially toward universal influenza vaccination. They preferred to expand recommendations among children first, because children have a higher risk of illness, compared with healthy adults; because there is greater feasibility of implementation of the recommendations among children; and because of the potential for herd immunity decreasing morbidity and mortality among adults.     

Long-term therapy with rifampin and the secondary antibody response to killed influenza vaccine

The secondary antibody response was studied in 22 patients with tuberculosis, 11 of whom were taking rifampin as part of their antituberculous regimen. The mean duration of rifampin therapy was 12.7 months. Hemagglutination-inhibiting antibody titers to bivalent influenza vaccine were determined before, and 4 and 8 weeks after, vaccination. There was no significant difference in the number of patients who developed a 4-fold or greater increase in titer, or in the level of titer response between the rifampin and control groups. Long-term therapy with rifampin was not found to suppress the secondary antibody response to influenza vaccination.     

Policies to increase influenza and pneumococcal immunizations in chronically ill and institutionalized settings

BACKGROUND: The objective of this study was to understand better the status of and ways to improve dissemination of influenza and pneumococcal standing-order vaccination policies to at-risk adults in health care institutions. METHODS: A statewide sample of 5 different types of institutions serving at-risk elderly persons in North Carolina was surveyed. A 45-question telephone survey was administered to infection control nurses or facility directors at 267 (86% response rate) health care facilities involved in direct patient care. RESULTS: A majority of respondents reported that influenza (81%) and pneumococcal (59%) diseases were important to their facility, and 63% stated that the influenza vaccine was very effective versus 47% for pneumococcal. Except nursing homes, few facilities reported adoption of standing-order policies to vaccinate routinely the at-risk adults. Over 70% of respondents stated that their facilities might consider adopting standing-order policies for influenza and pneumococcal disease. A majority of respondents also supported a state law that requires such vaccines for high-risk patients unless contraindicated or the patient refuses. CONCLUSIONS: Respondents across diverse health care institutions appear interested in adopting standing-order policies to increase influenza and pneumococcal vaccination rates and are more likely to do so if provided with appropriate administrative and/or financial support for implementation.     

Reduction in functional antibody activity against Streptococcus pneumoniae in vaccinated elderly individuals highly correlates with decreased IgG antibody avidity.

The pneumococcal polysaccharide vaccine is recommended as a means of preventing invasive disease in the elderly. We compared responses to the 23-valent polysaccharide vaccine in 46 previously unvaccinated, healthy, institutionalized elderly persons (mean age, 85.5 years) with those in 12 healthy younger adults (mean age, 37 years) by measuring prevaccination and postvaccination serum IgG antibody concentrations (by ELISA), functional antibody activity (by opsonophagocytosis), IgG antibody avidity, and passive protection in mice. Postvaccination IgG antibody concentrations for two serotypes (6B and 19F) of the five studied (4, 6B, 14, 19F, and 23F) were significantly lower in elderly than in younger adults; however, opsonophagocytic activity was significantly reduced for all serotypes in the elderly. Sera with reduced opsonophagocytic activity (titer, <64) correlated with low IgG antibody avidity and protected mice poorly against pneumococcal challenge. In elderly persons receiving polysaccharide vaccination, there was a significant reduction in the functionality of postvaccination antibodies, and this appeared to increase with advanced age.     

The effect of influenza vaccination on IL2 production in healthy elderly: implications for current vaccination practices.

Age-related senescence of T-cell mediated responses is well recognized. This study was designed to determine how aging affects the T-cell mediated Interleukin 2 (IL2) response to influenza vaccination. A group of healthy elderly individuals were compared to a control group of healthy young adults for their response to the 1990 influenza vaccine. Cultures of peripheral blood mononuclear cells (PBMC) were prepared from venous blood samples taken prevaccination (pre) and 8 and 12 weeks post-vaccination (post). PBMC cultures stimulated with inactivated A/Shanghai/16/89 (contained in the 1990 vaccine) and A/Philippine/2/82 (not contained in the vaccine) were assayed for peak IL2 activity. We find that after influenza vaccination, there was an insignificant increase in IL2 activity when PBMC from the young control group were stimulated with A/Shanghai/16/89 (pre, 5.14 U/mL/10(6) PBMC; post, 6.64 U/mL/10(6) PBMC) but there was a significant increase in IL2 activity when stimulated with A/Phillippine/2/82 (pre, 1.5 U/mL/10(6) PBMC; post, 8.3 U/mL/10(6) PBMC). In similar cultures of PBMC from the elderly group, there was a significant increase in IL2 response to both A/Shanghai/16/89 (pre, 1.6 U/mL/10(6) PBMC; post, 3.5 U/mL/10(6) PBMC) and A/Philippine/2/82 (pre, 0.86 U/mL/10(6) PBMC; post, 8.3 U/mL/10(6) PBMC). Measurements of CD4+/CD8+ populations were not affected by vaccination and were not significantly different in the two groups. Subgroup analysis of the elderly group revealed that previous influenza vaccination in 1989 did not significantly affect IL2 levels measured in the present study. This study shows that in healthy elderly, influenza vaccination effectively restores IL2 activity to normal. There appears to be an age-related decrease in the duration of T-cell memory.(ABSTRACT TRUNCATED AT 250 WORDS)     

Immune response to influenza vaccine in the elderly: Association with nutritional and physical status

Aim: To investigate the distribution of hemagglutination inhibition (HI) titers before and after influenza vaccination and to examine the relationship between physical and nutritional factors and the change in HI titer after influenza vaccination in the elderly. Methods: Pre‐post‐vaccination HI titers were determined from 203 individuals aged 65 years or older residing in a nursing home. For the assessment of physical and nutritional status, information was retrieved from care records. Results: The immune response to vaccination was assessed as good in 122 subjects based on a fourfold rise or more in HI titer after vaccination for at least one of three vaccine strains. In univariate logistic regression analysis with poor versus good immune response as the dependent variable, factors found to be significantly associated with a poor immune response were disability, a combination of body mass index less than 18.5 and bodyweight loss in 6 months or 5% or more, mid‐upper‐arm circumference of less than 80%, arm muscle circumference of less than 80% and total protein of less than 6.5 g/dL. Physical and nutritional indicators might be useful in identifying individuals who are unlikely to have a good immune response to influenza vaccination. In a multivariate analysis, the association remained significant for a low level of activities of daily living and a combination of body mass index of less than 18.5 and bodyweight loss in 6 months of 5% or more. Conclusion: Elderly individuals with poor physical and nutritional status tended to respond poorly to influenza vaccination. A low level of activities of daily living and a combination of being underweight and having had recent bodyweight loss are good indicators of a poor immune response. Geriatr Gerontol Int 2011; 11: 63–68.