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How does geographical diversity shape vaccine efficacy?

  • Mohammad Abavisani (Student Research Committee, Mashhad University of Medical Sciences) ;
  • Bahareh Ansari (Immunology Research Center, Mashhad University of Medical Sciences) ;
  • Negar Ebadpour (Immunology Research Center, Mashhad University of Medical Sciences) ;
  • Amirhossein Sahebkar (Center for Global Health Research, Saveetha Medical College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University)
  • Received : 2024.04.20
  • Accepted : 2024.06.04
  • Published : 2024.10.31

Abstract

Vaccination is a cornerstone of public health, saving millions of lives each year by preventing a variety of infectious diseases. Yet, despite global vaccination efforts, emerging research highlights significant geographical disparities in vaccine efficacy and immunogenicity. These variations underscore the critical interplay between immunological factors and environmental, genetic, and nutritional elements across different populations. Our review article aimed to explore the multifactorial reasons behind geographical variations in vaccine efficacy. Also, this study has shown how important host factors like age, obesity, gender, and genetic diversity, especially within the major histocompatibility complex, are in determining how well a vaccine works. Nutritional status, namely deficiencies in micronutrients such as vitamins and zinc, and lifestyle factors including stress, sleep, alcohol consumption, and physical activity are also shown to have profound effects on vaccine-induced immunity. Importantly, our paper also brought to light the influence of microbial and ecological factors, such as the gut microbiome and environmental pollutants, on the immune system's response to vaccination. The findings emphasize the importance of tailoring vaccination strategies to accommodate the unique immunological landscapes shaped by geographical and societal factors. This tailored approach could enhance vaccine efficacy, reduce disparities in vaccine response, and ultimately contribute to the global fight against infectious diseases.

Keywords

References

  1. Andre FE, Booy R, Bock HL, et al. Vaccination greatly reduces disease, disability, death and inequity worldwide. Bull World Health Organ 2008;86:140-6. 
  2. Lewnard JA, Lo NC, Arinaminpathy N, Frost I, Laxminarayan R. Childhood vaccines and antibiotic use in low-and middle-income countries. Nature 2020;581:94-9. 
  3. Rachlin A, Danovaro-Holliday MC, Murphy P, Sodha SV, Wallace AS. Routine vaccination coverage: worldwide, 2021. MMWR Morb Mortal Wkly Rep 2022;71:1396-400. 
  4. Muhoza P, Danovaro-Holliday MC, Diallo MS, et al. Routine vaccination coverage: worldwide, 2020. MMWR Morb Mortal Wkly Rep 2021;70:1495-500. 
  5. Kim SY, Ahmad S. Global, regional, and national disruptions to COVID-19 vaccine coverage in 237 countries and territories, March 2022: a systematic analysis for World Health Organization COVID-19 Dashboard, Release 1. Life Cycle 2022;2:e14. 
  6. Ghaznavi C, Eguchi A, Suu Lwin K, et al. Estimating global changes in routine childhood vaccination coverage during the COVID-19 pandemic, 2020-2021. Vaccine 2023;41:4151-7. 
  7. Lipsitch M, Dean NE. Understanding COVID-19 vaccine efficacy. Science 2020;370:763-5. 
  8. Slifka MK, Amanna I. How advances in immunology provide insight into improving vaccine efficacy. Vaccine 2014;32:2948-57. 
  9. Madison AA, Shrout MR, Renna ME, Kiecolt-Glaser JK. Psychological and behavioral predictors of vaccine efficacy: considerations for COVID-19. Perspect Psychol Sci 2021;16:191-203. 
  10. Gold Y, Somech R, Mandel D, Peled Y, Reif S. Decreased immune response to hepatitis B eight years after routine vaccination in Israel. Acta Paediatr 2003;92:1158-62. 
  11. Simonsen O, Kristiansen M, Aggerbeck H, Hau C, Heron I. Fall-off in immunity following diphtheria revaccination: an 8 year follow-up study. APMIS 1996;104:921-5. 
  12. Falahi S, Kenarkoohi A. Host factors and vaccine efficacy: implications for COVID-19 vaccines. J Med Virol 2022;94:1330-5. 
  13. Zimmermann P, Curtis N. Factors that influence the immune response to vaccination. Clin Microbiol Rev 2019;32:e00084-18. 
  14. van Dorst MM, Pyuza JJ, Nkurunungi G, et al. Immunological factors linked to geographical variation in vaccine responses. Nat Rev Immunol 2024;24:250-63. 
  15. Choe YJ, Blatt DB, Lee HJ, Choi EH. Associations between geographic region and immune response variations to pneumococcal conjugate vaccines in clinical trials: a systematic review and meta-analysis. Int J Infect Dis 2020;92:261-8. 
  16. Coccia M, Burny W, Demoitie MA, Gillard P, van den Berg RA, van der Most R. Subsequent AS01-adjuvanted vaccinations induce similar transcriptional responses in populations with different disease statuses. PLoS One 2022;17:e0276505. 
  17. Ovsyannikova IG, Dhiman N, Jacobson RM, Poland GA. Human leukocyte antigen polymorphisms: variable humoral immune responses to viral vaccines. Expert Rev Vaccines 2006;5:33-43. 
  18. Jordan A, Carding SR, Hall LJ. The early-life gut microbiome and vaccine efficacy. Lancet Microbe 2022;3:e787-94. 
  19. Gonzalez-Dias P, Lee EK, Sorgi S, et al. Methods for predicting vaccine immunogenicity and reactogenicity. Hum Vaccin Immunother 2020;16:269-76. 
  20. Korenkov D, Isakova-Sivak I, Rudenko L. Basics of CD8 T-cell immune responses after influenza infection and vaccination with inactivated or live attenuated influenza vaccine. Expert Rev Vaccines 2018;17:977-87. 
  21. Gustafson CE, Kim C, Weyand CM, Goronzy JJ. Influence of immune aging on vaccine responses. J Allergy Clin Immunol 2020;145:1309-21. 
  22. Crotty S, Ahmed R. Immunological memory in humans. Semin Immunol 2004;16:197-203. 
  23. Van Damme P, Dionne M, Leroux-Roels G, et al. Persistence of HBsAg-specific antibodies and immune memory two to three decades after hepatitis B vaccination in adults. J Viral Hepat 2019;26:1066-75. 
  24. Lynn DJ, Benson SC, Lynn MA, Pulendran B. Modulation of immune responses to vaccination by the microbiota: implications and potential mechanisms. Nat Rev Immunol 2022;22:33-46. 
  25. Nakaya HI, Hagan T, Duraisingham SS, et al. Systems analysis of immunity to influenza vaccination across multiple years and in diverse populations reveals shared molecular signatures. Immunity 2015;43:1186-98. 
  26. Mohr E, Siegrist CA. Vaccination in early life: standing up to the challenges. Curr Opin Immunol 2016;41:1-8. 
  27. Lee YC, Newport MJ, Goetghebuer T, et al. Influence of genetic and environmental factors on the immunogenicity of Hib vaccine in Gambian twins. Vaccine 2006;24:5335-40. 
  28. Siegrist CA. Neonatal and early life vaccinology. Vaccine 2001;19:3331-46. 
  29. Vitetta L, Saltzman ET, Thomsen M, Nikov T, Hall S. Adjuvant probiotics and the intestinal microbiome: enhancing vaccines and immunotherapy outcomes. Vaccines (Basel) 2017;5:50. 
  30. Lesichkova S, Mihailova S, Mihaylova A, Gesheva N, Yankova P, Naumova E. Age-related dynamics in post-vaccine antibody immune response to diphtheria and tetanus toxoid in Bulgarian subjects. Acta Med Bulg 2021;48:46-52. 
  31. Agarwal S, Busse PJ. Innate and adaptive immunosenescence. Ann Allergy Asthma Immunol 2010;104:183-90. 
  32. Scholz JL, Diaz A, Riley RL, Cancro MP, Frasca D. A comparative review of aging and B cell function in mice and humans. Curr Opin Immunol 2013;25:504-10. 
  33. Chen WH, Kozlovsky BF, Effros RB, Grubeck-Loebenstein B, Edelman R, Sztein MB. Vaccination in the elderly: an immunological perspective. Trends Immunol 2009;30:351-9. 
  34. Goronzy JJ, Weyand CM. Understanding immunosenescence to improve responses to vaccines. Nat Immunol 2013;14:428-36. 
  35. Kim DK, Riley LE, Hunter P, et al. Recommended immunization schedule for adults aged 19 years or older, United States, 2018. Ann Intern Med 2018;168:210-20. 
  36. Enani S, Przemska-Kosicka A, Childs CE, et al. Impact of ageing and a synbiotic on the immune response to seasonal influenza vaccination; a randomised controlled trial. Clin Nutr 2018;37:443-51. 
  37. Collier DA, Ferreira IA, Datir R, et al. Age-related heterogeneity in neutralising antibody responses to SARS-CoV-2 following BNT162b2 vaccination. MedRxiv [Preprint] 2021 Feb 3. https://doi.org/10.1101/2021.02.03.21251054 
  38. Muller L, Andree M, Moskorz W, et al. Age-dependent immune response to the Biontech/Pfizer BNT162b2 coronavirus disease 2019 vaccination. Clin Infect Dis 2021;73:2065-72. 
  39. Schwarz T, Tober-Lau P, Hillus D, et al. Delayed antibody and T-cell response to BNT162b2 vaccination in the elderly, Germany. Emerg Infect Dis 2021;27:2174-8. 
  40. Frasca D, Blomberg BB. The impact of obesity and metabolic syndrome on vaccination success. Interdiscip Top Gerontol Geriatr 2020;43:86-97. 
  41. Yang S, Tian G, Cui Y, et al. Factors influencing immunologic response to hepatitis B vaccine in adults. Sci Rep 2016;6:27251. 
  42. Callahan ST, Wolff M, Hill HR, Edwards KM; NIAID Vaccine and Treatment Evaluation Unit (VTEU) Pandemic H1N1 Vaccine Study Group. Impact of body mass index on immunogenicity of pandemic H1N1 vaccine in children and adults. J Infect Dis 2014;210:1270-4. 
  43. Banga N, Guss P, Banga A, Rosenman KD. Incidence and variables associated with inadequate antibody titers after pre-exposure rabies vaccination among veterinary medical students. Vaccine 2014;32:979-83. 
  44. Kipshidze N, Kipshidze N, Fried M. COVID-19 vaccines: special considerations for the obese population. Obes Surg 2021;31:3854-6. 
  45. Pellini R, Venuti A, Pimpinelli F, et al. Obesity may hamper SARS-CoV-2 vaccine immunogenicity. MedRXiv [Preprint] 2021 Feb 24. https://doi.org/10.1101/2021.02.24.21251664 
  46. Fischinger S, Boudreau CM, Butler AL, Streeck H, Alter G. Sex differences in vaccine-induced humoral immunity. Semin Immunopathol 2019;41:239-49. 
  47. Klein SL, Marriott I, Fish EN. Sex-based differences in immune function and responses to vaccination. Trans R Soc Trop Med Hyg 2015;109:9-15. 
  48. Klein SL, Flanagan KL. Sex differences in immune responses. Nat Rev Immunol 2016;16:626-38. 
  49. Engler RJ, Nelson MR, Klote MM, et al. Half- vs full-dose trivalent inactivated influenza vaccine (2004-2005): age, dose, and sex effects on immune responses. Arch Intern Med 2008;168:2405-14. 
  50. Zhu Z, Xu L, Chen G. Is there a difference in the efficacy of COVID-19 vaccine in males and females?: a systematic review and meta-analysis. Hum Vaccin Immunother 2021;17:4741-6. 
  51. Kashkouli AR, Jafari M, Yousefi P. Effects of gender on the efficacy and response to COVID-19 vaccination; a review study on current knowledge. J Ren Endocrinol 2022;8:e25064. 
  52. Green MS, Peer V, Magid A, Hagani N, Anis E, Nitzan D. Gender differences in adverse events following the Pfizer-BioNTech COVID-19 vaccine. Vaccines (Basel) 2022;10:233. 
  53. Peer V, Muhsen K, Betser M, Green MS. Antibody response to pertussis vaccination in pregnant and nonpregnant women: the role of sex hormones. Vaccines (Basel) 2021;9:637. 
  54. Gameiro CM, Romao F, Castelo-Branco C. Menopause and aging: changes in the immune system: a review. Maturitas 2010;67:316-20. 
  55. Giefing-Kroll C, Berger P, Lepperdinger G, Grubeck-Loebenstein B. How sex and age affect immune responses, susceptibility to infections, and response to vaccination. Aging Cell 2015;14:309-21. 
  56. Engelmann F, Rivera A, Park B, Messerle-Forbes M, Jensen JT, Messaoudi I. Impact of estrogen therapy on lymphocyte homeostasis and the response to seasonal influenza vaccine in post-menopausal women. PLoS One 2016;11:e0149045. 
  57. Gall SA, Myers J, Pichichero M. Maternal immunization with tetanus-diphtheria-pertussis vaccine: effect on maternal and neonatal serum antibody levels. Am J Obstet Gynecol 2011;204:334. 
  58. Munoz FM, Bond NH, Maccato M, et al. Safety and immunogenicity of tetanus diphtheria and acellular pertussis (Tdap) immunization during pregnancy in mothers and infants: a randomized clinical trial. JAMA 2014;311:1760-9. 
  59. Hoang HT, Leuridan E, Maertens K, et al. Pertussis vaccination during pregnancy in Vietnam: results of a randomized controlled trial Pertussis vaccination during pregnancy. Vaccine 2016;34:151-9. 
  60. Abu Raya B, Srugo I, Kessel A, et al. The effect of timing of maternal tetanus, diphtheria, and acellular pertussis (Tdap) immunization during pregnancy on newborn pertussis antibody levels: a prospective study. Vaccine 2014;32:5787-93. 
  61. Zimmermann P, Perrett KP, Messina NL, et al. The effect of maternal immunisation during pregnancy on infant vaccine responses. EClinicalMedicine 2019;13:21-30. 
  62. Bertley FM, Ibrahim SA, Libman M, Ward BJ. Measles vaccination in the presence of maternal antibodies primes for a balanced humoral and cellular response to revaccination. Vaccine 2004;23:444-9. 
  63. Pabst HF, Spady DW, Carson MM, Krezolek MP, Barreto L, Wittes RC. Cell-mediated and antibody immune responses to AIK-C and Connaught monovalent measles vaccine given to 6 month old infants. Vaccine 1999;17:1910-8. 
  64. Gans H, DeHovitz R, Forghani B, Beeler J, Maldonado Y, Arvin AM. Measles and mumps vaccination as a model to investigate the developing immune system: passive and active immunity during the first year of life. Vaccine 2003;21:3398-405. 
  65. Halperin SA, Langley JM, Ye L, et al. A randomized controlled trial of the safety and immunogenicity of tetanus, diphtheria, and acellular pertussis vaccine immunization during pregnancy and subsequent infant immune response. Clin Infect Dis 2018;67:1063-71. 
  66. Cortes-Selva D, Gibbs L, Ready A, et al. Maternal schistosomiasis impairs offspring Interleukin-4 production and B cell expansion. PLoS Pathog 2021;17:e1009260. 
  67. Malhotra I, McKibben M, Mungai P, et al. Effect of antenatal parasitic infections on anti-vaccine IgG levels in children: a prospective birth cohort study in Kenya. PLoS Negl Trop Dis 2015;9:e0003466. 
  68. Malhotra I, LaBeaud AD, Morris N, et al. Cord blood antiparasite interleukin 10 as a risk marker for compromised vaccine immunogenicity in early childhood. J Infect Dis 2018;217:1426-34. 
  69. Diotti RA, Caputo V, Sautto GA. Conventional and nontraditional delivery methods and routes of vaccine administration. In: Ohtake S, Kolhe P, editors. Practical aspects of vaccine development. Amsterdam: Academic Press; 2022. p. 329-55. 
  70. Sanchez L, Matsuoka O, Inoue S, et al. Immunogenicity and safety of high-dose quadrivalent influenza vaccine in Japanese adults ≥65 years of age: a randomized controlled clinical trial. Hum Vaccin Immunother 2020;16:858-66. 
  71. Edelman R, Deming ME, Toapanta FR, et al. The SENIEUR protocol and the efficacy of hepatitis B vaccination in healthy elderly persons by age, gender, and vaccine route. Immun Ageing 2020;17:9. 
  72. Ragni MV, Lusher JM, Koerper MA, Manco-Johnson M, Krause DS. Safety and immunogenicity of subcutaneous hepatitis A vaccine in children with haemophilia. Haemophilia 2000;6:98-103. 
  73. Fessard C, Riche O, Cohen JH. Intramuscular versus subcutaneous injection for hepatitis B vaccine. Vaccine 1988;6:469. 
  74. Carpenter SL, Soucie JM, Presley RJ, et al. Hepatitis B vaccination is effective by subcutaneous route in children with bleeding disorders: a universal data collection database analysis. Haemophilia 2015;21:e39-43. 
  75. Fortier EE, Rooney J, Dardente H, Hardy MP, Labrecque N, Cermakian N. Circadian variation of the response of T cells to antigen. J Immunol 2011;187:6291-300. 
  76. de Bree LC, Mourits VP, Koeken VA, et al. Circadian rhythm influences induction of trained immunity by BCG vaccination. J Clin Invest 2020;130:5603-17. 
  77. Long JE, Drayson MT, Taylor AE, Toellner KM, Lord JM, Phillips AC. Morning vaccination enhances antibody response over afternoon vaccination: a cluster-randomised trial. Vaccine 2016;34:2679-85. 
  78. Zhang H, Liu Y, Liu D, et al. Time of day influences immune response to an inactivated vaccine against SARS-CoV-2. Cell Res 2021;31:1215-7. 
  79. McLaren PJ, Coulonges C, Bartha I, et al. Polymorphisms of large effect explain the majority of the host genetic contribution to variation of HIV-1 virus load. Proc Natl Acad Sci U S A 2015;112:14658-63. 
  80. Ge D, Fellay J, Thompson AJ, et al. Genetic variation in IL28B predicts hepatitis C treatment-induced viral clearance. Nature 2009;461:399-401. 
  81. Walker WG, Hillis WD, Hillis A. Hepatitis B infection in patients with end stage renal disease: some characteristics and consequences. Trans Am Clin Climatol Assoc 1981;92:142-51. 
  82. Kruger A, Adams P, Hammer J, et al. Hepatitis B surface antigen presentation and HLA-DRB1*: lessons from twins and peptide binding studies. Clin Exp Immunol 2005;140:325-32. 
  83. Hennig BJ, Fielding K, Broxholme J, et al. Host genetic factors and vaccine-induced immunity to hepatitis B virus infection. PLoS One 2008;3:e1898. 
  84. Gemmati D, Longo G, Gallo I, et al. Host genetics impact on SARS-CoV-2 vaccine-induced immunoglobulin levels and dynamics: the role of TP53, ABO, APOE, ACE2, HLAA, and CRP genes. Front Genet 2022;13:1028081. 
  85. Afzaljavan F, Chaeichi Tehrani N, Rivandi M, et al. The dilemma of TP53 codon 72 polymorphism (rs1042522) and breast cancer risk: a case-control study and meta-analysis in the Iranian population. Cell J 2020;22:185-92. 
  86. Salazar M, Deulofeut H, Granja C, et al. Normal HBsAg presentation and T-cell defect in the immune response of nonresponders. Immunogenetics 1995;41:366-74. 
  87. Tan PL, Jacobson RM, Poland GA, Jacobsen SJ, Pankratz VS. Twin studies of immunogenicity: determining the genetic contribution to vaccine failure. Vaccine 2001;19:2434-9. 
  88. Hohler T, Stradmann-Bellinghausen B, Starke R, et al. C4A deficiency and nonresponse to hepatitis B vaccination. J Hepatol 2002;37:387-92. 
  89. Ugolini M, Gerhard J, Burkert S, et al. Recognition of microbial viability via TLR8 drives TFH cell differentiation and vaccine responses. Nat Immunol 2018;19:386-96. 
  90. Tsang TK, Wang C, Tsang NN, et al. Impact of host genetic polymorphisms on response to inactivated influenza vaccine in children. NPJ Vaccines 2023;8:21. 
  91. Bucasas KL, Franco LM, Shaw CA, et al. Early patterns of gene expression correlate with the humoral immune response to influenza vaccination in humans. J Infect Dis 2011;203:921-9. 
  92. Clifford HD, Yerkovich ST, Khoo SK, et al. Toll-like receptor 7 and 8 polymorphisms: associations with functional effects and cellular and antibody responses to measles virus and vaccine. Immunogenetics 2012;64:219-28. 
  93. Voigt EA, Ovsyannikova IG, Haralambieva IH, et al. Genetically defined race, but not sex, is associated with higher humoral and cellular immune responses to measles vaccination. Vaccine 2016;34:4913-9. 
  94. Heath PT. Haemophilus influenzae type b conjugate vaccines: a review of efficacy data. Pediatr Infect Dis J 1998;17(9 Suppl):S117-22. 
  95. Hetherington SV, Lepow ML. Correlation between antibody affinity and serum bactericidal activity in infants. J Infect Dis 1992;165:753-6. 
  96. Calder PC. Feeding the immune system. Proc Nutr Soc 2013;72:299-309. 
  97. Wintergerst ES, Maggini S, Hornig DH. Contribution of selected vitamins and trace elements to immune function. Ann Nutr Metab 2007;51:301-23. 
  98. Gombart AF, Pierre A, Maggini S. A review of micronutrients and the immune system-working in harmony to reduce the risk of infection. Nutrients 2020;12:236. 
  99. Calder PC. Nutrition, immunity and COVID-19. BMJ Nutr Prev Health 2020;3:74-92. 
  100. Rayman MP, Calder PC. Optimising COVID-19 vaccine efficacy by ensuring nutritional adequacy. Br J Nutr 2021;126:1919-20. 
  101. Gibson A, Edgar JD, Neville CE, et al. Effect of fruit and vegetable consumption on immune function in older people: a randomized controlled trial. Am J Clin Nutr 2012;96:1429-36. 
  102. Fata FT, Herzlich BC, Schiffman G, Ast AL. Impaired antibody responses to pneumococcal polysaccharide in elderly patients with low serum vitamin B12 levels. Ann Intern Med 1996;124:299-304. 
  103. Haase H, Rink L. The immune system and the impact of zinc during aging. Immun Ageing 2009;6:9. 
  104. Hamza SA, Mousa SM, Taha SE, Adel LA, Samaha HE, Hussein DA. Immune response of 23-valent pneumococcal polysaccharide vaccinated elderly and its relation to frailty indices, nutritional status, and serum zinc levels. Geriatr Gerontol Int 2012;12:223-9. 
  105. Siddiqui FQ, Ahmad MM, Kakar F, Akhtar S, Dil AS. The role of vitamin A in enhancing humoral immunity produced by antirabies vaccine. East Mediterr Health J 2001;7:799-804. 
  106. Sudfeld CR, Navar AM, Halsey NA. Effectiveness of measles vaccination and vitamin A treatment. Int J Epidemiol 2010;39(Suppl 1):i48-55. 
  107. Goncalves-Mendes N, Talvas J, Duale C, et al. Impact of vitamin D supplementation on influenza vaccine response and immune functions in deficient elderly persons: a randomized placebo-controlled trial. Front Immunol 2019;10:65. 
  108. Zitt E, Sprenger-Mahr H, Knoll F, Neyer U, Lhotta K. Vitamin D deficiency is associated with poor response to active hepatitis B immunisation in patients with chronic kidney disease. Vaccine 2012;30:931-5. 
  109. Meydani SN, Meydani M, Blumberg JB, et al. Vitamin E supplementation and in vivo immune response in healthy elderly subjects: a randomized controlled trial. JAMA 1997;277:1380-6. 
  110. Stantic-Pavlinic M, Banic S, Marin J, Klemenc P. Vitamin C: a challenge in management of rabies. Swiss Med Wkly 2004;134:326-7. 
  111. Ivory K, Prieto E, Spinks C, et al. Selenium supplementation has beneficial and detrimental effects on immunity to influenza vaccine in older adults. Clin Nutr 2017;36:407-15. 
  112. Broome CS, McArdle F, Kyle JA, et al. An increase in selenium intake improves immune function and poliovirus handling in adults with marginal selenium status. Am J Clin Nutr 2004;80:154-62. 
  113. Pedersen AF, Zachariae R, Bovbjerg DH. Psychological stress and antibody response to influenza vaccination: a meta-analysis. Brain Behav Immun 2009;23:427-33. 
  114. Glaser R, Kiecolt-Glaser JK, Bonneau RH, Malarkey W, Kennedy S, Hughes J. Stress-induced modulation of the immune response to recombinant hepatitis B vaccine. Psychosom Med 1992;54:22-9. 
  115. Burns VE, Drayson M, Ring C, Carroll D. Perceived stress and psychological well-being are associated with antibody status after meningitis C conjugate vaccination. Psychosom Med 2002;64:963-70. 
  116. Glaser R, Sheridan J, Malarkey WB, MacCallum RC, Kiecolt-Glaser JK. Chronic stress modulates the immune response to a pneumococcal pneumonia vaccine. Psychosom Med 2000;62:804-7. 
  117. Gallagher S, Phillips AC, Drayson MT, Carroll D. Caregiving for children with developmental disabilities is associated with a poor antibody response to influenza vaccination. Psychosom Med 2009;71:341-4. 
  118. Miller GE, Cohen S, Pressman S, Barkin A, Rabin BS, Treanor JJ. Psychological stress and antibody response to influenza vaccination: when is the critical period for stress, and how does it get inside the body? Psychosom Med 2004;66:215-23. 
  119. Brydon L, Walker C, Wawrzyniak A, et al. Synergistic effects of psychological and immune stressors on inflammatory cytokine and sickness responses in humans. Brain Behav Immun 2009;23:217-24. 
  120. Glaser R, Robles TF, Sheridan J, Malarkey WB, Kiecolt-Glaser JK. Mild depressive symptoms are associated with amplified and prolonged inflammatory responses after influenza virus vaccination in older adults. Arch Gen Psychiatry 2003;60:1009-14. 
  121. Kiecolt-Glaser JK, Derry HM, Fagundes CP. Inflammation: depression fans the flames and feasts on the heat. Am J Psychiatry 2015;172:1075-91. 
  122. Patel NP, Vukmanovic-Stejic M, Suarez-Farinas M, et al. Impact of Zostavax vaccination on T-cell accumulation and cutaneous gene expression in the skin of older humans after varicella zoster virus antigen-specific challenge. J Infect Dis 2018;218(suppl_2):S88-98. 
  123. Irwin MR, Levin MJ, Laudenslager ML, et al. Varicella zoster virus-specific immune responses to a herpes zoster vaccine in elderly recipients with major depression and the impact of antidepressant medications. Clin Infect Dis 2013;56:1085-93. 
  124. Afsar B, Elsurer R, Eyileten T, Yilmaz MI, Caglar K. Antibody response following hepatitis B vaccination in dialysis patients: does depression and life quality matter? Vaccine 2009;27:5865-9. 
  125. Kiecolt-Glaser JK, Preacher KJ, MacCallum RC, Atkinson C, Malarkey WB, Glaser R. Chronic stress and age-related increases in the proinflammatory cytokine IL-6. Proc Natl Acad Sci U S A 2003;100:9090-5. 
  126. Pressman SD, Cohen S, Miller GE, Barkin A, Rabin BS, Treanor JJ. Loneliness, social network size, and immune response to influenza vaccination in college freshmen. Health Psychol 2005;24:297-306. 
  127. Phillips AC, Carroll D, Burns VE, Ring C, Macleod J, Drayson M. Bereavement and marriage are associated with antibody response to influenza vaccination in the elderly. Brain Behav Immun 2006;20:279-89. 
  128. Xiao K, Gillissie ES, Lui LM, et al. Immune response to vaccination in adults with mental disorders: a systematic review. J Affect Disord 2022;304:66-77. 
  129. Gallagher S, Howard S, Muldoon OT, Whittaker AC. Social cohesion and loneliness are associated with the antibody response to COVID-19 vaccination. Brain Behav Immun 2022;103:179-85. 
  130. Prather AA, Hall M, Fury JM, et al. Sleep and antibody response to hepatitis B vaccination. Sleep 2012;35:1063-9. 
  131. Spiegel K, Sheridan JF, Van Cauter E. Effect of sleep deprivation on response to immunization. JAMA 2002;288:1471-2. 
  132. Kang KW, Kim J, Kim KT, et al. Association between electronic device use at bedtime and COVID-19 vaccine-related adverse events during the COVID-19 pandemic in Korean adults: a nationwide cross-sectional population-based study. J Korean Med Sci 2023;38:e413. 
  133. Lange T, Perras B, Fehm HL, Born J. Sleep enhances the human antibody response to hepatitis A vaccination. Psychosom Med 2003;65:831-5. 
  134. Messaoudi I, Pasala S, Grant K. Could moderate alcohol intake be recommended to improve vaccine responses? Expert Rev Vaccines 2014;13:817-9. 
  135. Solopov PA. COVID-19 vaccination and alcohol consumption: justification of risks. Pathogens 2023;12:163. 
  136. Younas M, Carrat F, Desaint C, Launay O, Corbeau P; ANRS HB03 VIHVAC-B Trial Group. Immune activation, smoking, and vaccine response. AIDS 2017;31:171-3. 
  137. Petras M, Olear V, Molitorisova M, et al. Factors influencing persistence of diphtheria immunity and immune response to a booster dose in healthy Slovak adults. Vaccines (Basel) 2019;7:139. 
  138. Namujju PB, Pajunen E, Simen-Kapeu A, et al. Impact of smoking on the quantity and quality of antibodies induced by human papillomavirus type 16 and 18 AS04-adjuvanted virus-like-particle vaccine: a pilot study. BMC Res Notes 2014;7:445. 
  139. Ferrara P, Ponticelli D, Aguero F, et al. Does smoking have an impact on the immunological response to COVID-19 vaccines?: evidence from the VASCO study and need for further studies. Public Health 2022;203:97-9. 
  140. Yamamoto S, Tanaka A, Ohmagari N, et al. Use of heated tobacco products, moderate alcohol drinking, and anti-SARS-CoV-2 IgG antibody titers after BNT162b2 vaccination among Japanese healthcare workers. Prev Med 2022;161:107123. 
  141. Edwards KM, Pung MA, Tomfohr LM, et al. Acute exercise enhancement of pneumococcal vaccination response: a randomised controlled trial of weaker and stronger immune response. Vaccine 2012;30:6389-95. 
  142. Kohut ML, Cooper MM, Nickolaus MS, Russell DR, Cunnick JE. Exercise and psychosocial factors modulate immunity to influenza vaccine in elderly individuals. J Gerontol A Biol Sci Med Sci 2002;57:M557-62. 
  143. Irwin MR, Olmstead R, Oxman MN. Augmenting immune responses to varicella zoster virus in older adults: a randomized, controlled trial of Tai Chi. J Am Geriatr Soc 2007;55:511-7. 
  144. Sallis R, Young DR, Tartof SY, et al. Physical inactivity is associated with a higher risk for severe COVID-19 outcomes: a study in 48 440 adult patients. Br J Sports Med 2021;55:1099-105. 
  145. Cox FE. Concomitant infections, parasites and immune responses. Parasitology 2001;122 Suppl:S23-38. 
  146. Greenwood BM. The epidemiology of malaria. Ann Trop Med Parasitol 1997;91:763-9. 
  147. Hartgers FC, Yazdanbakhsh M. Co-infection of helminths and malaria: modulation of the immune responses to malaria. Parasite Immunol 2006;28:497-506. 
  148. Muyanja E, Ssemaganda A, Ngauv P, et al. Immune activation alters cellular and humoral responses to yellow fever 17D vaccine. J Clin Invest 2014;124:3147-58. 
  149. Elias D, Akuffo H, Pawlowski A, Haile M, Schon T, Britton S. Schistosoma mansoni infection reduces the protective efficacy of BCG vaccination against virulent Mycobacterium tuberculosis. Vaccine 2005;23:1326-34. 
  150. Cooper PJ, Espinel I, Paredes W, Guderian RH, Nutman TB. Impaired tetanus-specific cellular and humoral responses following tetanus vaccination in human onchocerciasis: a possible role for interleukin-10. J Infect Dis 1998;178:1133-8. 
  151. Malhotra I, Mungai P, Wamachi A, et al. Helminth- and Bacillus Calmette-Guerin-induced immunity in children sensitized in utero to filariasis and schistosomiasis. J Immunol 1999;162:6843-8. 
  152. Tweyongyere R, Nassanga BR, Muhwezi A, et al. Effect of Schistosoma mansoni infection and its treatment on antibody responses to measles catch-up immunisation in pre-school children: a randomised trial. PLoS Negl Trop Dis 2019;13:e0007157. 
  153. Natukunda A, Zirimenya L, Nassuuna J, et al. The effect of helminth infection on vaccine responses in humans and animal models: a systematic review and meta-analysis. Parasite Immunol 2022;44:e12939. 
  154. Kemper CA, Haubrich R, Frank I, et al. Safety and immunogenicity of hepatitis A vaccine in human immunodeficiency virus-infected patients: a double-blind, randomized, placebo-controlled trial. J Infect Dis 2003;187:1327-31. 
  155. Fritzsche C, Bergmann L, Loebermann M, Glass A, Reisinger EC. Immune response to hepatitis A vaccine in patients with HIV. Vaccine 2019;37:2278-83. 
  156. van Riet E, Retra K, Adegnika AA, et al. Cellular and humoral responses to tetanus vaccination in Gabonese children. Vaccine 2008;26:3690-5. 
  157. Brown J, Baisley K, Kavishe B, et al. Impact of malaria and helminth infections on immunogenicity of the human papillomavirus-16/18 AS04-adjuvanted vaccine in Tanzania. Vaccine 2014;32:611-7. 
  158. McElhaney JE, Garneau H, Camous X, et al. Predictors of the antibody response to influenza vaccination in older adults with type 2 diabetes. BMJ Open Diabetes Res Care 2015;3:e000140. 
  159. Cheong HJ, Song JY, Park JW, et al. Humoral and cellular immune responses to influenza vaccine in patients with advanced cirrhosis. Vaccine 2006;24:2417-22. 
  160. Gaeta GB, Pariani E, Amendola A, et al. Influenza vaccination in patients with cirrhosis and in liver transplant recipients. Vaccine 2009;27:3373-5. 
  161. Sayyad B, Alavian SM, Najafi F, et al. Efficacy of influenza vaccination in patients with cirrhosis and inactive carriers of hepatitis B virus infection. Iran Red Crescent Med J 2012;14:623-30. 
  162. Simao AL, Palma CS, Izquierdo-Sanchez L, et al. Cirrhosis is associated with lower serological responses to COVID-19 vaccines in patients with chronic liver disease. JHEP Rep 2023;5:100697. 
  163. Al-Dury S, Waern J, Waldenstrom J, et al. Impaired SARS-CoV-2-specific T-cell reactivity in patients with cirrhosis following mRNA COVID-19 vaccination. JHEP Rep 2022;4:100496. 
  164. Giambra V, Piazzolla AV, Cocomazzi G, et al. Effectiveness of booster dose of anti SARS-CoV-2 BNT162b2 in cirrhosis: longitudinal evaluation of humoral and cellular response. Vaccines (Basel) 2022;10:1281. 
  165. Roni DA, Pathapati RM, Kumar AS, et al. Safety and efficacy of hepatitis B vaccination in cirrhosis of liver. Adv Virol 2013;2013:196704. 
  166. Aziz A, Aziz S, Li DS, et al. Efficacy of repeated high-dose hepatitis B vaccine (80 microg) in patients with chronic liver disease. J Viral Hepat 2006;13:217-21. 
  167. He T, Zhou Y, Xu P, et al. Safety and antibody response to inactivated COVID-19 vaccine in patients with chronic hepatitis B virus infection. Liver Int 2022;42:1287-96. 
  168. Wang WX, Jia R, Song JW, et al. Immunogenicity of inactivated coronavirus disease 2019 vaccines in patients with chronic hepatitis B undergoing antiviral therapy. Front Microbiol 2022;13:1056884. 
  169. Mattos AA, Gomes EB, Tovo CV, Alexandre CO, Remiao JO. Hepatitis B vaccine efficacy in patients with chronic liver disease by hepatitis C virus. Arq Gastroenterol 2004;41:180-4. 
  170. Ashhab AA, Rodin H, Campos M, et al. Response to hepatitis B virus vaccination in individuals with chronic hepatitis C virus infection. PLoS One 2020;15:e0237398. 
  171. Madan RP, Tan M, Fernandez-Sesma A, et al. A prospective, comparative study of the immune response to inactivated influenza vaccine in pediatric liver transplant recipients and their healthy siblings. Clin Infect Dis 2008;46:712-8. 
  172. Davidov Y, Tsaraf K, Cohen-Ezra O, et al. Immunogenicity and adverse effects of the 2-dose BNT162b2 messenger RNA vaccine among liver transplantation recipients. Liver Transpl 2022;28:215-23. 
  173. Guarino M, Cossiga V, Esposito I, Furno A, Morisco F. Effectiveness of SARS-CoV-2 vaccination in liver transplanted patients: the debate is open! J Hepatol 2022;76:237-9. 
  174. Feng L, Niu Y, Chen H, et al. Immunogenicity of different hepatitis B virus vaccination schedules in liver transplant recipients. Hepatol Res 2013;43:495-501. 
  175. Naruse H, Ito H, Izawa H, et al. Immunogenicity of BNT162b2 mRNA COVID-19 vaccine in patients with cardiovascular disease. J Clin Med 2021;10:5498. 
  176. Schramm R, Costard-Jackle A, Rivinius R, et al. Poor humoral and T-cell response to two-dose SARS-CoV-2 messenger RNA vaccine BNT162b2 in cardiothoracic transplant recipients. Clin Res Cardiol 2021;110:1142-9. 
  177. Furer V, Eviatar T, Zisman D, et al. Immunogenicity and safety of the BNT162b2 mRNA COVID-19 vaccine in adult patients with autoimmune inflammatory rheumatic diseases and in the general population: a multicentre study. Ann Rheum Dis 2021;80:1330-8. 
  178. Watanabe M, Balena A, Tuccinardi D, et al. Central obesity, smoking habit, and hypertension are associated with lower antibody titres in response to COVID-19 mRNA vaccine. Diabetes Metab Res Rev 2022;38:e3465. 
  179. Soegiarto G, Wulandari L, Purnomosari D, et al. Hypertension is associated with antibody response and breakthrough infection in health care workers following vaccination with inactivated SARS-CoV-2. Vaccine 2022;40:4046-56. 
  180. Sheridan PA, Paich HA, Handy J, et al. The antibody response to influenza vaccination is not impaired in type 2 diabetics. Vaccine 2015;33:3306-13. 
  181. Marfella R, Sardu C, D'Onofrio N, et al. Glycaemic control is associated with SARS-CoV-2 breakthrough infections in vaccinated patients with type 2 diabetes. Nat Commun 2022;13:2318. 
  182. Marfella R, D'Onofrio N, Sardu C, et al. Does poor glycaemic control affect the immunogenicity of the COVID-19 vaccination in patients with type 2 diabetes: the CAVEAT study. Diabetes Obes Metab 2022;24:160-5. 
  183. Xiang F, Long B, He J, et al. Impaired antibody responses were observed in patients with type 2 diabetes mellitus after receiving the inactivated COVID-19 vaccines. Virol J 2023;20:22. 
  184. Zhou X, Lu H, Sang M, et al. Impaired antibody response to inactivated COVID-19 vaccines in hospitalized patients with type 2 diabetes. Hum Vaccin Immunother 2023;19:2184754. 
  185. Fabrizi F, Dixit V, Martin P, Messa P. Meta-analysis: the impact of diabetes mellitus on the immunological response to hepatitis B virus vaccine in dialysis patients. Aliment Pharmacol Ther 2011;33:815-21. 
  186. Elsharkawy DM, El-khaleegy HA, Mohamed SA, Mohamed GA. Seroprotection status of hepatitis B vaccine in children with type 1 diabetes mellitus. Int J Med Arts 2021;3:1748-53. 
  187. Onal Z, Ersen A, Bayramoglu E, Yaroglu Kazanci S, Onal H, Adal E. Seroprotection status of hepatitis B and measles vaccines in children with type 1 diabetes mellitus. J Pediatr Endocrinol Metab 2016;29:1013-7. 
  188. Leonardi S, Vitaliti G, Garozzo MT, Miraglia del Giudice M, Marseglia G, La Rosa M. Hepatitis B vaccination failure in children with diabetes mellitus?: the debate continues. Hum Vaccin Immunother 2012;8:448-52. 
  189. Eibl N, Spatz M, Fischer GF, et al. Impaired primary immune response in type-1 diabetes: results from a controlled vaccination study. Clin Immunol 2002;103(3 Pt 1):249-59. 
  190. D'Addio F, Sabiu G, Usuelli V, et al. Immunogenicity and safety of SARS-CoV-2 mRNA vaccines in a cohort of patients with type 1 diabetes. Diabetes 2022;71:1800-6. 
  191. Emeksiz HC, Hepokur MN, Sahin SE, et al. Immunogenicity, safety and clinical outcomes of the SARS-CoV-2 BNT162b2 vaccine in adolescents with type 1 diabetes. Front Pediatr 2023;11:1191706. 
  192. Brydak LB, Machala M. Humoral immune response to influenza vaccination in patients from high risk groups. Drugs 2000;60:35-53. 
  193. Weinberg A, Boulware D, Dighero B, Orban T; Type 1 Diabetes TrialNet Abatacept Study Group. Effect of abatacept on immunogenicity of vaccines in individuals with type 1 diabetes. Vaccine 2013;31:4791-4. 
  194. Thakkar A, Gonzalez-Lugo JD, Goradia N, et al. Seroconversion rates following COVID-19 vaccination among patients with cancer. Cancer Cell 2021;39:1081-90. 
  195. Herishanu Y, Avivi I, Aharon A, et al. Efficacy of the BNT162b2 mRNA COVID-19 vaccine in patients with chronic lymphocytic leukemia. Blood 2021;137:3165-73. 
  196. Maneikis K, Sablauskas K, Ringeleviciute U, et al. Immunogenicity of the BNT162b2 COVID-19 mRNA vaccine and early clinical outcomes in patients with haematological malignancies in Lithuania: a national prospective cohort study. Lancet Haematol 2021;8:e583-92. 
  197. Shroff RT, Chalasani P, Wei R, et al. Immune responses to two and three doses of the BNT162b2 mRNA vaccine in adults with solid tumors. Nat Med 2021;27:2002-11. 
  198. Barriere J, Chamorey E, Adjtoutah Z, et al. Impaired immunogenicity of BNT162b2 anti-SARS-CoV-2 vaccine in patients treated for solid tumors. Ann Oncol 2021;32:1053-5. 
  199. Chen Z, Zhu P, Liu Z, et al. Weakened humoral immune responses of inactivated SARS-CoV-2 vaccines in patients with solid tumors. Cancer Commun (Lond) 2023;43:280-4. 
  200. Ariamanesh M, Porouhan P, PeyroShabany B, et al. Immunogenicity and safety of the inactivated SARS-CoV-2 vaccine (BBIBP-CorV) in patients with malignancy. Cancer Invest 2022;40:26-34. 
  201. de Lavallade H, Garland P, Sekine T, et al. Repeated vaccination is required to optimize seroprotection against H1N1 in the immunocompromised host. Haematologica 2011;96:307-14. 
  202. Mariotti J, Spina F, Carniti C, et al. Long-term patterns of humoral and cellular response after vaccination against influenza A (H1N1) in patients with hematologic malignancies. Eur J Haematol 2012;89:111-9. 
  203. Ide Y, Imamura Y, Ohfuji S, et al. Immunogenicity of a monovalent influenza A(H1N1)pdm09 vaccine in patients with hematological malignancies. Hum Vaccin Immunother 2014;10:2387-94. 
  204. Whitaker JA, Parikh SA, Shanafelt TD, et al. The humoral immune response to high-dose influenza vaccine in persons with monoclonal B-cell lymphocytosis (MBL) and chronic lymphocytic leukemia (CLL). Vaccine 2021;39:1122-30. 
  205. Chin-Yee BH, Monkman K, Hussain Z, Minuk LA. Attitudes toward vaccination for pandemic H1N1 and seasonal influenza in patients with hematologic malignancies. J Support Oncol 2011;9:156-60. 
  206. Deng P, Yang T, Zhang H, et al. Prospective clinical trial of hepatitis B vaccination for children with hematological malignancies: a study on the safety and immunogenicity efficacy. Hum Vaccin Immunother 2021;17:4578-86. 
  207. Tohme RA, Awosika-Olumo D, Nielsen C, et al. Evaluation of hepatitis B vaccine immunogenicity among older adults during an outbreak response in assisted living facilities. Vaccine 2011;29:9316-20. 
  208. Aggeletopoulou I, Davoulou P, Konstantakis C, Thomopoulos K, Triantos C. Response to hepatitis B vaccination in patients with liver cirrhosis. Rev Med Virol 2017;27:e1942. 
  209. Willuweit K, Frey A, Passenberg M, et al. Patients with liver cirrhosis show high immunogenicity upon COVID-19 vaccination but develop premature deterioration of antibody titers. Vaccines (Basel) 2022;10:377. 
  210. Ruether DF, Schaub GM, Duengelhoef PM, et al. SARS-CoV2-specific humoral and T-cell immune response after second vaccination in liver cirrhosis and transplant patients. Clin Gastroenterol Hepatol 2022;20:162-72. 
  211. Vardeny O, Sweitzer NK, Detry MA, Moran JM, Johnson MR, Hayney MS. Decreased immune responses to influenza vaccination in patients with heart failure. J Card Fail 2009;15:368-73. 
  212. Drummond GR, Vinh A, Guzik TJ, Sobey CG. Immune mechanisms of hypertension. Nat Rev Immunol 2019;19:517-32. 
  213. Pellini R, Venuti A, Pimpinelli F, et al. Initial observations on age, gender, BMI and hypertension in antibody responses to SARS-CoV-2 BNT162b2 vaccine. EClinicalMedicine 2021;36:100928. 
  214. Seo YB, Baek JH, Lee J, et al. Long-term immunogenicity and safety of a conventional influenza vaccine in patients with type 2 diabetes. Clin Vaccine Immunol 2015;22:1160-5. 
  215. Van Der Meeren O, Peterson JT, Dionne M, et al. Prospective clinical trial of hepatitis B vaccination in adults with and without type-2 diabetes mellitus. Hum Vaccin Immunother 2016;12:2197-203. 
  216. Vasilev G, Kabakchieva P, Miteva D, Batselova H, Velikova T. Effectiveness and safety of COVID-19 vaccines in patients with diabetes as a factor for vaccine hesitancy. World J Diabetes 2022;13:738-51. 
  217. D'Onofrio L, Fogolari M, Amendolara R, et al. Reduced early response to SARS-CoV2 vaccination in people with type 1 and type 2 diabetes, a 6 months follow-up study: the CoVaDiab study I. Diabetes Metab Res Rev 2023;39:e3601. 
  218. Loubet P, Kerneis S, Groh M, et al. Attitude, knowledge and factors associated with influenza and pneumococcal vaccine uptake in a large cohort of patients with secondary immune deficiency. Vaccine 2015;33:3703-8. 
  219. Wumkes ML, van der Velden AM, Los M, et al. Serum antibody response to influenza virus vaccination during chemotherapy treatment in adult patients with solid tumours. Vaccine 2013;31:6177-84. 
  220. Puthillath A, Trump DL, Andrews C, et al. Serological immune responses to influenza vaccine in patients with colorectal cancer. Cancer Chemother Pharmacol 2011;67:111-5. 
  221. Monin-Aldama L, Laing AG, Munoz-Ruiz M, et al. Interim results of the safety and immune-efficacy of 1 versus 2 doses of COVID-19 vaccine BNT162b2 for cancer patients in the context of the UK vaccine priority guidelines. MedRxiv [Preprint] 2021 Mar 17. https://doi.org/10.1101/2021.03.17.21253131 
  222. Tran S, Truong TH, Narendran A. Evaluation of COVID-19 vaccine response in patients with cancer: an interim analysis. Eur J Cancer 2021;159:259-74. 
  223. Javadinia SA, Alizadeh K, Mojadadi MS, et al. COVID-19 vaccination in patients with malignancy; a systematic review and meta-analysis of the efficacy and safety. Front Endocrinol (Lausanne) 2022;13:860238. 
  224. Purohit S, Alvarez O, O'Brien R, Andreansky S. Durable immune response to inactivated H1N1 vaccine is less likely in children with sickle cell anemia receiving chronic transfusions. Pediatr Blood Cancer 2012;59:1280-3. 
  225. Payne AB, Adamkiewicz TV, Grosse SD, et al. Influenza vaccination rates and hospitalizations among Medicaid enrollees with and without sickle cell disease, 2009-2015. Pediatr Blood Cancer 2021;68:e29351. 
  226. Long CB, Ramos I, Rastogi D, et al. Humoral and cell-mediated immune responses to monovalent 2009 influenza A/H1N1 and seasonal trivalent influenza vaccines in high-risk children. J Pediatr 2012;160:74-81. 
  227. Ballester OF, Abdallah JM, Prasad AS. Impaired IgM antibody responses to an influenza virus vaccine in adults with sickle cell anemia. Am J Hematol 1985;20:409-12. 
  228. Sheikh M, Ahmadi-Vasmehjani A, Atashzar MR, Karbalaie Niya MH, Ebrahimian A, Baharlou R. Influenza vaccine booster stimulates antibody response in beta thalassemia major patients. Lab Med 2022;53:602-8. 
  229. Bonanni P, Grazzini M, Niccolai G, et al. Recommended vaccinations for asplenic and hyposplenic adult patients. Hum Vaccin Immunother 2017;13:359-68. 
  230. Woldemeskel BA, Karaba AH, Garliss CC, et al. The BNT162b2 mRNA vaccine elicits robust humoral and cellular immune responses in people living with human immunodeficiency virus (HIV). Clin Infect Dis 2022;74:1268-70. 
  231. Ferreira RB, Antunes LC, Finlay BB. Should the human microbiome be considered when developing vaccines? PLoS Pathog 2010;6:e1001190. 
  232. Cianci R, Franza L, Massaro MG, Borriello R, De Vito F, Gambassi G. The interplay between immunosenescence and microbiota in the efficacy of vaccines. Vaccines (Basel) 2020;8:636. 
  233. Huda MN, Lewis Z, Kalanetra KM, et al. Stool microbiota and vaccine responses of infants. Pediatrics 2014;134:e362-72. 
  234. Mullie C, Yazourh A, Thibault H, et al. Increased poliovirus-specific intestinal antibody response coincides with promotion of Bifidobacterium longum-infantis and Bifidobacterium breve in infants: a randomized, double-blind, placebo-controlled trial. Pediatr Res 2004;56:791-5. 
  235. Praharaj I, Parker EPK, Giri S, et al. Influence of nonpolio enteroviruses and the bacterial gut microbiota on oral poliovirus vaccine response: a study from South India. J Infect Dis 2019;219:1178-86. 
  236. Brotman RM, Ravel J, Bavoil PM, Gravitt PE, Ghanem KG. Microbiome, sex hormones, and immune responses in the reproductive tract: challenges for vaccine development against sexually transmitted infections. Vaccine 2014;32:1543-52. 
  237. Harris VC, Armah G, Fuentes S, et al. Significant correlation between the infant gut microbiome and rotavirus vaccine response in rural Ghana. J Infect Dis 2017;215:34-41. 
  238. Eloe-Fadrosh EA, McArthur MA, Seekatz AM, et al. Impact of oral typhoid vaccination on the human gut microbiota and correlations with s. Typhi-specific immunological responses. PLoS One 2013;8:e62026. 
  239. Hagan T, Cortese M, Rouphael N, et al. Antibiotics-driven gut microbiome perturbation alters immunity to vaccines in humans. Cell 2019;178:1313-28. 
  240. Ponziani FR, Coppola G, Rio P, et al. Factors influencing microbiota in modulating vaccine immune response: a long way to go. Vaccines (Basel) 2023;11:1609. 
  241. Abavisani M, Foroushan SK, Ebadpour N, Sahebkar A. Deciphering the gut microbiome: the revolution of artificial intelligence in microbiota analysis and intervention. Curr Res Biotechnol 2024;7:100211. 
  242. Ouwehand AC, Bergsma N, Parhiala R, et al. Bifidobacterium microbiota and parameters of immune function in elderly subjects. FEMS Immunol Med Microbiol 2008;53:18-25. 
  243. Alanzi A, Honkala S, Honkala E, Varghese A, Tolvanen M, Soderling E. Effect of Lactobacillus rhamnosus and Bifidobacterium lactis on gingival health, dental plaque, and periodontopathogens in adolescents: a randomised placebo-controlled clinical trial. Benef Microbes 2018;9:593-602. 
  244. Calder PC, Ortega EF, Meydani SN, et al. Nutrition, immunosenescence, and infectious disease: an overview of the scientific evidence on micronutrients and on modulation of the gut microbiota. Adv Nutr 2022;13:S1-26. 
  245. Yeh TL, Shih PC, Liu SJ, et al. The influence of prebiotic or probiotic supplementation on antibody titers after influenza vaccination: a systematic review and meta-analysis of randomized controlled trials. Drug Des Devel Ther 2018;12:217-30. 
  246. Castro-Herrera VM, Fisk HL, Wootton M, et al. Combination of the probiotics Lacticaseibacillus rhamnosus GG and Bifidobacterium animalis subsp. lactis, BB-12 has limited effect on biomarkers of immunity and inflammation in older people resident in care homes: results from the probiotics to reduce infections iN CarE home reSidentS randomized, controlled trial. Front Immunol 2021;12:643321. 
  247. Kusumo PD, Bela B, Wibowo H, Munasir Z, Surono IS. Lactobacillus plantarum IS-10506 supplementation increases faecal sIgA and immune response in children younger than two years. Benef Microbes 2019;10:245-52. 
  248. Fernandez-Ferreiro A, Formigo-Couceiro FJ, Veiga-Gutierrez R, et al. Effects of Loigolactobacillus coryniformis K8 CECT 5711 on the immune response of elderly subjects to COVID-19 vaccination: a randomized controlled trial. Nutrients 2022;14:228. 
  249. Abavisani M, Ebadpour N, Khoshrou A, Sahebkar A. Boosting vaccine effectiveness: the groundbreaking role of probiotics. J Agric Food Res 2024;16:101189. 
  250. Morales JS, Valenzuela PL, Losa-Reyna J, et al. The importance of lifestyle and environmental exposures on COVID-19. In: Selk-Ghaffari M, Memari A, Mahdaviani B, Kordi R, editors. Physical activity and pandemics: lessons learned from COVID-19. Singapore: Springer Nature Singapore; 2023. p. 31-47. 
  251. Jones R, Macmillan A, Reid P. Climate change mitigation policies and co-impacts on indigenous health: a scoping review. Int J Environ Res Public Health 2020;17:9063. 
  252. Wen HJ, Guo YL, Su PH, Sun CW, Wang SJ. Prenatal and childhood exposure to phthalic acid esters and vaccination antibodies in children: a 15-year follow-up birth cohort study. Environ Int 2020;145:106134. 
  253. Franza L, Cianci R. Pollution, inflammation, and vaccines: a complex crosstalk. Int J Environ Res Public Health 2021;18:6330. 
  254. Grandjean P, Andersen EW, Budtz-Jorgensen E, et al. Serum vaccine antibody concentrations in children exposed to perfluorinated compounds. JAMA 2012;307:391-7. 
  255. Zheng K, Zeng Z, Tian Q, Huang J, Zhong Q, Huo X. Epidemiological evidence for the effect of environmental heavy metal exposure on the immune system in children. Sci Total Environ 2023;868:161691. 
  256. Lin X, Xu X, Zeng X, Xu L, Zeng Z, Huo X. Decreased vaccine antibody titers following exposure to multiple metals and metalloids in e-waste-exposed preschool children. Environ Pollut 2017;220(Pt A):354-63. 
  257. Moyal DD, Fourtanier AM. Broad-spectrum sunscreens provide better protection from solar ultraviolet-simulated radiation and natural sunlight-induced immunosuppression in human beings. J Am Acad Dermatol 2008;58(5 Suppl 2):S149-54. 
  258. Paynter S, Ware RS, Sly PD, Williams G, Weinstein P. Seasonal immune modulation in humans: observed patterns and potential environmental drivers. J Infect 2015;70:1-10. 
  259. Linder N, Abudi Y, Abdalla W, et al. Effect of season of inoculation on immune response to rubella vaccine in children. J Trop Pediatr 2011;57:299-302. 
  260. Norval M, Woods GM. UV-induced immunosuppression and the efficacy of vaccination. Photochem Photobiol Sci 2011;10:1267-74. 
  261. Brand A, Brand H, Schulte in den Baumen T. The impact of genetics and genomics on public health. Eur J Hum Genet 2008;16:5-13. 
  262. Abavisani M, Rahimian K, Mahdavi B, et al. Mutations in SARS-CoV-2 structural proteins: a global analysis. Virol J 2022;19:220. 
  263. Abavisani M, Rahimian K, Kodori M, et al. In silico analysis of the substitution mutations and evolutionary trends of the SARS-CoV-2 structural proteins in Asia. Iran J Basic Med Sci 2022;25:1299-307. 
  264. Orangi S, Ojal J, Brand SP, et al. Epidemiological impact and cost-effectiveness analysis of COVID-19 vaccination in Kenya. BMJ Glob Health 2022;7:e009430. 
  265. Pollard AJ, Bijker EM. A guide to vaccinology: from basic principles to new developments. Nat Rev Immunol 2021;21:83-100. 
  266. Lahariya C. Vaccine epidemiology: a review. J Family Med Prim Care 2016;5:7-15. 
  267. Mangtani P, Abubakar I, Ariti C, et al. Protection by BCG vaccine against tuberculosis: a systematic review of randomized controlled trials. Clin Infect Dis 2014;58:470-80. 
  268. Babalola S. Determinants of the uptake of the full dose of diphtheria-pertussis-tetanus vaccines (DPT3) in Northern Nigeria: a multilevel analysis. Matern Child Health J 2009;13:550-8. 
  269. Halliday L, Thomson JA, Roberts L, Bowen S, Mead C. Influenza vaccination of staff in aged care facilities in the ACT: how can we improve the uptake of influenza vaccine? Aust N Z J Public Health 2003;27:70-5. 
  270. Horby PW, Williams A, Burgess MA, Wang H. Prevalence and determinants of influenza vaccination in Australians aged 40 years and over: a national survey. Aust N Z J Public Health 2005;29:35-7. 
  271. Brown K, Fraser G, Ramsay M, et al. Attitudinal and demographic predictors of measles-mumps-rubella vaccine (MMR) uptake during the UK catch-up campaign 2008-09: cross-sectional survey. PLoS One 2011;6: e19381. 
  272. Stokley S, Shaw KM, Barker L, Santoli JM, Shefer A. Impact of state vaccine financing policy on uptake of heptavalent pneumococcal conjugate vaccine. Am J Public Health 2006;96:1308-13. 
  273. Macounova P, Stankova A, Mad'ar R. Chickenpox: do vaccinate or do not vaccinate? Pediatr Praxi 2022;23:188-91. https://doi.org/10.36290/ped.2022.041 
  274. Smedley J, Poole J, Waclawski E, et al. Influenza immunisation: attitudes and beliefs of UK healthcare workers. Occup Environ Med 2007;64:223-7. 
  275. Uwemedimo OT, Findley SE, Andres R, Irigoyen M, Stockwell MS. Determinants of influenza vaccination among young children in an inner-city community. J Community Health 2012;37:663-72. 
  276. Barreto ML, Pilger D, Pereira SM, et al. Causes of variation in BCG vaccine efficacy: examining evidence from the BCG REVAC cluster randomized trial to explore the masking and the blocking hypotheses. Vaccine 2014;32:3759-64. 
  277. Muehlhans S, Richard G, Ali M, et al. Safety reporting in developing country vaccine clinical trials: a systematic review. Vaccine 2012;30:3255-65. 
  278. Levine MM. Immunogenicity and efficacy of oral vaccines in developing countries: lessons from a live cholera vaccine. BMC Biol 2010;8:129. 
  279. Vesikari T, Karvonen A, Prymula R, et al. Efficacy of human rotavirus vaccine against rotavirus gastroenteritis during the first 2 years of life in European infants: randomised, double-blind controlled study. Lancet 2007;370:1757-63. 
  280. Madhi SA, Cunliffe NA, Steele D, et al. Effect of human rotavirus vaccine on severe diarrhea in African infants. Malawi Med J 2016;28:108-14. 
  281. Hallander HO, Paniagua M, Espinoza F, et al. Calibrated serological techniques demonstrate significant different serum response rates to an oral killed cholera vaccine between Swedish and Nicaraguan children. Vaccine 2002;21:138-45. 
  282. Stoffel NU, Uyoga MA, Mutuku FM, et al. Iron deficiency anemia at time of vaccination predicts decreased vaccine response and iron supplementation at time of vaccination increases humoral vaccine response: a birth cohort study and a randomized trial follow-up study in Kenyan infants. Front Immunol 2020;11:1313. 
  283. Black GF, Weir RE, Floyd S, et al. BCG-induced increase in interferon-gamma response to mycobacterial antigens and efficacy of BCG vaccination in Malawi and the UK: two randomised controlled studies. Lancet 2002;359:1393-401. 
  284. Kabagenyi J, Natukunda A, Nassuuna J, et al. Urban-rural differences in immune responses to mycobacterial and tetanus vaccine antigens in a tropical setting: a role for helminths? Parasitol Int 2020;78:102132. 
  285. van Riet E, Adegnika AA, Retra K, et al. Cellular and humoral responses to influenza in gabonese children living in rural and semi-urban areas. J Infect Dis 2007;196:1671-8. 
  286. Gust D, Brown C, Sheedy K, Hibbs B, Weaver D, Nowak G. Immunization attitudes and beliefs among parents: beyond a dichotomous perspective. Am J Health Behav 2005;29:81-92. 
  287. Hammond J. Vaccine confidence, coverage, and hesitancy worldwide: a literature analysis of vaccine hesitancy and potential causes worldwide [dissertation]. Columbia (SC): University of South Carolina; 2020. 
  288. World Health Organization. Ten threats to global health in 2019. Geneva: World Health Organization; 2019. 
  289. Danabal KG, Magesh SS, Saravanan S, Gopichandran V. Attitude towards COVID 19 vaccines and vaccine hesitancy in urban and rural communities in Tamil Nadu, India: a community based survey. BMC Health Serv Res 2021;21:994.