The intersection of biological sex and gender in adverse events following seasonal influenza vaccination in older adults
Abstract Background Women/females report more adverse events (AE) following immunization than men/males for many vaccines, including the influenza and COVID-19 vaccines. This discrepancy is often dismissed as a reporting bias, yet the relative contributions of biological sex and gender are poorly un...
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| Format: | Article |
| Language: | English |
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BMC
2023-08-01
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| Series: | Immunity & Ageing |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12979-023-00367-3 |
| _version_ | 1827708325276418048 |
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| author | Janna R. Shapiro Kumba Seddu Han-Sol Park John S. Lee Patrick S. Creisher Anna Yin Patrick Shea Helen Kuo Huifen Li Engle Abrams Sean X. Leng Rosemary Morgan Sabra L. Klein |
| author_facet | Janna R. Shapiro Kumba Seddu Han-Sol Park John S. Lee Patrick S. Creisher Anna Yin Patrick Shea Helen Kuo Huifen Li Engle Abrams Sean X. Leng Rosemary Morgan Sabra L. Klein |
| author_sort | Janna R. Shapiro |
| collection | DOAJ |
| description | Abstract Background Women/females report more adverse events (AE) following immunization than men/males for many vaccines, including the influenza and COVID-19 vaccines. This discrepancy is often dismissed as a reporting bias, yet the relative contributions of biological sex and gender are poorly understood. We investigated the roles of sex and gender in the rate of AE following administration of the high-dose seasonal influenza vaccine to older adults (≥ 75 years) using an AE questionnaire administered 5–8 days post-vaccination. Participant sex (male or female) was determined by self-report and a gender score questionnaire was used to assign participants to one of four gender categories (feminine, masculine, androgynous, or undifferentiated). Sex steroid hormones and inflammatory cytokines were measured in plasma samples collected prior to vaccination to generate hypotheses as to the biological mechanism underpinning the AE reported. Results A total of 423 vaccines were administered to 173 participants over four influenza seasons (2019-22) and gender data were available for 339 of these vaccinations (2020-22). At least one AE was reported following 105 vaccinations (25%), by 23 males and 82 females. The majority of AE occurred at the site of injection, were mild, and transient. The odds of experiencing an AE were 3-fold greater in females than males and decreased with age to a greater extent in females than males. The effects of gender, however, were not statistically significant, supporting a central role of biological sex in the occurrence of AE. In males, estradiol was significantly associated with IL-6 and with the probability of experiencing an AE. Both associations were absent in females, suggesting a sex-specific effect of estradiol on the occurrence of AE that supports the finding of a biological sex difference. Conclusions These data support a larger role for biological sex than for gender in the occurrence of AE following influenza vaccination in older adults and provide an initial investigation of hormonal mechanisms that may mediate this sex difference. This study highlights the complexities of measuring gender and the importance of assessing AE separately for males and females to better understand how vaccination strategies can be tailored to different subsets of the population. |
| first_indexed | 2024-03-10T17:02:07Z |
| format | Article |
| id | doaj.art-abe71db02f9848f48d11323b3abd7b4b |
| institution | Directory Open Access Journal |
| issn | 1742-4933 |
| language | English |
| last_indexed | 2024-03-10T17:02:07Z |
| publishDate | 2023-08-01 |
| publisher | BMC |
| record_format | Article |
| series | Immunity & Ageing |
| spelling | doaj.art-abe71db02f9848f48d11323b3abd7b4b2023-11-20T10:55:22ZengBMCImmunity & Ageing1742-49332023-08-0120111310.1186/s12979-023-00367-3The intersection of biological sex and gender in adverse events following seasonal influenza vaccination in older adultsJanna R. Shapiro0Kumba Seddu1Han-Sol Park2John S. Lee3Patrick S. Creisher4Anna Yin5Patrick Shea6Helen Kuo7Huifen Li8Engle Abrams9Sean X. Leng10Rosemary Morgan11Sabra L. Klein12W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public HealthW. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public HealthW. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public HealthW. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public HealthW. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public HealthW. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public HealthW. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public HealthDepartment of International Health, Johns Hopkins Bloomberg School of Public HealthDivision of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of MedicineDivision of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of MedicineW. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public HealthDepartment of International Health, Johns Hopkins Bloomberg School of Public HealthW. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public HealthAbstract Background Women/females report more adverse events (AE) following immunization than men/males for many vaccines, including the influenza and COVID-19 vaccines. This discrepancy is often dismissed as a reporting bias, yet the relative contributions of biological sex and gender are poorly understood. We investigated the roles of sex and gender in the rate of AE following administration of the high-dose seasonal influenza vaccine to older adults (≥ 75 years) using an AE questionnaire administered 5–8 days post-vaccination. Participant sex (male or female) was determined by self-report and a gender score questionnaire was used to assign participants to one of four gender categories (feminine, masculine, androgynous, or undifferentiated). Sex steroid hormones and inflammatory cytokines were measured in plasma samples collected prior to vaccination to generate hypotheses as to the biological mechanism underpinning the AE reported. Results A total of 423 vaccines were administered to 173 participants over four influenza seasons (2019-22) and gender data were available for 339 of these vaccinations (2020-22). At least one AE was reported following 105 vaccinations (25%), by 23 males and 82 females. The majority of AE occurred at the site of injection, were mild, and transient. The odds of experiencing an AE were 3-fold greater in females than males and decreased with age to a greater extent in females than males. The effects of gender, however, were not statistically significant, supporting a central role of biological sex in the occurrence of AE. In males, estradiol was significantly associated with IL-6 and with the probability of experiencing an AE. Both associations were absent in females, suggesting a sex-specific effect of estradiol on the occurrence of AE that supports the finding of a biological sex difference. Conclusions These data support a larger role for biological sex than for gender in the occurrence of AE following influenza vaccination in older adults and provide an initial investigation of hormonal mechanisms that may mediate this sex difference. This study highlights the complexities of measuring gender and the importance of assessing AE separately for males and females to better understand how vaccination strategies can be tailored to different subsets of the population.https://doi.org/10.1186/s12979-023-00367-3SexGenderBSRIAdverse eventsInfluenzaOlder adults |
| spellingShingle | Janna R. Shapiro Kumba Seddu Han-Sol Park John S. Lee Patrick S. Creisher Anna Yin Patrick Shea Helen Kuo Huifen Li Engle Abrams Sean X. Leng Rosemary Morgan Sabra L. Klein The intersection of biological sex and gender in adverse events following seasonal influenza vaccination in older adults Immunity & Ageing Sex Gender BSRI Adverse events Influenza Older adults |
| title | The intersection of biological sex and gender in adverse events following seasonal influenza vaccination in older adults |
| title_full | The intersection of biological sex and gender in adverse events following seasonal influenza vaccination in older adults |
| title_fullStr | The intersection of biological sex and gender in adverse events following seasonal influenza vaccination in older adults |
| title_full_unstemmed | The intersection of biological sex and gender in adverse events following seasonal influenza vaccination in older adults |
| title_short | The intersection of biological sex and gender in adverse events following seasonal influenza vaccination in older adults |
| title_sort | intersection of biological sex and gender in adverse events following seasonal influenza vaccination in older adults |
| topic | Sex Gender BSRI Adverse events Influenza Older adults |
| url | https://doi.org/10.1186/s12979-023-00367-3 |
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