Age-related immune response heterogeneity to SARS-CoV-2 vaccine BNT162b2

Abstract: Although two-dose mRNA vaccination provides excellent protection against SARS-CoV-2, there is little information about vaccine efficacy against variants of concern (VOC) in individuals above eighty years of age1. Here we analysed immune responses following vaccination with the BNT162b2 mRNA vaccine2 in elderly participants and younger healthcare workers. Serum neutralization and levels of binding IgG or IgA after the first vaccine dose were lower in older individuals, with a marked drop in participants over eighty years old. Sera from participants above eighty showed lower neutralization potency against the B.1.1.7 (Alpha), B.1.351 (Beta) and P.1. (Gamma) VOC than against the wild-type virus and were more likely to lack any neutralization against VOC following the first dose. However, following the second dose, neutralization against VOC was detectable regardless of age. The frequency of SARS-CoV-2 spike-specific memory B cells was higher in elderly responders (whose serum showed neutralization activity) than in non-responders after the first dose. Elderly participants showed a clear reduction in somatic hypermutation of class-switched cells. The production of interferon-γ and interleukin-2 by SARS-CoV-2 spike-specific T cells was lower in older participants, and both cytokines were secreted primarily by CD4 T cells. We conclude that the elderly are a high-risk population and that specific measures to boost vaccine responses in this population are warranted, particularly where variants of concern are circulating

Bell’s Palsy

Audience: Emergency medicine residents and medical students on emergency medicine rotations. Introduction: This oral board review case tests the resident’s ability to differentiate between benign and life-threatening causes of acute facial paralysis. Bell’s Palsy is a peripheral facial nerve palsy with a prevalence of 15-40 per 100,000.1The diagnosis is mainly clinical, based on focused history and thorough neurologic examination, particularly of the cranial nerves. The etiology is unknown; viral reactivation is suspected to be the culprit in the majority of cases and is the target of current therapy, although alternate etiologies of peripheral facial paralysis should be ruled out. The primary objective of the emergency physician is to rule out life-threatening and function-threatening etiologies of facial nerve paralysis (eg, cerebrovascular accident), initiate conservative management, and coordinate appropriate follow-up. Objectives: At the end of this oral boards session, examinees will: 1) Demonstrate ability to perform a thorough neurologic examination including full cranial nerve exam, National Institutes of Health (NIH) stroke scale assessment, strength and sensation and reflex testing, pronator drift, speech repetition. 2) Differentiate between Bell’s Palsy and acute stroke with facial paralysis. 3) List appropriate laboratory testing for a case of peripheral facial nerve paralysis (basic metabolic panel [BMP]; complete blood count [CBC]; coagulation studies if considering lumbar puncture; human immunodeficiency virus (HIV) test if high-risk by history, or if bilateral; Lyme titer if in endemic area, or if bilateral). 4) Select appropriate treatments (steroids, eye lubricant and patch, PCP referral) for peripheral facial nerve paralysis. Methods: Oral boards case Topics: Paralysis, Bell’s palsy, facial nerve paralysis, Lyme disease, viral syndrome, neurologic emergenc