Hybrid immunity in older adults is associated with reduced SARS-CoV-2 infections following BNT162b2 COVID-19 immunisation.

BACKGROUND: Older adults, particularly in long-term care facilities (LTCF), remain at considerable risk from SARS-CoV-2. Data on the protective effect and mechanisms of hybrid immunity are skewed towards young adults precluding targeted vaccination strategies. METHODS: A single-centre longitudinal seroprevalence vaccine response study was conducted with 280 LCTF participants (median 82 yrs, IQR 76-88 yrs; 95.4% male). Screening by SARS-CoV-2 polymerase chain reaction with weekly asymptomatic/symptomatic testing (March 2020-October 2021) and serology pre-/post-two-dose Pfizer-BioNTech BNT162b2 vaccination for (i) anti-nucleocapsid, (ii) quantified anti-receptor binding domain (RBD) antibodies at three time-intervals, (iii) pseudovirus neutralisation, and (iv) inhibition by anti-RBD competitive ELISA were conducted. Neutralisation activity: antibody titre relationship was assessed via beta linear-log regression and RBD antibody-binding inhibition: post-vaccine infection relationship by Wilcoxon rank sum test. RESULTS: Here we show neutralising antibody titres are 9.2-fold (95% CI 5.8-14.5) higher associated with hybrid immunity (p < 0.00001); +7.5-fold (95% CI 4.6-12.1) with asymptomatic infection; +20.3-fold, 95% (CI 9.7-42.5) with symptomatic infection. A strong association is observed between antibody titre: neutralising activity (p < 0.00001) and rising anti-RBD antibody titre: RBD antibody-binding inhibition (p < 0.001), although 18/169 (10.7%) participants with high anti-RBD titre (>100BAU/ml), show inhibition <75%. Higher RBD antibody-binding inhibition values are associated with hybrid immunity and reduced likelihood of infection (p = 0.003). CONCLUSIONS: Hybrid immunity in older adults was associated with considerably higher antibody titres, neutralisation and inhibition capacity. Instances of high anti-RBD titre with lower inhibition suggests antibody quantity and quality as independent potential correlates of protection, highlighting added value of measuring inhibition over antibody titre alone to inform vaccine strategy.

Older adults continue to be at risk of COVID-19, particularly in residential care home settings. We investigated the effect of infection and vaccination on antibody development and subsequent SARS-CoV-2 infection in older adults. Antibodies are proteins that the immune system produces on infection or vaccination that can help respond to subsequent infection with SARS-CoV-2. We found that older adults produce antibodies to SARS-CoV-2 after 2-doses of Pfizer BioNTech BNT162b2 vaccine. The strongest immune responses were seen among those older adults who also had prior history of infection. The results highlight the importance of both antibody quality and quantity when considering possible indicators of protection against COVID-19 and supports the need for a third, booster, vaccination in this age group..

A literature review of interprofessional working and intermediate care in the UK.

AIMS AND OBJECTIVES: This systematic literature review aimed at addressing two questions: first, what evidence exists regarding intermediate care in the UK; and what interventions have been used to develop interprofessional working in intermediate care in the UK? A systematic review of the literature from 2000-2006 resulted in a total of 104 full-text articles describing research into intermediate care in the UK. BACKGROUND: The review was the first stage of a large, national project evaluating and developing interprofessional working among health and social care staff, particularly in relation to the intermediate care of older people. DESIGN: Systematic literature review. METHODS: All the literature was reviewed by one reviewer, and a second review was carried out by a team of reviewers to ensure each article was reviewed twice, independently. One article was reviewed by all the reviewers to ensure inter-rater reliability; finally, all the reviews were amalgamated, which resulted in one summary per article. RESULTS: The main findings drawn from this systematic literature review are that research carried out on intermediate care in the UK has a diverse set of aims, for example economic evaluations, delivery of intermediate care and exploring the views and perceptions of those involved in intermediate care. CONCLUSIONS: Although several articles include discussions about the importance of interprofessional working in intermediate care, no article specifically focused on the interprofessional focus of intermediate care, and there was no research about interventions used to develop interprofessional working. RELEVANCE TO CLINICAL PRACTICE: Intermediate care as a policy has been interpreted very differently across the four countries of the UK; there is no one preferred or consistent interpretation to its delivery.

Step up to the mark, leaders.

These are challenging times for all of us. Reconfiguration, redundancy and redeployment abound and uncertainty is often the only certainty. The pressure on individuals can feel immense but this is not the era for the faint hearted. This is the time for real leaders to come to the fore, focus on the horizon and create the future.

Reinvent, reorganise and reform.

The OCTOBER spending review set out the government's plans for the country in the coming years. The review is one of the most challenging we have seen and will affect us all. This, along with the proposals in the white paper on NhS reform and efficiency and public sector job losses, paints a difficult picture of uncertainty. In addition, we are midway through a review of pension reform and as yet undecided funding plans for sustaining public pensions.

Work smarter.

A new government brings with it a sense of uncertainty for us all as we consider how its policies will affect the work that we do in the future. What is certain is that the number of older people in the population will continue to increase and their needs will have to be met.

Expert support for dementia.

The National Dementia strategy published in February 2009 set out an ambitious five-year programme of reform and development of dementia care in england. This has set in train work on the strategy's 17 objectives. Nurses have a pivotal role to play in the delivery of the change which people with dementia and their carers want to see.

Policy in practice.

The National Dementia Strategy published in February 2009 set out an ambitious five-year programme of reform and development of dementia care in England. This has set in train work on the strategy's 17 objectives. Nurses have a pivotal role to play in the delivery of the change which people with dementia and their carers want to see.

Shared knowledge.

Hospitals are streamlined organisations. They provide care that has to be adapted for all ages, conditions and individual expectations. While the majority of people using general hospital services are older people, the NHS seems to struggle with the fact that its core business is delivering care to this group. To deliver that care well staff must be educated and trained appropriately.

Ensuring smooth transitions.

We often pay attention to the trauma of hospital admission with its consequent anxiety and loss of autonomy and control. I am less convinced that we apply the same sensitivities to the transfer of care or discharge from hospital.

Deprivation, liberty and dignity.

The Mental Capacity Act Deprivation of Liberty Safeguards came into force in April for all hospitals and care homes. This important legislation sets in place clear expectations for organisations about individuals in their care who cannot make decisions about that care and/or treatment because they lack mental capacity, and need to be protected from harm in their best interests. This could mean depriving individuals of their their liberty.

Assume nothing for me.

I have encountered a number of people recently who have used paternalistic language when referring to older people. It has made me consider how society views older people and how outdated views of ageing still dominate individual thinking. The image conjured up is of pleasant, passive and compliant older people waiting to be 'done too', in awe that someone in a uniform will make the right decision for them and pronounce their fate.

Change in direction on abuse.

The Department of Health (DH) consultation on proposed changes to the No Secrets (DH 2000) guidance to protect vulnerable adults from abuse has closed. The task now is to analyse responses and consider the proposals and changes suggested. The complexity of the issue and the number of interested parties from health and social care, the judiciary and police, and housing and care providers, present a real challenge in ensuring the right balance between autonomy, choice, and social and potential legal responsibility.

Policy in practice accentuate the positive.

I was at an event recently run by the charity Counsel and Care, which focused on older people in the media. It provided an opportunity to reflect on how society thinks about older people and how powerful the media are in shaping public opinion. The media have the potential for positive and negative portrayals in print and online and to influence how we all think. As negative stories about older people abound, we need to take some responsibility in challenging the media at a national and local level.

A stronger voice for older people.

I often hear the question 'How are we going to involve older people?' This is guaranteed to make my hackles rise, not because we shouldn't ask it but because we still have to. As we embrace a future where older people are the majority group in society, we need to move from thinking 'how do we' to making this involvement implicit.

Confusion: an age-old problem.

Despite the fact that around one third of older people admitted to hospital over the age of 65 years has delirium, this serious condition gets little attention in either practice or journals. It is often not recognised and is not routinely assessed, but its impact is significant. Lack of diagnosis and treatment can mean that many older people follow care trajectories that could otherwise be avoided, and can result in long-term care and unnecessary suffering.

One chance to get it right.

Recently I chaired a conference hosted by the National Council for Palliative Care focusing on the issues of comorbidity and dying with dignity. Being a conference chair is one sure way of concentrating your mind and thoughts on speaker presentations because you have to pick up the threads, link speakers together and summarise the conference.

Keep older people safe.

It is estimated that more than half a million older people experience some form of abuse. A whole-profession response is needed to protect vulnerable people and stop the perpetrators.

Connecting with the grass roots of care and caring.

I have just had the privilege of attending the RCN's Nursing Older People Conference in Cardiff entitled, 'Respecting the difference: dilemmas in dignity and diversity'. In the current climate, being able to take time out to hear about new practice and reflect on the world in which we work is both important and precious time. It presents an opportunity to hear about developments, meet a range of people working across services and listen to the real issues facing them.