Sex-specific effects of age and body mass index on antibody responses to seasonal influenza vaccines in healthcare workers

Helen Kuo, Janna R. Shapiro, Santosh Dhakal, Rosemary Morgan, Ashley L. Fink, Hsuan Liu, Jason W. Westerbeck, Kristyn E. Sylvia, Han Sol Park, Rebecca L. Ursin, Patrick Shea, Kathryn Shaw-Saliba, Katherine Fenstermacher, Richard Rothman, Andrew Pekosz, Sabra L. Klein

Research output: Contribution to journalArticlepeer-review


Healthcare institutions with mandatory influenza vaccination policies have over 90% vaccination rates among healthcare workers (HCWs) resulting in a population that has received the influenza vaccine in many, consecutive years. This study explored the impact of sex and other host factors in pre- and post-vaccination neutralizing antibody (nAb) titers and seroconversion against the H1N1 and H3N2 influenza A viruses (IAVs) among HCWs enrolled into a cross-sectional serosurvey during the annual Johns Hopkins Hospital employee vaccination campaign in the 2017–18 and 2018–19 seasons. The study enrolled 111 participants (male = 38, female = 73) in 2017–18 and 163 (male = 44, female = 119) in 2018–19. Serum samples were collected immediately prior to vaccination and approximately 28 days later and nAb titers to vaccine strains determined. An intersectional approach was used to disaggregate the combined effects of sex with age and body mass index (BMI) in the nAb response. Differences between the pre- or post-vaccination geometric mean nAb titers between male and female HCWs were not observed. Male HCWs were 2.86 times more likely to seroconvert compared to female HCWs in 2017–2018, but the same trend was not observed in the following year. When data were disaggregated by age and sex, older female HCWs had higher H1N1 pre- and post-vaccination nAb titers compared to male HCWs in the same age group for both vaccination campaign seasons. In both years, the decline in H3N2 pre-vaccination titers with increasing BMI was greater in female than male HCW. The sex-specific effects of age and BMI on nAb responses to seasonal influenza vaccines require greater consideration.

Original languageEnglish (US)
Pages (from-to)1634-1642
Number of pages9
Issue number11
StatePublished - Mar 8 2022


  • Aging
  • Body mass index
  • Neutralizing antibody
  • Obesity
  • Sex difference
  • Vaccine efficacy

ASJC Scopus subject areas

  • General Veterinary
  • Public Health, Environmental and Occupational Health
  • Infectious Diseases
  • Molecular Medicine
  • General Immunology and Microbiology


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