The main conclusion of this study is that very old adults produce measurable amounts of anti-S antibodies after vaccination against SARS-CoV-2, mainly in anti-N seropositive subjects (i.e. i.e. with prior SARS-CoV-2 infection), whose antibody titer is similar to that of younger individuals. It is also evident that older adults, who have not contracted the virus naturally (anti-N negative), produce fewer anti-S antibodies than younger adults. This is the first report providing post-vaccination serological data in subjects aged 90 years and over to the best of our knowledge.

The characteristics of this subpopulation must be taken into account in the strategy for organizing the vaccination campaign against Sars-CoV-2. They are at high risk of developing severe symptoms related to COVID-19, but leading an inactive and often isolated lifestyle, it has been speculated that they would be less likely to contract and transmit the virus. For this reason, different strategies for administering vaccination to the elderly have been adopted in other countries. For example, in the United States, the vaccine has been given primarily to healthcare professionals and adults over the age of 65.17. In China, however, until March 2021, the government did not recommend vaccination for adults over 60, prioritizing preventive measures (i.e. social isolation, home confinement and quarantine ) to protect the elderly.18. In countries where priority has been given to preventive measures (i.e. social isolation, home confinement and quarantine) to protect older people19researchers interested in aging point to the negative consequences of social isolation and loneliness on the mental and physical health of the elderly20.21.

In addition, very old adults have different beliefs about vaccination against COVID-19. Among the main enablers of vaccination, the intentions are convenience (both individual and collective), psychological and physiological well-being, collective well-being, regulatory support referents, and confidence in the government’s ability to deliver vaccinations. the people.22. At the same time, the various barriers to vaccination intentions are vaccine ineffectiveness, side effects, safety, unfavorable regulatory referents, and accessibility, affordability and availability of COVID-19 vaccines.22.

Data obtained from the analysis of a cohort composed of 97 subjects + 90 years suggest that the specific antibody response profiles to the SARS-CoV-2 virus are distinct in different age groups and that strategies targeted at age for vaccination management may be warranted. These data demonstrate that the production of SARS-CoV-2 IgG antibodies differed between different age groups. In addition, other studies have focused mainly on elderly patients hospitalized23; this study investigated antibody responses to vaccination in non-hospitalized patients, thus indicating vaccination in relatively healthy subjects, such as the elderly receiving home care.

This study obtained a comprehensive assessment of the quantitative and qualitative SARS-CoV-2 antibody profiles of very old adults, focusing on age and sex. Thus, the data obtained show that the differences in SARS-CoV-2 serology in the general population compared to older adults could be partly due to age-related immune responses.

This data analysis highlighted that gender is a critical factor to consider when assessing serostatus after SARS-CoV-2 infection and/or vaccination; although prior infections and age represent the most critical determinants of anti-spike antibody titer, gender contributes significantly to this value, especially among the younger age categories13. These data are critical for managing factors that facilitate vaccine intentions (i.e., vaccine efficacy), given that women respond differently to the COVID-19 pandemic with respect to vaccination. risk perception and behavior that men24.25.

Another interesting data is that, even in older adults, higher levels of anti-SARS-CoV-2 IgG were found in subjects who contracted the virus and were subsequently vaccinated, confirming what has already been found in the general population26.

Considerable effort has been devoted to the development of vaccines against COVID-19 and the promotion of vaccination campaigns. As of February 14, 2022, 10,227,670,521 doses of vaccine have been administered worldwide1. It would therefore be essential to optimize and standardize the vaccine administration strategy to obtain the maximum possible efficiency. In many Western countries, the government has focused on vaccinating older adults as soon as possible. For example, in the United States, adults over 65 were the first group (along with health care providers) to receive the vaccines. In the United States, about 48 million (86.9%) of the population over the age of 65 have received at least one dose of the COVID-19 vaccine, and about 42 million (76.5%) of the population are fully vaccinated by June 202127. In contrast, the Chinese government did not recommend vaccination for adults over 60 until March 2021.28.

As a result, vaccination coverage among the elderly in China was dramatically different from most other countries. China has yet to release official data on vaccination coverage among the elderly. However, it is widely believed that the current vaccination coverage rate among older Chinese adults is extremely low, as older adults report a high level of doubt about the effectiveness of vaccines.22. They have different perceptions of vaccination than the younger population; some older adults rely on traditional home health practices and healthy lifestyles as strategies to maintain health22.

In addition, several studies also indicate that risk perception and worry decrease with age.29. Older men have lower risk perception and are less likely to implement health behavior changes than women and younger people24. All of this very likely influenced the perception of risk and behavior of the elderly and could also affect the rate of vaccination participation. On the other hand, a limited number of studies have examined older adults’ vaccination intentions and associated facilitators and barriers.22demonstrating that there are specific factors (having chronic illnesses, having a healthcare professional talk about side effects and the importance of getting vaccinated) and barriers (concerns about vaccine effectiveness and side effects)22.

Finally, the trend in antibody titer against SARS-CoV-2 could support strategies for administering an extra dose of vaccine as an extra dose (provided, as part of the primary vaccination cycle, for transplant recipients and immunocompromised) or booster (provided, at least 6 months from the end of the primary cycle, to the general population depending on the epidemiological evolution). In particular, the antibody titer could be used as a supporting index to establish the need for an additional dose, especially in the elderly, whose humoral response to infections may be less effective due to immunosenescence.30.31 than those who had contracted the infection26.

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