Sex differences in the efficacy and safety of SARS-CoV-2 vaccination in residents of long-term care facilities: insights from the GeroCovid Vax study

• Published in: Internal and emergency medicine 2023-08, Vol.18 (5), p.1337-1347
• Main Authors: Trevisan, Caterina, Raparelli, Valeria, Malara, Alba, Abbatecola, Angela Marie, Noale, Marianna, Palmieri, Annapina, Fedele, Giorgio, Di Lonardo, Anna, Leone, Pasqualina, Schiavoni, Ilaria, Stefanelli, Paola, Volpato, Stefano, Antonelli Incalzi, Raffaele, Onder, Graziano
• Format: Article
• Language: English
• Subjects: Antibodies; Antibody response; Cardiovascular diseases; Cognitive ability; Comorbidity; COVID-19; COVID-19 vaccines; Diabetes mellitus; Females; Gender differences; Gender Medicine; Im - Original; Immune response; Immune response (humoral); Immunoglobulin G; Internal Medicine; Long term health care; Medicin och hälsovetenskap; Medicine; Medicine & Public Health; Severe acute respiratory syndrome coronavirus 2; Sex differences; Side effects
• ISSN: 1828-0447; 1970-9366; 1970-9366
• DOI: 10.1007/s11739-023-03283-y

Despite the reported sex-related variations in the immune response to vaccination, whether the effects of SARS-CoV-2 vaccination differ by sex is still under debate, especially considering old vulnerable individuals, such as long-term care facilities (LTCFs) residents. This study aimed to evaluate COVID-19 infections, adverse events, and humoral response after vaccination in a sample of LTCF residents. A total of 3259 LTCF residents (71% females; mean age: 83.4 ± 9.2 years) were enrolled in the Italian-based multicenter GeroCovid Vax study. We recorded the adverse effects occurring during the 7 days after vaccine doses and COVID-19 cases over 12 months post-vaccination. In a subsample of 524 residents (69% females), pre- and post-vaccination SARS-CoV-2 trimeric S immunoglobulin G (Anti-S-IgG) were measured through chemiluminescent assays at different time points. Only 12.1% of vaccinated residents got COVID-19 during the follow-up, without any sex differences. Female residents were more likely to have local adverse effects after the first dose (13.3% vs. 10.2%, p  = 0.018). No other sex differences in systemic adverse effects and for the following doses were recorded, as well as in anti-S-IgG titer over time. Among the factors modifying the 12-month anti-S-IgG titers, mobility limitations and depressive disorder were more likely to be associated with higher and lower levels in the antibody response, respectively; a significantly lower antibody titer was observed in males with cardiovascular diseases and in females with diabetes or cognitive disorders. The study suggests that, among LTCF residents, SARS-CoV-2 vaccination was effective regardless of sex, yet sex-specific comorbidities influenced the antibody response. Local adverse reactions were more common in females.