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Lack of sleep can jeopardize vaccine effectiveness

Published:November 09, 2016DOI:https://doi.org/10.1016/j.ajic.2016.10.003
      To the Editor:
      Recently, Lee et al
      • Lee P.H.
      • Cowling B.J.
      • Yang L.
      Seasonal influenza vaccination among Chinese health care workers.
      presented an innovative article that evaluated the knowledge, attitudes, and opinions of health care workers and the factors associated with influenza vaccination. We would also like to note that the main consequence of effective vaccination is a lower occupation of hospital beds by patients affected by diseases due to a nonefficient vaccination or lack thereof.
      We believe there are some additional considerations that should be mentioned. For example, chronic short-term sleep can increase susceptibility to infectious disease due a lower antibody response.
      • Prather A.A.
      • Hall M.
      • Fury J.M.
      • Ross D.C.
      • Muldoon M.F.
      • Cohen S.
      • et al.
      Sleep and antibody response to hepatitis B vaccination.
      Lee et al
      • Lee P.H.
      • Cowling B.J.
      • Yang L.
      Seasonal influenza vaccination among Chinese health care workers.
      did not qualitatively or quantitatively evaluate the sleep of each individual. Evidence suggests that the response to influenza vaccination may be impaired in individuals with chronic sleep restriction.
      • Spiegel K.
      • Sheridan J.F.
      • Van Cauter E.
      Effect of sleep deprivation on response to immunization.
      Our main suggestion for future studies is that the assessment of sleep should be used as an adjustment factor in the statistical model. A fast and low-cost way to accomplish this would be through questionnaires (eg, the sleep quality score determined by the Pittsburgh Sleep Quality Index). For more depth, we suggest assessing the prevalence of sleep disorders in any given cohort study and its relationship with the effectiveness of vaccination.
      Most health care workers are subject to chronic sleep restriction and shift work.
      • Chang Y.S.
      • Chen H.L.
      • Hsu C.Y.
      • Su S.F.
      • Liu C.K.
      • Hsu C.
      Nurses working on fast rotating shifts overestimate cognitive function and the capacity of maintaining wakefulness during the daytime after a rotating shift.
      • Anderson C.
      • Sullivan J.P.
      • Flynn-Evans E.E.
      • Cade B.E.
      • Czeisler C.A.
      • Lockley S.W.
      Deterioration of neurobehavioral performance in resident physicians during repeated exposure to extended duration work shifts.
      • Wolkow A.
      • Ferguson S.
      • Aisbett B.
      • Main L.
      Effects of work-related sleep restriction on acute physiological and psychological stress responses and their interactions: A review among emergency service personnel.
      Restricted sleep is a factor associated with metabolic disorders such as obesity, metabolic syndrome, insulin resistance, and type 2 diabetes.
      • Faraut B.
      • Boudjeltia K.Z.
      • Vanhamme L.
      • Kerkhofs M.
      Immune, inflammatory and cardiovascular consequences of sleep restriction and recovery.
      Due to exposure to light at night, the bodies of these workers secrete a lower concentration of the hormone melatonin, which participates in control of biological rhythms, including regulation of sleep. Physiologically, high melatonin concentrations are associated with lower levels of body temperature, alertness, and performance.
      • Arendt J.
      Shift work: coping with the biological clock.
      In addition, melatonin and cortisol play important roles in controlling responses to pathogens.
      • Hardeland R.
      • Cardinali D.P.
      • Brown G.M.
      • Pandi-Perumal S.R.
      Melatonin and brain inflammaging.
      • Dong T.
      • Zhi L.
      • Bhayana B.
      • Wu M.X.
      Cortisol-induced immune suppression by a blockade of lymphocyte egress in traumatic brain injury.
      Craniofacial characteristics of the Asian population in the sample studied by the authors (Chinese subjects), may trigger sleep disorders.
      • Polesel D.N.
      • Okazaki K.M.
      • Nozoe K.T.
      • Andersen M.L.
      • Tufik S.
      Obstructive sleep apnea as a potential confounding factor in atherosclerosis in the Asian population.
      All these factors affect immune health, well-being, and quality of life.
      The present-day lifestyle jeopardizes sleep in populations around the world, and the main consequences of lack of sleep can be exacerbated by concurrent obesity, sedentary lifestyle, and bad eating habits.
      • Tufik S.
      • Andersen M.L.
      • Bittencourt L.R.A.
      • De Mello M.T.
      Paradoxical sleep deprivation: neurochemical, hormonal and behavioral alterations. Evidence from 30 years of research.
      Importantly, some studies indicate that obese individuals have an increased risk for hospitalizations during influenza seasons, which is probably due to a less-protective immune response against influenza virus.
      • Kwong J.C.
      • Campitelli M.A.
      • Rosella L.C.
      Obesity and respiratory hospitalizations during influenza seasons in Ontario, Canada: a cohort study.
      Thus, obesity may be a mediating factor of vaccine response and should be included as a factor in analyses.
      We recognize the value of the study by Lee et al,
      • Lee P.H.
      • Cowling B.J.
      • Yang L.
      Seasonal influenza vaccination among Chinese health care workers.
      which discusses the importance of awareness about the previous history of vaccination as a predictive factor for influenza vaccination. In view of today's modern society, we invite authors and other research groups to include sleep evaluation and measurements of obesity such as waist circumference in analyses as 2 of the main parameters influencing immune health and quality of life.

      References

        • Lee P.H.
        • Cowling B.J.
        • Yang L.
        Seasonal influenza vaccination among Chinese health care workers.
        Am J Infect Control. 2016; (Sep 21. [Epub ahead of print])
        • Prather A.A.
        • Hall M.
        • Fury J.M.
        • Ross D.C.
        • Muldoon M.F.
        • Cohen S.
        • et al.
        Sleep and antibody response to hepatitis B vaccination.
        Sleep. 2012; 35: 1063-1069
        • Spiegel K.
        • Sheridan J.F.
        • Van Cauter E.
        Effect of sleep deprivation on response to immunization.
        JAMA. 2002; 288: 1471-1472
        • Chang Y.S.
        • Chen H.L.
        • Hsu C.Y.
        • Su S.F.
        • Liu C.K.
        • Hsu C.
        Nurses working on fast rotating shifts overestimate cognitive function and the capacity of maintaining wakefulness during the daytime after a rotating shift.
        Sleep Med. 2013; 14: 605-613
        • Anderson C.
        • Sullivan J.P.
        • Flynn-Evans E.E.
        • Cade B.E.
        • Czeisler C.A.
        • Lockley S.W.
        Deterioration of neurobehavioral performance in resident physicians during repeated exposure to extended duration work shifts.
        Sleep. 2012; 35: 1137-1146
        • Wolkow A.
        • Ferguson S.
        • Aisbett B.
        • Main L.
        Effects of work-related sleep restriction on acute physiological and psychological stress responses and their interactions: A review among emergency service personnel.
        Int J Occup Med Environ Health. 2015; 28: 183-208
        • Faraut B.
        • Boudjeltia K.Z.
        • Vanhamme L.
        • Kerkhofs M.
        Immune, inflammatory and cardiovascular consequences of sleep restriction and recovery.
        Sleep Med Rev. 2012; 16: 137-149
        • Arendt J.
        Shift work: coping with the biological clock.
        Occup Med (Lond). 2010; 60: 10-20
        • Hardeland R.
        • Cardinali D.P.
        • Brown G.M.
        • Pandi-Perumal S.R.
        Melatonin and brain inflammaging.
        Prog Neurobiol. 2015; 127-128: 46-63
        • Dong T.
        • Zhi L.
        • Bhayana B.
        • Wu M.X.
        Cortisol-induced immune suppression by a blockade of lymphocyte egress in traumatic brain injury.
        J Neuroinflammation. 2016; 13: 197
        • Polesel D.N.
        • Okazaki K.M.
        • Nozoe K.T.
        • Andersen M.L.
        • Tufik S.
        Obstructive sleep apnea as a potential confounding factor in atherosclerosis in the Asian population.
        J Neurol Sci. 2014; 346: 333-334
        • Tufik S.
        • Andersen M.L.
        • Bittencourt L.R.A.
        • De Mello M.T.
        Paradoxical sleep deprivation: neurochemical, hormonal and behavioral alterations. Evidence from 30 years of research.
        An Acad Bras Cienc. 2009; 81: 521-538
        • Kwong J.C.
        • Campitelli M.A.
        • Rosella L.C.
        Obesity and respiratory hospitalizations during influenza seasons in Ontario, Canada: a cohort study.
        Clin Infect Dis. 2011; 53: 413-421

      Linked Article

      • Seasonal influenza vaccination among Chinese health care workers
        American Journal of Infection ControlVol. 45Issue 5
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          The World Health Organization recommends that health care workers (HCWs) receive influenza vaccination annually1 because they may face occupational risk of infection. Although the effectiveness of influenza vaccination in reducing illness days of HCWs has been demonstrated,2,3 the vaccination rate of HCWs is low in China, with seasonal influenza vaccination rates of 13%-18% during the 2008 and 2009 seasons in Beijing.4,5 To plan for further interventions aiming to increase influenza vaccination among HCWs, this study aimed to examine the knowledge, attitudes, and opinions of the HCWs and the factors associated with influenza vaccination in HCWs in China, with all analysis stratified by types of HCWs.
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