Morning Flu Vaccinations May Be More Effective Interview with:

Dr Anna C. Phillips PhD CPsychol AFBPsS Reader in Behavioural Medicine School of Sport, Exercise & Rehabilitation Sciences University of Birmingham Edgbaston Birmingham

Dr. Anna Phillips

Dr Anna C. Phillips PhD CPsychol AFBPsS
Reader in Behavioural Medicine
School of Sport, Exercise & Rehabilitation Sciences
University of Birmingham
Edgbaston Birmingham What is the background for this study? What are the main findings?

Dr. Phillips: We know that various factors can affect the response to vaccination and that older adults have a poorer response than younger people, i.e. they produce fewer antibodies.  We also know that many immune messengers and important hormones have daily rhythms in their levels and wanted to test whether the antibody response to vaccination might also be affected by time of day.  We randomised surgeries to giving morning or afternoon vaccinations and tested before and one month after the vaccination for levels of antibodies.

Two of the three flu strains (viruses) contained in the vaccine showed a higher antibody response in the morning than in the afternoon, up to 4 x higher to one of the strains (A/California) and 1.5 x higher to the B strain. None of the potential mechanisms we measured (immune messengers, hormones) seemed to be driving this effect. What should clinicians and patients take away from your report?

Dr. Phillips: While we still have to test the extent to which these findings relate to protection against disease, it is always more protective to have more antibodies, therefore we would recommend morning vaccination now, certainly with flu in older adults.  Any other risk-free intervention that resulted in a 367% higher or 139% higher response in patients (A/Cal and B strain, respectively) would be considered very effective!  This means that responses were 70% and 30% higher, respectively, in the morning than those in the afternoon. What recommendations do you have for future research as a result of this study?

Dr. Phillips: We are planning to test the effectiveness of this intervention in terms of how it relates to incidence of flu as well as seeing if it works in older adults with a range of additional illnesses and medications. We would also like to see if the findings extend to other important vaccines of different types such as pneumonia. Is there anything else you would like to add?

Dr. Phillips: This is a cost free risk free intervention that can be employed now while we are waiting to conduct the definitive trial and find out the mechanisms.

We would welcome feedback from clinicians about whether they are considering changing to offering the annual flu jab in the morning (at least to as many patients who will take them up on the offer). Thank you for your contribution to the community.


Joanna E. Long et al. Morning vaccination enhances antibody response over afternoon vaccination: A cluster-randomised trial.
Vaccine, April 2016 DOI: 1016/j.vaccine.2016.04.032

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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