Can sleep or stress affect your COVID-19 vaccination?

COVID-19 vaccines are enormously effective in protecting yourself from the deadly virus. Is there a way to improve them even more?

To learn more, a major new study from UC San Francisco is recruiting 600 unvaccinated Bay Area residents to investigate whether a variety of predictors, such as age, sleep, stress, and emotional well-being, could influence the power and persistence of our body’s defenses.

“We are measuring factors that may lead to a more robust response, as well as factors that we believe will dampen or weaken the antibody response,” said UCSF professor of psychiatry Elissa Epel, co-investigator of the Building Optimal Antibodies Study project.

There may be ways to compensate for deficiencies in vaccines, by contracting emotional, behavioral or other interventions, according to the research team.

In a race against time, the US is rushing to expand access to valuable COVID-19 vaccines. By Friday, about 17 percent of Americans had been vaccinated.

Although they are very good, they are not perfect. A two-dose regimen of the Pfizer and Moderna vaccines prevents 92.6% of infections two weeks after the second injection. Johnson & Johnson’s vaccine is 72% effective.

In some rare cases, people can still develop COVID-19 despite vaccination. The California Department of Public Health declined to reveal the number of so-called “breakthrough cases,” but said it is studying where and how often they occur.

Vaccines are designed to give the immune system a lasting memory of the viral components so that it can attack when confronted with the real pathogen. It responds by unfolding T cells, which identify and kill infected cells, and B cells, which produce antibodies that bind to the virus so that it cannot enter the cell.

But experience with other vaccines shows that not all respond equally well. And our defenses fade at different rates. While the new evidence shows that the Pfizer vaccine is effective for at least six months, its long-term durability is unknown.

By measuring antibodies and T cells over time, “this study will help us understand the ‘time course’ of people’s responses,” said Aric Prather, associate professor in the Department of Psychiatry and a co-investigator at the UCSF study.

“What are the factors in our lives that can really contribute and create an improved response?” he said. “Or maybe putting people at risk, through a suboptimal response?”

For example, age is known to play a role. The flu vaccine is 70% to 90% effective in young adults, but less than 55% effective in the elderly, according to the US Centers for Disease Control and Prevention. As we age, there is a decrease in the number, activity, and diversity of the immune system’s protective T cells, a process that scientists call “immunosenescence.” By the age of 50, our T-cell production is less than 10% of its peak.

Insufficient sleep is another predictor of how well our immune systems respond to vaccination, according to Prather. Sleepless nights have been shown to increase a person’s susceptibility to developing the common cold. It also silences the body’s response to flu and hepatitis vaccines.

“When people don’t get the sleep they need, they can’t build the army of T cells that are important to protect us against viruses,” Prather said.

Chronic stress is also known to affect the antibody response to the flu vaccine. Stress, such as the death of a loved one, financial loss, and parental stress from school closings, can disrupt immune regulating hormones.

“The adrenaline response to stress helps us, but if it is too extreme at the time of vaccination, it can interfere with the molecular pathways of the immune response,” Epel said.

The team is specifically calling on people of color, who have been burdened by both stress and discrimination, to see if these factors influence the response to the vaccine.

Obesity is linked to a weakened immune response to the COVID-19 virus. And vaccines for other infections often don’t work as well in overweight people, suggesting that the COVID-19 shot might not be completely protective.

A person’s genetics, or underlying health, could also play a role, according to UCSF’s Dr. Monica Gandhi. For example, people who are very immunosuppressed may have a duller response.

All of this could spell a potential problem for a COVID-19 vaccine.

Study volunteers will complete questionnaires over a six-month period. Your mood will be asked several times a day. They will also be asked questions like, “What was the most stressful thing that happened to you today?” “How many hours did you sleep last night?” “How did you feel the quality of your sleep last night?”

Only unvaccinated people are eligible to participate. UCSF cannot provide the vaccine as part of the study, so volunteers must be inoculated elsewhere.

Your blood will be tested on three different occasions: before vaccination, one month after the second vaccination, and six months after the second vaccination. They will be paid up to $ 300 for completing all aspects of the study.

In the blood, the scientists will measure the immune system’s response, counting the levels of antibodies and T cells. We don’t yet know exactly how many cells are needed to ensure protection, Epel said. But it is possible to assess the overall vigor of an immune response.

The team will also measure the volunteers’ telomeres, the protective caps on the ends of chromosomes. Longer telomeres indicate a younger immune system, with cells that can divide more strongly when exposed to antigens. Shorter telomere lengths have been linked to more severe infection with a cold virus and a poorer antibody response to influenza vaccination.

This information will be kept private, according to the team. It will be “de-identified,” meaning it will be kept separate from a person’s name, phone number, or email, and no one outside of the study staff will have access to the records, including their employer.