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December 15, 1999

Stress-Induced Immunomodulation—Reply

Author Affiliations

Phil B.FontanarosaMD, Interim CoeditorIndividualAuthorMargaret A.WinkerMD, Deputy EditorIndividualAuthorStephenLurieMD PhD, Fishbein FellowIndividualAuthor

JAMA. 1999;282(23):2209-2210. doi:10-1001/pubs.JAMA-ISSN-0098-7484-282-23-jbk1215

In Reply: The intent of our article was to present evidence that stress-induced down-regulation/dysregulation of the immune response has implications for infectious disease. Our intent was not to provide surrogate evidence, but rather to establish biological plausibility. We described 3 vaccine studies to demonstrate that there is evidence that stress affects the antibody and T-cell response to hepatitis B and influenza vaccines. There is evidence that older adults who show poor responses to vaccines also have higher rates of clinical illness, including influenza virus infections.1 Drs Petticrew and Hunter are concerned that smoking could account for the relationship between stress and development of upper respiratory tract infections. The 2 studies we cite did control for smoking and other health behaviors; smoking had no substantial effect on the relative risk for infection with 5 different strains of respiratory virus.2,3

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