Impaired response to 13-valent pneumococcal conjugate vaccine (PCV13) in children with recurrent respiratory infections and chronic cough

Abstract

Background: Functional antibodies (FAB) test refers to the measurement of specific IgG antibodies against vaccines to exclude clinically significant antibody deficiency. Most healthy infants and children (>90%) develop antibodies to the majority of serotypes included in PCV13 (1).

Aim: To examine the incidence of impaired PCV13 response in children referred to a tertiary paediatric respiratory centre with recurrent respiratory infections (RRI) and/or chronic cough (CC).

Methods: Retrospective review of case notes.

Results: 137 patients, between age 2 and 15 years old who had FAB test were identified with history of RRI and/or CC, within a two year period. Mean age was 5.9 years (2-14), 46.7% of children were female. 73% had a history of RRI, 76.6% had a history of CC and 49.6% had a history of both RRI and CC. Diagnosis of asthma (36.5%) and preschool wheeze (41.6%) were common.  32.8% of patients with RRI and/or CC and 37% of patients with history of RRI only, had impaired response to PCV13, with specific antibody concentration of 0.35 ug/ml or higher to less than seven PCV13 serotypes. Those on prophylactic Azithromycin or on moderate to high dose of inhaled corticosteroids were more likely to have impaired response to PCV13 (OR 1.51, 95%CI 1.51 0.53-4.27 and OR 2.7 95%CI 0.94-7.77 respectively).

Conclusion: Paediatric patients referred to tertiary centre with RRI and/or CC have high incidence of impaired response to PCV13 compared to general population and may benefit from booster vaccination against pneumococcus.

1. Doffinger et al. Age specific responses to Pneumovax in healthy children.  Clinical & Experimental Immunology (2008) 154: 72-72.