Influence of age on the response to Streptococcus pneumoniae vaccine in patients with recurrent infections and normal immunoglobulin concentrations,☆☆,,★★

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Abstract

Background: A deficient antibody response to polysaccharide antigens is determined by measuring the response to the 23-valent pneumococcal polysaccharide vaccine. However, the diagnosis of this specific antibody deficiency is hampered by the lack of sufficient data and standardized testing of the response to pneumococcal polysaccharides. Methods: All patients evaluated in our allergy/immunology clinic for recurrent respiratory infections between 1995 and 1997 without immunoglobulin, IgG subclass, or other known primary or secondary immunodeficiency were included in this analysis. IgG antipneumococcal serotypes 1, 3, 4, 6B, 9V, 14, 18C, 19F, and 23F were determined by a modified ELISA protocol. An adequate IgG antibody response to an individual serotype was arbitrarily defined as a postimmunization antibody titer of 1.3 μg/ml or greater or at least four times the baseline value. Results: A total of 113 patients fulfilling the criteria for inclusion in this analysis were divided into five age groups. The geometric means for preimmunization and postimmunization pneumococcal antibody titers for all serotypes increased with age. For postimmunization antibody concentrations, there was a sharp increase in the specific antibody concentrations in adults in comparison with all pediatric age groups ranging in age from 7 months to 16 years. Similarly, the number of serotypes to which there was an adequate response also increased with age. Conclusion: We conclude that the definition of what constitutes an adequate response to pneumococcal immunization needs further definition. It is clear, however, that age has an important influence on the intensity of the response to most pneumococcal polysaccharides. Correlation studies between antibody concentrations in different IgG subclasses, functional studies, and protection studies against mucosal and invasive pneumococcal infections are in progress, and these should contribute to a refined definition of a normal response. The availability of a standardized method for the measurement of IgG antibodies against relevant pneumococcal serotypes is an important step toward this goal. (J Allergy Clin Immunol 1998;102:215-21.)

Section snippets

Patient population

Patients referred to our allergy/immunology clinic for recurrent infections are evaluated according to a standard protocol, which includes a detailed history of infections, antibiotic use, and a laboratory evaluation, including immunoglobulin and IgG subclass determinations and the measurement of specific antibodies to pneumococcal polysaccharides. All patients evaluated between 1995 and 1997 who did not have immunoglobulin, IgG subclass, or other known primary or secondary immunodeficiency

RESULTS

A total of 113 patients fulfilling the criteria for inclusion in this analysis were divided into the following age groups: (1) under 2 years old (n = 14), (2) 2 to 5 years old (n = 44), (3) 6 to 10 years old (n = 25), (4) 11 to 16 years old (n = 10), and (5) adults (n = 20; 10 with recurrent infections and 10 healthy adults).

In patients with recurrent respiratory infections, the geometric means for preimmunization and postimmunization pneumococcal antibody titers for all serotypes increased

DISCUSSION

Current recommendations for the use of the pneumococcal polysaccharide vaccine are designed to protect against pneumonia and invasive disease in individuals at risk.10 The indications for the use of the vaccine in our clinic are based on the importance of S. pneumoniae as the cause for otitis media and sinusitis, as well as on the emerging antibiotic resistance of several pneumococcal serotypes. Pneumococci cause 20% to 40% of otitis media11 and variable percentages of sinusitis. It has been

Acknowledgements

We thank Ms. Sally Sorensen for expert technical assistance.

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    From athe Division of Allergy and Immunology, Department of Pediatrics, Louisiana State University Medical Center, New Orleans; and bthe Children’s Hospital of New Orleans.

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    Supported in part by an unrestricted grant from Lederle-Praxis Biologicals.

    Reprint requests: Ricardo U. Sorensen, MD, Department of Pediatrics, LSU Medical Center, 1542 Tulane Ave., New Orleans, LA 70112-2822.

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