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Pneumococcal 13-valent conjugate vaccine administration after inferior response to pneumococcal vaccine

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Background:

The pneumococcal vaccine, a nonconjugated vaccine, may be used to evaluate the integrity of the humoral immune system. Those patients with an inferior response to a nonconjugated vaccine may be vaccinated with a conjugated vaccine, which elicits both a B- and T-cell response.

Objective:

We evaluated the immunogenicity of a conjugated vaccine in patients with inferior responses to a nonconjugated vaccine.

Methods:

This was an institutional review board approved retrospective study that involved 22 patients with suspected specific antibody deficiency who received a nonconjugated vaccine, followed by a conjugated vaccine. Patients with an inferior response had <70% response in pneumococcal serotypes (1.3 μg/mL, with at least a two to fourfold increase), whereas protective responses were those with a >70% response. These patients were subsequently administered a conjugated vaccine at various time intervals (1‐36 months), and titers were evaluated 4‐6 weeks later.

Results:

A protective response was found in 6 of 22 patients (average age, 62.2 years) after conjugated vaccine administration. Half of the responders were vaccinated <12 months after nonconjugated vaccine administration. The majority of the nonresponders (n = 16) received a conjugated vaccine <12 months after a nonconjugated vaccine. Of the nonresponders, 10 received a conjugated vaccine <12 months after a nonconjugated vaccine and did not mount a protective response. Other associated immunologic findings included hypogammaglobulinemia (n = 6), low immunoglobulin G1 (IgG1) levels (n = 5), and low IgG2 levels (n = 6).

Conclusion:

The majority of the patients with an inferior response to a nonconjugated vaccine also had an inferior response to a conjugated vaccine. Conjugated vaccine administration time did not affect the response rate. Analysis of the data demonstrated that patients with suspected specific antibody deficiency may not benefit from a conjugated vaccine, which suggested a defect that may affect more than pure antibody responses. Also, the majority of patients with IgG2 deficiency mounted an inadequate response to Pneumococcal 13-valent conjugate vaccine.
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Keywords: Pneumococcal vaccine; Prevnar vaccine; conjugate vaccine; immunodeficiency; immunoglobulins; nonconjugate vaccine; polysaccharide vaccine; specific antibody deficiency; vaccine; vaccine titers

Document Type: Research Article

Publication date: 2017-09-01

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  • Allergy and Asthma Proceedings is a peer reviewed publication dedicated to distributing timely scientific research regarding advancements in the knowledge and practice of allergy, asthma and immunology. Its primary readership consists of allergists and pulmonologists.

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    The journal is indexed in Thomson Reuters Web of Science and Science Citation Index Expanded, plus the National Library of Medicine's PubMed service.
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