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Immune Response Post-Administration of Polyvalent Pneumococcal Vaccine and Implications
Regarding Clinical Efficacy
J. M. ...
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Immune response post administration of polyvalent pneumococcal vaccine and implications regarding clinical efficacy


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J. M. Khan D.O. H. M. Nasir D.O.1,2, W. M. Ryan III D.O.
Larkin Community Hospital, Miami, FL
Allergy and Immunology Fellowship Program

Published in: Health & Medicine
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Immune response post administration of polyvalent pneumococcal vaccine and implications regarding clinical efficacy

  1. 1. Immune Response Post-Administration of Polyvalent Pneumococcal Vaccine and Implications Regarding Clinical Efficacy J. M. Khan D.O.1,2, H. M. Nasir D.O.1,2, W. M. Ryan III D.O.1,2 1 Larkin Community Hospital, Miami, FL 2 Allergy and Immunology Fellowship Program, Nova Southeastern University College of Osteopathic Medicine, Davie, FL Introduction Acknowledgments Conclusion Despite low antibody titers post vaccine administration, it may be possible to confer immunity using pneumococcal vaccine. There appears to be a decrease in invasive pneumococcal disease post- vaccine administration, however, there is conflicting data on whether or not this decreases all-cause mortality, as mentioned. Further studies are necessary to determine antibody levels for immunity to each serotype. Other factors would also need further study in addition to measurement of IgG levels and subtype levels (IgG1, IgG2, IgG3, and IgG4), including evaluation of opsonization and phagocytosis involving each specific serotype in both in-vitro and in-vivo models. In adult populations, additional studies would also need to be performed to determine the efficacy of use of a conjugate vaccine as previous studies have shown superior immunogenicity in pediatric populations. Methods Pneumococcal vaccine is FDA approved in adults > 50 and children > 2 at increased risk for developing pneumococcal disease. Due to multiple serotypes, there is no discrete level for antibody titers which confer protective immunity. We hypothesize that immunity can be achieved despite suboptimal antibody response. There are over 90 different capsular serotypes of pneumococcus which have been identified to date. There are multiple formulations of the pneumococcal vaccine available, but for the purposes of this discussion, we focus on 7-valent and 23-valent vaccines (Prevnar and Pneumovax, respectively), as they have been the most widely studies to date in both pediatric and adult populations. 7-valent, 10-valent, and 13-valent vaccines are formulated as conjugate vaccines, whereas the 23-valent vaccine is not. Currently, the 23-valent vaccine includes 23 purified capsular polysaccharide antigens including serotypes: 1, 2, 3, 4, 5, 6B, 7F, 8, 9N, 9V, 10A, 11A, 12F, 14, 15B, 17F, 18C, 19A, 19F, 20, 22F, 23F, and 33F. These serotypes were chosen to represent 85 to 90 percent of the serotypes that cause invasive disease in the United States. A 2008 meta-analysis by the Cochrane group that assessed the efficacy of PPSV23 for preventing pneumococcal infection in adults had the following findings: strong evidence of efficacy against IPD (odds ratio 0.26, 95% CI 0.15-0.46), inconclusive evidence regarding efficacy against all-cause pneumonia, no reductions in all-cause mortality.1 Immune responses in immunocomprimised patients vary, and are not included in the scope of this discussion. Results References Nova Southeastern University- Larkin Community Hospital Program Director: Shahnaz Fatteh, M.D. Walter M. Ryan, III, D.O., FAAAAI We reviewed data from prospective/retrospective studies evaluating vaccine efficacy. IgM and IgG antibody levels were measured by ELISA pre and 2-3 weeks post administration. Incidence of pneumococcal disease was noted post-vaccine administration. Studies were controlled for gender, race, and age. Percent response rates were compared using titers and analyzed in the context of clinical guidelines suggesting antibody concentration of 1.3 µg/ml or higher or 200 to 300 ng of antibody nitrogen per ml (N/ml-1) per serotype, a 4-fold rise in antibody titer from baseline, and in age > 5 years, a response to at least 70% of serotypes. In patients age 2-5 years, a response to 50% of the capsular antigens was expected to confer protective immunity.2 Healthy adults were noted to show a 2-fold increase in antibody titers after vaccination. Higher pre-immunization antibody concentrations to a specific serotype showed a smaller rise after immunization. This does not meet clinical criteria for an adequate immune response. Clinical efficacy studies revealed an inconsistent relationship between vaccination administration and subsequent development of pneumococcal disease. 1. Moberley SA, Holden J, Tatham DP, Andrews RM. Vaccines for preventing pneumococcal infection in adults. Cochrane Database Syst Rev 2008; :CD000422 2. Sorenson RU, Leiva LE, Giangrosso PA. Response to heptavalent conjugate Streptococcus pneumoniae vaccine in children with recurrent infections who are unresponsive to the polysaccharide vaccine. Pediatr Infect Dis J 1998; 17: 685 3. Jackson LA, Neuzel KM, Yu O. Effectiveness of pneumococcal polysaccharide vaccine in older adults. NEJM 2003; 348: 18 Disclosures No financial disclosures to report