title: Safety and immunogenicity of Staphylococcus aureus type 5 capsular polysaccharide-Pseudomonas aeruginosa recombinant exoprotein A conjugate vaccine in patients on hemodialysis.
abstract: Seventeen volunteers with ESRD on hemodialysis, negative for infection with HIV or hepatitis B and C and not receiving immunosuppressive therapy, were injected two times 6 wk apart with 25 micrograms of Staphylococcus aureus Type 5 capsular polysaccharide-Pseudomonas aeruginosa exoprotein A (rEPA) conjugate. Controls were healthy adults, 18 to 44 yr old, injected previously with the same vaccine. None of the patients had fever or significant elevations in their SGOT or SGPT attributable to the vaccine. Two vaccinees had transient induration > 1 cm in diameter at the injection site. The preimmunization geometric mean (GM) Type 5 antibody levels of the ESRD patients and controls were similar. Type 5 antibody levels of the three major immunoglobulin (lg) classes rose at 2 and 6 wk after immunization (P < 0.001 for lgG, P < 0.005 for lgM, and P = 0.0001 for lgA). Reimmunization at 6 wk did not elicit a booster response. At 6 months, the GM lgG level of the patients was approximately 50% of that of the healthy volunteers and 14 of 17 had a more than fourfold higher antibody level than the preimmune value. The GM lgM level, in contrast, declined to the preimmunization value. Vaccine-induced Type 5 antibodies had opsonophagocytic activity. There was a slight increase of lgG antibodies to the heterologous S. aureus Type 8 polysaccharide (P < 0.01) that was sustained at 6 months. The S. aureus Type 5-rEPA vaccine is safe and immunogenic in ESRD patients, and evaluation of its effectiveness against S. aureus bacteremia in this at-risk group is planned.
authors.affiliation: Nephrology Service, Walter Reed Army Medical Center, Washington, DC, USA.
authors.forename: P G
authors.initials: PG
authors.lastname: Welch
authors.forename: A
authors.initials: A
authors.lastname: Fattom
authors.forename: J
authors.initials: J
authors.lastname: Moore
authors.forename: R
authors.initials: R
authors.lastname: Schneerson
authors.forename: J
authors.initials: J
authors.lastname: Shiloach
authors.forename: D A
authors.initials: DA
authors.lastname: Bryla
authors.forename: X
authors.initials: X
authors.lastname: Li
authors.forename: J B
authors.initials: JB
authors.lastname: Robbins
mesh_terms: D036002:ADP Ribose Transferases; D000293:Adolescent; D000328:Adult; D000907:Antibodies, Bacterial / Q000032:analysis; D000917:Antibody Formation; D016667:Bacterial Capsules; D001427:Bacterial Toxins; D001428:Bacterial Vaccines / Q000009:adverse effects / Q000276:immunology*; D005098:Exotoxins / Q000009:adverse effects / Q000276:immunology*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000276:immunology / Q000628:therapy; D009305:Nasopharynx / Q000382:microbiology; D011135:Polysaccharides, Bacterial / Q000276:immunology*; D011994:Recombinant Proteins; D006435:Renal Dialysis; D012449:Safety; D013211:Staphylococcus aureus / Q000302:isolation & purification; D018074:Vaccines, Conjugate / Q000009:adverse effects* / Q000276:immunology*; D037521:Virulence Factors; D000097668:Pseudomonas aeruginosa Exotoxin A
chemical_list: D036002:ADP Ribose Transferases; D000907:Antibodies, Bacterial; D001427:Bacterial Toxins; D001428:Bacterial Vaccines; D005098:Exotoxins; D011135:Polysaccharides, Bacterial; D011994:Recombinant Proteins; D018074:Vaccines, Conjugate; D037521:Virulence Factors; D000097668:Pseudomonas aeruginosa Exotoxin A; C054106:capsular polysaccharide, type 5, Staphylococcus aureus