title: Response to a heptavalent conjugate Streptococcus pneumoniae vaccine in children with recurrent infections who are unresponsive to the polysaccharide vaccine.
abstract: OBJECTIVE
  To determine whether children with recurrent respiratory infections who failed to respond to the conventional polysaccharide vaccine would respond to a pneumococcal conjugate vaccine.
  
  
  METHODS
  Children referred to our clinic for recurrent respiratory infections who had no known primary or secondary immunodeficiencies were immunized with a 23-valent pneumococcal polysaccharide vaccine. IgG antibodies to pneumococcal serotypes 1, 3, 4, 6B, 9V, 14, 18C, 19F and 23F were determined by enzyme-linked immunosorbent assay before and 4 to 6 weeks after immunization. An adequate IgG antibody response to an individual serotype was arbitrarily defined as a postimmunization antibody titer > or =1.3 microg/ml or at least 4 times the preimmunization value. Immunization with an experimental CRM197-heptavalent pneumococcal conjugate vaccine was offered to patients without an adequate response to 4 or more vaccine serotypes (nonresponders). Post-conjugate immunization antibody concentrations were measured 4 to 6 weeks later.
  
  
  RESULTS
  In nonresponder patients (n = 17) geometric mean post-conjugate immunization (C) serum antibody concentrations (microg/ml) compared with post-polysaccharide (PS) concentrations were: (serotype, C vs. PS) 4, 1.11 vs. 0.30 (P = 0.000227); 6B, 0.46 vs. 0.20 (P = 0.017267); 9V, 0.82 vs. 0.29 (P = 0.002163); 14, 1.88 vs. 0.27 (P = 0.000615); 18C, 0.98 vs. 0.32 (P = 0.021962); 19F, 1.24 vs. 0.34 (P = 0.002844); and 23F, 0.87 vs. 0.16 (P = 0.000194). In responder patients (n = 67), after 1 dose of the polysaccharide vaccine, geometric mean antibody concentrations were: 4, 1.05; 6B, 0.96; 9V, 1.55; 14, 1.65; 18C, 1.62; 19F, 1.30; and 23F, 1.02.
  
  
  CONCLUSIONS
  Our results show that a pneumococcal conjugate vaccine is capable of inducing an IgG response in patients with recurrent infections who had failed to mount an adequate response to the polysaccharide vaccine. Conjugate vaccines may be of value in the management of children with recurrent pneumococcal respiratory infections.
authors.affiliation: Department of Pediatrics, Louisiana State University Medical Center, New Orleans 70112-2822, USA. rsorensen@mail.peds.lsumc.edu
authors.forename: R U
authors.initials: RU
authors.lastname: Sorensen
authors.forename: L E
authors.initials: LE
authors.lastname: Leiva
authors.forename: P A
authors.initials: PA
authors.lastname: Giangrosso
authors.forename: B
authors.initials: B
authors.lastname: Butler
authors.forename: F C
authors.initials: FC
authors.lastname: Javier
authors.forename: D M
authors.initials: DM
authors.lastname: Sacerdote
authors.forename: N
authors.initials: N
authors.lastname: Bradford
authors.forename: C
authors.initials: C
authors.lastname: Moore
mesh_terms: D000293:Adolescent; D000907:Antibodies, Bacterial / Q000097:blood*; D001428:Bacterial Vaccines / Q000008:administration & dosage / Q000276:immunology*; D002648:Child; D002675:Child, Preschool; D004797:Enzyme-Linked Immunosorbent Assay; D006801:Humans; D007115:Immunization Schedule; D007074:Immunoglobulin G / Q000097:blood; D011008:Pneumococcal Infections / Q000517:prevention & control* / Q000628:therapy; D011135:Polysaccharides, Bacterial / Q000276:immunology; D012008:Recurrence; D012141:Respiratory Tract Infections / Q000517:prevention & control* / Q000628:therapy; D013296:Streptococcus pneumoniae / Q000276:immunology*; D018074:Vaccines, Conjugate / Q000008:administration & dosage / Q000276:immunology*
chemical_list: D000907:Antibodies, Bacterial; D001428:Bacterial Vaccines; D007074:Immunoglobulin G; D011135:Polysaccharides, Bacterial; D018074:Vaccines, Conjugate