title: Specific antibody response against the 23-valent pneumococcal vaccine in patients with alpha(1)-antitrypsin deficiency with and without bronchiectasis.
abstract: OBJECTIVE
  To assess the specific antibody response against polyvalent pneumococcal vaccine in patients with alpha(1)-antitrypsin deficiency (AATD) and respiratory infections.
  
  
  METHODS
  We investigated specific IgG, IgG1, and IgG2 antibody responses against the 23-valent antipneumococcal vaccine in 18 patients with AATD phenotype PiZZ, 9 of whom had bronchiectasis and 4 a history of recurrent pneumonia, and compared them with a control group of 40 healthy volunteers.
  
  
  METHODS
  Blood samples were drawn just prior to and 3 weeks after immunization.
  
  
  RESULTS
  Quantification of specific IgG and its subclasses was performed by an enzyme-linked immunosorbent assay. For patients with AATD, mean increases in specific antipneumococcal titers were 4.7-fold (25 to 75% quartiles, 2.5- to 6.8-fold) for total IgG, 3.2-fold (1.2- to 4.9-fold) for IgG1, and 2.1-fold (1.8- to 3.7-fold) for IgG2. For the control group, the values were 3.3-fold (1.8- to 5.8-fold) for total IgG, 2. 5-fold (1.9- to 3.4-fold) for IgG1, and 3.1-fold (1.9- to 4.5-fold) for IgG2; differences were not significant. Patients with bronchiectasis showed a tendency toward higher levels of IgG subclasses than both control subjects and patients without bronchiectasis; however, there was a tendency toward lower postvaccination serum levels of specific antipneumococcal IgG, IgG1, and IgG2 in patients with bronchiectasis compared with patients without bronchiectasis, but this trend did not reach statistical significance. Three of the four patients with recurrent pneumonia did not show an appropriate IgG2 response.
  
  
  CONCLUSIONS
  These results suggest that, as a group, patients with AATD have a preserved antibody response against pneumococcal polysaccharides. Patients with bronchiectasis show a tendency toward a decreased antibody response, even with increased serum levels of most Ig types. Individuals with an impaired IgG2 response seem to be at increased risk of recurrent pneumonia. Considering the pernicious effect of pulmonary infections on these patients and the preserved antibody response in a majority of them, pneumococcal vaccination should be recommended to patients with AATD.
authors.affiliation: Department of Pneumology, Hospital General Vall d'Hebron, Barcelona, Spain. marcm@hg.vhebron.es
authors.forename: M
authors.initials: M
authors.lastname: Miravitlles
authors.forename: J
authors.initials: J
authors.lastname: de Gracia
authors.forename: M J
authors.initials: MJ
authors.lastname: Rodrigo
authors.forename: M J
authors.initials: MJ
authors.lastname: Cruz
authors.forename: M
authors.initials: M
authors.lastname: Vendrell
authors.forename: R
authors.initials: R
authors.lastname: Vidal
authors.forename: F
authors.initials: F
authors.lastname: Morell
mesh_terms: D000328:Adult; D000917:Antibody Formation / Q000276:immunology*; D000918:Antibody Specificity / Q000276:immunology*; D001428:Bacterial Vaccines / Q000008:administration & dosage / Q000276:immunology*; D001987:Bronchiectasis / Q000175:diagnosis / Q000276:immunology*; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D008297:Male; D008875:Middle Aged; D022242:Pneumococcal Vaccines; D011018:Pneumonia, Pneumococcal / Q000175:diagnosis / Q000276:immunology / Q000517:prevention & control; D012008:Recurrence; D012307:Risk Factors; D019896:alpha 1-Antitrypsin Deficiency / Q000175:diagnosis / Q000276:immunology*
chemical_list: D001428:Bacterial Vaccines; D007074:Immunoglobulin G; D022242:Pneumococcal Vaccines