Assessment of humoral immunity to poliomyelitis, tetanus, hepatitis B, measles, rubella, and mumps in children after chemotherapy.
BACKGROUND
To evaluate the effect of chemotherapy on humoral immunity to vaccine-preventable disease, the authors investigated the persistence of protective antibody titers in a group of patients who were alive and well after they were treated for pediatric malignancies.


METHODS
Serum antibody levels were evaluated for polio, tetanus, hepatitis B, rubella, mumps, and measles in 192 children. The terms lack of immunity and loss of immunity, respectively, were used to describe the absence of immunity in patients who were tested only after chemotherapy and in patients who were tested both before and after chemotherapy and determined to have immunity before chemotherapy.


RESULTS
Overall, the absence of a protective serum antibody titer for hepatitis B, measles, mumps, rubella, tetanus, and polio was detected in 46%, 25%, 26%, 24%, 14%, and 7% of patients, respectively. On univariate analysis, loss of antibodies against rubella, mumps, and tetanus was associated significantly with younger age (P < 0.001, P = 0.02, and P = 0.001, respectively), and loss of antibodies against measles was significantly associated with younger age and female gender (P = 0.0003 and P = 0.008, respectively). The administration of 59 booster vaccinations to 51 patients who had lost > or = 1 protective antibody titer resulted in an overall response rate of 93%.


CONCLUSIONS
Chemotherapy induced different rates of loss of protective antibody titers depending on the type of vaccination administered. This finding may be responsible for the failure of vaccination programs for patients who have undergone chemotherapy. The administration of a booster dose after the completion of chemotherapy is a simple and cost-effective way to restore humoral immunity against most vaccine-preventable diseases.
Department of Pediatrics, Faculty of Medicine and Surgery, University of Padua, Padua, Italy.
Matteo
M
Zignol
Marta
M
Peracchi
Gloria
G
Tridello
Marta
M
Pillon
Federica
F
Fregonese
Ruggiero
R
D'Elia
Luigi
L
Zanesco
Simone
S
Cesaro
D000917:Antibody Formation / Q000502:physiology; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D016001:Confidence Intervals; D005260:Female; D005500:Follow-Up Studies; D006509:Hepatitis B / Q000276:immunology / Q000517:prevention & control; D017325:Hepatitis B Vaccines / Q000008:administration & dosage / Q000276:immunology*; D006801:Humans; D007117:Immunization, Secondary; D016867:Immunocompromised Host; D008297:Male; D008457:Measles / Q000276:immunology / Q000517:prevention & control; D022542:Measles-Mumps-Rubella Vaccine / Q000008:administration & dosage / Q000276:immunology*; D009107:Mumps / Q000276:immunology / Q000517:prevention & control; D009369:Neoplasms / Q000188:drug therapy / Q000276:immunology*; D011051:Poliomyelitis / Q000276:immunology / Q000517:prevention & control; D011055:Poliovirus Vaccine, Oral / Q000008:administration & dosage / Q000276:immunology*; D011336:Probability; D012409:Rubella / Q000276:immunology / Q000517:prevention & control; D013742:Tetanus / Q000276:immunology / Q000517:prevention & control; D013745:Tetanus Toxoid / Q000008:administration & dosage / Q000276:immunology*; D014611:Vaccination / Q000379:methods
D017325:Hepatitis B Vaccines; D022542:Measles-Mumps-Rubella Vaccine; D011055:Poliovirus Vaccine, Oral; D013745:Tetanus Toxoid