Immunogenity of the pneumococcal polysaccharide vaccine in COPD patients. The effect of systemic steroids.
BACKGROUND
To investigate if systemic steroids influence the antibody response to the 23-valent pneumococcal polysaccaride vaccine (23-PPV) in COPD patients.


METHODS
COPD patients on: (a) > or =10mg of prednisolone/day (SS, n = 30); (b) inhalative steroids (IS, n= 30); (c) controls without COPD (CG, n= 29) were vaccinated with 23-PPV. The concentration (microg/ml) of capsular specific anti-pneumococcal IgG antibodies (AB) for the serotypes (PNC) 4,6B,9V,14,18C,19F,23F were measured by Elisa technique before, 3 and 12 months (m) after vaccination. Non-responders were defined when AB-concentrations did neither doubled nor reach > or = 1 microg/ml.


RESULTS
N=24 (CG), n=29 (IS), n= 18 (SS) patients completed the study (mean age 64yrs.). Serious adverse events were not observed. Geometric mean (GM) AB-concentration of all serotypes increased significantly (CG, IS, SS) 3 and 12m after vaccination (P<0.05). The percentage of non-responders ranged between 16% (PNC 19F, IS) and 65% (PNC 4, SS) after 3 m and 21% (PNC 19F, IS) and 82% (PNC 4, CG) after 12m. Neither post-vaccine AB-concentrations (3 and 12m) nor the rate of non-responders differed significantly between patients on systemic steroids and the other groups (IS, CG).


CONCLUSIONS
Systemic steroids did not influence the AB-response. In all groups mean AB-concentration increased significantly after vaccination but an important percentage of subjects of all three groups were non-responders.
de Roux
A
A
Department of Chest and Infectious Diseases, City Hospital Heckeshorn, Free University Berlin, Germany.
Schmidt
N
N
Rose
M
M
Zielen
S
S
Pletz
M
M
Lode
H
H
D000368:Aged; D000369:Aged, 80 and over; D000907:Antibodies, Bacterial / Q000096:biosynthesis*; D005260:Female; D005938:Glucocorticoids / Q000494:pharmacology* / Q000627:therapeutic use; D006801:Humans; D007108:Immune Tolerance / Q000187:drug effects; D007074:Immunoglobulin G / Q000096:biosynthesis; D008297:Male; D008875:Middle Aged; D022242:Pneumococcal Vaccines / Q000276:immunology*; D011135:Polysaccharides, Bacterial / Q000276:immunology; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy / Q000276:immunology*; D012703:Serotyping; D013296:Streptococcus pneumoniae / Q000145:classification / Q000276:immunology; D014611:Vaccination
D000907:Antibodies, Bacterial; D005938:Glucocorticoids; D007074:Immunoglobulin G; D022242:Pneumococcal Vaccines; D011135:Polysaccharides, Bacterial