title: Administration of protein-conjugate pneumococcal vaccine to patients who have invasive disease after splenectomy despite their having received 23-valent pneumococcal polysaccharide vaccine.
abstract: Patients who undergo splenectomy are at greatly increased risk for overwhelming pneumococcal bacteremia and death. Twenty-three-valent pneumococcal polysaccharide vaccine (PPV-23), which contains capsular polysaccharides (PSs) from 23 common serotypes of Streptococcus pneumoniae, is strongly recommended for such patients. The capacity to respond to PPV-23 by producing immunoglobulin (Ig) G is genetically regulated. Some proportion of adults do not respond and, despite postsplenectomy administration of PPV-23, may remain susceptible to recurrent pneumococcal sepsis. Here, we describe 2 patients who had recurring pneumococcal bacteremia after undergoing splenectomy despite having received numerous doses of PPV-23. Heptavalent protein-conjugate pneumococcal vaccine (PCPV-7) was then administered, and it induced high levels of IgG to all 7 PSs; in one of the patients, functional activity against 5 of the 7 PSs was demonstrable, both in vitro and in vivo. Recurrent pneumococcal bacteremia in patients who have undergone splenectomy may indicate a genetically regulated failure to respond to PPV-23; PCPV-7 may stimulate production of IgG to PSs in such patients.
authors.affiliation: Infectious Disease Section, Michael E. DeBakey Veterans Affairs Medical Center, and Department of Medicine, Baylor College of Medicine, Houston, Texas 77030, USA. daniel.musher@med.va.gov
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Musher
authors.forename: Heather
authors.initials: H
authors.lastname: Ceasar
authors.forename: Erna M
authors.initials: EM
authors.lastname: Kojic
authors.forename: Benjamin L
authors.initials: BL
authors.lastname: Musher
authors.forename: Joseph C
authors.initials: JC
authors.lastname: Gathe
authors.forename: Sandra
authors.initials: S
authors.lastname: Romero-Steiner
authors.forename: A Clinton
authors.initials: AC
authors.lastname: White
mesh_terms: D000328:Adult; D000907:Antibodies, Bacterial / Q000097:blood*; D016470:Bacteremia / Q000276:immunology / Q000628:therapy; D000069443:Heptavalent Pneumococcal Conjugate Vaccine; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D008297:Male; D022401:Meningococcal Vaccines / Q000008:administration & dosage* / Q000276:immunology; D008875:Middle Aged; D011008:Pneumococcal Infections / Q000276:immunology* / Q000628:therapy; D022242:Pneumococcal Vaccines / Q000008:administration & dosage* / Q000276:immunology; D011183:Postoperative Complications; D013156:Splenectomy; D013296:Streptococcus pneumoniae / Q000276:immunology*
chemical_list: C414006:23-valent pneumococcal capsular polysaccharide vaccine; D000907:Antibodies, Bacterial; D000069443:Heptavalent Pneumococcal Conjugate Vaccine; D007074:Immunoglobulin G; D022401:Meningococcal Vaccines; D022242:Pneumococcal Vaccines