title: Immune response to pneumococcal conjugate vaccination in asplenic individuals.
abstract: Asplenic individuals are at increased risk of infection with Streptococcus pneumoniae. The immune response to pneumococcal conjugate vaccine has not been investigated in this clinical risk group. We investigated immune responses to pneumococcal vaccination in asplenic individuals. Eligible subjects aged > or =4 years received one dose 7-valent pneumococcal conjugate vaccine (PCV7) and, if no prior 23-valent polysaccharide vaccine (PPV23) had been received within previous 5 years, one dose was given 6 months following PCV7. Pre- and post-vaccination blood samples were taken. Pneumococcal serotype-specific IgG levels were determined for 9 serotypes; the 7 in PCV7 plus serotypes1 and by standardized ELISA. One hundred and eleven asplenic individuals were recruited [median age 54.8 years, (18.1-81.8)]. Median age at splenectomy was 29.6 years (3.6-78.3); 108 (97.3%) individuals had previously received PPV23. Compliance with UK recommendations on immunization and prophylaxis in this group was poor, 91 (82%) subjects had received Haemophilus influenzae type b conjugate vaccine and only 68 (62%) had received meningococcal serogroup C conjugate vaccine. In total 61 (55%) subjects were taking antibiotic prophylaxis and 12 subjects had reported previous invasive pneumococcal disease, five episodes of which occurred post-splenectomy. High serotype-specific IgG concentrations were observed pre-PCV7, with significant increases (p < 0.01) in geometric mean concentrations pre- to post-PCV7 for the PCV7 serotypes. Post-PCV7, between 27% (serotype 14) and 69% (serotype 23F) of subjects had a > or =2-fold rise in IgG. Pre-PCV7, the percentage of individuals with levels > or =0.35 microg/mL ranged between 77% (serotype 4) and 97% (serotypes 14, 19F), whilst post-PCV7 this was 90% (serotype 6B) and 99% (serotype 14). No significant increases were observed post-PPV23. Asplenic individuals responded well to PCV7, though protective levels were demonstrated pre-PCV7 in majority of participants due to prior PPV23. Although immunogenic, there is insufficient evidence here to recommend routine PCV7 immunization over PPV23 immunization in adult asplenic individuals.
authors.affiliation: Health Protection Agency North West, Manchester Laboratory, Manchester Medical Microbiology Partnership, Manchester Royal Infirmary, Manchester, UK. elaine.stanford@hpa.org.uk
authors.forename: Elaine
authors.initials: E
authors.lastname: Stanford
authors.forename: Fiona
authors.initials: F
authors.lastname: Print
authors.forename: Michelle
authors.initials: M
authors.lastname: Falconer
authors.forename: Kenneth
authors.initials: K
authors.lastname: Lamden
authors.forename: Samuel
authors.initials: S
authors.lastname: Ghebrehewet
authors.forename: Nick
authors.initials: N
authors.lastname: Phin
authors.forename: David
authors.initials: D
authors.lastname: Baxter
authors.forename: Matthew
authors.initials: M
authors.lastname: Helbert
authors.forename: Rosemary
authors.initials: R
authors.lastname: McCann
authors.forename: Nick
authors.initials: N
authors.lastname: Andrews
authors.forename: Paul
authors.initials: P
authors.lastname: Balmer
authors.forename: Ray
authors.initials: R
authors.lastname: Borrow
authors.forename: Edward
authors.initials: E
authors.lastname: Kaczmarski