Seven-valent pneumococcal conjugate vaccine in pediatric solid organ transplant recipients: a prospective study of safety and immunogenicity.
OBJECTIVE
To determine the safety and immunogenicity of the conjugate pneumococcal vaccine (PCV7) in pediatric solid organ transplant recipients.


METHODS
Pediatric solid organ transplant recipients were prospectively enrolled at > or =4 months following transplantation. Eligible pneumococcal vaccine-naive subjects received 3 doses of PCV7 at 8 week intervals, followed 8 weeks later by a dose of the 23-valent vaccine (PV23). Serology was done at baseline, 8 weeks following doses 2 and 3 of PCV7 and 8-12 weeks after PV23. Repeated measures analyses were done using SAS 9.


RESULTS
Eighty-one recipients commenced immunization at a median age of 7.8 (0.6-17.5) years and a median time from transplantation to immunization of 1.3 (0.3-6.0) years. There were 31 heart, 18 liver, 5 lung, and 27 kidney recipients. Reported adverse events following vaccine doses included local reactions (PCV7: PV23 = 19%:16%) and fever (PCV7: PV23 = 3.8%:4.9%) and there were no serious reactions. Two doses of PCV7 induced > or =2 fold increases in geometric mean concentrations (GMCs) in all organ groups. Cardiac and lung recipients demonstrated additional benefit from a third dose of PCV7. The cardiac recipients showed most benefit from boosting with PV23 with significant increases in GMC's (P < or = 0.008). The time of initiation of the vaccine strategy posttransplantation predicted seroprotection.


CONCLUSIONS
PCV7 was safe and immunogenic in solid organ recipients. Three doses of this vaccine appear beneficial for selected organ groups. PV23 when administered at >/=1 year posttransplantation was useful in boosting antibody responses in patient groups demonstrating lower rates of responsiveness.
Barton
Michelle
M
Division of Infectious Diseases, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario.
Wasfy
Samia
S
Dipchand
Anne I
AI
Hébert
Diane
D
Ng
Vicky
V
Solomon
Melinda
M
Fecteau
Anne
A
Stephen
Derek
D
Allen
Upton
U
D000293:Adolescent; D000704:Analysis of Variance; D002648:Child; D002675:Child, Preschool; D005260:Female; D000069443:Heptavalent Pneumococcal Conjugate Vaccine; D006801:Humans; D007223:Infant; D008297:Male; D016377:Organ Transplantation; D022242:Pneumococcal Vaccines / Q000008:administration & dosage / Q000009:adverse effects* / Q000276:immunology*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D014181:Transplantation Immunology
C414006:23-valent pneumococcal capsular polysaccharide vaccine; D000069443:Heptavalent Pneumococcal Conjugate Vaccine; D022242:Pneumococcal Vaccines