title: Nonprotective responses to pediatric vaccines occur in children who are otitis prone.
abstract: OBJECTIVE
  We recently found that children who experience recurrent otitis media despite individualized care (stringently-defined otitis prone [sOP]) do not develop an antibody response to several vaccine candidate protein antigens expressed by Streptococcus pneumonia (Spn) and Haemophilus influenzae. Here we sought to determine if these same children also failed to develop antibody to routine pediatric vaccinations.
  
  
  METHODS
  One hundred forty sera collected from children age 6-24 months were analyzed. sOP (n=34) and age-matched non-sOP (n=34) children were assessed for IgG concentrations to diphtheria toxoid, tetanus toxoid, pertussis toxoid, filamentous hemagglutinin, pertactin (DTaP), polio, hepatitis B, H. influenzae type b capsule polyribosyl-ribitol-phosphate (PRP) and Spn capsular polysaccharide conjugate vaccine.
  
  
  RESULTS
  IgG protective titers to diphtheria toxoid (P=0.006), tetanus toxoid (P<0.0001), pertussis toxoid (P<0.0001), filamentous hemagglutinin (P=0.001), pertactin (P=0.005), hepatitis B (P<0.0001), polio 3 (P=0.03) and Spn 23F (P=0.01) but not polio 1,2, PRP or Spn 6B, and 14 were decreased in sOP versus non-sOP children using generalized estimating equations. A high percentage of sOP children had nonprotective antibody values that persisted until 24 months of age despite routine boosters.
  
  
  CONCLUSIONS
  sOP children may fail to achieve protective antibody concentrations after several routine vaccinations.
authors.affiliation: From the *Center for Infectious Disease and Immunology, Research Institute, Rochester General Hospital; †Legacy Pediatrics; and ‡Department of Biostatistics and Computational Biology, University of Rochester, Rochester, NY.
authors.forename: Michael E
authors.initials: ME
authors.lastname: Pichichero
authors.forename: Janet R
authors.initials: JR
authors.lastname: Casey
authors.forename: Anthony
authors.initials: A
authors.lastname: Almudevar
mesh_terms: D000907:Antibodies, Bacterial / Q000097:blood / Q000276:immunology; D000914:Antibodies, Viral / Q000097:blood / Q000276:immunology; D016009:Chi-Square Distribution; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007117:Immunization, Secondary; D007074:Immunoglobulin G / Q000097:blood / Q000276:immunology; D007223:Infant; D008297:Male; D010033:Otitis Media / Q000097:blood / Q000276:immunology*; D014611:Vaccination; D014612:Vaccines / Q000008:administration & dosage / Q000276:immunology*
chemical_list: D000907:Antibodies, Bacterial; D000914:Antibodies, Viral; D007074:Immunoglobulin G; D014612:Vaccines