title: Lower response to early T-cell-dependent vaccination after neurotrauma or neurosurgery in adults.
abstract: BACKGROUND
  Recent international guidelines recommend vaccination with a 13-valent pneumococcal conjugate vaccine to reduce the risk of meningitis after neurotrauma with cerebrospinal fluid leak. The antibody response and optimal time point for vaccination have not been established and because the risk of meningitis is at the highest shortly after trauma, early vaccination is preferable. This study aimed to investigate the antibody response and to ensure that central nervous system injury-induced immunodepression did not affect the response to a T-cell-dependent conjugate vaccine when administered shortly after the injury.
  
  
  METHODS
  So as not to interfere with routine pneumococcal vaccination, a conjugate vaccine against Haemophilus influenza type b (Hib) was chosen for the study. Thirty-three patients with basilar skull fracture and 23 patients undergoing transsphenoidal pituitary gland surgery were vaccinated within 10 days after trauma/surgery and 29 control patients at least three weeks after trauma/surgery. Sera were collected pre- and post-vaccination for analysis of anti-Hib concentration.
  
  
  RESULTS
  Four patients with post-vaccination target antibody concentration before vaccination were excluded from analysis. In the neurotrauma and neurosurgery groups 10/32 (31%) and 5/20 (25%) patients, respectively, were non-responders compared with 3/29 (10%) in the control group. Log10 anti-Hib concentrations in the neurotrauma, neurosurgery and control groups were 1.52 ± 0.15, 1.38 ± 0.15 and 1.81 ± 0.12 μg/ml, respectively.
  
  
  CONCLUSIONS
  The majority of the patients responded to vaccination. However, the number of responders was significantly decreased and antibody concentration significantly lower in patients vaccinated early after the trauma/surgery. Investigation of the pneumococcal conjugate vaccine response in neurotrauma patients is therefore urgent.
authors.affiliation: Dept of Medical Sciences, Section of Infectious Diseases, Uppsala University, Sweden. Electronic address: anna.ljunghill_hedberg@medsci.uu.se.
authors.forename: Anna Ljunghill
authors.initials: AL
authors.lastname: Hedberg
authors.affiliation: Dept of Medical Sciences, Section of Infectious Diseases, Uppsala University, Sweden.
authors.forename: Karlis
authors.initials: K
authors.lastname: Pauksens
authors.affiliation: Dept of Neuroscience, Section of Neurosurgery, Uppsala University, Sweden.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Ronne-Engström
authors.affiliation: Dept of Medical Sciences, Section of Infectious Diseases, Uppsala University, Sweden.
authors.forename: Maria
authors.initials: M
authors.lastname: Lundberg
authors.affiliation: Dept of Neuroscience, Section of Rehabilitation Medicine, Uppsala University, Sweden.
authors.forename: Björn
authors.initials: B
authors.lastname: Johansson
authors.affiliation: National Institute for Health and Welfare, Helsinki, Finland.
authors.forename: Helena
authors.initials: H
authors.lastname: Käyhty
authors.affiliation: Dept of Medical Sciences, Section of Infectious Diseases, Uppsala University, Sweden.
authors.forename: Jan
authors.initials: J
authors.lastname: Sjölin
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000907:Antibodies, Bacterial / Q000097:blood* / Q000276:immunology; D005260:Female; D018073:Haemophilus Vaccines / Q000008:administration & dosage* / Q000276:immunology; D019741:Haemophilus influenzae type b / Q000276:immunology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009493:Neurosurgery; D022242:Pneumococcal Vaccines / Q000008:administration & dosage*; D013601:T-Lymphocytes / Q000276:immunology; D014611:Vaccination; D018074:Vaccines, Conjugate / Q000008:administration & dosage / Q000276:immunology; D055815:Young Adult
chemical_list: C538862:13-valent pneumococcal vaccine; D000907:Antibodies, Bacterial; D018073:Haemophilus Vaccines; D022242:Pneumococcal Vaccines; D018074:Vaccines, Conjugate
keywords: Conjugate vaccine; Meningitis; Neurotrauma