title: Clinical and Serologic Response to the 23-valent Polysaccharide Pneumococcal Vaccine in Children and Teens with Recurrent Upper Respiratory Tract Infections and Selective Antibody Deficiency.
abstract: We report the clinical and serological response of 72 children and adolescents after immunization with the 23-valent polysaccharide pneumococcal vaccine (PPV23). All had been diagnosed with recurrent upper respiratory tract infections and low antipneumococcal immunity. Forty-five (62%) of these patients had received PCV7, the 7-serotype pneumococcal conjugated vaccine (Prevnar7). After immunization with the polysaccharide vaccine, 69 (96%) patients, including 42 of the 45 who had previously been immunized with the conjugate vaccine, had a positive clinical response including 12 patients (17%) whose serological response to the polysaccharide vaccine was inadequate. Clinical and serological response to PPV23 was assessed at approximately 1, 3 and 6 months after immunization. Our study also confirmed that a small group of patients with recurrent upper respiratory tract infections are unable to develop a normal response to pneumococcal and other bacterial polysaccharides despite vaccination with the newer conjugated vaccines. This immunodeficiency has been named selective antibody deficiency with normal immunoglobulins or impaired polysaccharide responsiveness. These patients did well after administration of intravenous IgG.
authors.affiliation: From the *Pediatric Specialists of Texas, Methodist Healthcare System, San Antonio, Texas; †Internal Medicine Training Program, RAHC-University of Texas Health Science Center at San Antonio, Harlingen, Texas; ‡Pediatric Hematology and Oncology Fellowship Program, University of Texas Southwestern Medical Center, Dallas, Texas; ‡Division of Infectious Diseases, Department of Medicine, University of Texas Health Sciences Center at San Antonio, San Antonio, Texas; and ¶Department of Pediatrics, University of Texas Health Sciences Center at San Antonio, San Antonio, Texas.
authors.forename: Jaime
authors.initials: J
authors.lastname: Estrada
authors.forename: Maria
authors.initials: M
authors.lastname: Najera
authors.forename: Natalie
authors.initials: N
authors.lastname: Pounds
authors.forename: Gabriel
authors.initials: G
authors.lastname: Catano
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Infante
mesh_terms: D000293:Adolescent; D000328:Adult; D000907:Antibodies, Bacterial / Q000097:blood*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007153:Immunologic Deficiency Syndromes / Q000150:complications* / Q000276:immunology*; D008297:Male; D011008:Pneumococcal Infections / Q000517:prevention & control*; D022242:Pneumococcal Vaccines / Q000008:administration & dosage / Q000276:immunology*; D012008:Recurrence; D012141:Respiratory Tract Infections / Q000453:epidemiology*; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: C414006:23-valent pneumococcal capsular polysaccharide vaccine; D000907:Antibodies, Bacterial; D022242:Pneumococcal Vaccines