Pneumococcal vaccination is recommended as a quality indicator for management of children with systemic lupus erythematosus. Literature on the immunogenicity of pneumococcal vaccines (PCVs) in children is scant. We sought to prospectively evaluate via an observational study, the immunogenicity to sequential children with lupus. Out of a cohort of 26 patients, approximately 65% achieved > 70% vaccinated serotype antibody levels of > 1.3 mcg/dL following PCV13, and of 22 patients followed through PPSV23 vaccination, 59% achieved the same. Patients with rituximab exposure in the 6 months prior to a vaccination were more likely to not achieve protective serotype levels (p < 0.01 for PCV13, trend p = 0.07 for PPSV23). Three of 22 patients with no apparent risk factors did not achieve protective serotype levels. Non-responders to PCV13 generally did not respond to PPSV23. Retrospective healthy controls achieved 100% protective levels in response to PPSV23 vaccination, with 95% of serotypes being > 1.3 mcg/dL. Thus, sequential 13- and 23-valent pneumococcal vaccines achieve protective status for approximately two thirds of pediatric lupus patients in our population. Lack of response to vaccine may be secondary to induced or inherent functional impairments in the patient.
A 16-year old boy with chronic granulomatous disease (CGD) developed Psychrobacter immobilis septicemia during a course of fulminant hepatic failure. The patient died despite aggressive management with antimicrobials and corticosteroids. While Psychrobacter immobilis rarely affects humans, it should be considered an organism that can cause sepsis in patients with CGD.
BackgroundThe U.S.A. Accreditation Council for Graduate Medical Education (ACGME) requires that graduate medical education programs in A/I prepare specialists to provide expert medical care for patients with A/I disorders. The A/I intensive education course (boot camp) program was implemented at the University of South Florida (USF) to facilitate fellows' education of common clinical and diagnostic procedures conducted in the specialty. Educational methods included PowerPoint presentations and demonstration of clinical and diagnostic procedures by faculty and senior fellows and hands-on participation by the fellows-in-training. The topics covered included: anaphylaxis, spirometry, exhaled nitric oxide determination, routine and special skin testing, prescribing and administering immunotherapy, asthma education and inhaler technique, management of atopic dermatitis, food challenge, patch testing, antibiotic desensitization and challenge, principles of treatment with intravenous and subcutaneous gammaglobulin, and special immunology testing.MethodsSix A/I fellows (four 1st and two 2nd year) participated in the boot camp on July 22, 2011. All completed a 49-item multiple-choice pre-test followed by the boot camp, after which same questions were administered as post-test. Scores were compared by paired t test.ResultsSix participants completed the study. The average number of correct answers increased from 26.3/49 to 39.0/49 with pre- and post-test mean scores of 53.8% and 79.6%, respectively (P = 0.009). There was a significant difference between 1st and 2nd year fellows in test results when comparing pre- and post-test scores (P ≤ 0.05).ConclusionsAn educational boot camp approach integrating theory and practice about A/I clinical and diagnostic procedures significantly increased the competency of A/I fellows at the beginning of their first and second year of training.
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