The clinical relevance of IgM and IgA anti-pneumococcal polysaccharide ELISA assays in patients with suspected antibody deficiency

Janssen, Lisanne M. A.; Heron, Michiel; Murk, Jean-Luc; Leenders, Alexander C. A. P.; Rijkers, Ger T.; Vries, Esther de

doi:10.1111/cei.13605

Cited by 5 publications

(4 citation statements)

References 29 publications

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“…In addition, 6 months after the first vaccination with PCV13, there was already a significant difference in the total IgA concentrations ( P < 0.05). Even if the relevance of an IgA vaccination response after pneumococcal immunization still requires further research, it can be assumed that IgA as the predominant immunoglobulin isotype in the upper and lower respiratory tract with other effector mechanisms than IgG has a considerable protective effect ( 28 ). In saliva, however, mainly polymeric, stabilized secretory IgA is found ( 29 ).…”

Section: Discussionmentioning

confidence: 99%

Antibody responses after sequential vaccination with PCV13 and PPSV23 in patients with moderate to severe plaque psoriasis under immunosuppressive therapy

Helmer,

van de Sand,

Wojtakowski

et al. 2024

mBio

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A crucial step in lowering the risk of invasive pneumococcal illness in high-risk populations, such as individuals with plaque psoriasis, is pneumococcal vaccination. The serologic response to the sequential vaccination with Prevenar 13 (PCV13) and Pneumovax 23 (PPSV23) in psoriasis patients under immunosuppressive therapy is still poorly characterized despite national recommendations suggesting vaccination for immunocompromised patients. In this prospective study, we investigated the serological response in 57 patients under active systemic treatment for moderate to severe plaque psoriasis who underwent sequential vaccination with PCV13 followed by PPSV23. Our analysis focused on global and serotype-specific anti-pneumococcal antibody responses over a 7-month period post-vaccination. Our findings reveal a robust serological response in patients with plaque psoriasis under systemic therapy. When comparing our results with a cohort of kidney transplant recipients who completed a similar sequential vaccination protocol, psoriasis patients showed higher antibody concentrations. In psoriasis patients, the mean levels of all global antibody classes tested (IgG, IgG2, IgA, IgM) increased more than 4-fold ( P < 0.0001) and serotype-specific antibodies more than 1.9-fold ( P < 0.01). In addition to providing strong evidence of the safety and effectiveness of sequential pneumococcal vaccination in individuals with plaque psoriasis, our work sheds light on the complex interactions that exist between immunosuppressive treatment, vaccination schedule, and antibody responses in various risk groups. IMPORTANCE To protect against severe courses of infection with Streptococcus pneumoniae , the national guidelines recommend sequential vaccination for these patients. However, there are only studies on the efficacy of a single administration of these vaccines in this particular risk group. The immunological responses to the vaccine were correlated with clinical patient data. In summary, our study shows for the first time that sequential vaccination is immunogenic in patients with moderate to severe plaque psoriasis.

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Section: Discussionmentioning

confidence: 99%

Antibody responses after sequential vaccination with PCV13 and PPSV23 in patients with moderate to severe plaque psoriasis under immunosuppressive therapy

Helmer,

van de Sand,

Wojtakowski

et al. 2024

mBio

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“…Decreased anti-pneumococcal IgA and IgM levels have been observed in healthy adult blood donors [18], but have also been associated with a pronounced rate of respiratory infections in patients with CVID [34] and primary antibody deficiency (PAD) [35]. It is also known that individuals characterized as having an intact humoral response based on measurement of serotype-specific IgG concentration can still display impaired anti-pneumococcal IgM and IgA levels [36]. Thus, an additional determination of anti-pneumococcal IgM and IgA concentrations could yield more precise information on the humoral response to pneumococcal vaccines in individuals, but the clinical benefit is questionable [36].…”

Section: Discussionmentioning

confidence: 99%

“…It is also known that individuals characterized as having an intact humoral response based on measurement of serotype-specific IgG concentration can still display impaired anti-pneumococcal IgM and IgA levels [36]. Thus, an additional determination of anti-pneumococcal IgM and IgA concentrations could yield more precise information on the humoral response to pneumococcal vaccines in individuals, but the clinical benefit is questionable [36].…”

Section: Discussionmentioning

confidence: 99%

Antibody responses after sequential vaccination with PCV13 and PPSV23 in kidney transplant recipients

et al. 2023

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Purpose Vaccination against Streptococcus pneumoniae is recommended in transplant recipients to reduce the morbidity and mortality from invasive pneumococcal disease. Previous studies indicate that transplant recipients can produce specific antibodies after vaccination with the 13-valent pneumococcal conjugate vaccine Prevenar 13 (PCV13) or the pneumococcal polysaccharide vaccine Pneumovax 23 (PPSV23). National guidelines recommend sequential vaccination with PCV13 followed by PPSV23 in kidney transplant patients. However, there are currently no data on the serological response in kidney transplant recipients, who received a sequential vaccination with PCV13 and PPSV23. Methods In the current study, we sequentially vaccinated 46 kidney transplant recipients with PCV13 and PPSV23 and determined global and serotype-specific anti-pneumococcal antibody responses in the year following vaccination. Results Serotype-specific and global anti-pneumococcal antibody concentrations were significantly higher compared to baseline. We observed that serotype-specific antibody responses varied by serotype (between 2.2- and 2.9-fold increase after 12 months). The strongest responses after 12 months were detected against the serotypes 9N (2.9-fold increase) and 14 (2.8-fold increase). Global antibody responses also varied with respect to immunoglobulin class. IgG2 revealed the highest increase (2.7-fold), IgM the lowest (1.7-fold). Sequential vaccination with both vaccines achieved higher antibody levels in comparison with a historical cohort studied at our institute, that was vaccinated with PCV13 alone. During the 12-months follow-up period, none of the patients developed pneumococcal-associated pneumonia or vaccination-related allograft rejection. Conclusion In conclusion, we strongly recommend sequential vaccination over single immunization in kidney transplant recipients.

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“…An impaired IgG response to polysaccharide antigens can be diagnosed if wild-type infections with S. pneumoniae or vaccination with a pure polysaccharide vaccine (e.g., Pneumovax ™ ) do not result in a significant increase of pneumococcal-specific IgG antibodies ( 11 – 13 ). Commercially available tests to assess IgM and IgA pneumococcal polysaccharide specific antibodies before and after pneumococcal polysaccharide based vaccinations are not routinely used but may be helpful in testing patients with IEI under IgG replacement therapy ( 14 – 16 ).…”

Section: Introductionmentioning

confidence: 99%

Monogenic Inborn Errors of Immunity with impaired IgG response to polysaccharide antigens but normal IgG levels and normal IgG response to protein antigens

Fasshauer,

Dinges,

Staudacher

et al. 2024

Front. Pediatr.

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In patients with severe and recurrent infections, minimal diagnostic workup to test for Inborn Errors of Immunity (IEI) includes a full blood count, IgG, IgA and IgM. Vaccine antibodies against tetanus toxoid are also frequently measured, whereas testing for anti-polysaccharide IgG antibodies and IgG subclasses is not routinely performed by primary care physicians. This basic approach may cause a significant delay in diagnosing monogenic IEI that can present with an impaired IgG response to polysaccharide antigens with or without IgG subclass deficiency at an early stage. Our article reviews genetically defined IEI, that may initially present with an impaired IgG response to polysaccharide antigens, but normal or only slightly decreased IgG levels and normal responses to protein or conjugate vaccine antigens. We summarize clinical, genetic, and immunological findings characteristic for these IEI. This review may help clinicians to identify patients that require extended immunologic and genetic evaluations despite unremarkable basic immunologic findings. We recommend the inclusion of anti-polysaccharide IgG antibodies as part of the initial routine work-up for possible IEI.

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The clinical relevance of IgM and IgA anti-pneumococcal polysaccharide ELISA assays in patients with suspected antibody deficiency

Abstract: This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

Cited by 5 publications

References 29 publications

Antibody responses after sequential vaccination with PCV13 and PPSV23 in patients with moderate to severe plaque psoriasis under immunosuppressive therapy

Antibody responses after sequential vaccination with PCV13 and PPSV23 in patients with moderate to severe plaque psoriasis under immunosuppressive therapy

Antibody responses after sequential vaccination with PCV13 and PPSV23 in kidney transplant recipients

Monogenic Inborn Errors of Immunity with impaired IgG response to polysaccharide antigens but normal IgG levels and normal IgG response to protein antigens

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