Evaluation of antibody response to the heptavalent pneumococcal conjugate vaccine in pediatric chronic kidney disease

Abstract

Pneumococcal vaccination has been recommended for immunocompromised children, including patients with chronic kidney disease. We determined pneumococcal immunoglobulin (Ig)G antibodies to serotypes 4, 6B, 9V, 14, 18C, 19F, and 23F before and after 48 pediatric patients with chronic renal failure were administered heptavalent conjugated pneumococcal vaccine. The patients were between 1 and 9 years of age and were separated into a conservative treatment group (Group 1) and a dialysis group (Group 2). The antibody response to the vaccinal serotypes was evaluated by measuring antibody concentrations before the first dose and 60 days after the second one. Pre-vaccinal IgG concentrations > or = 0.35 microg/ml were detected for all serotypes in at least 50% of the patients in both groups. Patients from both groups showed a statistically indistinguishable behavior in terms of the medians of post-vaccination IgG levels. An "adequate" vaccine response was defined as a post-immunization level of specific pneumococcal serotype antibody > or = 0.35 microg/ml, based on the World Health Organization's (WHO) protective antibody concentration definition for pneumococcal conjugate vaccines, or on a fourfold increase over baseline for at least five of the seven antigens of the vaccine. An "adequate" vaccinal response was obtained in 100% of the patients of both groups using WHO's definition, or in 45.8% of Group 1 patients and 37.5% of Group 2 patients when the criterion was a fourfold antibody increase over baseline antibody concentrations.

Immunogenicity of 13-Valent Conjugate Pneumococcal Vaccine in Patients 50 Years and Older with End-Stage Renal Disease and on Dialysis

“…In children on dialysis, a trial with a 7-valent conjugate pneumococcal vaccine demonstrated antibody responses against at least one serotype in all patients at 60 days postvaccination (16). Only 9/24 (37.5%) children on dialysis achieved a 4-fold rise in the concentrations of antibodies to at least five of the seven serotypes over the concentrations at the baseline.…”

Immunogenicity and safety of the 13-valent Pneumococcal Conjugate vaccine in 23-valent pneumococcal polysaccharide vaccine-naive and pre-immunized patients under treatment with chronic haemodialysis: a longitudinal quasi-experimental phase IV study

“…Two small trials studied conjugated pneumococcal vaccines. In the first, more than half of 48 children vaccinated with PCV-7 were non-responders, defined as the absence of a more than four-fold rise in antibody levels for at least five serotypes [14]. In the second, PCV-13 vaccination in 25 adult dialysis patients resulted in a certain antibody response at 2 months that grossly disappeared after 1 year [15].…”

Vaccine administration in children with chronic kidney disease

“…In that study, HB seroconversion rates and the number of subjects with a protective titer of 10 mIU/mL or greater for antibody against HBsAg (anti-HBs) were lower among children who were taking steroids and also those who were not taking immunosuppressants; this suggested that SSNS was the major cause of their impaired immune responses. Children on dialysis also have a reduced immune response to PCV7 with post-vaccination antibody concentrations only 40% higher than baseline concentrations [60]. Similarly, the MMR vaccine was able to induce adequate antibody responses to all the antigens in only three of ten children on dialysis although antibody responses were observed to measles in eight children, mumps in five children, and rubella in eight children [61].…”