Impact of pneumococcal vaccine response on asthma exacerbation frequency in young children

Abstract

Introduction Chronic asthma is a heterogeneous disease, and increased eosinophils have been shown to predict increased asthma exacerbations, especially in adults. Recent recommendations suggest the need for supplemental PPV‐23 vaccination in older children with chronic asthma. Methods To investigate differences in preschool asthma, our case‐cohort study comprised of 127 children, mean age 47 months (32‐65), with a history of asthma exacerbations requiring more than three courses of systemic steroid bursts and more than six antibiotics courses in the previous year. Results At baseline, mean antibody titer response to Streptococcus pneumoniae was decreased at 2.6 ± 2 out of 14 serotypes, despite prior complete pneumococcal conjugate vaccine (PCV) vaccinations. All children were readministered pneumococcal vaccinations with PCV‐13 booster and/or PPSV‐23. Mean postvaccination pneumococcal vaccine (PV) titer response was 16 ± 5 out of 23 serotypes. After contacting 91 parents/caretakers, 75 responded with less frequency of corticosteroids and antibiotic use for asthma exacerbations after PV. This group had baseline eosinophil counts of 211 ± 36/µL, while those without improvement were significantly higher at 371 ± 123/µL,*P < .05. There were no significant differences (P > .05) between the two groups from other baseline measures including demography or atopic status. Conclusions This subset of children with exacerbation‐prone asthma had poor antibody titer response to Streptococcus pneumoniae, even with prior complete PCV‐13 immunization. Identification of low antibody responses to PV serotypes may provide a targeted therapeutic approach to reduce wheezing exacerbations in a precise asthma phenotype in children.

Impact of Therapeutics on Unified Immunity During Allergic Asthma and Respiratory Infections

“…A subset of asthmatic children with high eosinophil count had poor antibody titers to Spn, even with complete PCV-13 immunization ( 313 ). Specific clinical and preclinical studies are necessary to determine the efficacy of pneumococcal vaccines in asthmatics as it is under-investigated, and studies are confounded by differences in age and other susceptibility factors like comorbidity.…”

Complex pathways leading to future paediatric asthma exacerbations

“…Another consideration is the developing immune system and the current study spans a wide age range, 5-18 years. In a study by EISENLOHR et al [10], a study of 127 younger children, mean age 47 months (32-65 months), reveals that low vaccine antibody responses may identify a younger population at risk for asthma exacerbation or wheezing with illness.…”

A comprehensive overview of pneumococcal vaccination recommendations for adults in South Africa, 2022

“…High-risk adult asthmatics have been shown in some studies to have a 2-to greater than 6-fold increased risk of IPD and pneumococcal pneumonia (51)(52)(53) and some studies, particularly in children, indicate that vaccination may reduce corticosteroid and antibiotic use (54) but without an effect on hospitalization for pneumococcal CAP (55,56).…”