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Helmer L, van de Sand L, Wojtakowski T, Otte M, Witzke O, Sondermann W, Krawczyk A, Lindemann M. Antibody responses after sequential vaccination with PCV13 and PPSV23 in patients with moderate to severe plaque psoriasis under immunosuppressive therapy. mBio 2024:e0048224. [PMID: 38832785 DOI: 10.1128/mbio.00482-24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Accepted: 04/24/2024] [Indexed: 06/05/2024] Open
Abstract
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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Affiliation(s)
- Lorena Helmer
- Department of Infectious Diseases, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Lukas van de Sand
- Department of Infectious Diseases, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Thea Wojtakowski
- Institute for Transfusion Medicine, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Mona Otte
- Department of Infectious Diseases, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Oliver Witzke
- Department of Infectious Diseases, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Wiebke Sondermann
- Department of Dermatology, Venereology and Allergology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Adalbert Krawczyk
- Department of Infectious Diseases, University Hospital Essen, University Duisburg-Essen, Essen, Germany
- Institute for Virology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Monika Lindemann
- Institute for Transfusion Medicine, University Hospital Essen, University Duisburg-Essen, Essen, Germany
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2
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Ceuppens F, Meyts I, Bossuyt X, De Boeck K. Pneumococcal antibody response in children with recurrent respiratory tract infections: A descriptive study. Arch Pediatr 2024:S0929-693X(24)00055-1. [PMID: 38811264 DOI: 10.1016/j.arcped.2023.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 10/17/2023] [Accepted: 12/10/2023] [Indexed: 05/31/2024]
Abstract
BACKGROUND The pneumococcal antibody response after vaccination with unconjugated pneumococcal vaccine can be evaluated as part of the diagnostic work-up of children with recurrent respiratory tract infections to detect an underlying polysaccharide antibody deficiency. Little is known about the prevalence of polysaccharide antibody deficiency in this population and its therapeutic consequences. OBJECTIVES This study aimed to investigate the prevalence of polysaccharide antibody deficiency in children with recurrent respiratory tract infections and to correlate polysaccharide responsiveness with clinical severity. In addition, we aimed to evaluate differences in the immunoglobulin (Ig)G2/IgG ratio, IgA level, and age in relation to the number of deficient serotype-specific antibody responses. METHODS Polysaccharide antibody titers for pneumococcal serotypes 8, 9N, and 15B; clinical characteristics; and immunoglobulin levels of 103 children with recurrent respiratory tract infections were retrospectively assessed. American Academy of Allergy, Asthma, and Immunology guidelines were used for the interpretation of the polysaccharide antibody response. RESULTS Overall, 28 children (27.2 %) were diagnosed with polysaccharide antibody deficiency. No correlation was found between the number of deficient serotype-specific antibody responses and clinical severity. The study participants with a normal response to all three serotypes had a higher IgG2/IgG ratio than those with one or more deficient responses (p < 0.003). No significant correlation between IgA levels and polysaccharide responsiveness was found. The median age of children with normal polysaccharide responsiveness for the three tested serotypes was higher than that of children with a deficient response to one or more serotypes (p < 0.0025). CONCLUSION For a large group of children (18.4 %) with recurrent respiratory tract infections, an underlying mechanism for their susceptibility was defined thanks to diagnostic unconjugated pneumococcal polysaccharide vaccination. Further research is needed to formulate age-specific normal values for polysaccharide responsiveness and to investigate the usefulness of the IgG2/IgG ratio in determining the need for diagnostic unconjugated pneumococcal polysaccharide vaccination.
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Affiliation(s)
- Falke Ceuppens
- Department of Paediatrics, University Hospital Leuven, Belgium
| | - Isabelle Meyts
- Department of Paediatrics, University Hospital Leuven, Belgium; Department of Microbiology, Immunology and Transplantation, KULeuven, Belgium.
| | - Xavier Bossuyt
- Department of Microbiology, Immunology and Transplantation, KULeuven, Belgium; Department of Laboratory Medicine, University Hospital Leuven, Belgium
| | - Kris De Boeck
- Department of Paediatrics, University Hospital Leuven, Belgium
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Govindan V, Ganaie FA, Ramakrishnan SM, Ravindran S, Mavuppadi AM, Ravikumar KL. Estimation of baseline IgG antibody levels to 23 pneumococcal vaccine-type capsular polysaccharides in healthy vaccine naïve Indian adults. Vaccine 2023:S0264-410X(23)00497-8. [PMID: 37173269 DOI: 10.1016/j.vaccine.2023.04.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 04/26/2023] [Accepted: 04/26/2023] [Indexed: 05/15/2023]
Abstract
Since immunological responses to pneumococcal vaccines are assessed by a fold-increase in antibody levels relative to pre-immunization levels, it is therefore critical to determine baseline antibody levels to establish putative threshold as a measure of normal response. Herein, for the first time, we measured baseline IgG antibody levels in 108 healthy unvaccinated Indian adults using WHO-recommended ELISA. Median baseline IgG concentration ranged between 0.54 µg/mL to 12.35 µg/mL. Highest levels of baseline capsule polysaccharide (cPS)-specific IgG were found against types 14, 19A, and 33F. Whereas, lowest baseline IgG levels were observed against types 3, 4, and 5. Overall, ∼79 % of study population had median baseline IgG levels ≥1.3 µg/mL against 74 % of cPS's. Substantial baseline antibody levels in unvaccinated adults were observed. The study would be critical in bridging gaps in baseline immunogenicity data and may offer a valuable foundation for evaluating immune response of Indian adults to pneumococcal vaccination.
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Affiliation(s)
- Vandana Govindan
- Central Research Laboratory, Kempegowda Institute of Medical Sciences, Bangalore, India
| | - Feroze A Ganaie
- Department of Medicine, Division of Pulmonary, Allergy, and Critical Care, University of Alabama at Birmingham, AL, USA
| | - Shincy M Ramakrishnan
- Central Research Laboratory, Kempegowda Institute of Medical Sciences, Bangalore, India
| | - Shilpa Ravindran
- Central Research Laboratory, Kempegowda Institute of Medical Sciences, Bangalore, India
| | - Akhila M Mavuppadi
- Central Research Laboratory, Kempegowda Institute of Medical Sciences, Bangalore, India
| | - K L Ravikumar
- Central Research Laboratory, Kempegowda Institute of Medical Sciences, Bangalore, India.
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Peterson LK. Application of vaccine response in the evaluation of patients with suspected B-cell immunodeficiency: Assessment of responses and challenges with interpretation. J Immunol Methods 2022; 510:113350. [PMID: 36067869 DOI: 10.1016/j.jim.2022.113350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 08/01/2022] [Accepted: 08/30/2022] [Indexed: 12/31/2022]
Abstract
Diagnostic vaccination is an integral component in the evaluation of patients suspected to have a B cell or humoral deficiency. Evaluation of antibody production in response to both protein- and polysaccharide-based vaccines aids in distinguishing between specific categories of humoral deficiency. Although assessment of pneumococcal polysaccharide responses is widely available and included in diagnostic guidelines, significant variability still exists in the measurement and interpretation of these responses. Interpretation can also be complicated by age, vaccination history and treatment with immunoglobulin replacement therapy. Despite the challenges and limitations of evaluating pneumococcal polysaccharide vaccine responses, it can provide valuable diagnostic and prognostic information to guide therapeutic intervention. Future efforts are needed to further standardize measurement and interpretation of pneumococcal antibody responses to vaccination and to identify and establish other methods and/or vaccines as alternatives to pneumococcal vaccination to address the challenges in certain patient populations.
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Affiliation(s)
- Lisa K Peterson
- Department of Pathology, University of Utah, 15 N Medical Dr. East Ste. 1100, Salt Lake City, UT 84112, USA; ARUP Institute for Clinical and Experimental Pathology, 500 Chipeta Way, Salt Lake City, UT 84108, USA.
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5
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Garrido HMG, Schnyder JL, Haydari B, Vollaard AM, Tanck MWT, de Bree GJ, Meek B, Grobusch MP, Goorhuis A. Immunogenicity of the 13-valent pneumococcal conjugate vaccine followed by the 23-valent pneumococcal polysaccharide in people living with HIV on combination antiretroviral therapy. Int J Antimicrob Agents 2022; 60:106629. [PMID: 35760223 DOI: 10.1016/j.ijantimicag.2022.106629] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 06/07/2022] [Accepted: 06/19/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND People living with HIV (PLWH) are at increased risk of pneumococcal infections compared with the general population. The objective of this study was to investigate the immunogenicity of the combined pneumococcal vaccination schedule in PLWH. METHODS In this prospective cohort study, adult PLWH on antiretroviral therapy and HIV negative controls received the 13-valent pneumococcal conjugate vaccine (PCV13) at baseline followed by the 23-valent polysaccharide vaccine (PPSV23) at month 2. Serotype-specific IgG levels of 24 vaccine serotypes were measured (months 0, 2, 4, 6, 12). The primary outcome was seroprotection at month 4, defined as the proportion of patients with a post-immunization IgG concentration of ≥1.3 µg/mL for ≥70% (17/24) of vaccine serotypes. FINDINGS Samples of 120 patients were analysed. Seroprotection at month 4 was 49% (39/80) for PLWH and 82% (28/34) in controls. At month 12, seroprotection had decreased to 23% (18/79) and 63% (22/35), respectively. Nadir CD4 counts ≥ 200 cells/mm3, preserved kidney function and co-administration of the diphtheria-tetanus-polio (DTP) vaccine were associated with better seroprotection among PLWH. IgG levels of both PLWH and controls (all 24 vaccine serotypes) were significantly higher compared with baseline at all timepoints. INTERPRETATION Although IgG levels of all 24 vaccine serotypes increased significantly in both PLWH and controls, only a minority of PLWH achieved seroprotection after PCV13 followed by PPSV23. In addition, protective immunity waned rapidly. Further research into alternative vaccinations strategies for PLWH is needed, such as vaccination schedules with higher-valent pneumococcal vaccines. The DTP vaccine may augment pneumococcal vaccination responses.
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Affiliation(s)
- Hannah M Garcia Garrido
- Amsterdam UMC, Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, University of Amsterdam, Amsterdam Institute for Infection and Immunity, Amsterdam, The Netherlands.
| | - Jenny L Schnyder
- Amsterdam UMC, Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, University of Amsterdam, Amsterdam Institute for Infection and Immunity, Amsterdam, The Netherlands
| | - Beheshta Haydari
- Amsterdam UMC, Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, University of Amsterdam, Amsterdam Institute for Infection and Immunity, Amsterdam, The Netherlands
| | - Albert M Vollaard
- Center for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Michael W T Tanck
- Amsterdam UMC, Department of Epidemiology and Data Science, University of Amsterdam, Amsterdam, The Netherlands
| | - Godelieve J de Bree
- Amsterdam UMC, Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, University of Amsterdam, Amsterdam Institute for Infection and Immunity, Amsterdam, The Netherlands
| | - Bob Meek
- St. Antonius Hospital, Department of Medical Microbiology and Immunology, Nieuwegein, the Netherlands
| | - Martin P Grobusch
- Amsterdam UMC, Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, University of Amsterdam, Amsterdam Institute for Infection and Immunity, Amsterdam, The Netherlands
| | - Abraham Goorhuis
- Amsterdam UMC, Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, University of Amsterdam, Amsterdam Institute for Infection and Immunity, Amsterdam, The Netherlands
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Lawrence MG, Borish L. Specific antibody deficiency: Pearls and pitfalls for diagnosis. Ann Allergy Asthma Immunol 2022; 129:572-578. [PMID: 35671934 DOI: 10.1016/j.anai.2022.05.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 05/20/2022] [Accepted: 05/25/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Specific antibody deficiency is an immune deficiency defined by the presence of normal quantitative levels of immunoglobulins but impaired antibody responses to polysaccharide antigens in patients presenting with frequent otosinopulmonary infections with pyogenic bacteria. This review summarizes the pitfalls associated with defining exactly what constitutes an "impaired" antibody response to polysaccharide antigens and the importance of documenting actual pyogenic infections before making a diagnosis of an immune deficiency. DATA SOURCES PubMed review using the following words: specific antibody deficiency, pneumococcal vaccination, salmonella vaccination, infectious sinusitis Study Selection: This review focused on key studies that have been utilized to define what constitutes a "normal" humoral immune response to pneumococcal and salmonella vaccination in healthy subjects as well as published papers defining current expert opinion. RESULTS Published studies demonstrate wide variability in response to pneumococcal vaccination in healthy individuals making it daunting to define what constitutes an abnormal response. These challenges are exacerbated by striking laboratory variability in reporting results. CONCLUSION Clinical evaluations in individuals with self-reported recurrent acute sinusitis or lower respiratory infections need to document an infectious etiology with pyogenic bacteria and must rule out an underlying primary airway inflammatory disorder before consideration is made regarding the presence of an immune deficiency. In addition, decision making regarding diagnosis and treatment of patients being evaluated for humoral immunodeficiency should not hinge solely on the strict application of defined cutoffs for "normal" response to a single polysaccharide vaccine, but rather a global assessment of humoral immune function in the context of the clinical presentation.
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Affiliation(s)
- Monica G Lawrence
- Department of Medicine - University of Virginia, Charlottesville, Virginia; Department of Pediatrics - University of Virginia, Charlottesville, Virginia.
| | - Larry Borish
- Department of Medicine - University of Virginia, Charlottesville, Virginia; Department of Microbiology - University of Virginia, Charlottesville, Virginia
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Immunogenicity of the 13-Valent Pneumococcal Conjugate Vaccine (PCV13) Followed by the 23-Valent Pneumococcal Polysaccharide Vaccine (PPSV23) in Adults with and without Immunosuppressive Therapy. Vaccines (Basel) 2022; 10:vaccines10050795. [PMID: 35632551 PMCID: PMC9146363 DOI: 10.3390/vaccines10050795] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 05/06/2022] [Accepted: 05/10/2022] [Indexed: 11/16/2022] Open
Abstract
Immunosuppressive therapy increases the risk of pneumococcal disease. This risk can be mitigated by pneumococcal vaccination. The objective of this study was to investigate the immunogenicity of the 13-valent pneumococcal conjugate vaccine (PCV13), followed by the 23-valent pneumococcal polysaccharide vaccine (PPSV23), in adults with and without immunosuppressive therapy. We performed a prospective cohort study among adults using conventional immunomodulators (cIM), biological immunomodulators (bIM), combination therapy, and controls during 12 months. The primary outcome was seroprotection, defined as the proportion of patients with a postimmunization IgG concentration of ≥1.3 µg/mL for at least 70% (17/24) of the serotypes of PCV13 + PPSV23. We included 214 participants. For all 24 vaccine serotypes, IgG levels increased significantly in both treatment subgroups and controls, with peak seroprotection rates of 44% (combination therapy), 58% (cIM), 57% (bIM), and 82% (controls). By month 12, seroprotection had decreased to 24%, 48%, 39%, and 63%, respectively. Although pneumococcal vaccination with PCV13 + PPSV23 was immunogenic in all treatment groups, impaired vaccination responses were observed in patients using immunosuppressive medication. Apart from the obvious recommendation to administer vaccines before such medication is started, alternative vaccination strategies, such as additional PCV13 doses or higher-valent pneumococcal vaccines, should be investigated.
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8
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Garcia Garrido HM, Haggenburg S, Schoordijk MCE, Meijer E, Tanck MWT, Hazenberg MD, Rutten CE, Bree GJ, Nur E, Meek B, Grobusch MP, Goorhuis A. Immunogenicity of a 5-dose pneumococcal vaccination schedule following allogeneic hematopoietic stem cell transplantation. Am J Hematol 2022; 97:592-602. [PMID: 35147238 PMCID: PMC9303771 DOI: 10.1002/ajh.26493] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 01/13/2022] [Accepted: 02/07/2022] [Indexed: 12/24/2022]
Abstract
The optimal schedule of pneumococcal vaccination after allogeneic hematopoietic stem cell transplantation (allo‐HSCT) remains controversial. The objective of this study was to investigate the immunogenicity of a 5‐dose pneumococcal vaccination schedule in adult allo‐HSCT recipients with and without immunosuppressive therapy. In this prospective cohort study, allo‐HSCT recipients received four doses of the 13‐valent pneumococcal conjugate vaccine (PCV13) and one dose of the 23‐valent pneumococcal polysaccharide vaccine (PPSV23) starting 4–6 months after allo‐HSCT. PCV13 was administered at T0, T1, T2, and T8 (T = months from enrollment) and PPSV23 at T10. Serum was collected at T0, T4, T8, T10, and T12, and IgG levels were measured for all 24 vaccine serotypes by immunoassay. The primary outcome was overall seroprotection at T12 defined as an IgG concentration ≥1.3 μg/ml for 17/24 vaccine serotypes in allo‐HCST recipients with and without immunosuppressive therapy at baseline. Secondary outcomes were serotype‐specific seroprotection and dynamics of IgG levels. We included 89 allo‐HSCT recipients in the final analysis. Overall seroprotection was 47% (15/32) for patients without immunosuppressive therapy at baseline versus 24% (11/46) for patients with immunosuppressive therapy (p = .03). Seroprotection was higher for PCV13 serotypes (78% and 54% respectively; p = .03) and lower for PPSV23‐unique serotypes (28% and 13% respectively; p = .1). IgG concentrations increased significantly over time for all 24 serotypes. Concluding, although immunogenicity of PCV13 serotypes was reasonable, the poor response to PPSV23 serotypes resulted in an insufficient overall response to pneumococcal vaccination for allo‐HSCT recipients. Research into vaccination strategies with higher‐valent T‐cell‐dependent pneumococcal vaccines is needed.
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Affiliation(s)
- Hannah M. Garcia Garrido
- Amsterdam UMC, Centre of Tropical Medicine and Travel Medicine, Department of Infectious Diseases University of Amsterdam, Amsterdam institute for Infection and Immunity Amsterdam The Netherlands
| | - Sabine Haggenburg
- Amsterdam UMC, Department of Hematology, Amsterdam Institute for Infection and Immunity Cancer Center Amsterdam Amsterdam The Netherlands
| | - Marieke C. E. Schoordijk
- Amsterdam UMC, Department of Hematology, Amsterdam Institute for Infection and Immunity Cancer Center Amsterdam Amsterdam The Netherlands
| | - Ellen Meijer
- Amsterdam UMC, Department of Hematology, Amsterdam Institute for Infection and Immunity Cancer Center Amsterdam Amsterdam The Netherlands
| | - Michael W. T. Tanck
- Amsterdam UMC, Department of Epidemiology and Data Science University of Amsterdam Amsterdam The Netherlands
| | - Mette D. Hazenberg
- Amsterdam UMC, Department of Hematology, Amsterdam Institute for Infection and Immunity Cancer Center Amsterdam Amsterdam The Netherlands
- Department of Hematopoiesis Sanquin Research Amsterdam The Netherlands
| | - Caroline E. Rutten
- Amsterdam UMC, Department of Hematology, Amsterdam Institute for Infection and Immunity Cancer Center Amsterdam Amsterdam The Netherlands
| | - Godelieve J. Bree
- Amsterdam UMC, Centre of Tropical Medicine and Travel Medicine, Department of Infectious Diseases University of Amsterdam, Amsterdam institute for Infection and Immunity Amsterdam The Netherlands
| | - Erfan Nur
- Amsterdam UMC, Department of Hematology, Amsterdam Institute for Infection and Immunity Cancer Center Amsterdam Amsterdam The Netherlands
- Department of Hematopoiesis Sanquin Research Amsterdam The Netherlands
| | - Bob Meek
- Department of Medical Microbiology and Immunology St. Antonius Hospital Nieuwegein the Netherlands
| | - Martin P. Grobusch
- Amsterdam UMC, Centre of Tropical Medicine and Travel Medicine, Department of Infectious Diseases University of Amsterdam, Amsterdam institute for Infection and Immunity Amsterdam The Netherlands
| | - Abraham Goorhuis
- Amsterdam UMC, Centre of Tropical Medicine and Travel Medicine, Department of Infectious Diseases University of Amsterdam, Amsterdam institute for Infection and Immunity Amsterdam The Netherlands
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Pneumococcal IgG Antibody Responses to 23vPPV in Healthy Controls Using an Automated ELISA. J Clin Immunol 2022; 42:760-770. [PMID: 35230563 DOI: 10.1007/s10875-022-01230-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 02/10/2022] [Indexed: 10/19/2022]
Abstract
Measurement of pre- and post-pneumococcal antibody levels after immunization with the 23-valent capsular polysaccharide pneumococcal vaccine (23vPPV) is indicative of a T-independent antibody response. The World Health Organisation ELISA is considered gold standard yet is labor-intensive and technically difficult to perform. Interpretation criteria defining an adequate response to 23vPPV remain controversial. The diagnostic Immunology Laboratory at The Royal Children's Hospital, Melbourne (RCH), performs an in-house multi-serotype automated ELISA. The primary objective of this study was to verify RCH interpretation criteria for the laboratory's automated ELISA. Forty pneumococcal conjugate vaccine (PCV)-naïve healthy adults aged 18 to 25 years and 22 PCV-primed healthy children aged 2 to 5 years were immunized with 23vPPV. A serum sample was collected immediately prior and 28 to 42 (± 7) days post immunization. Samples were analyzed on the Tecan Freedom Evo 200 ELISA with adequate response defined as post-immunization antibody level of 1.3 µg/mL or fourfold rise from baseline in ≥ 10/15 serotypes in adult participants and ≥ 4/8 serotypes in pediatric participants. Thirty-nine (97.5%) adults and 22 (100%) children achieved an adequate response to 23vPPV. In PCV-naïve adults, serotypes contained within the conjugate vaccines were less immunogenic, with 12 (30%) adults not achieving an adequate antibody response when only PCV serotypes were used for interpretation. Our diagnostic laboratory has verified the interpretation criteria used for an automated multi-serotype pneumococcal ELISA method. Clinical Trial Registration: ANZCTR registration number ACTRN12618000822280.
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Hansen AT, Söderström A, Jørgensen CS, Larsen CS, Petersen MS, Bernth Jensen JM. Diagnostic Vaccination in Clinical Practice. Front Immunol 2021; 12:717873. [PMID: 34659207 PMCID: PMC8514775 DOI: 10.3389/fimmu.2021.717873] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 09/13/2021] [Indexed: 12/01/2022] Open
Abstract
Testing the antibody response to vaccination (diagnostic vaccination) is crucial in the clinical evaluation of primary immunodeficiency diseases. Guidelines from the American Academy of Allergy, Asthma & Immunology (AAAAI) provide detailed recommendations for diagnostic vaccination with pure pneumococcal polysaccharide vaccines (PPV). However, the degree of compliance with these guidelines and the utility of the guidelines in actual practice are undescribed. To address this, we systematically evaluated diagnostic vaccination in adult patients with suspected primary immunodeficiency diseases in a single tertiary center from 2011 to 2016 (n = 229). We found that full compliance with the AAAAI guidelines was achieved for only 39 patients (17%), suggesting that the guidelines are not easy to follow. Worse, interpretation according to the guidelines was heavily influenced by which serotype-specific antibodies that were used for the evaluation. We found that the arbitrary choices of serotype-specific antibodies could change the fraction of patients deemed to have ‘adequate immunity’ by a factor of four, exposing an inherent flaw in the guidelines. The flaw relates to dichotomous principles for data interpretation under the AAAAI guidelines. We therefore propose a revised protocol for diagnostic vaccination limited to PPV vaccination, subsequent antibody measurements, and data interpretation using Z-scores. The Z-score compiles multiple individual antibody levels, adjusted for different weighting, into one single continuous variable for each patient. In contrast to interpretation according to the AAAAI guidelines, the Z-scores were robust to variations in the choice of serotype-specific antibodies used for interpretation. Moreover, Z-scores revealed reduced immunity after vaccination in the patients with recurrent pneumonia (a typical symptom of antibody deficiency) compared with control patients. Assessment according to the AAAAI guidelines failed to detect this difference. We conclude that our simplified protocol and interpretation with Z-scores provides more robust clinical results and may enhance the value of diagnostic vaccination.
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Affiliation(s)
- Anette Tarp Hansen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Anna Söderström
- Department of Clinical Immunology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Immunology and Transfusion Medicine, Karolinska University Hospital, Stockholm, Sweden
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LaFon D, Kim YI, Burton R, Dransfield M, Nahm M. Pneumococcal Antibody Function for Immunologic Evaluation: Normal Results in Older Adults, and a Novel Analytical Model for Vaccine Response. J Clin Immunol 2021; 41:1964-1968. [PMID: 34462839 DOI: 10.1007/s10875-021-01126-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 08/18/2021] [Indexed: 10/20/2022]
Affiliation(s)
- David LaFon
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama At Birmingham, Birmingham, AL, USA. .,UAB Lung Health Center, University of Alabama At Birmingham, Birmingham, AL, USA.
| | - Young-Il Kim
- Division of Preventive Medicine, University of Alabama At Birmingham, Birmingham, AL, USA
| | - Robert Burton
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama At Birmingham, Birmingham, AL, USA
| | - Mark Dransfield
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama At Birmingham, Birmingham, AL, USA.,UAB Lung Health Center, University of Alabama At Birmingham, Birmingham, AL, USA.,Birmingham VA Medical Center, Birmingham, AL, USA
| | - Moon Nahm
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama At Birmingham, Birmingham, AL, USA.,Department of Microbiology, University of Alabama At Birmingham, Birmingham, AL, USA
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12
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Ameratunga R, Longhurst H, Steele R, Woon ST. Comparison of Diagnostic Criteria for Common Variable Immunodeficiency Disorders (CVID) in the New Zealand CVID Cohort Study. Clin Rev Allergy Immunol 2021; 61:236-244. [PMID: 34236581 DOI: 10.1007/s12016-021-08860-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2021] [Indexed: 11/28/2022]
Abstract
Common variable immunodeficiency disorders (CVID) are the most frequent symptomatic primary immune deficiencies in adults and children. In addition to recurrent and severe infections, patients with CVID are susceptible to autoimmune and inflammatory complications. The aetiologies of these uncommon conditions are, by definition, unknown. When the causes of complex disorders are uncertain, diagnostic criteria may offer valuable guidance to the management of patients. Over the last two decades, there have been four sets of diagnostic criteria for CVID in use. The original 1999 European Society for Immunodeficiencies and Pan-American Society for Immunodeficiency (ESID/PAGID) criteria are less commonly used than the three newer criteria: Ameratunga et al (Clin Exp Immunol 174:203-211, 2013), ESID (J Allergy Clin Immunol Pract, 2019) and ICON (J Allergy Clin Immunol Pract 4:38-59, 2016) criteria. The primary aim of the present study was to compare the utility of diagnostic criteria in a well-characterised cohort of CVID patients. The New Zealand CVID cohort study (NZCS) commenced in 2006 and currently comprises one hundred and thirteen patients, which represents approximately 70% of all known CVID patients in NZ. Many patients have been on subcutaneous or intravenous (SCIG/IVIG) immunoglobulin treatment for decades. Patients were given a clinical diagnosis of CVID as most were diagnosed before the advent of newer diagnostic criteria. Application of the three commonly used CVID diagnostic criteria to the NZCS showed relative sensitivities as follows: Ameratunga et al (Clin Exp Immunol 174:203-211, 2013), possible and probable CVID, 88.7%; ESID (J Allergy Clin Immunol Pract, 2019), 48.3%; and ICON (J Allergy Clin Immunol Pract 4:38-59, 2016), 47.1%. These differences were mostly due to the low rates of diagnostic vaccination challenges in patients prior to commencing SCIG/IVIG treatment and mirror similar findings in CVID cohorts from Denmark and Finland. Application of the Ameratunga et al (Clin Exp Immunol 174:203-211, 2013) CVID diagnostic criteria to patients on SCIG/IVIG may obviate the need to stop treatment for vaccine studies, to confirm the diagnosis.
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Affiliation(s)
- Rohan Ameratunga
- Department of Clinical Immunology, Auckland City Hospital, Auckland, New Zealand. .,Department of Virology and Immunology, Auckland City Hospital, Auckland, New Zealand. .,Department of Molecular Medicine and Pathology, University of Auckland, Auckland, New Zealand.
| | - Hilary Longhurst
- Department of Clinical Immunology, Auckland City Hospital, Auckland, New Zealand.,Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Richard Steele
- Department of Virology and Immunology, Auckland City Hospital, Auckland, New Zealand
| | - See-Tarn Woon
- Department of Clinical Immunology, Auckland City Hospital, Auckland, New Zealand.,Department of Molecular Medicine and Pathology, University of Auckland, Auckland, New Zealand
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13
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Kaur R, Pham M, Pichichero M. Serum antibody levels to pneumococcal polysaccharides 22F, 33F, 19A and 6A that correlate with protection from colonization and acute otitis media in children. Vaccine 2021; 39:3900-3906. [PMID: 34116872 DOI: 10.1016/j.vaccine.2021.05.089] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 04/16/2021] [Accepted: 05/23/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Serotypes 22F and 33F have been added to a new pneumococcal-conjugate vaccine (PCV-15) because of their prevalence in causing invasive pneumococcal diseases (IPD). METHOD We measured anti-polysaccharide 22F, 33F, 19A and 6A antibodies in children before and after pneumococcal colonization and acute otitis media (AOM) episodes caused by these specific-serotypes. A two-step method for construction of correlate of protection (COP) models included using a generalized estimating equation for the relationship between antibody level, age and colonization history followed by logistic-regression modelling that included colonization or AOM episodes as independent variables, and age adjusted antibody level as the predictor. RESULTS A vaccine-induced serum antibody level of 0.45 μg/ml for 22F, 0.51 μg/ml for 6A and 4.1 μg/ml for 19A correlated with prevention of pneumococcal colonization by respective serotypes (insufficient number of cases for 33F to find COP against colonization). Antibody levels of 0.25 μg/ml for 22F, 33F and 6A and 2 μg/ml for 19A correlated with prevention of AOM by the respective serotypes. CONCLUSIONS A COP threshold of anti-22F, 33F, 19A and 6A serum antibodies for NP colonization and AOM in young children can be derived using GEE and logistic regression modelling.
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Affiliation(s)
- Ravinder Kaur
- Center for Infectious Diseases and Immunology, Rochester General Hospital Research Institute, Rochester, NY, United States.
| | - Minh Pham
- School of Mathematical Sciences, College of Science, Rochester Institute of Technology, Rochester, NY, United States
| | - Michael Pichichero
- Center for Infectious Diseases and Immunology, Rochester General Hospital Research Institute, Rochester, NY, United States
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14
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Park MA, Jenkins SM, Smith CY, Pyle RC, Sacco KA, Ryu E, Hagan JB, Joshi AY, Snyder MR, Abraham RS. Pneumococcal serotype-specific cut-offs based on antibody responses to pneumococcal polysaccharide vaccination in healthy adults. Vaccine 2021; 39:2850-2856. [PMID: 33896666 DOI: 10.1016/j.vaccine.2021.04.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 04/06/2021] [Accepted: 04/08/2021] [Indexed: 02/08/2023]
Abstract
Antibody responses to pneumococcal polysaccharide vaccination are frequently used as a diagnostic tool for humoral immunodeficiencies, part of the larger collection of inborn errors of immunity. Currently, arbitrary criteria, such as a serotype specific titer of >/= 1.3 µg/mL is most often used as a cut-off for interpretation of pneumococcal antibody responses. The magnitude of the antibody response to each of the 23 serotypes in Pneumovax®, and serotype-specific cut-offs in healthy pneumococcal vaccine-naïve adults has not been previously characterized. IgG antibody concentrations were measured prospectively for 23 pneumococcal serotypes pre and 4-6 weeks post-Pneumovax® vaccination in 100 healthy adults, using a multiplex bead-based assay. Antibodies to 19 of 23 serotypes were informative for distinguishing subjects who responded to vaccination, and the serotype threshold was determined to be 9 of 19 serotypes, which characterized an antibody response to pneumococcal vaccination. While this study may facilitate classification of IgG serotype-specific antibody responses post-pneumococcal vaccination in adult patients undergoing diagnostic immunological evaluation for antibody immunodeficiencies or other relevant contexts, additional studies in healthy children and S. pneumoniae protein-conjugate-vaccinated healthy adults will need to be undertaken in the future.
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Affiliation(s)
- Miguel A Park
- Division of Allergic Diseases, Department of Medicine, USA; Mayo Clinic, Rochester, MN, USA
| | - Sarah M Jenkins
- Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, USA; Mayo Clinic, Rochester, MN, USA
| | - Carin Y Smith
- Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, USA; Mayo Clinic, Rochester, MN, USA
| | - Regan C Pyle
- Division of Allergic Diseases, Department of Medicine, USA; Allergy, Asthma & Immunology of the Rockies, PC., Glenwood Springs, CO, USA
| | - Keith A Sacco
- Allergy & Immunology Program, National Institutes of Health, USA
| | - Euijung Ryu
- Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, USA; Mayo Clinic, Rochester, MN, USA
| | - John B Hagan
- Division of Allergic Diseases, Department of Medicine, USA; Mayo Clinic, Rochester, MN, USA
| | - Avni Y Joshi
- Division of Allergic Diseases, Department of Medicine, USA; Mayo Clinic, Rochester, MN, USA
| | - Melissa R Snyder
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Roshini S Abraham
- Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, Columbus, OH, USA.
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15
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Chernikova D, Stiehm R, Estevez D, Song CH. Comparison of Two Different Criteria for Specific Antibody Deficiency in Patients With Chronic and Recurrent Rhinosinusitis. ALLERGY & RHINOLOGY 2020; 11:2152656720980408. [PMID: 33403153 PMCID: PMC7739085 DOI: 10.1177/2152656720980408] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background Specific antibody deficiency (SAD) is highly associated with chronic rhinosinusitis (CRS) and is defined by inadequate post-vaccination percentage of protective (≥1.3 ug/mL) pneumococcal antibody serotypes divided by total tested serotypes (post-pPA). Objective Although < 70% post-pPA has been used commonly as the criterion for SAD, we sought to evaluate the clinical outcome of a different definition of SAD. Methods 203 patients aged 6 to 70 years with CRS were classified, retrospectively by pre-vaccination pPA (pre-pPA) and post-pPA by two different criteria. Using 70% as the threshold for adequate pneumococcal antibody (PA) response, patients were classified as: Group A (adequate pre-pPA), Group B (inadequate pre-pPA, adequate post-pPA), Group C (inadequate pre-pPA, inadequate post-pPA, SAD). Using 50% as the threshold, patients were similarly classified as: Group A’, B’ and C’. Results The recurrence rate of sinusitis during the next one year in Group A (pre-pPA ≥70%) was significantly less than that of Group A’ (pre-pPA ≥50%) (10% vs. 34%, P = .03). Group A had lower incidence of sinusitis than Group B (pre-pPA < 70%, post-pPA ≥70%) (10% vs. 34%, P = .025). Among Group B’ patients, the recurrence rate of sinusitis was significantly less among those with post-pPA of ≥70% than those with 50%–69% (28% vs. 69%, P < .01). Conclusion Employment of a 70% pPA threshold for SAD in comparison to a 50% threshold would decrease the incidence of sinusitis in the next one year by vaccinating patients in 51–69% pPA range. Pre-existing PAs (Group A) yielded a higher protection against sinusitis than vaccine-acquired antibodies (Group B).
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Affiliation(s)
| | - Richard Stiehm
- Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Dennys Estevez
- Department of Pediatrics, Harbor-UCLA, Torrance, California
| | - Charles H Song
- Department of Pediatrics, Harbor-UCLA, Torrance, California
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16
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Isolating polysaccharide IgG pneumococcal antibody responses by pre-adsorption of conjugate vaccine serotypes: A modified approach for the conjugate vaccine era. J Immunol Methods 2020; 486:112846. [PMID: 32882318 DOI: 10.1016/j.jim.2020.112846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 08/18/2020] [Accepted: 08/26/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND Assessment of pure polysaccharide response to the 23-valent pneumococcal polysaccharide vaccine (PPV23) can be biased by previous exposure to the conjugate vaccine (PCV). We applied pre-analytical modification to the existing ELISA by pre-incubating serum with PCV. METHODS PCV-adsorbed and non-adsorbed sera were prepared before measuring the concentration of anti-pneumococcal capsular polysaccharide (PCP) IgG antibodies by the whole pneumococcal ELISA. Paired pre and post-pneumococcal vaccination sera from 73 subjects were analyzed and the baseline anti-PCP IgG for each sample was subtracted from the post-vaccination value to measure vaccine responses. Absolute change in titers and fold changes were then compared between both methods. RESULTS In the PCV-vaccinated group (n = 28), pre-adsorption with PCV significantly reduced the vaccine responses compared to non-adsorbed sera [median increase in anti-PCP titers: 27.55 mg/l and 45.98 mg/l, respectively]. In addition, the median fold change dropped significantly from 3.026 to 2.313. In PPV23-vaccinated immunocompetent subjects (n = 28) there was a significant difference in anti-PCP responses with PCV adsorption [median values: 73.71 mg/l without and 51.04 mg/l with adsorption]. All the antibody deficiency patients (n = 17) displayed poor PPV23 responses. Although PPV23 responsiveness was not statistically different between both methods, we have observed a trend for lower anti-PCP IgG titers in PCV-adsorbed sera compared to non-adsorbed ones. Serotype-specific IgG analysis using a multiplexed bead-based immunoassay performed on 10 paired samples confirmed that the adsorption observed is specific to PCV serotypes. CONCLUSION Pre-analytical modification to the conventional ELISA by removing the PCV-specific serotypes may differentiate true polysaccharide response from recall response induced by previous PCV vaccination.
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17
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Perez EE, Ballow M. Diagnosis and management of Specific Antibody Deficiency. Immunol Allergy Clin North Am 2020; 40:499-510. [PMID: 32654695 DOI: 10.1016/j.iac.2020.03.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Specific antibody deficiency is a primary immunodeficiency disease recognized by the International Union of Immunology Societies and defined by recurrent respiratory infections with normal immunoglobulins, but diminished antibody responses to polysaccharide antigens after vaccination with the 23 valent pneumococcal polysaccharide vaccine. Clinical immunologists struggle with diagnosis and treatment, because the definition of an adequate response to immunization remains controversial. Specific antibody deficiency is managed clinically with close follow-up and prompt treatment of infections, antibiotic prophylaxis, or immune globulin therapy. Treatment is individualized using clinical judgment and existing practice guidelines, which will likely evolve as more studies become available.
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Affiliation(s)
- Elena E Perez
- Allergy Associates of the Palm Beaches, 840 US Highway 1, Suite 235, North Palm Beach, FL 33408, USA.
| | - Mark Ballow
- Department of Pediatrics, Division of Allergy and Immunology, All Children's Research Institute, University of South Florida, Johns Hopkins Children's Hospital, 140 7th Avenue South, CRI 4008, St Petersburg, FL 33701, USA
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18
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Pulvirenti F, Milito C, Cavaliere FM, Mezzaroma I, Cinetto F, Quinti I. IGA Antibody Induced by Immunization With Pneumococcal Polysaccharides Is a Prognostic Tool in Common Variable Immune Deficiencies. Front Immunol 2020; 11:1283. [PMID: 32695106 PMCID: PMC7336165 DOI: 10.3389/fimmu.2020.01283] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 05/20/2020] [Indexed: 12/02/2022] Open
Abstract
The evaluation of the response to vaccination in patients with inborn errors of immunity is a tool to evaluate T-dependent and T-independent antibody residual function of B lymphocytes and it is part of the diagnostic definition for Common Variable Immune Deficiencies. Currently used classifications for Common Variable Immune Deficiencies patients are based on the frequency of B cell subsets, and have been proven as a valid instrument for identification of patients at higher risk of infectious and non-infectious complications. This 6-years period observational study delineated the measurement of specific IgA antibodies induced by a 23-valent pneumococcal polysaccharides vaccine by a standardized ELISA for the quantification of IgA antibodies to all 23 pneumococcal serotypes as an additional prognostic marker in 74 CVID patients. The inability to mount an IgA-mediated response against the pneumococcal polysaccharide antigens or the inability to maintain the antibody response over time identified poor IgA CVID responders with severe immunological impairment, great risk of co-morbidities, and poor prognosis. The division of CVID patient into specific IgA-non responders and IgA-responders discriminated better than other CVID classifications for infectious risk, while it overlapped for non-infectious complications. Our study suggested to add the evaluation of the antibody response by the 23-valent IgA assay in the clinical monitoring of CVID patients.
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Affiliation(s)
- Federica Pulvirenti
- Department of Molecular Medicine, "Sapienza" University of Rome, Rome, Italy
| | - Cinzia Milito
- Department of Molecular Medicine, "Sapienza" University of Rome, Rome, Italy
| | | | - Ivano Mezzaroma
- Department of Translational and Precision, "Sapienza" University of Rome, Rome, Italy
| | - Francesco Cinetto
- Department of Medicine-DIMED, University of Padova, Padua, Italy.,Internal Medicine I, Ca' Foncello Hospital, Treviso, Italy
| | - Isabella Quinti
- Department of Molecular Medicine, "Sapienza" University of Rome, Rome, Italy
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19
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Marsh RA, Orange JS. Antibody deficiency testing for primary immunodeficiency: A practical review for the clinician. Ann Allergy Asthma Immunol 2019; 123:444-453. [PMID: 31446132 DOI: 10.1016/j.anai.2019.08.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 08/14/2019] [Accepted: 08/18/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To review selected published studies related to the diagnostic evaluation of antibody deficiency. DATA SOURCES Published literature. STUDY SELECTIONS Studies related to the diagnostic evaluation of antibody deficiency and existing recommendations were selected. RESULTS Many primary immunodeficiency diseases include humoral deficiency. Practical tests used in the clinical evaluation of patients for possible antibody deficiency include immunoglobulin measurement, specific antibody titers, and B-cell enumeration and phenotyping. CONCLUSION Clinically available tests can be used to readily evaluate patients for antibody deficiencies.
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Affiliation(s)
- Rebecca A Marsh
- Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio; Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Jordan S Orange
- Department of Pediatrics, Columbia University College of Physicians and Surgeons, New York, New York; NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, New York
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20
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LaFon DC, Nahm MH. Measuring quantity and function of pneumococcal antibodies in immunoglobulin products. Transfusion 2019; 58 Suppl 3:3114-3120. [PMID: 30536435 DOI: 10.1111/trf.15015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 10/03/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND Immunoglobulin replacement therapy is a cornerstone of the treatment of primary immunodeficiencies. Preparations used for replacement therapy are processed by purifying immunoglobulins from large pools of plasma, which were obtained from healthy donors. The constituent antibodies in these products depend on the immune history of the donor pool as well as manufacturing processes that differ among manufacturers. For these reasons various methods have been proposed to examine the levels and function of antibodies to organisms such as Streptococcus pneumoniae, which frequently causes infections in patients with immunodeficiencies. Pneumococcal antibody levels or antibody function can be measured with enzyme-linked immunosorbent assay (ELISA) or multiplexed opsonophagocytosis assay (MOPA). Although these assays were developed initially to assess the immunogenicity of pneumococcal vaccines, the techniques have been adapted to evaluate immunoglobulin products as well. STUDY DESIGN AND METHODS This article provides a concise review of the analytic techniques for measuring pneumococcal antibodies and prior studies of immunoglobulin products utilizing these methods. RESULTS Studies utilizing these assays have demonstrated that antibody levels of immunoglobulin products can vary with time, location, and manufacturer. CONCLUSIONS We highlight current issues and future considerations concerning measurement of pneumococcal antibodies in immunoglobulin products, and the assays used for this purpose.
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Affiliation(s)
- David C LaFon
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Moon H Nahm
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, Alabama.,Department of Microbiology, University of Alabama at Birmingham, Birmingham, Alabama
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21
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Sheen YH, Kizilbash S, Ryoo E, Wi CI, Park M, Abraham RS, Ryu E, Divekar R, Juhn Y. Relationship between asthma status and antibody response pattern to 23-valent pneumococcal vaccination. J Asthma 2019; 57:381-390. [PMID: 30784333 DOI: 10.1080/02770903.2019.1575394] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Objective: Asthma poses an increased risk for serious pneumococcal disease, but little is known about the influence of asthma status on the 23-valent serotype-specific pneumococcal antibody response. We examined differences in antibody titers between pre- and post-vaccination with 23-valent pneumococcal polysaccharide vaccine (PPSV-23) in relation to asthma status. Methods: Asthma status was retrospectively ascertained by the Predetermined Asthma Criteria in an existing vaccine cohort through comprehensive medical record review. Twenty-three serotype-specific pneumococcal antibody titers measured at baseline and 4-6 weeks post-vaccination were analyzed. Vaccine responses to PPSV-23 were calculated from pre- to post-vaccine titers for each of the serotypes. Results: Of the 64 eligible and enrolled subjects, 18 (28%) had asthma. Controls (i.e., subjects without asthma) demonstrated a statistically significant fold change response compared to their baseline for all serotypes, while those with asthma did not mount a significant response to serotypes 7F, 22F, and 23F. The overall vaccine response as measured by fold change over baseline was lower in subjects with asthma than controls. Conclusions: Poorer humoral immune responses to PPSV-23 as measured by fold change were more likely to be observed in subjects with asthma compared to controls. We recommend the consideration of asthma status when interpreting vaccine response for immune competence workup through larger studies. Further studies are warranted to replicate these findings.
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Affiliation(s)
- Youn H Sheen
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA.,Department of Pediatrics, CHA University School of Medicine, Seoul, Korea
| | - Sarah Kizilbash
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA.,Department of Pediatrics, School of Medicine, University of Minnesota, Twin Cities, MN, USA
| | - Eell Ryoo
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA.,Department of Pediatrics, Gil Hospital, Gachon University, Incheon, Korea
| | - Chung-Il Wi
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | - Miguel Park
- Division of Allergic Diseases, Mayo Clinic, Rochester, MN, USA
| | - Roshini S Abraham
- Division of Clinical Biochemistry and Immunology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Euijung Ryu
- Department of Health Sciences and Research, Mayo Clinic, Rochester, MN, USA
| | - Rohit Divekar
- Division of Allergic Diseases, Mayo Clinic, Rochester, MN, USA
| | - Young Juhn
- Department of Pediatric and Adolescent Medicine/Internal Medicine, Mayo Clinic, Rochester, MN, USA
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22
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Parker AR, Park MA, Harding S, Abraham RS. The total IgM, IgA and IgG antibody responses to pneumococcal polysaccharide vaccination (Pneumovax®23) in a healthy adult population and patients diagnosed with primary immunodeficiencies. Vaccine 2019; 37:1350-1355. [DOI: 10.1016/j.vaccine.2019.01.035] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 10/05/2018] [Accepted: 01/08/2019] [Indexed: 12/17/2022]
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23
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Sorensen RU, Edgar D. Specific Antibody Deficiencies in Clinical Practice. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2019; 7:801-808. [PMID: 30682575 DOI: 10.1016/j.jaip.2019.01.024] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 01/11/2019] [Accepted: 01/11/2019] [Indexed: 12/11/2022]
Abstract
Specific antibody deficiency (SAD) is defined as the inability to mount an antibody response to purified Streptococcus pneumoniae capsular polysaccharide antigens in the presence of normal immunoglobulin concentrations and normal antibody responses to protein antigens. In this review, we discuss the difficulties in using presently available testing methods to adequately define SAD. The fact that there are different forms of SADs to pneumococcal surface polysaccharides is detailed. The diagnostic and therapeutic implications of recognizing that, in addition to SAD, there are other forms of SAD in the response to S. pneumoniae polysaccharides are described in detail. The conclusion of this review is that assessment of immunity and therapeutic actions to deal with SADs need to be based on clinical evidence rather than solely on arbitrarily defined antibody responses.
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Affiliation(s)
- Ricardo U Sorensen
- Department of Pediatrics, Louisiana State University Health Science Center, New Orleans, La; Louisiana Primary Immunodeficiency Network, New Orleans, La; Faculty of Medicine, University of La Frontera, Temuco, Chile.
| | - David Edgar
- Regional Immunology Service, The Royal Hospitals, Belfast Health & Social Care Trust and Queen's University Belfast, Belfast, Northern Ireland, UK
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24
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LaFon DC, Nahm MH. Interlaboratory variability in multiplexed pneumococcal antibody testing. J Allergy Clin Immunol 2018; 143:1255-1257. [PMID: 30468776 DOI: 10.1016/j.jaci.2018.10.057] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 10/10/2018] [Accepted: 10/22/2018] [Indexed: 10/27/2022]
Affiliation(s)
- David C LaFon
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, Ala
| | - Moon H Nahm
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, Ala; Department of Microbiology, University of Alabama at Birmingham, Birmingham, Ala.
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25
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Outpacing the pneumococcus: Antibody dynamics in the first few days following pneumococcal capsular antigen stimulation. Sci Rep 2018; 8:15376. [PMID: 30337597 PMCID: PMC6193966 DOI: 10.1038/s41598-018-33735-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 09/19/2018] [Indexed: 11/08/2022] Open
Abstract
Children in developing countries are frequently exposed to the pneumococcus, but few develop invasive pneumococcal disease (IPD). We test the hypothesis that natural variation exists in the rapidity of IgG responses following exposure to pneumococcal polysaccharides, and that these differences are sufficiently great to affect susceptibility to and outcome of IPD. We recruited children aged 24–36 months, who had recovered from IPD, and age-matched healthy controls and vaccinated them with 1 dose of the 23-valent PPV to mimic natural exposure. We collected serum samples after vaccination and analysed the dynamics of anti-polysaccharide antibody responses to several capsular antigens. Mean IgG response times to different serotypes were 6.4–7.3 days, with standard deviations of 0.9–1.85 days, suggesting a natural range in response times of up to 7 days. Serotype 1 elicited the largest fold-rise, serotype 23F the smallest. The proportion of responses achieved by day 7 was similar in children with a history of IPD and healthy children. There was considerable natural variation in the rapidity of anti-capsular IgG responses extending over 4–7 days. There was no evidence to suggest that children who have experienced IPD respond more slowly to heterologous pneumococcal capsular antigens than do healthy children.
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26
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Pneumococcal vaccination in adult solid organ transplant recipients: A review of current evidence. Vaccine 2018; 36:6253-6261. [PMID: 30217523 DOI: 10.1016/j.vaccine.2018.08.069] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 08/22/2018] [Accepted: 08/27/2018] [Indexed: 12/20/2022]
Abstract
This narrative review summarizes the current literature relating to pneumococcal vaccination in adult solid organ transplant (SOT) recipients, who are at risk of invasive pneumococcal disease (IPD) with its attendant high morbidity and mortality. The effect of the pneumococcal polysaccharide vaccine has been examined in several small cohort studies in SOT recipients, most of which were kidney transplant recipients. The outcomes for these studies have been laboratory seroresponses or functional antibody titers. Overall, in most of these studies the transplant recipients were capable of generating measurable serological responses to pneumococcal vaccination but these responses were less than those of healthy controls. A mathematical model estimated the effectiveness of polysaccharide vaccination in SOT recipients to be one third less than those of patients with HIV. The evidence for the efficacy of the pneumococcal conjugate vaccine in SOT is based on a small number of randomized controlled trials in liver and kidney transplant recipients. These trials demonstrated that SOT recipients mounted a serological response following vaccination however there was no benefit to the use of prime boosting (conjugate vaccine followed by polysaccharide vaccine). Currently there are no randomized studies investigating the clinical protection rate against IPD after pneumococcal vaccination by either vaccine type or linked to vaccine titers or other responses against pneumococcus. Concerns that vaccination may increase the risk of adverse alloresponses such as rejection and generation of donor specific antibodies are not supported by studies examining this aspect of vaccine safety. Pneumococcal vaccination is a potentially important strategy to reduce IPD in SOT recipients and is associated with excellent safety. Current international recommendations are based on expert opinion from conflicting data, hence there is a clear need for further high-quality studies in this high-risk population examining optimal vaccination regimens. Such studies should focus on strategies to optimize functional immune responses.
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Measuring immune responses to pneumococcal vaccines. J Immunol Methods 2018; 461:37-43. [PMID: 30098317 DOI: 10.1016/j.jim.2018.08.002] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 07/25/2018] [Accepted: 08/03/2018] [Indexed: 11/23/2022]
Abstract
Quantitative assays that measure immune response to pneumococcal vaccines are not only important for the evaluation of vaccine immunogenicity and efficacy, but are also utilized in the clinical diagnosis of immune deficiency syndromes. Analytical methods have progressed in order to meet changing demands in both of these areas, from early methods to ELISA, and most recently multiplex bead array assays and opsonophagocytosis assays (OPA). It is necessary to understand the evolution of such techniques and the criteria for their interpretation in order to better inform the application of currently available methods, and to guide future investigation into assay development.
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Dendle C, Stuart RL, Polkinghorne KR, Balloch A, Kanellis J, Ling J, Kummrow M, Moore C, Thursky K, Buttery J, Mulholland K, Gan PY, Holdsworth S, Mulley WR. Seroresponses and safety of 13-valent pneumococcal conjugate vaccination in kidney transplant recipients. Transpl Infect Dis 2018; 20:e12866. [PMID: 29512234 DOI: 10.1111/tid.12866] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 11/06/2017] [Accepted: 11/07/2017] [Indexed: 01/11/2023]
Abstract
BACKGROUND Conjugated pneumococcal vaccine is recommended for kidney transplant recipients, however, their immunogenicity and potential to trigger allograft rejection though generation of de novo anti-human leukocyte antigen antibodies has not been well studied. METHODS Clinically stable kidney transplant recipients participated in a prospective cohort study and received a single dose of 13-valent conjugate pneumococcal vaccine. Anti-pneumococcal IgG was measured for the 13 vaccine serotypes pre and post vaccination and functional anti-pneumococcal IgG for 4 serotypes post vaccination. Anti-human leukocyte antigen antibodies antibodies were measured before and after vaccination. Kidney transplant recipients were followed clinically for 12 months for episodes of allograft rejection or invasive pneumococcal disease. RESULTS Forty-five kidney transplant recipients participated. Median days between pre and post vaccination serology was 27 (range 21-59). Post vaccination, there was a median 1.1 to 1.7-fold increase in anti-pneumococcal IgG antibody concentrations for all 13 serotypes. Kidney transplant recipients displayed a functional antibody titer ≥1:8 for a median of 3 of the 4 serotypes. Post vaccination, there were no de novo anti-human leukocyte antigen antibodies, no episodes of biopsy proven rejection or invasive pneumococcal disease. CONCLUSION A single dose of 13-valent conjugate pneumococcal vaccine elicits increased titers and breadth of functional anti-pneumococcal antibodies in kidney transplant recipients without stimulating rejection or donor-specific antibodies.
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Affiliation(s)
- Claire Dendle
- Centre for Inflammatory Diseases, School of Clinical Sciences, Monash University and Monash Infectious Diseases, Monash Health, Clayton, Vic., Australia
| | - Rhonda L Stuart
- Centre for Inflammatory Diseases, School of Clinical Sciences, Monash University and Monash Infectious Diseases, Monash Health, Clayton, Vic., Australia
| | - Kevan R Polkinghorne
- Centre for Inflammatory Diseases, School of Clinical Sciences, Monash University, Clayton, Vic., Australia.,Department of Nephrology, Monash Medical Centre, Clayton, Vic., Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Prahran, Vic., Australia
| | - Anne Balloch
- Murdoch Children's Research Institute, Parkville, Vic., Australia
| | - John Kanellis
- Centre for Inflammatory Diseases, School of Clinical Sciences, Monash University, Clayton, Vic., Australia.,Department of Nephrology, Monash Medical Centre, Clayton, Vic., Australia
| | - Johnathan Ling
- Department of Nephrology, Monash Medical Centre, Clayton, Vic., Australia
| | - Megan Kummrow
- Victorian Transplantation and Immunogenetics Service, West Melbourne, Vic., Australia
| | - Chelsea Moore
- Victorian Transplantation and Immunogenetics Service, West Melbourne, Vic., Australia
| | - Karin Thursky
- University of Melbourne, Parkville, Vic., Australia.,Victorian Infectious Diseases Service, Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity, Melbourne, Vic., Australia
| | - Jim Buttery
- Department of Epidemiology and Preventive Medicine, Monash University, Prahran, Vic., Australia.,Department of Infection and Immunity, Monash Children's Hospital, Monash Health, Melbourne, Vic., Australia
| | - Kim Mulholland
- Murdoch Children's Research Institute, Parkville, Vic., Australia
| | - Poh-Yi Gan
- Centre for Inflammatory Diseases, School of Clinical Sciences, Monash University, Clayton, Vic., Australia
| | - Stephen Holdsworth
- Centre for Inflammatory Diseases, School of Clinical Sciences, Monash University, Clayton, Vic., Australia.,Department of Nephrology, Monash Medical Centre, Clayton, Vic., Australia
| | - William R Mulley
- Centre for Inflammatory Diseases, School of Clinical Sciences, Monash University, Clayton, Vic., Australia.,Department of Nephrology, Monash Medical Centre, Clayton, Vic., Australia
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Perez E, Bonilla FA, Orange JS, Ballow M. Corrigendum: Specific Antibody Deficiency: Controversies in Diagnosis and Management. Front Immunol 2018; 9:450. [PMID: 29576764 PMCID: PMC5863213 DOI: 10.3389/fimmu.2018.00450] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 02/20/2018] [Indexed: 11/17/2022] Open
Abstract
[This corrects the article on p. 586 in vol. 8, PMID: 28588580.].
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Affiliation(s)
- Elena Perez
- Allergy Associates of the Palm Beaches, North Palm Beach, FL, United States
| | | | - Jordan S. Orange
- Texas Children’s Hospital, Baylor College of Medicine, Houston, TX, United States
| | - Mark Ballow
- Division of Allergy and Immunology, Department of Pediatrics, University of South Florida, Saint Petersburg, FL, United States
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30
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Fernández F, Campillay R, Palma V, Norambuena X, Quezada A, Inostroza J. [Specific antibody deficiency: Primary immunodeficiency associated to respiratory allergy]. ACTA ACUST UNITED AC 2017; 88:252-257. [PMID: 27614984 DOI: 10.1016/j.rchipe.2016.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 08/17/2016] [Indexed: 11/19/2022]
Abstract
Specific antibody deficiency (SAD) with normal immunoglobulin and normal B cells is a primary immunodeficiency characterized by reduced ability to produce antibodies to specific antigens especially polysaccharides. OBJECTIVE To describe the characteristics of patients diagnosed with SAD emphasizing the association between primary immunodeficiency and allergic diseases. PATIENTS AND METHOD Descriptive study showing patients with SAD treated at a public hospital between August 2007 and July 2015. Other secondary or primary immunodeficiency was discarded. The diagnosis of SAD was based on recurrent infections and abnormal response to pneumococcal polysaccharide vaccine assessed by specific IgG to 10 pneumococcal serotypes. RESULTS Twelve patients were included, 4 males, mean age 6 years, recurrent pneumonia predominated (91.7%) as well as other respiratory and invasive infections. All patients with SAD had associated asthma, 11 had allergic rhinitis, and other allergies. Three patients did not respond to any of the 10 serotypes contained in pneumococcal polysaccharide vaccine, and those who responded were with low titers. Treatment with conjugate pneumococcal vaccine was favorable in 11/12 patients. CONCLUSION In children older than 2 years with recurrent respiratory infections or invasive S. pneumoniae infections with normal immunoglobulin we recommend to investigate SAD, especially if they have a concurrent allergic disease.
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Affiliation(s)
| | | | - Valeria Palma
- Programa de Especialistas en Inmunología, Santiago, Chile
| | - Ximena Norambuena
- Servicio de Pediatría, Hospital Dr. Exequiel González Cortés, Santiago, Chile
| | - Arnoldo Quezada
- Departamento de Pediatría Sur, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Jaime Inostroza
- Centro Jeffrey Modell para Diagnóstico e Investigación en Inmunodeficiencias Primarias, Facultad de Medicina, Universidad de La Frontera, Temuco, Chile
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31
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Lopez B, Bahuaud M, Fieschi C, Mehlal S, Jeljeli M, Rogeau S, Brabant S, Deleplancque AS, Dubucquoi S, Poizot S, Terriou L, Launay D, Batteux F, Labalette M, Lefèvre G. Value of the Overall Pneumococcal Polysaccharide Response in the Diagnosis of Primary Humoral Immunodeficiencies. Front Immunol 2017; 8:1862. [PMID: 29326723 PMCID: PMC5742330 DOI: 10.3389/fimmu.2017.01862] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 12/07/2017] [Indexed: 01/04/2023] Open
Abstract
Background An overall response assay [OVA, based on a 23-valent pneumococcal polysaccharide vaccine (PPV23)] is widely used to screen for anti-pneumococcal antibodies. Given the heterogeneity of response from one polysaccharide (PS) to another, a World Health Organization-standardized serotype-specific enzyme-linked immunosorbent assay (SSA) is considered to be the only reliable method for testing anti-PS antibody responses in individuals with suspected primary immunodeficiencies (PIDs). Objective To evaluate the OVA relative to the reference SSA. Methods Serum samples of adult patients referred for a suspected PID were collected before and then 4–8 weeks after immunization with PPV23. The anti-pneumococcal response was systematically assessed with an SSA (7–16 serotypes) and interpreted according to the American Academy of Asthma, Allergy and Immunology’s current guidelines. We used receiver operating characteristic curves and agreement indices to assess the OVA’s diagnostic value in a first cohort. In order to validate these findings, a second (validation) cohort was then prospectively included. Results Sixty-two adult patients were included, and 42 (67.7%) were defined as poor responders according to the SSA. Only the post-immunization titer in the OVA was able to correctly identify poor responders; a titer below 110 mg/L gave a positive predictive value of 100% [identifying 24 (57.1%) of the 42 poor responders], and similar levels of diagnostic performance were observed in the validation cohort. The pre-vaccination antibody titer, the post/pre-vaccination antibody titer ratio and a post-vaccination titer above 110 mg/L in the OVA were not predictive of the response in the SSA. Conclusion A post-vaccination antibody titer below 110 mg/L in the OVA was constantly associated with a poor PPV23 response using the SSA. In all other cases, SSA is the only reliable method for assessing diagnostic vaccination with PPV23.
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Affiliation(s)
- Benjamin Lopez
- CHU Lille, Institut d'Immunologie, Lille, France.,Univ. Lille, U995 - LIRIC - Lille Inflammation Research International Center, Lille, France
| | - Mathilde Bahuaud
- CHU Hôpital Cochin, Laboratoire d'Immunologie Biologique, Plateforme d'Immuno-monitoring Vaccinal, AP-HP, Paris, France
| | - Claire Fieschi
- Sorbonne Paris Cité, Université Paris Diderot, Hôpital Saint-Louis, Service d'Immunopathologie Clinique, Paris, France
| | - Souad Mehlal
- CHU Hôpital Cochin, Laboratoire d'Immunologie Biologique, Plateforme d'Immuno-monitoring Vaccinal, AP-HP, Paris, France
| | - Mohamed Jeljeli
- CHU Hôpital Cochin, Laboratoire d'Immunologie Biologique, Plateforme d'Immuno-monitoring Vaccinal, AP-HP, Paris, France
| | - Stéphanie Rogeau
- CHU Lille, Institut d'Immunologie, Lille, France.,Univ. Lille, U995 - LIRIC - Lille Inflammation Research International Center, Lille, France
| | | | | | - Sylvain Dubucquoi
- CHU Lille, Institut d'Immunologie, Lille, France.,Univ. Lille, U995 - LIRIC - Lille Inflammation Research International Center, Lille, France
| | | | - Louis Terriou
- Univ. Lille, U995 - LIRIC - Lille Inflammation Research International Center, Lille, France.,CHU Lille, Département de Médecine Interne et Immunologie Clinique, Centre National de Référence Maladies Systémiques et Auto-immunes Rares, Lille, France
| | - David Launay
- CHU Lille, Département de Médecine Interne et Immunologie Clinique, Centre National de Référence Maladies Systémiques et Auto-immunes Rares, Lille, France
| | - Frédéric Batteux
- CHU Hôpital Cochin, Laboratoire d'Immunologie Biologique, Plateforme d'Immuno-monitoring Vaccinal, AP-HP, Paris, France
| | - Myriam Labalette
- CHU Lille, Institut d'Immunologie, Lille, France.,Univ. Lille, U995 - LIRIC - Lille Inflammation Research International Center, Lille, France
| | - Guillaume Lefèvre
- CHU Lille, Institut d'Immunologie, Lille, France.,Univ. Lille, U995 - LIRIC - Lille Inflammation Research International Center, Lille, France.,CHU Lille, Département de Médecine Interne et Immunologie Clinique, Centre National de Référence Maladies Systémiques et Auto-immunes Rares, Lille, France
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32
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Ibrahim DD, Ousmane S, Moumouni K, Mahamane AE. Measurement of pneumococcal IgG antibody, carriage and infection with Streptococcus pneumoniae in children under five years of age with acute respiratory infection in Niger. J Infect Public Health 2017; 10:657-660. [PMID: 28668654 DOI: 10.1016/j.jiph.2017.05.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Revised: 05/02/2017] [Accepted: 05/30/2017] [Indexed: 10/19/2022] Open
Abstract
Pneumonia is the major cause of mortality in children under five years. A total of 751 children aged 1-59 months admitted for acute respiratory infection were included in this study. Pneumococcal serum IgG antibody was determined by ELISA. Carriage of Streptococcus pneumoniae was determined by molecular analyses of nasopharyngeal swabbings, and the rapid urinary diagnostic test Binax NOW®Sp was used for detection of pneumococcal antigen in urine. A total of 224 (29.8%) children had vaccination record books, and among them, 186 (83%) were vaccinated with the 23-Valent Pneumococcal Polysaccharide Vaccine (PPSV-23), 7 (3%) were vaccinated with the 13-Valent Pneumococcal Conjugate Vaccine (PCV-13), and 31 (14%) had not been vaccinated. IgG levels against pneumococcal polysaccharide were ≥1.3μg/mL in most of the children (99.4%). The carriage rate of S. pneumoniae was 39%, and the Binax NOW®Sp test was positive in 26% of children. There was no significant variation between the means of IgG concentrations against pneumococcal polysaccharides as related to vaccination status, age and nasopharyngeal carriage of S. pneumoniae. However, there was a weak positive correlation between age and level of IgG (r=0.08; p=0.021), and there was a significant variation (p=0.038) of the IgG level according to presence of S. pneumoniae antigen in urine. The presence of S. pneumoniae antigen in urine is significantly (p≤0.01) higher in children with nasopharyngeal carriage of S. pneumoniae (40%) than non-carriers (20%). This study shows that S. pneumoniae has high circulation in children under the age of five years either through infection or carriage.
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Affiliation(s)
- Dan D Ibrahim
- Centre de Recherche Médicale et Sanitaire (CERMES),634 Boulevard de la Nation YN034, BP 10 887, Niamey, Niger.
| | - Sani Ousmane
- Centre de Recherche Médicale et Sanitaire (CERMES),634 Boulevard de la Nation YN034, BP 10 887, Niamey, Niger
| | - Kamayé Moumouni
- Hôpital National de Niamey (HNN), Service de pédiatrie A, BP 238, Niamey, Niger
| | - Ali E Mahamane
- Centre de Recherche Médicale et Sanitaire (CERMES),634 Boulevard de la Nation YN034, BP 10 887, Niamey, Niger
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33
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Perez E, Bonilla FA, Orange JS, Ballow M. Specific Antibody Deficiency: Controversies in Diagnosis and Management. Front Immunol 2017; 8:586. [PMID: 28588580 PMCID: PMC5439175 DOI: 10.3389/fimmu.2017.00586] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 05/02/2017] [Indexed: 11/17/2022] Open
Abstract
Specific antibody deficiency (SAD) is a primary immunodeficiency disease characterized by normal immunoglobulins (Igs), IgA, IgM, total IgG, and IgG subclass levels, but with recurrent infection and diminished antibody responses to polysaccharide antigens following vaccination. There is a lack of consensus regarding the diagnosis and treatment of SAD, and its clinical significance is not well understood. Here, we discuss current evidence and challenges regarding the diagnosis and treatment of SAD. SAD is normally diagnosed by determining protective titers in response to the 23-valent pneumococcal polysaccharide vaccine. However, the definition of an adequate response to immunization remains controversial, including the magnitude of response and number of pneumococcal serotypes needed to determine a normal response. Confounding these issues, anti-polysaccharide antibody responses are age- and probably serotype dependent. Therapeutic strategies and options for patients with SAD are often based on clinical experience due to the lack of focused studies and absence of a robust case definition. The mainstay of therapy for patients with SAD is antibiotic prophylaxis. However, there is no consensus regarding the frequency and severity of infections warranting antibiotic prophylaxis and no standardized regimens and no studies of efficacy. Published expert guidelines and opinions have recommended IgG therapy, which are supported by observations from retrospective studies, although definitive data are lacking. In summary, there is currently a lack of evidence regarding the efficacy of therapeutic strategies for patients with SAD. We believe that it is best to approach each patient as an individual and progress through diagnostic and therapeutic interventions together with existing practice guidelines.
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Affiliation(s)
- Elena Perez
- Allergy Associates of the Palm Beaches, North Palm Beach, FL, USA
| | | | - Jordan S. Orange
- Texas Children’s Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Mark Ballow
- Division of Allergy and Immunology, Department of Pediatrics, University of South Florida, Saint Petersburg, FL, USA
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34
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Repeat pneumococcal polysaccharide vaccine in Indigenous Australian adults is associated with decreased immune responsiveness. Vaccine 2017; 35:2908-2915. [DOI: 10.1016/j.vaccine.2017.04.040] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 04/08/2017] [Accepted: 04/13/2017] [Indexed: 11/22/2022]
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35
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Quezada A, Maggi L, Norambuena X, Inostroza J, Quevedo F. Response to pneumococcal polysaccharide vaccine in children with asthma, and children with recurrent respiratory infections, and healthy children. Allergol Immunopathol (Madr) 2016; 44:376-81. [PMID: 27255476 DOI: 10.1016/j.aller.2016.01.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Revised: 01/11/2016] [Accepted: 01/29/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND To analyse specific immune response to the 23-valent pneumococcal polysaccharide vaccine by measuring pneumococcal antibodies in children with asthma and with respiratory recurrent infection (RRI) as compared to healthy children. METHODS The study included 60 children, divided into three groups: 20 with asthma, 20 with RRI, and 20 healthy controls. Post-vaccination specific IgG antibodies against 10 pneumococcal serotypes (S1, S3, S4, S5, S6B, S9V, S14, S18C, S19F, and S23F) contained in the 23-valent pneumococcal polysaccharide vaccine (PPV) were measured. A specific IgG concentration ≥1.3μg/mL was considered a protective response to the vaccine. For statistical analysis, levels of specific IgG antibodies against each of the 10 pneumococcal serotypes were compared across the three groups of children using the x(2) test. RESULTS All of the children showed antipneumococcal antibody levels >1.3μg/mL for over 70% of the serotypes, considered within the normal range of response. Average IgG antibody levels and percentages of children protected were statistically comparable among the three groups studied. CONCLUSION The asthmatic children without RRI had pneumococcal antibody levels and percentages of serotype-specific protection to PPV comparable to those of healthy children. Asthmatic children with recurrent infections should be evaluated for specific antibody deficiency (SAD). Because asthma patients are at high risk for invasive pneumococcal infections, it would be worthwhile to explore systematic administration of PPV in children over the age of two years who have not received a pneumococcal conjugate vaccine, considering the positive response to PPV reported here.
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Affiliation(s)
- A Quezada
- Department of Pediatrics, School of Medicine, University of Chile, Santiago de Chile, Chile.
| | - L Maggi
- Department of Pediatrics, School of Medicine, University of Chile, Santiago de Chile, Chile
| | - X Norambuena
- Children's Hospital, Dr. Exequiel Gonzalez Cortes, Santiago de Chile, Chile
| | - J Inostroza
- Clinical Laboratory, University of La Frontera, Temuco, Chile
| | - F Quevedo
- Public Health School University of Chile, Santiago de Chile, Chile
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36
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Schaballie H, Wuyts G, Dillaerts D, Frans G, Moens L, Proesmans M, Vermeulen F, De Boeck K, Meyts I, Bossuyt X. Effect of previous vaccination with pneumococcal conjugate vaccine on pneumococcal polysaccharide vaccine antibody responses. Clin Exp Immunol 2016; 185:180-9. [PMID: 26939935 DOI: 10.1111/cei.12784] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/29/2016] [Indexed: 11/30/2022] Open
Abstract
During the past 10 years, pneumococcal conjugate vaccine (PCV) has become part of the standard childhood vaccination programme. This may impact upon the diagnosis of polysaccharide antibody deficiency by measurement of anti-polysaccharide immunoglobulin (Ig)G after immunization with unconjugated pneumococcal polysaccharide vaccine (PPV). Indeed, contrary to PPV, PCV induces a T-dependent, more pronounced memory response. The antibody response to PPV was studied retrospectively in patients referred for suspected humoral immunodeficiency. The study population was divided into four subgroups based on age (2-5 years versus ≥ 10 years) and time tested (1998-2005 versus 2010-12). Only 2-5-year-old children tested in 2010-12 had been vaccinated with PCV prior to PPV. The PCV primed group showed higher antibody responses for PCV-PPV shared serotypes 4 and 18C than the unprimed groups. To a lesser extent, this was also found for non-PCV serotype 9N, but not for non-PCV serotypes 19A and 8. Furthermore, PCV-priming elicited a higher IgG2 response. In conclusion, previous PCV vaccination affects antibody response to PPV for shared serotypes, but can also influence antibody response to some non-PCV serotypes (9N). With increasing number of serotypes included in PCV, the diagnostic assessment for polysaccharide antibody deficiency requires careful selection of serotypes that are not influenced by prior PCV (e.g. serotype 8). Further research is needed to identify more serotypes that are not influenced.
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Affiliation(s)
- H Schaballie
- Department of Pediatrics, University Hospitals Leuven.,Department of Microbiology and Immunology, KU Leuven - University of Leuven
| | - G Wuyts
- Department of Microbiology and Immunology, KU Leuven - University of Leuven
| | - D Dillaerts
- Department of Microbiology and Immunology, KU Leuven - University of Leuven
| | - G Frans
- Department of Microbiology and Immunology, KU Leuven - University of Leuven.,Department of Laboratory Medicine, University Hospitals Leuven, Belgium
| | - L Moens
- Department of Microbiology and Immunology, KU Leuven - University of Leuven
| | - M Proesmans
- Department of Pediatrics, University Hospitals Leuven
| | - F Vermeulen
- Department of Pediatrics, University Hospitals Leuven
| | - K De Boeck
- Department of Pediatrics, University Hospitals Leuven
| | - I Meyts
- Department of Pediatrics, University Hospitals Leuven.,Department of Microbiology and Immunology, KU Leuven - University of Leuven
| | - X Bossuyt
- Department of Microbiology and Immunology, KU Leuven - University of Leuven.,Department of Laboratory Medicine, University Hospitals Leuven, Belgium
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37
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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. Pediatr Infect Dis J 2016; 35:205-8. [PMID: 26517331 DOI: 10.1097/inf.0000000000000964] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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.
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38
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Knutsen AP, Leiva LE, Caruthers C, Rodrigues J, Sorensen RU. Streptococcus pneumoniae antibody titres in patients with primary antibody deficiency receiving intravenous immunoglobulin (IVIG) compared to subcutaneous immunoglobulin (SCIG). Clin Exp Immunol 2015; 182:51-6. [PMID: 26230522 PMCID: PMC4578508 DOI: 10.1111/cei.12665] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Revised: 05/29/2015] [Accepted: 06/07/2015] [Indexed: 11/28/2022] Open
Abstract
Intravenous immunoglobulin (IVIG) and subcutaneous immunoglobulin (SCIG) are effective in the treatment of patients with primary antibody deficiency disorders (PAD). The purpose of this study was to evaluate Streptococcus pneumoniae (Spn) antibody titres to 14 serotypes in patients receiving IVIG compared to SCIG and to correlate Spn antibody levels to clinical outcome. The doses of immunoglobulin (Ig)G/kg/month were similar in both IVIG and SCIG groups. In 11 patients treated with IVIG, Spn antibody titres were ≥ 1·3 μg/ml to 99·4 ± 2·1% of the 14 serotypes at peak IVIG but decreased to 66·9 ± 19·8% at trough IVIG. Loss of Spn titres ≥ 1·3 μg/ml was most frequent for Spn serotypes 1, 4, 9V and 23. This correlated with lower Spn antibody titres to these serotypes at peak IVIG compared to the other serotypes. In 13 patients treated with SCIG, Spn antibody titres were protective to 58·2 ± 23·3% of the serotypes 3-5 days after infusion, similar to trough IVIG. Similarly, the Spn serotypes with the least protective percentages were the same as the ones observed in trough IVIG. There were no annualized serious bacterial infections (aSBI) in either group. However, there were significantly decreased annualized other infections (aOI) in the SCIG group compared to the IVIG-treated group, 0·8 ± 0·7 versus 2·2 ± 1·2 infections/patient/year (P = 0·004). Breakthrough aOI did not correlate with protective or higher serum Spn antibody titres.
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Affiliation(s)
- A P Knutsen
- Department of Pediatrics, Division Allergy & Immunology, Jeffrey Modell Diagnostic Center for Primary Immunodeficiencies, Saint Louis UniversitySt Louis, MO
| | - L E Leiva
- Department of Pediatrics, Allergy/Immunology Division, Jeffrey Modell Diagnostic Center for Primary Immunodeficiencies, Louisiana State University Health Sciences CenterNew Orleans, LA, USA
| | - C Caruthers
- Department of Pediatrics, Division Allergy & Immunology, Jeffrey Modell Diagnostic Center for Primary Immunodeficiencies, Saint Louis UniversitySt Louis, MO
| | - J Rodrigues
- Department of Pediatrics, Division Allergy & Immunology, Jeffrey Modell Diagnostic Center for Primary Immunodeficiencies, Saint Louis UniversitySt Louis, MO
| | - R U Sorensen
- Department of Pediatrics, Allergy/Immunology Division, Jeffrey Modell Diagnostic Center for Primary Immunodeficiencies, Louisiana State University Health Sciences CenterNew Orleans, LA, USA
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Abstract
Patients with specific antibody deficiency (SAD) have a deficient immunologic response to polysaccharide antigens. Such patients experience sinopulmonary infections with increased frequency, duration, or severity compared with the general population. SAD is definitively diagnosed by immunologic challenge with a pure polysaccharide vaccine in patients 2 years old and older who have otherwise intact immunity, using the 23-valent pneumococcal polysaccharide vaccine as the current gold standard. Specific antibody deficiencies comprise multiple immunologic phenotypes. Treatment must be tailored based on the severity of symptoms. Most patients have a good prognosis. The deficiency may resolve over time, especially in children.
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Clay ELJ, Burrell T, Belhorn T, Redding-Lallinger R. Immunogenicity of pneumococcal vaccination in a patient with sickle hemoglobinopathy: a case report. Clin Case Rep 2015; 3:618-21. [PMID: 26273454 PMCID: PMC4527808 DOI: 10.1002/ccr3.276] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Revised: 10/18/2014] [Accepted: 12/04/2014] [Indexed: 11/13/2022] Open
Abstract
Despite decrease in morbidity and mortality from invasive pneumococcal disease (IPD), individuals with asplenia remain at risk for IPD compared to the general population. This report describes a young adult with hemoglobin SD and documented splenic autoinfarction with pneumococcal sepsis, meningitis, and pneumonia within seven months of immunization with PPSV-23.
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Affiliation(s)
- E Leila Jerome Clay
- Division of Hematology and Oncology, Departments of Pediatrics and Internal Medicine, Georgia Regents UniversityAugusta, Georgia, USA
| | - Tierra Burrell
- Department of Pediatrics, University of CincinnatiCincinnati, Ohio, USA
| | - Thomas Belhorn
- Division of Infectious Disease, Department of Pediatrics, University of North Carolina School of MedicineChapel Hill, North Carolina, USA
| | - Rupa Redding-Lallinger
- Division of Hematology and Oncology, Departments of Pediatrics and Internal Medicine, University of North Carolina School of MedicineChapel Hill, North Carolina, USA
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Abstract
BACKGROUND Recurrent invasive pneumococcal disease (rIPD) occurs mostly in children with an underlying disease, but some cases remain unexplained. Immunodeficiency has been described in children with rIPD, but the prevalence is unknown. We used a nationwide registry of all laboratory-confirmed cases of rIPD to identify cases of unexplained rIPD and examine them for immunodeficiency. METHODS Cases of rIPD in children 0-15 years of age from 1980 to 2008 were identified. Children without an obvious underlying disease were screened for complement function, T-cell, B-cell, natural killer--cell counts and concentration of immunoglobulins. B-cell function was evaluated by measuring antibody response to polysaccharide-based pneumococcal vaccination and the extent of fraction of somatic hypermutation. Toll-Like receptor (TLR) signaling function and mutations in key TLR-signaling molecules were examined. RESULTS In total, rIPD were observed in 54 children (68 cases of rIPD of 2192 IPD cases). Children with classical risk factors for IPD were excluded, and among the remaining 22 children, 15 were eligible for analysis. Of these 6 (40%) were complement C2-deficient. Impaired vaccination response was found in 6 children of whom 3 were C2 deficient. One patient had a severe TLR signaling dysfunction. No mutations in IRAK4, IKBKG or MYD88 were found. CONCLUSION Of an unselected cohort of children with rIPD at least 11% were C2 deficient. Data suggest that screening for complement deficiencies and deficient antibody response to pneumococcal vaccines in patients with more than 1 episode of IPD is warranted.
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Quezada A, Norambuena X, Inostroza J, Rodríguez J. Specific antibody deficiency with normal immunoglobulin concentration in children with recurrent respiratory infections. Allergol Immunopathol (Madr) 2015; 43:292-7. [PMID: 25498324 DOI: 10.1016/j.aller.2014.07.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Revised: 07/22/2014] [Accepted: 07/31/2014] [Indexed: 12/13/2022]
Abstract
BACKGROUND Response to polysaccharide antigens is a test to evaluate the immunological competence of children with recurrent respiratory infections (RRI) of unknown cause and no other immune system abnormality. In order to detect specific antibody deficiency (SAD), a group of children with RRI without other immunodeficiency were prospectively studied. METHODS We included 20 children (12 male), age range 3-14 years, with six or more annual episodes of respiratory infections (RI); one or more monthly episodes of RI during the winter months; or three or more annual episodes of lower RI. The children were immunised with 23-valent polysaccharide anti-pneumococcal vaccine, and ELISA was used to measure anti-polysaccharide IgG antibody levels for 10 pneumococcal serotypes at baseline (T0), and 45 days (T1) and one year post-immunisation (T2). Post-immunisation response above 1.3 μg/ml for more than 50% of the serotypes was considered normal for children 2-5 years, and for more than 70% of the serotypes in children older than 5 years. RESULTS At T1 19/20 children showed a normal response for their age, and only one patient showed a deficient response, suggestive of classic moderate SAD. At T2, 8/20 patients showed deficient responses, suggestive of impaired persistence of specific antibodies. There was a noteworthy association between deficient response and asthma and allergic rhinitis. CONCLUSIONS We propose first ruling out local or systemic causes, then performing serum immunoglobulin IgM, IgG, IgA, IgE and IgG subclass levels, and finally measuring response to polysaccharide pneumococcal antigens for detection of SAD.
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43
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Modulatory Role of Intravenous Gammaglobulin (IgIV) on the in vitro Antibody Response to a Pneumococcal Polysaccharide Antigen. J Clin Immunol 2014; 35:206-12. [DOI: 10.1007/s10875-014-0120-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Accepted: 12/04/2014] [Indexed: 11/27/2022]
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Browning MJ, Lim MT, Kenia P, Whittle M, Doffinger R, Barcenas-Morales G, Kumararatne D, Viskaduraki M, O'Callaghan C, Gaillard EA. Pneumococcal polysaccharide vaccine responses are impaired in a subgroup of children with cystic fibrosis. J Cyst Fibros 2014; 13:632-8. [DOI: 10.1016/j.jcf.2014.02.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Revised: 01/30/2014] [Accepted: 02/06/2014] [Indexed: 11/26/2022]
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Podjasek JC, Jung JA, Kita H, Park MA, Juhn YJ. The FACT score in predicting pneumococcal antibody levels in asthmatics. J Asthma 2014; 52:370-5. [PMID: 25329680 DOI: 10.3109/02770903.2014.974815] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND There is no measure currently available to identify asthmatics with potential immune incompetence. OBJECTIVE We propose use of a novel scoring system called the FACT score, which is formulated based on four parameters: (1) Family history of asthma, (2) Atopic conditions, (3) Bacterial colonization and (4) Th1 versus Th2 immune profile. METHODS This was a cross-sectional study involving 16 asthmatics and 14 non-asthmatics. The first two parameters of the FACT score were obtained via a chart review and interview. For the third parameter, nasopharyngeal swab samples were cultured. The ratio of interleukin-5 to interferon-gamma for each patient was measured by peripheral blood mononuclear cells cultured with house dust mite. Antibodies to 23 pneumococcal antigens were used for humoral immunity. RESULTS The FACT scores for asthmatics (mean ± SD: 5.2 ± 1.87) were higher than those for non-asthmatics (mean ± SD: 3.3 ± 1.5) (p = 0.008). Of the 16 asthmatics, 7 (44%) had 12 or more positive serotype-specific polysaccharide antibodies, whereas 12 of 14 (86%) of non-asthmatics subjects had 12 or more positive serotype-specific polysaccharide antibodies (p = 0.014). Overall, the FACT score was inversely correlated with the number of positive serotype-specific antibody levels [rho (ρ) = -0.38, p = 0.04]. The proportions of subjects with 12 or more positive serotype-specific antibodies among non-asthmatics and asthmatics below and above the median of the FACT scores were 86, 50 and 38%, respectively (p = 0.052). CONCLUSIONS The FACT score may help us identify a subset of asthmatics with immune incompetence. Study findings need to be replicated in a larger study.
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Affiliation(s)
- Jenna C Podjasek
- Division of Allergic Diseases, Mayo Clinic , Rochester, MN , USA
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46
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Are complement deficiencies really rare? Overview on prevalence, clinical importance and modern diagnostic approach. Mol Immunol 2014; 61:110-7. [DOI: 10.1016/j.molimm.2014.06.030] [Citation(s) in RCA: 132] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Revised: 06/18/2014] [Accepted: 06/23/2014] [Indexed: 01/18/2023]
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47
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Duchamp M, Sterlin D, Diabate A, Uring-Lambert B, Guérin-El Khourouj V, Le Mauff B, Monnier D, Malcus C, Labalette M, Picard C. B-cell subpopulations in children: National reference values. IMMUNITY INFLAMMATION AND DISEASE 2014; 2:131-40. [PMID: 25505547 PMCID: PMC4257758 DOI: 10.1002/iid3.26] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Revised: 05/15/2014] [Accepted: 05/17/2014] [Indexed: 12/15/2022]
Abstract
Peripheral B-lymphocytes undergo a series of changes during the first few years of life. Encounters with foreign antigens lead to maturation and differentiation. Several primary antibody deficiencies (PADs) affecting B-cell development are associated with abnormalities in the composition and/or differentiation of B-cell compartments. The most recent international classifications of primary immunodeficiencies (PIDs) and common variable immunodeficiencies (CVID) have highlighted the importance of B-cell immunophenotyping and age-specific reference intervals for diagnostic purposes. We established national reference values for memory B-cell subpopulations, on the basis of CD27 and surface IgD expression in the peripheral blood of 242 healthy children. We report here the absolute counts and percentages of naive, switched and non-switched memory B-cells for seven age groups, from neonates to adults. We found that the naive B-cells percentage declined between the ages of 6 months and 8 years, after which it remained stable at about 70–80%. Memory B-cells are already present at birth and their numbers increase throughout childhood, stabilizing between the ages of 12 and 18 years. The definition of reference intervals for pediatric B-cell levels should facilitate the screening and diagnosis of various B-cell immunodeficiencies. This multicenter study, providing national reference values, should thus facilitate immunological diagnosis in children.
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Affiliation(s)
- Marie Duchamp
- Study Center of Primary Immunodeficiencies, Assistance Publique-Hôpitaux de Paris (APHP), Necker Hospital Paris, France
| | - Delphine Sterlin
- Study Center of Primary Immunodeficiencies, Assistance Publique-Hôpitaux de Paris (APHP), Necker Hospital Paris, France
| | - Aminata Diabate
- Study Center of Primary Immunodeficiencies, Assistance Publique-Hôpitaux de Paris (APHP), Necker Hospital Paris, France
| | | | | | - Brigitte Le Mauff
- Laboratory of Immunology, Caen Hospital, Université de Caen Basse Normandie Caen, France
| | - Delphine Monnier
- Laboratory of Immunology, Cell Therapy and Hematopoiesis, Pontchaillou Hospital Rennes, France
| | - Christophe Malcus
- Laboratory of Immunology, Hospices Civils de Lyon, Edouard Herriot Hospital Lyon, France
| | | | - Capucine Picard
- Study Center of Primary Immunodeficiencies, Assistance Publique-Hôpitaux de Paris (APHP), Necker Hospital Paris, France ; Laboratory of Human Genetics of Infectious Diseases, Necker Branch, INSERM UMR 1163, Necker Medical School, Imagine Institute, Paris Descartes University-Sorbonne Paris Cité Paris, France ; Centre de référence des déficits immunitaires héréditaires (CEREDIH), APHP, Necker Hospital Paris, France
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48
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Albin S, Cunningham-Rundles C. An update on the use of immunoglobulin for the treatment of immunodeficiency disorders. Immunotherapy 2014; 6:1113-26. [PMID: 25428649 PMCID: PMC4324501 DOI: 10.2217/imt.14.67] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
For patients with significant antibody deficiencies, immunoglobulin therapy is the mainstay of treatment as it significantly reduces both the frequency and severity of infections. The formulations and delivery methods of immunoglobulin have evolved over time, and continued improvements have allowed for increased access to this effective medication. This review is an update on the current status of immunoglobulin therapy in immunodeficiency disorders, and discusses the mechanisms, forms and dosing, and indications for immunoglobulin replacement.
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Affiliation(s)
- Stephanie Albin
- Division of Allergy & Clinical Immunology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Charlotte Cunningham-Rundles
- Division of Allergy & Clinical Immunology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
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Tuerlinckx D, Florkin B, Ferster A, De Schutter I, Chantrain C, Haerynck F, Philippet P, Strengers P, Laub R. Pneumococcal antibody levels in children with PID receiving immunoglobulin. Pediatrics 2014; 133:e154-62. [PMID: 24366995 DOI: 10.1542/peds.2013-1155] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Clinical data are lacking on optimal levels of specific antipneumococcal antibodies (PnPsAbs) in patients with primary immunodeficiency (PID) receiving intravenous immunoglobulin (IVIG) replacement. Objectives were to conduct a prospective multicenter study providing data on total immunoglobulin G (IgG) and peak/trough levels of PnPsAbs specifically targeting the 16 most prevalent pneumococcal serotypes in IVIG-treated children with PID; to compare trough PnPsAb levels with those measured in healthy adults and the IVIG product; and to evaluate PnPsAb protection correlates with thresholds based on World Health Organization. METHODS Patients received 7 consecutive IVIG infusions. Total IgG and PnPsAb levels were determined on plasma samples obtained before and after infusion. RESULTS Twenty-two children with PID were treated with IVIG (mean weekly dose: 0.10 g/kg). The mean trough and peak levels of total IgG were 7.77 and 13.93 g/L, respectively. Trough and peak geometric mean concentrations and distribution curves differed between serotypes and showed wide dispersion (0.17-7.96 µg/mL). In patients (89%-100%), antibodies against most serotypes reached trough levels ≥ 0.2 µg/mL, a threshold considered protective against invasive pneumococcal infection. For several serotypes, trough levels reached ≥ 1.0 to 1.3 µg/mL, the level found in adults. Trough geometric mean concentrations correlated well with the PnPsAb contents of the IVIG product. CONCLUSIONS In IVIG-treated children with PID, protective PnPsAb levels for most pathogenic serotypes were obtained. A correlation was observed between PnPsAb levels in patients and in the IVIG product. This offers the potential to improve infection prevention by adapting the IVIG product and dose according to epidemiology.
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Affiliation(s)
- David Tuerlinckx
- Department of Pediatrics, Université Catholique de Louvain, CHU Mont-Godinne, 5530 Yvoir, Belgium.
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50
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Ameratunga R, Woon ST, Gillis D, Koopmans W, Steele R. New diagnostic criteria for common variable immune deficiency (CVID), which may assist with decisions to treat with intravenous or subcutaneous immunoglobulin. Clin Exp Immunol 2013; 174:203-11. [PMID: 23859429 DOI: 10.1111/cei.12178] [Citation(s) in RCA: 137] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2013] [Indexed: 01/15/2023] Open
Abstract
Common variable immune deficiency (CVID) is the most frequent symptomatic primary immune deficiency in adults. The standard of care is intravenous immunoglobulin (IVIG) or subcutaneous immunoglobulin (scIG) therapy. The cause of CVID is currently unknown, and there is no universally accepted definition of CVID. This creates problems in determining which patients will benefit from IVIG/scIG treatment. In this paper, we review the difficulties with the commonly used European Society of Immune Deficiencies (ESID) and the Pan American Group for Immune Deficiency (PAGID) definition of CVID. We propose new criteria for the diagnosis of CVID, which are based on recent scientific discoveries. Improved diagnostic precision will assist with treatment decisions including IVIG/scIG replacement. We suggest that asymptomatic patients with mild hypogammaglobulinaemia are termed hypogammaglobulinaemia of uncertain significance (HGUS). These patients require long-term follow-up, as some will evolve into CVID.
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Affiliation(s)
- R Ameratunga
- Department of Virology and Immunology, Auckland City Hospital, Auckland, New Zealand; Department of Clinical Immunology, Auckland City Hospital, Auckland, New Zealand
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