Changes in pneumococcal carriage prevalence and factors associated with carriage in Norwegian children, four years after introduction of PCV13

Background

Streptococcus pneumoniae carriage is often asymptomatic but can cause invasive pneumococcal disease. Pneumococcal carriage is a prerequisite for disease, with children as main reservoir and transmitters. Childhood carriage can therefore be used to determine which serotypes circulate in the population and which may cause disease in the non-vaccinated population. In 2006, a pneumococcal conjugate vaccine (PCV7) was introduced into the Norwegian Childhood Immunisation Programme, which was replaced by the more valent PCV13 in 2011. We investigated changes in pneumococcal carriage prevalence 4 years after switching to PCV13 compared to three previous surveys, and analysed factors associated with carriage in children.

Methods

We conducted a cross-sectional study in Norway, autumn 2015, among children attending day-care centres. We collected questionnaire data and nasopharyngeal swabs to identify pneumococcal serotypes. We compared the carriage prevalence in 2015 with surveys conducted in the same setting performed before widespread vaccination (2006; n = 610), 2 years after PCV7 introduction (2008; n = 600), and 2 years after switching to PCV13 (2013; n = 874). Using multilevel logistic regression we determined the association between pneumococcal carriage and previously associated factors.

Results

In 2015, 896 children participated, with age ranging from 8 to 80 months. The overall carriage prevalence was 48/100 children [95%CI 44–53] in 2015, 38% [29–46] lower than in 2006 pre-PCV7, and 23% [12–32] lower than in 2013, 2 years after switching to PCV13. The PCV13 carriage prevalence was 2.8/100 children [1.9–4.2] in 2015. Increasing age (p < 0.001), recent antimicrobial use (odds ratio = 0.42 [0.21–0.57]) and being vaccinated (odds ratio = 0.37 [0.29–0.47]) were negatively associated with carriage.

Conclusions

Our study showed a continued decrease in overall pneumococcal carriage, mainly fuelled by the decline in vaccine serotypes after vaccine introduction. Childhood vaccination with PCV13 should be continued to keep low PCV13 carriage, transmission and disease. Furthermore, the low prevalence of PCV13-type carriage in children endorse the choice of not recommending PCV13 in addition to the 23-valent pneumococcal polysaccharide vaccine to most medical risk groups in Norway, as little disease caused by these serotypes can be expected.

Seroepidemiological study after a long-distance industrial outbreak of legionnaires' disease

Following a long-distance outbreak of Legionnaires' disease from an industrial air scrubber in Norway in 2005, a seroepidemiological study measuring levels of immunoglobulin G (IgG) and IgM antibodies to Legionella pneumophila was performed with a polyvalent enzyme-linked immunosorbent assay. One year after the outbreak, IgG levels in employees (n = 213) at the industrial plant harboring the scrubber and in blood donors (n = 398) from the outbreak county were low but significantly higher (P < or = 0.002) than those in blood donors (n = 406) from a nonexposed county. No differences in IgM levels among the three groups were found after adjustment for gender and age. Home addresses of the seroresponders in the exposed county clustered to the city of the outbreak, in contrast to the scattering of addresses of the seroresponding donors in the nonexposed county. Factory employees who operated at an open biological treatment plant had significantly higher IgG and IgM levels (P < or = 0.034) than those working >200 m away. Most of the healthy seroresponders among the factory employees worked near this exposure source. Immunoblotting showed that IgG and IgM antibodies in 82.1% of all seroresponders were directed to the lipopolysaccharide of the L. pneumophila serogroup 1 outbreak strain. In conclusion, 1 year after the long-distance industrial outbreak a small increase in IgG levels of the exposed population was observed. The open biological treatment plant within the industrial premises, however, constituted a short-distance exposure source of L. pneumophila for factory employees working nearby.

Detection of measles- and mumps-specific IgG antibodies in paired serum and oral fluid samples from Norwegian conscripts

The aim of this study was to measure the seroprevalence to mumps in Norwegian conscripts belonging to the first children vaccination cohorts that had been offered two doses of MMR vaccine. The seroprevalence to mumps was 76% with the Microimmune assay and 85% with the Enzygnost assay. We also compared the performance of the Microimmune assay for detection of mumps- and measles-specific IgG antibodies in 340 paired serum and oral fluid samples from the conscripts and evaluated the effect of revaccination. Mumps-specific IgG antibodies were detected in only 61% of the oral fluids. In contrast, high levels of measles-specific IgG antibodies were detected in both the serum and oral fluid samples. Based on these results, we are only able to recommend the use of oral fluid for surveillance of measles in Norway. Our results may also indicate that the seroprevalence necessary to interrupt transmission of mumps has not been reached in vaccinated young adult Norwegians. Seroconversion was observed in all initially measles seronegative conscripts after revaccination, whereas 23 of 27 initially mumps seronegative conscripts failed to seroconvert.

Carriage of Streptococcus pneumoniae in healthy Norwegian children attending day-care centres

An observational study to examine Streptococcus pneumoniae carriage in Norwegian children was initiated after two cases of pneumococcal meningitis, caused by the England(14)-9 clone, occurred in one day-care centre in Oslo. All children recruited from the day-care centre where the cases occurred were vaccinated with a seven-valent pneumococcal conjugate vaccine; the other participants who attended three other day-care centres nearby were not. The children were followed for 9 months, and three samplings took place. At the first visit, 45.7% of the children were colonised by pneumococci in the nasopharynx. The children harboured a variety of serotypes, with serotypes 6A, 23F, 6B and 19F being the most frequent. The numbers of children carrying vaccine serotypes decreased in both the vaccinated and the non-vaccinated groups. Thus, no significant effect of vaccine on carriage was detected in this relatively small study.

Pneumococcal conjugate vaccine followed by pneumococcal polysaccharide vaccine; immunogenicity in patients with ataxia-telangiectasia

The immunodeficiency in Ataxia-telangiectasia (A-T) is characterised by low T and B cell counts, low levels of IgE, IgA and/or IgG2, and especially low levels of pneumococcal antibodies. The 23-valent pneumococcal polysaccharide vaccine (PPV23) has previously been shown not to be effective in A-T, but these patients are capable of making protective antibodies to other vaccines such as diphtheria and tetanus toxin, promising effect of the seven-valent pneumococcal conjugated vaccine (PCV7). Nine A-T patients and 25 age and sex matched controls were vaccinated with both PCV7 and PPV23, and three A-T patients were vaccinated with PCV7 only. In the A-T patients, no significant increase in pneumococcal antibody levels were observed after the single PCV7, while the subsequent PPV23 vaccination resulted in a significant increase in antibody levels to the PPV23 mix, as well as to serotype 4, 14, 19F and to the geometric mean of serotype 4, 6B, 14, 18C, 19F, 23F which increased from median 0.2 (range 0.1-0.5) microg/mL to 0.6 (0.2-1.5) microg/mL (P= 0.014). Compared to the patients' baseline levels, the vaccinations induced a 1.5- to 7-fold increase in antibodies to the six different serotypes tested. The increases in pneumococcal antibody titres were lower than those observed in the controls (9- to 34-fold increase). The results are valuable in planning the care of A-T patients, using PCV7 to trigger and PPV23 to booster the immune response and possibly prevent severe pneumococcal disease.

The impact of an early truncating founder ATM mutation on immunoglobulins, specific antibodies and lymphocyte populations in ataxia-telangiectasia patients and their parents

Eleven Norwegian patients (aged 2-33 years, seven males and four females) with Ataxia-telangiectasia (A-T) and their parents were investigated. Five of the patients were homozygous for the same ATM mutation, 3245delATCinsTGAT, a Norwegian founder mutation. They had the lowest IgG2 levels; mean (95% confidence interval) 0.23 (0.05-0.41) g/l versus 0.91 (0.58-1.26) g/l in the other patients (P = 0.002). Among the 11 A-T patients, six had IgG2 deficiency, six had IgA deficiency (three in combination with IgG2 deficiency) and seven had low/undetectable IgE values. All patients had very low levels of antibodies to Streptococcus pneumoniae 0.9 (0.4-1.4) U/ml, while normal levels were found in their parents 11.1 (8.7-13.4) U/ml (P < 0.001). A positive linear relationship between pneumococcal antibodies and IgG2 (r = 0.85, P = 0.001) was found in the patients. Six of 11 had diphtheria antibodies and 7 of 11 tetanus antibodies after childhood vaccinations, while 4 of 7 Hemophilus influenzae type b (Hib) vaccinated patients had protective antibodies. Ten patients had low B cell (CD19+) counts, while six had low T cell (CD3+) counts. Of the T cell subpopulations, 11 had low CD4+ cell counts, six had reduced CD8+ cell counts, and four had an increased portion of double negative (CD3+/CD4-/CD8-) gamma delta T cells. Of the 22 parents (aged 23-64 years) 12 were heterozygous for the ATM founder mutation. Abnormalities in immunoglobulin levels and/or lymphocyte subpopulations were also observed in these carriers, with no correlation to a special ATM genotype.

The immune response to pneumococcal polysaccharide vaccine in zinc-depleted mice

Zinc depletion affects several facets of the immune system and the resistance to infections. We assessed the effect of zinc deprivation on the immune response to the pneumococcal polysaccharide antigens in the commercially available Pneumovax pneumococcal vaccine. Young female BALB/c mice were fed diets with 2.7, 5.8 or 25 micro g of elemental zinc per mg diet. After six weeks of pair feeding, there were significant differences in the mean body weights between the feeding groups and we demonstrated a dose response of the zinc level in the diet on growth. The induced zinc deficiency had no discernible effect on the antipneumococcal polysaccharide immunoglobulin M (IgM) response following immunization with the pneumococcal vaccine. Although zinc depletion has a detrimental effect on the immune system, the murine T-cell-independent response to antigens such as those in the pneumococcal polysaccharide capsule does not seem to be affected.

Serum bactericidal activity correlates with the vaccine efficacy of outer membrane vesicle vaccines against Neisseria meningitidis serogroup B disease

For evaluation of serum bactericidal activity (SBA) as surrogate for the efficacy of outer membrane vesicle (OMV) vaccines against Neisseria meningitidis serogroup B disease, we have reanalyzed data from a randomized double blind placebo-controlled efficacy trial involving 172000 secondary school students (aged 13-14 years) in Norway (1988-1991). A cohort of the efficacy trial consisting of 880 individuals was selected for immunogenicity studies. An efficacy of 87% was calculated for a 10-month observation period. However, after an observation period of 29 months, the estimated efficacy against group B disease induced by vaccination was 57%. The immunogenicity study showed that the SBA geometric mean titer (GMT) for the vaccinees was 2.4 before vaccination and 19.0 six weeks after the second vaccine dose. One year after vaccination the GMT was reduced to 2.8. A separate three-dose study with 304 adolescents showed that with a third dose at 10 months after the second dose (i.e. when cases of disease started to appear) a strong booster response was induced. Ten months after the second dose the SBA was reduced to near pre-immunization level. Following the third dose the SBA geometric mean titer of 2.7 increased to 62.3. One year after the third dose, the GMT was markedly higher than 6 weeks after the second dose (12.6 versus 8.8). Thus, protection after vaccination corresponds with the level of SBA. In order to reach lasting protective levels of SBA in a population, three vaccine doses are probably required. Measurements of SBA are likely to be useful for evaluating various upcoming formulations and improvements of immunization regimens for OMV vaccines.

Predictive value of immunologic parameters and HIV RNA in relation to humoral pneumococcal polysaccharide vaccine responses in patients with HIV infection

In the study presented here immunologic markers and HIV RNA were related to specific antibody responses in 50 HIV-infected patients who had moderate immunodeficiency (median CD4+, 295) and were vaccinated with a pneumococcal polysaccharide vaccine. Low responses were associated with low IgG2 or high IgM levels ( P=0.01) and good responses with high IgG4 ( P=0.05) or IgG2 ( P=0.07) or low beta(2) microglobulin ( P=0.04) levels. A combination of IgG2 levels >1.0 g/l and IgM <1.6 g/l at baseline significantly predicted a twofold or better response in logistic regression analysis ( P=0.025). Neither CD4+ lymphocyte counts nor HIV RNA levels were predictive, but it should be noted that good antibody responses were not restricted to patients with high CD4+ cell counts or low HIV RNA levels.

Humoral immunity to viral and bacterial antigens in lymphoma patients 4-10 years after high-dose therapy with ABMT. Serological responses to revaccinations according to EBMT guidelines

The aim of this study was to investigate the late effects of ABMT on the immune system with regard to protective humoral immunity against common antigens and responses to recall antigens (vaccines). The vaccines were given according to EBMT guidelines from 1995. The protocol included 35 patients with malignant lymphoma in CR 4-10 years after ABMT, and 35 controls. The results show that prior to ABMT the proportion of patients with protective immunity against poliomyelitis, tetanus and diphtheria was similar to that of controls. At study entry 4-10 years after ABMT, the proportion of patients with protective immunity against poliomyelitis and diphtheria was reduced, while all patients maintained protection against tetanus. A significant decrease in geometric mean antibody concentrations or titres was observed against all three antigens during this period. Serum levels of antibodies against different pneumococcal serotypes were lower in the patients than in the controls prior to vaccination. The responses to pneumococcal vaccination, which is considered to be a T cell-independent vaccine, were studied. Unlike controls, a minority of patients achieved protective levels of antibodies after a single vaccination. Despite persistent levels of protective antibodies in many patients post ABMT, secondary booster responses after one vaccination with T cell-dependent vaccines (tetanus, diphtheria and polio) were absent. In conclusion, this study shows that post ABMT, a full re-vaccination program was necessary to mount responses comparable to those observed after a single vaccination in controls.

Meningococcal outer membrane vesicle vaccine given intranasally can induce immunological memory and booster responses without evidence of tolerance

We have studied the ability of outer membrane vesicle (OMV) vaccines from Neisseria meningitidis serogroup B to induce vaccine-specific antibody and spleen cell proliferative responses in mice after being administered intranasally (i.n.) and/or subcutaneously (s.c.). A series of four weekly i.n. doses (25 microg) without adjuvant or a single s.c. dose (2.5 microg) with aluminum hydroxide was followed 2 months later by secondary i.n. or s.c. immunizations. After i.n. priming, both immunoglobulin G (IgG) antibody responses in serum, measured by enzyme-linked immunosorbent assay, and IgA antibodies in saliva and extracts of feces were significantly boosted by later i.n. immunizations. The IgG antibody responses in serum were also significantly augmented by secondary s.c. immunization after i.n. as well as s.c. priming. Sera from mice immunized i.n. reached the same level of bactericidal activity as after s.c. immunizations. The s.c. immunizations alone, however, had no effect on mucosal IgA antibody responses, but could prime for booster antibody responses in secretions to later i.n. immunizations. The i.n. immunizations also led to marked OMV-specific spleen cell proliferation in vitro. Both serum antibody responses and spleen cell proliferation were higher after i.n. priming and later s.c. immunizations than after s.c. immunizations alone. There was thus no evidence that i.n. priming had induced immunological tolerance within the B- or T-cell system. Our results indicate that a nonproliferating meningococcal OMV vaccine given i.n. can induce immunological memory and that it may be favorably combined with similar vaccines for injections.

Radioimmunotherapy with iodine-131 tositumomab in patients with low-grade non-Hodgkin's B-cell lymphoma does not induce loss of acquired humoral immunity against common antigens

Thirty-one previously untreated patients with follicular low-grade B-cell non-Hodgkin's lymphoma expressing the CD20 antigen were treated with iodine-131 tositumomab therapy between 1996 and 1998. The therapy led to a temporary depletion of peripheral blood B-lymphocytes. Recovery of B-cells occurred in most cases by 3 to 6 months and in all patients by 12 months posttherapy. A temporary decline in T-cell subpopulations, but no reduction in serum immunoglobulin levels, could be observed. ELISA techniques were used to detect specific antibodies against rubella, mumps, varicella zoster, measles, and tetanus. Almost all patients remained seropositive against the different antigens during the 1- to 2-year follow-up. No significant reduction in antibody concentrations to tetanus or measles could be detected. The data show that acquired humoral immunity against common antigens appears to be preserved despite a temporary loss of B-lymphocytes.

Protective effect of Plantago major L. Pectin polysaccharide against systemic Streptococcus pneumoniae infection in mice

The antibacterial effect of a soluble pectin polysaccharide, PMII, isolated from the leaves of Plantago major, was examined in inbred NIH/OlaHsd and Fox Chase SCID mice experimentally infected with Streptococcus pneumoniae serotype 6B. Serotype 6B is known to give a more protracted infection when injected intraperitoneally into susceptible mice than more virulent serotypes like type 4. PMII was administered i.p. either once 3 days before challenge or once to thrice from 3 to 48 h after challenge. The number of bacteria in blood and the mouse survival rate were recorded. Pre-challenge administration of PMII and also lipopolysaccharide (LPS), included as a control, gave a dose-dependent protective effect against S. pneumoniae type 6B infection. However, injection of PMII after establishment of the infection in NIH/OlaHsd mice had no effect. The data demonstrate that, firstly, the polysaccharide fraction PMII from P. major protects against pneumococcal infection in mice when administered systemically prechallenge, and secondly that the protective effect is owing to stimulation of the innate and not the adaptive immune system.

Pneumococcal vaccine in the elderly: the Norwegian experience

Pneumococcal infections have increased during the last 10 to 15 years in Norway. Their incidence is now about 20 per 100,000 population for all age groups, but is 2 to 3 times higher among the elderly. In 1996, the Advisory Board of Infectious Disease Control, National Institute of Public Health, Norway, recommended that pneumococcal polysaccharide vaccine should be administered to all individuals aged > or = 65 years. This recommendation has led to an increased use of pneumococcal vaccine, with a marked peak during the influenza vaccination season.

Protective effect of beta-glucan against systemic Streptococcus pneumoniae infection in mice

The antimicrobial effect of soluble beta-1,3-D-glucan from Sclerotinia sclerotiorum (SSG) was examined in mice experimentally infected intraperitoneally (i.p.) with Streptococcus pneumoniae serotypes 4 and 6B. SSG was administered i.p. either 3 days before challenge or 3-48 h after challenge. The number of bacteria in blood samples and the mouse survival rates were recorded. Pre-challenge SSG administration protected dose-dependently against both S. pneumoniae type 4 and 6B infections. SSG injected 24 h post-challenge had a curative effect against type 6B but not type 4 pneumococcal infection. The data demonstrate that SSG administered systemically protects against pneumococcal infection in mice.

Intranasal immunization with heat-inactivated Streptococcus pneumoniae protects mice against systemic pneumococcal infection

In order to study the mucosal and serum antibody response to polysaccharide-encapsulated bacteria in mice, a preparation of heat-inactivated Streptococcus pneumoniae type 4 was administered, with and without cholera toxin, at various mucosal sites. It appeared that intranasal immunization of nonanesthesized animals was superior to either oral, gastric, or colonic-rectal antigen delivery with regard to the induction of serum immunoglobulin G (IgG) and IgA, as well as saliva IgA antibodies specific for pneumococci. The marked IgA antibody response in feces after intranasal, but not after oral or gastric, immunization is suggestive of a cellular link between the nasal induction site and the distant mucosal effector sites. Intranasal immunization also induced antibodies in serum and in mucosal secretions against type-specific capsular polysaccharide. IgA and IgG antibody levels in pulmonary lavage fluids correlated well with saliva IgA and serum IgG antibodies, respectively. Antibody determinations in pulmonary secretions may therefore be redundant in some cases, and the number of experimental animals may be reduced accordingly. After intraperitoneal challenge with type 4 pneumococci, mice immunized intranasally were protected against both systemic infection and death, even without the use of cholera toxin as a mucosal adjuvant. Thus, an efficient intranasal vaccine against invasive pneumococcal disease may be based on a very simple formulation with whole killed pneumococci.

Human opsonins induced during meningococcal disease recognize outer membrane proteins PorA and PorB

Human opsonins directed against specific meningococcal outer membrane structures in sera obtained during meningococcal disease were quantified with a recently developed antigen-specific, opsonin-dependent phagocytosis and oxidative burst assay. Outer membrane vesicles (OMVs) and PorA (class 1) and PorB (class 3) proteins purified from mutants of the same strain (44/76; B:15:P1.7. 16) were adsorbed to fluorescent beads, opsonized with acute- and convalescent-phase sera from 40 patients with meningococcal disease, and exposed to human leukocytes. Flow cytometric quantitation of the resulting leukocyte phagocytosis products (PPs) demonstrated that disease-induced serum opsonins recognized meningococcal OMV components and both porins. The PPPorA and PPPorB values induced by convalescent-phase sera correlated positively with the PPOMV values. However, the PPPorB values were higher than the PPPorA values in convalescent-phase sera (medians [ranges] of 754 [17 to 1,057] and 107 [4 to 458], respectively) (P < 0.0001) and correlated positively with higher levels of immunoglobulin G against PorB than against PorA as evaluated by enzyme-linked immunosorbent assay. Extensive individual variations in the anti-OMV and antiporin serum opsonic activities between patients infected by serotypes and serosubtypes homologous and heterologous to the target antigens were observed. Simultaneously measured oxidative burst activity correlated with the opsonophagocytosis, an indication that both of these important steps in the in vitro phagocytic elimination of meningococci are initiated by opsonins directed against OMV components, including PorA and PorB. In conclusion, human patient opsonins against meningococcal OMV components and in particular PorB epitopes were identified by this new method, which might facilitate selection of opsonin-inducing meningococcal antigens for inclusion in future vaccines.

Interleukin-13 and human immunoglobulin E production in severe combined immunodeficiency mice transplanted with human peripheral blood lymphocytes

As normal mice do not respond to interleukin-13 (IL-13), we have used mice with severe combined immunodeficiency transplanted with human peripheral blood lymphocytes (hu-PBL-SCID mice) as an in vivo model for studying human IL-13. PBL from three donors (two allergic and one non-allergic) were prestimulated with IL-13 in vitro and thereafter transplanted into SCID mice. As evidenced by flow cytometry, IL-13 in the in vitro cell cultures was physiologically active and suppressed CD14 expression, while it enhanced the expression of CD23 on human monocytes. In the in vivo experiments, SCID mice transplanted with cells from both allergic donors produced twice as high maximum levels of IgE when the cells were preincubated with IL-13 in vitro before transplantation, as compared with mice receiving cells that had not been preincubated with IL-13. Two succeeding intraperitoneal (i.p.) injections of IL-13 resulted in a further increase of maximum IgE levels. Using cells from the non-allergic donor, no enhancing effect of IL-13 was observed. Transplanted human cells from one allergic donor examined were shown to migrate to the spleen and lungs of the recipient mice, while cells from the non-allergic donor were found only in the peritoneal cavity. Altogether, our results indicate that IL-13 enhances human IgE production in vivo and suggest that lymphocytes in allergic individuals are hyper-reactive to this cytokine. Furthermore, the allergic status of the cell donor may affect migration and engraftment of cells transplanted into SCID mice.

Human IgE production in hu-PBL-SCID mice injected with birch pollen and diesel exhaust particles

Mice with severe combined immunodeficiency were transplanted with human peripheral blood lymphocytes (hu-PBL-SCID mice). The response to immunisation with birch pollen was used to study possible effects of diesel exhaust particles (DEP) and aluminium hydroxide (Al(OH)3) on human IgE production in this human in vivo model. The adjuvants were well tolerated, as determined by the number of human cells in the peritoneal cavity at the end of the experiments. Total and birch pollen-specific IgE was detected in 76 and 41% of the mice, respectively. In the present experiments where the mice were stimulated early with birch pollen, a doubling in percentage of hu-PBL-SCID mice with production of specific IgE was observed, as compared to later stimulation used in previous experiments. Although a tendency to higher total IgE levels was observed after treatment with DEP, no statistically significant adjuvant effect of DEP or Al(OH)3 could be demonstrated. Electron microscopy analysis after immunogold labelling showed that the major birch pollen allergen Bet v I was released from the pollen grains and adsorbed to the surface of the DEP. Early stimulation with allergen appears to be important for optimal production of specific IgE in the hu-PBL-SCID model. However, our results show that further improvements are needed in order to demonstrate the expected effects from adjuvants and environmental pollutants.

Total and birch pollen-specific human IgE in mice with severe combined immunodeficiency transplanted with human peripheral blood lymphocytes: donor dependence, seasonal variation and in vivo half-life

BACKGROUND

There is a need for animal in vivo models in the study of human allergy. The aim of the present experiments was to study production and catabolism of human IgE in mice with severe combined immunodeficiency transplanted with human peripheral blood lymphocytes (hu-PBL-SCID mice).

METHODS

Groups of SCID mice were transplanted intraperitoneally with hu-PBL from the same three donors in five experiments. Subgroups of transplanted mice were immunized with birch pollen. Production of human total and birch pollen-specific IgE in the hu-PBL-SCID mice was analyzed over a 7-week period.

RESULTS

Human IgE was detected in 93% of the hu-PBL-SCID mice, and the production showed reproducible donor-dependent kinetics. Production of birch pollen-specific human IgE, however, was seen only in mice transplanted with cells from birch pollen-allergic donors. A greater proportion of the mice produced specific IgE when the experiment was started in, or some months after a birch pollen season with high pollen counts. The half-lives of passively transferred human IgE were determined to be 24.0 and 23.4 h for total and birch pollen-specific IgE, respectively.

CONCLUSIONS

This study demonstrates that human IgE production in hu-PBL-SCID mice is very reproducible when the same donor is used several times. Specific IgE production in recipient mice seems to require the use of cell donors with the actual specific allergy, and is most readily obtained during or after a period of donor allergen exposure. The short half-lives found indicate that hu-PBL-SCID mice have a high ongoing production of human IgE.

Enhancement of Streptococcus pneumoniae serotype 6B infection in mice after passive immunization with human serum

Passive immunization in an experimental pneumococcal infection model has been proposed as a way to further characterize the protective capacity of human post vaccination sera. However, in experiments described in the present paper, we found that the same human immune serum that induced some degree of protection when NIHS mice were challenged with one strain of Streptococcus pneumoniae serotype 6B, did not confer protection when the mice were challenged with another strain of serotype 6B. On the contrary, with this bacterial strain, six different human sera appeared to enhance pneumococcal infection leading to higher levels of bacteremia and more rapid death of passively immunized than of non-immunized mice. In contrast, mice passively immunized with mouse immune serum showed reduced bacteremia and enhanced survival after challenge with the same dose of the same strain of pneumococci. The enhancing property of human serum did not seem to be caused by anti-type 6B antibodies. However, we cannot exclude the possibility that human antibodies are less protective than mouse antibodies against type 6B infection. Our results indicate that negative results in passive immunization experiments with human sera should be interpreted with caution.

Human antibody response to a pneumococcal vaccine in SCID-PBL-hu mice and simultaneously vaccinated human cell donors

Severe combined immunodeficient (SCID) mice were transplanted intraperitoneally with human peripheral blood lymphocytes (PBL) from nine healthy human donors (SCID-PBL-hu mice). None of the donors had ever received pneumococcal vaccine. Ten days after transplantation, 62 out of 111 transplanted mice and six of the nine donors were vaccinated with a 23-valent pneumococcal polysaccharide vaccine. For each donor, human IgG was detected in 91.7-100% of the SCID-PBL-hu mice, whereas specific human IgG antipneumococcal antibodies were demonstrated in 16.7-100% of the vaccinated SCID-PBL-hu mice. Most of the mice transplanted with cells from the same donor showed similar antibody response patterns in terms of kinetics and antibody levels. A significant antibody response was only obtained in mice that received cells from donors with relatively high antipneumococcal antibody levels at the time of transplantation, or donors that showed a substantial increase in antibody levels after vaccination. The immune response in the SCID-PBL-hu mice did not always reflect the ability of the respective donor to produce antipneumococcal antibodies. The donor dependency of the antipneumococcal antibody response has great practical importance for the use of the SCID-PBL-hu model. Donors should not be chosen randomly. By selecting donors whose cells have been found to result in successful engraftment, functional SCID-PBL-hu mice can be obtained for the study of human immune responses and function in an in vivo experimental model.

The antibody response after immunization with pneumococcal polysaccharide vaccine in splenectomized mice: the effect of re-immunization with pneumococcal antigens

Splenectomized individuals are at increased risk of acquiring fulminant pneumococcal infections. In an experimental mouse model, we have studied how removal of the spleen influences the anti-pneumococcal antibody response to s.c. primary immunization with a 23-valent pneumococcal polysaccharide vaccine and to re-immunization 5 months later. In splenectomized BALB/c mice the antibody response to serotypes 1, 4, 7F, and 19F was reduced both after the first and after the second immunization, compared to that in normal mice. In contrast, splenectomized and normal CBA/J mice produced similar antibody levels to serotypes 1 and 4 after the second immunization, although the response to these serotypes was reduced in splenectomized mice after the first immunization. After i.v. injection with heat-killed pneumococci serotype 4, splenectomized BALB/c mice that had been immunized 5 months earlier with 23-valent vaccine were able to mount higher antibody levels which were reached earlier than in unprimed splenectomized mice. However, normal mice that had been vaccinated 5 months earlier had the highest antibody levels after immunization with pneumococci. Our results indicate that although splenectomized mice generally do not reach as high antibody levels as are seen in normal mice after pneumococcal immunization, they benefit from previous immunization with regard to antibody levels when given a second antigen challenge.

Engraftment and humoral immunity in SCID and RAG-2-deficient mice transplanted with human peripheral blood lymphocytes

SCID and RAG-2 deficient mice were transplanted intraperitoneally with human peripheral blood lymphocytes (hu-PBL-SCID and hu-PBL-RAG mice). Seven days after transplantation the mice were immunized with a pneumococcal polysaccharide vaccine. Flow cytometry analysis of cells from the peritoneal cavity and the spleen after 8-10 weeks revealed that human cells had more limited engraftment in RAG than in SCID recipient mice, and that more human cells were found in the spleen than in the peritoneal cavity. Functionality of the human cells recovered from these two locations was explored by the counting of human immunoglobulin secreting cells (hu-ISC). A total of 83% of the hu-PBL-SCID mice and 29% of the hu-PBL-RAG mice had detectable hu-ISC in the peritoneal cavity and/or the spleen. The kinetic profiles of human immunoglobulins in the mouse sera during the experiment showed donor dependency. More than 90% of the hu-PBL-SCID mice had detectable levels of human IgG, IgM and IgA, while 78% had detectable levels of IgE, whereas detectable levels of IgG, IgM, IgA and IgE were measured in 37%, 64%, 68% and 23% of the hu-PBL-RAG mice, respectively. Forty-seven per cent of immunized hu-PBL-SCID mice showed a human antipneumococcal IgG level that was significantly above the background level in non-immunized mice, while none of the hu-PBL-RAG mice produced any detectable levels of human antipneumococcal IgG. In short, human PBL showed a better engraftment and a better antibody response when transplanted into SCID mice than into RAG mice.

The antibody response to secondary immunization with pneumococcal polysaccharides in mice

The benefit of re-immunization with pneumococcal polysaccharide vaccine is an important question in clinical practice. In an experimental model, BALB/c and CBA/J mice were re-immunized s.c. with a 23-valent pneumococcal polysaccharide vaccine at various time intervals after a first immunization with the same vaccine. The antibody response after the secondary immunization showed similar kinetics as after primary immunization, and was mainly an IgM antibody response. Re-immunization at 28 days or earlier induced a decrease in the serum antibody levels to the vaccine. Reimmunization at 120 days or later induced higher antibody levels than after the first immunization. Significant increases in antibody levels to serotypes 1, 4, 7F and 19F out of six serotypes tested were observed. In CBA/J mice, but not in BALB/c mice, the dose used for primary immunization appeared to influence the magnitude of the antibody response to secondary immunization. Our results indicate that the time interval between primary and secondary immunization is an important determinant with regard to the magnitude of the antibody response to re-immunization with pneumococcal polysaccharide vaccine.

Virulence of Streptococcus pneumoniae in mice: a standardized method for preparation and frozen storage of the experimental bacterial inoculum

Animal models of pneumococcal infection are important to evaluate the protective capacity of new vaccine candidates. We have established a method to prepare and store the experimental inoculum without loss of virulence or number of bacteria. This allows a standardized inoculum from the same culture batch to be used in several experiments. Pneumococci were cultured to mid-logarithmic growth phase in Todd-Hewitt broth with 17% fetal calf serum. The bacterial broth was distributed into smaller volumes and immediately frozen on liquid nitrogen and stored at -70 degrees C. We have tested the virulence of five different pneumococcal serotypes in BALB/c, C57BL/6, and NIHS mice using inocula prepared by this method and stored without loss of virulence for up to 4 years. Serotypes 1, 4, 5 and 8 were highly virulent for the strains of mice tested whereas type 6B showed lower virulence and a peculiar, protracted course of infection. There were no clear differences in virulence between the different strains of mice with the exception of serotype 6B, which showed higher virulence in BALB/c and NIHS mice than in C57BL/6 mice.

[All persons without spleen should be given pneumococcal vaccine]

Splenectomized individuals run increased risk of developing overwhelming septicemia from encapsulated bacteria, especially Streptococcus pneumoniae. Polyvalent pneumococcal polysaccharide vaccine should be given to all splenectomized individuals above two years of age. Antipneumococcal antibody levels should be measured three to five years after the first vaccination, and persons with low antibody levels should be revaccinated. Splenectomized persons may be given a supply of penicillin V to enable them to start therapy while avaiting medical attention.

Antibody response to pneumococcal polysaccharide vaccine in young, adult and old mice

The anti-pneumococcal antibody response was studied in young (5-week-old) and adult (10-week-old) BALB/c and CBA/J mice and in adult (9-10-week-old) and old (12-, 18- and 24-month-old) AB6F1 and B6D2F1 mice after s.c. immunization with a 23-valent pneumococcal polysaccharide vaccine. Both young and adult mice showed a significant IgM antibody response to the vaccine 6 days after immunization with 1-11 micrograms antigen. There were significant immune responses to serotypes 1, 2, 4 and 7F in contrast to small responses to serotypes 14, 19F and 23F after immunization with the vaccine. One month after immunization, there were only marginal differences in IgM anti-pneumococcal antibody levels to the vaccine (anti-PPS) between immunized and unimmunized BALB/c mice, whereas in CBA/J mice the anti-PPS remained higher in immunized than in unimmunized mice. Immunization of old mice induced a significant IgM antibody response 6 days after immunization, but the anti-PPS thereafter decreased rapidly towards preimmunization values in AB6F1 mice. A significant IgG anti-PPS was not detected in any of the mice studied. The IgA anti-PPS tended to vary over time with no consistent pattern. It is important to carefully consider age and strain of the mice used when studying the immune response to pneumococcal polysaccharide antigens.

SCID-Hu mice immunized with a pneumococcal vaccine produce specific human antibodies and show increased resistance to infection

Seventy-eight severe combined immunodeficiency (SCID) mice were administered intraperitoneally 1 x 10(7) to 9 x 10(7) human peripheral blood mononuclear cells (PBL) in five experiments. Human immunoglobulin G (IgG) was detected in 70 to 88% of these SCID-PBL-Hu mice after cell transplantation, and all four subclasses were present. The total concentration of human IgG varied from less than 1 to 10.2 g/liter. The SCID-PBL-Hu mice with high concentrations of human IgG regularly had mono- or oligoclonal human IgG bands in serum, as demonstrated by agarose gel electrophoresis. Of the SCID-PBL-Hu mice that were immunized with a 23-valent pneumococcal polysaccharide vaccine, 63 to 78% developed a significant human IgG antipneumococcal antibody response, whereas only very low levels of human IgM and no human IgA antipneumococcal antibodies could be detected. Twelve to twenty-two percent of the SCID-PBL-Hu mice showed signs of leakiness; these mice developed a significant mouse IgM antipneumococcal antibody response and no human antibodies. SCID-PBL-Hu mice were challenged intraperitoneally with 10 50% lethal doses of Streptococcus pneumoniae serotype 4 to study the protective effect of immunization with pneumococcal vaccine. The immunized SCID-PBL-Hu mice showed less bacteremia than did all control groups, and survival was 45 to 60%. None of the unimmunized SCID-PBL-Hu mice survived.

Murine monoclonal antibodies against pneumococcal capsular polysaccharide types 4, 8, 22F and 19A/19F

Monoclonal antibodies (MAbs) were produced against pneumococcal capsular polysaccharides after subcutaneous immunization of BALB/c mice with a 23-valent vaccine (Pneumovax N, Merck, Sharp & Dohme). Selected antibodies were tested in ELISA against individual polysaccharides from 23 different pneumococcal types and in a dot blot assay with heat-killed whole bacteria adhered to nitrocellulose paper. Three MAbs (isotype IgM) were found to be specific for types 4, 8 and 22F, respectively, whereas one (isotype IgA) reacted both with 19A and 19F. Very mild acid hydrolysis of the capsular polysaccharides resulted in loss of reaction with the antibodies.

IgG subclass antibody responses to pneumococcal polysaccharide vaccine in splenectomized, otherwise normal, individuals

Subclasses of IgG antibodies to pneumococcal polysaccharide serotype antigens 4, 6A, and 23F were measured before and 4 weeks after vaccination with pneumococcal vaccine in young individuals splenectomized because of trauma and in a control group. An ELISA technique was applied. IgG2 anti-pneumococcal antibodies predominated before vaccination, especially against serotypes 4 and 6A. The youngest individuals in the splenectomy group tended to have lower IgG2 anti-pneumococcal antibody levels than the older ones. Vaccination induced antibodies of the IgG1 and IgG2 subclasses, and in some individuals also of the IgG4 subclass. Splenectomy does not seem to influence the IgG subclass pattern of antipneumococcal antibodies.

Autoantibodies in individuals splenectomized because of trauma

Sera from 104 individuals splenectomized because of abdominal trauma were examined for the occurrence of 9 different autoantibodies. Our findings indicate that the occurrence of autoantibodies in splenectomized individuals without systemic disease is not increased and does not differ significantly from that found in an age- and sex-matched control population.

Long-term effect of pneumococcal polysaccharide vaccination on serum IgM and IgG antibody levels in individuals splenectomized for trauma

The IgM and IgG pneumococcal antibody levels were measured one year after vaccination with a 14-valent pneumococcal polysaccharide vaccine in 12 individuals splenectomized due to trauma and 10 non-splenectomized individuals. The results were compared with the antibody levels before and four weeks after vaccination. One year after vaccination there were only minor differences between the two groups. The IgM response to most of the serotypes had almost vanished. There were only significant IgG responses to a few serotypes after one year, but the mean antibody levels of all the 14 serotypes showed some persistence of the IgG response. There was a tendency for the splenectomized individuals that were younger than 15 years of age to have a somewhat reduced antibody response after pneumococcal vaccination. This could indicate that pneumococcal vaccination might be less efficient in that group of individuals where the need for a protective vaccine is most urgent.

IgM and IgG response to pneumococcal polysaccharide vaccine in normal individuals and individuals splenectomized due to trauma

Twenty-one young, splenectomized, healthy individuals (S group) and ten healthy individuals (K group) were vaccinated with a 14-valent pneumococcal polysaccharide vaccine. All individuals in the S group were splenectomized due to abdominal trauma. IgM and IgG antibodies against each of the 14 pneumococcal serotypes were determined by enzyme-linked immunosorbent assay. Serum concentrations of IgM and IgG were measured by radial immunodiffusion. The mean prevaccination IgM pneumococcal antibody level was lower in the S group than in the K group for most of the serotypes. The mean total serum IgM was considerably reduced in the S group. Vaccination induced a significant IgM pneumococcal antibody response in both groups, but the response tended to be smaller in the S than in the K group. These findings may appear compatible with suboptimal immune regulation in the splenectomized individuals. There were small variations between the total serum IgG and the prevaccination IgG pneumococcal antibody level in the two groups. Both groups obtained a significant IgG pneumococcal antibody response after vaccination to most of the serotypes.