Stray-Pedersen A, Aaberge I S, Früh A, Abrahamsen T G
Department of Paediatrics, Rikshospitalet University Hospital, Oslo, Norway.
Clin Exp Immunol. 2005 Jun;140(3):507-16. doi: 10.1111/j.1365-2249.2005.02791.x.
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.
共济失调毛细血管扩张症(A-T)中的免疫缺陷表现为T细胞和B细胞数量减少、IgE、IgA和/或IgG2水平降低,尤其是肺炎球菌抗体水平较低。此前已证明23价肺炎球菌多糖疫苗(PPV23)对A-T患者无效,但这些患者能够对其他疫苗(如白喉和破伤风毒素)产生保护性抗体,七价肺炎球菌结合疫苗(PCV7)有望产生效果。9名A-T患者以及25名年龄和性别匹配的对照者接种了PCV7和PPV23,另有3名A-T患者仅接种了PCV7。在A-T患者中,单次接种PCV7后未观察到肺炎球菌抗体水平有显著升高,而随后接种PPV23导致针对PPV23混合疫苗以及血清型4、14、19F以及血清型4、6B、14、18C、19F、23F几何平均抗体水平显著升高,从中位数0.2(范围0.1 - 0.5)μg/mL升至0.6(0.2 - 1.5)μg/mL(P = 0.014)。与患者的基线水平相比,疫苗接种使针对所检测的六种不同血清型的抗体增加了1.5至7倍。肺炎球菌抗体滴度的升高低于在对照者中观察到的值(升高9至34倍)。这些结果对于规划A-T患者的护理很有价值,可使用PCV7激发并使用PPV23增强免疫反应,并可能预防严重的肺炎球菌疾病。