Rose Markus A, Schubert Ralf, Strnad Nicola, Zielen Stefan
Children's Hospital, Dept. of Paediatric Pneumology/Allergology, Frankfurt University, Theodor Stern Kai 7, 60590 Frankfurt am Main, Germany.
Clin Diagn Lab Immunol. 2005 Oct;12(10):1216-22. doi: 10.1128/CDLI.12.10.1216-1222.2005.
Pneumococcal polysaccharide vaccine (PPV) is of limited immunogenicity in infants and immunocompromised patients. Our prospective randomized controlled trial investigated whether priming with pneumococcal conjugate vaccine (PCV) induced specific immunological memory in previously nonresponders to PPV. Of a total of 33 children (2 to 18 years) with polysaccharide-specific immunodeficiency (PSI), group A (n = 16) received two doses of 7-valent PCV in a 4- to 6-week interval, and a booster dose of 23-valent PPV after one year. Group B (n = 17) received two doses of PPV in a 1-year interval exclusively. Specific antibody concentrations for serotypes 4, 5, 6B, 9V, 14, 18C, 19F, and 23F were determined (enzyme-linked immunosorbent assay) before and at 7 and 28 days after administration of the PPV booster and compared to an opsonophagocytosis assay. Of group A, 64 to 100% had antibody concentrations of > or = 1 microg/ml on day 28 after the booster versus 25 to 94% of group B. Group A had significantly higher antibody concentrations for all PCV-containing serotypes already on day 7, indicating early memory response. Antibody concentrations were in accordance with functional opsonic activity, although opsonic titers varied among individuals. Pneumococcal vaccination was well tolerated. The incidence of airway infections was reduced after priming with PCV (10/year for group A versus 15/year for group B). Following a PPV booster, even patients primarily not responding to PPV showed a rapid and more pronounced memory response after priming with PCV.
肺炎球菌多糖疫苗（PPV）在婴儿和免疫功能低下的患者中免疫原性有限。我们的前瞻性随机对照试验研究了用肺炎球菌结合疫苗（PCV）进行初次免疫是否能在先前对PPV无反应的人群中诱导特异性免疫记忆。在总共33名患有多糖特异性免疫缺陷（PSI）的儿童（2至18岁）中，A组（n = 16）在4至6周的间隔内接种两剂7价PCV，并在一年后接种一剂23价PPV加强针。B组（n = 17）仅在1年的间隔内接种两剂PPV。在接种PPV加强针之前以及接种后7天和28天测定血清型4、5、6B、9V、14、18C、19F和23F的特异性抗体浓度（酶联免疫吸附测定），并与吞噬作用测定进行比较。A组中，64%至100%的儿童在加强针接种后第28天抗体浓度≥1μg/ml，而B组为25%至94%。A组在第7天所有含PCV血清型的抗体浓度就显著更高，表明存在早期记忆反应。尽管个体间吞噬效价有所不同，但抗体浓度与功能性吞噬活性一致。肺炎球菌疫苗接种耐受性良好。用PCV进行初次免疫后呼吸道感染的发生率降低（A组为每年10次，B组为每年15次）。接种PPV加强针后，即使是最初对PPV无反应的患者在用PCV进行初次免疫后也表现出快速且更明显的记忆反应。
