造血干细胞移植后儿童的麻疹、破伤风、脊髓灰质炎病毒、B 型流感嗜血杆菌、C 群脑膜炎球菌及肺炎球菌疫苗再接种

Revaccination with measles, tetanus, poliovirus, Haemophilus influenzae type B, meningococcus C, and pneumococcus vaccines in children after hematopoietic stem cell transplantation.

作者信息

Patel Soonie R, Ortín Miguel, Cohen Bernard J, Borrow Ray, Irving Diane, Sheldon Joanne, Heath Paul T

机构信息

Pediatric Oncology Department, Royal Marsden Hospital, Sutton, United Kingdom.

出版信息

Clin Infect Dis. 2007 Mar 1;44(5):625-34. doi: 10.1086/511641. Epub 2007 Jan 24.

DOI:10.1086/511641

PMID:17278051

Abstract

BACKGROUND

There is a decrease in antibody levels after hematopoietic stem cell transplant (HSCT), and such patients may be at increased risk of acquiring vaccine-preventable infection. A simple and validated revaccination schedule is required. The aim of this study was to evaluate the immunogenicity of a revaccination schedule for pediatric HSCT recipients.

METHODS

Thirty-eight children (age, 1-18 years) who had undergone autologous or allogeneic HSCT for malignant diseases were recruited. All children received vaccinations in accordance with a predefined schedule. Antibody concentrations were measured before and 2-4 weeks after vaccination against tetanus; Haemophilus influenzae type b (Hib); meningococcus C; measles; poliovirus serotypes 1, 2, and 3; and 9 pneumococcus serotypes.

RESULTS

Before vaccination, protective antibody levels were found for tetanus in 95% of patients (geometric mean concentration [GMC], 0.07 IU/mL; 95% CI, 0.05-0.1 IU/mL), for Hib in 63% (GMC, 0.34 microg/mL; 95% CI, 0.21-0.57 microg/mL), for measles in 60% (GMC, 102 mIU/mL; 95% CI, 41-253 mIU/mL), for meningococcus C in 11% (geometric mean titer [GMT], 1:4; 95% CI, 1:2-1:8.4), for all 3 poliovirus serotypes in 29%, and for all 9 pneumococcal serotypes in 0%. Vaccination resulted in a significant increase (P < or = .05) in antibody levels to each vaccine antigen studied, with 100% of patients achieving protection against tetanus (GMC, 2.2 IU/mL; 95% CI, 1.8-2.7 IU/mL), 100% achieving protection against Hib (GMC, 8.4 microg/mL; 95% CI, 7.6-9.3 microg/mL), 100% achieving protection against measles (GMC, 2435 mIU/mL; 95% CI, 1724-3439 mIU/mL), 100% achieving protection against meningococcus C (GMT, 1:5706; 95% CI, 1:3510-1:9272), 92% achieving protection against the 3 poliovirus serotypes, and > or = 80% achieving protection against each of the heptavalent pneumococcal conjugate vaccine-associated serotypes. No factors relevant to age, underlying disease, or treatment type were found to significantly influence responses.

CONCLUSION

Revaccination of pediatric HSCT recipients in accordance with this revaccination schedule provides a high level of protection against these vaccine-preventable diseases.

摘要

背景

造血干细胞移植（HSCT）后抗体水平会下降，此类患者感染疫苗可预防疾病的风险可能会增加。需要一个简单且经过验证的再接种方案。本研究的目的是评估小儿HSCT受者再接种方案的免疫原性。

方法

招募了38名因恶性疾病接受自体或异基因HSCT的儿童（年龄1 - 18岁）。所有儿童均按照预定方案进行疫苗接种。在接种破伤风、b型流感嗜血杆菌（Hib）、C群脑膜炎球菌、麻疹、脊髓灰质炎病毒1、2和3型以及9种肺炎球菌血清型疫苗前及接种后2 - 4周测量抗体浓度。

结果

接种疫苗前，95%的患者破伤风抗体水平达到保护性水平（几何平均浓度[GMC]，0.07 IU/mL；95%置信区间，0.05 - 0.1 IU/mL），63%的患者Hib抗体水平达到保护性水平（GMC，0.34 μg/mL；95%置信区间，0.21 - 0.57 μg/mL），60%的患者麻疹抗体水平达到保护性水平（GMC，102 mIU/mL；95%置信区间，41 - 253 mIU/mL），11%的患者C群脑膜炎球菌抗体水平达到保护性水平（几何平均滴度[GMT]，1:4；95%置信区间，1:2 - 1:8.4），29%的患者对所有3种脊髓灰质炎病毒血清型抗体水平达到保护性水平，0%的患者对所有9种肺炎球菌血清型抗体水平达到保护性水平。接种疫苗后，针对所研究的每种疫苗抗原，抗体水平均显著升高（P≤0.05），100%的患者对破伤风获得保护（GMC，2.2 IU/mL；95%置信区间，1.8 - 2.7 IU/mL），100%的患者对Hib获得保护（GMC，8.4 μg/mL；95%置信区间，7.6 - 9.3 μg/mL），100%的患者对麻疹获得保护（GMC，2435 mIU/mL；95%置信区间，1724 - 3439 mIU/mL），100%的患者对C群脑膜炎球菌获得保护（GMT，1:5706；95%置信区间，1:3510 - 1:9272），92%的患者对3种脊髓灰质炎病毒血清型获得保护，≥80%的患者对每种七价肺炎球菌结合疫苗相关血清型获得保护。未发现与年龄、基础疾病或治疗类型相关的因素对反应有显著影响。