Estrada Jaime, Najera Maria, Pounds Natalie, Catano Gabriel, Infante Anthony J
From the *Pediatric Specialists of Texas, Methodist Healthcare System, San Antonio, Texas; †Internal Medicine Training Program, RAHC-University of Texas Health Science Center at San Antonio, Harlingen, Texas; ‡Pediatric Hematology and Oncology Fellowship Program, University of Texas Southwestern Medical Center, Dallas, Texas; ‡Division of Infectious Diseases, Department of Medicine, University of Texas Health Sciences Center at San Antonio, San Antonio, Texas; and ¶Department of Pediatrics, University of Texas Health Sciences Center at San Antonio, San Antonio, Texas.
Pediatr Infect Dis J. 2016 Feb;35(2):205-8. doi: 10.1097/INF.0000000000000964.
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.
我们报告了72名儿童和青少年接种23价肺炎球菌多糖疫苗（PPV23）后的临床和血清学反应。所有患者均被诊断为复发性上呼吸道感染且抗肺炎球菌免疫力低下。其中45名（62%）患者曾接种过7价肺炎球菌结合疫苗（PCV7，商品名Prevnar7）。接种多糖疫苗后，69名（96%）患者出现阳性临床反应，其中包括45名曾接种结合疫苗患者中的42名，有12名患者（17%）对多糖疫苗的血清学反应不足。在接种疫苗后约1个月、3个月和6个月评估对PPV23的临床和血清学反应。我们的研究还证实，一小部分复发性上呼吸道感染患者尽管接种了新型结合疫苗，但仍无法对肺炎球菌及其他细菌多糖产生正常反应。这种免疫缺陷被称为伴有正常免疫球蛋白的选择性抗体缺陷或多糖反应性受损。这些患者在静脉注射免疫球蛋白后情况良好。
