The Binding Site Group Limited, Birmingham, UK.
Division of Allergic Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA.
Vaccine. 2019 Feb 28;37(10):1350-1355. doi: 10.1016/j.vaccine.2019.01.035. Epub 2019 Feb 5.
Interpretation of the responses to the pneumococcal polysaccharide vaccine (Pneumovax®23, PPV) has proven challenging. In addition, there are few studies documenting the longevity of these responses.
The age-specific PPV IgM, IgA, IgG and IgG2 concentrations were determined pre, 4-6 weeks and 6 years post-vaccination in the serum of Prevnar®-naïve adults using VaccZyme™ pneumococcal capsular polysaccharide ELISAs.
The median pre-vaccination concentrations were; PPV IgM 53 U/mL (5-95% CI: 16-169 U/mL), IgA 23 U/mL (6-103 U/mL), IgG 41 mg/L (10-184 U/mL) and IgG2 18 mg/L (3-95 U/mL). 4-6 weeks post-vaccination there was a median 6-fold (5-95% CI: 2-24) increase in PPV IgM (median 315 U/mL (5-95% CI: 60-1133 U/mL), 18-fold (4-74) increase in IgA (369 U/mL (78-1802 U/mL)), 9-fold (2-19) increase in IgG (375 mg/L (77-1238 mg/L)) and 8-fold (1-20) increase in IgG2 (141 mg/L (25-573 mg/L)). This was significant for all isotypes in all age ranges (p < 0.0001). Six years post-vaccination median PPV concentrations were; IgM 54 U/mL (17-128), IgA 85 U/mL (19-279), IgG 148 mg/L (30-997) and IgG2 57 mg/L (9-437). The median concentrations for all ages 6 years post-vaccination were significantly elevated compared to the pre-vaccination titres for PPV IgA, IgG and IgG2 isotypes only. The PPV IgM and IgA responses were influenced by age. At 6 years post vaccination, in individuals with normal PPV IgG, 34 individuals had PPV IgM and/or IgA concentrations below the lower limit of the healthy adult ranges. We also used the healthy adult reference ranges developed in this study to assess a cohort of primary immunodeficiency (PID) patients.
These ranges will help to provide a framework for assessment and definition of normal response to PPV, which will facilitate clinical interpretation of a deficient polysaccharide response in those suspected of antibody deficiency.
对肺炎球菌多糖疫苗（Pneumovax®23，PPV）反应的解读一直具有挑战性。此外，几乎没有研究记录这些反应的持久性。
使用 VaccZyme™肺炎球菌荚膜多糖 ELISA 法，在 Prevenar® 疫苗接种前、接种后 4-6 周和 6 年，测定血清中特定年龄的 PPV IgM、IgA、IgG 和 IgG2 浓度。
接种前的中位数浓度分别为：PPV IgM 53 U/mL（5-95%CI：16-169 U/mL）、IgA 23 U/mL（6-103 U/mL）、IgG 41 mg/L（10-184 U/mL）和 IgG2 18 mg/L（3-95 U/mL）。接种后 4-6 周，PPV IgM 中位数增加了 6 倍（5-95%CI：2-24）（中位数 315 U/mL（5-95%CI：60-1133 U/mL））、IgA 增加了 18 倍（4-74）（369 U/mL（78-1802 U/mL））、IgG 增加了 9 倍（2-19）（375 mg/L（77-1238 mg/L））和 IgG2 增加了 8 倍（1-20）（141 mg/L（25-573 mg/L））。所有年龄组的所有同种型均有显著差异（p<0.0001）。接种后 6 年的中位数 PPV 浓度分别为：IgM 54 U/mL（17-128）、IgA 85 U/mL（19-279）、IgG 148 mg/L（30-997）和 IgG2 57 mg/L（9-437）。与接种前相比，所有年龄组接种后 6 年的中位数浓度均显著升高，仅在 PPV IgA、IgG 和 IgG2 同种型中升高。PPV IgM 和 IgA 反应受年龄影响。在接种后 6 年，在 IgG 正常的个体中，34 名个体的 PPV IgM 和/或 IgA 浓度低于健康成人范围的下限。我们还使用本研究中建立的健康成人参考范围评估了一组原发性免疫缺陷（PID）患者。
这些范围将有助于为评估和定义对 PPV 的正常反应提供框架，这将有助于在怀疑抗体缺陷的患者中对多糖反应缺陷进行临床解释。
