Biosecurity Program, Kirby Institute, Faculty of Medicine, University of New South Wales, Sydney, Australia.
Independent Scholar, Sydney, Australia.
Vaccine. 2019 Aug 14;37(35):5016-5024. doi: 10.1016/j.vaccine.2019.07.005. Epub 2019 Jul 9.
Data on long-term antibody responses to pneumococcal vaccines in the elderly, especially the frail elderly at greatest risk of severe disease, are limited. We followed up participants in a randomised trial of the immunogenicity of 23-valent polysaccharide vaccine (23vPPV) and 7 valent pneumococcal conjugate vaccines (PCV7) in hospitalised older adults.
We measured antibody to vaccine serotypes by standardised enzyme-linked immunosorbent assay (ELISA) and opsonophagocytic (OPA) assays. A follow up study was conducted six years after vaccination with 23vPPV alone or with PCV7 followed by 23vPPV six months later.
Of 215 surviving trial participants, 136 (63%) completed follow up; 62 received 23vPPV and 74 received PCV7 + 23vPPV. There was no significant difference in death and readmission between arms. Antibody levels by ELISA and OPA did not differ significantly between the two study arms at 72 months post-vaccination. ELISA and OPA antibody remained higher than baseline except for OPA antibody to 4, 6A, 6B, 9v, 19F and 23F, including in subjects with undetectable immunity at baseline.
While ELISA responses in both study arms remained high 6 years post-vaccination, considerable waning was observed by OPA in both study arms, which should be considered given the current single-dose recommendation in Australia. Further research is needed to inform pneumococcal vaccine recommendations in people over the age of 65.
关于老年人（尤其是患重病风险最高的体弱老年人）对肺炎球菌疫苗的长期抗体反应的数据有限。我们对一项 23 价多糖疫苗（23vPPV）和 7 价肺炎球菌结合疫苗（PCV7）在住院老年患者中免疫原性的随机试验的参与者进行了随访。
我们通过标准化酶联免疫吸附测定（ELISA）和调理吞噬（OPA）测定法测量了针对疫苗血清型的抗体。在接种 23vPPV 单独或接种 PCV7 六个月后再接种 23vPPV 六年后进行了一项随访研究。
在 215 名幸存的试验参与者中，有 136 名（63%）完成了随访；62 名接受了 23vPPV，74 名接受了 PCV7+23vPPV。两组之间的死亡和再入院率没有显著差异。接种疫苗 72 个月后，两组之间的 ELISA 和 OPA 抗体水平没有显著差异。ELISA 和 OPA 抗体水平仍高于基线，除了 OPA 抗体针对 4、6A、6B、9v、19F 和 23F 的抗体水平外，包括基线时免疫功能不可检测的受试者。
尽管两组的 ELISA 反应在接种疫苗后 6 年内仍保持较高水平，但在两组中均观察到 OPA 抗体显著下降，鉴于目前澳大利亚推荐的单剂方案，这一点值得考虑。需要进一步研究为 65 岁以上人群的肺炎球菌疫苗推荐提供信息。
