Department of Infectious Diseases, University Hospital Essen, University Duisburg-Essen, Essen, Germany; Department of Nephrology, University Hospital Essen, University Duisburg-Essen, Essen, Germany; Institute for Transfusion Medicine, University Hospital Essen, University Duisburg-Essen, Essen, Germany.
Institute for Transfusion Medicine, University Hospital Essen, University Duisburg-Essen, Essen, Germany.
Vaccine. 2020 Apr 9;38(17):3339-3350. doi: 10.1016/j.vaccine.2020.02.088. Epub 2020 Mar 13.
Vaccination against S. pneumoniae is recommended by national guidelines. Moderate immunogenicity of the 13-valent pneumococcal conjugate vaccine (PCV13) has been reported in adult kidney transplant recipients (KTR). This study further defines the immunogenicity of PCV13 in this cohort.
49 KTR were immunized with PCV13. A validated opsonophagocytic killing assay (OPA), a global anti-pneumococcal capsular polysaccharide (anti-PCP) IgG, IgG2, IgM and IgA ELISA, and - for selected patients - a serotype specific anti-PCP WHO reference ELISA were performed pre-vaccination and at month 1 and 12 post-vaccination.
Geometric mean OPA titers increased significantly for 13/13 serotypes at month 1 and for 10/13 serotypes at month 12 post-vaccination. Vaccine response defined as an OPA titer ≥1:8 was reached in 9/13 serotypes (median). 53% reached the vaccine response criteria at month 1 and 45% at month 12. At month 1 after vaccination, the median OPA titer in an age-group matched healthy reference population was 5- to 10-fold higher than in KTR. OPA titers correlated strongly with results to the global and serotype specific anti-PCP IgG ELISA. Lower OPA titers significantly (p < 0.05) correlated with albuminuria, an interval between vaccination and transplantation <12 months, age and treatment with mycophenolate mofetil. Global IgG, IgG2, IgM and IgA, as well as serotype specific anti-PCP antibody concentrations (12/13 serotypes) increased significantly at month 1 and 12 post-vaccination.
Kidney transplant recipients show a significant humoral response after vaccination with PCV13. Functional antibody response exists, but is not as vigorous as in healthy adults.
国家指南建议接种 S. pneumoniae 疫苗。已有研究报道，13 价肺炎球菌结合疫苗（PCV13）在成人肾移植受者（KTR）中的免疫原性为中等。本研究进一步明确了该人群中 PCV13 的免疫原性。
49 例 KTR 接种 PCV13。接种前及接种后 1 个月和 12 个月时，采用已验证的调理吞噬杀菌试验（OPA）、全抗肺炎球菌荚膜多糖（anti-PCP）IgG、IgG2、IgM 和 IgA ELISA，以及针对部分患者的血清型特异性抗-PCP WHO 参考 ELISA 进行检测。
13 个血清型中的 10 个在接种后 1 个月和 12 个月时 OPA 滴度显著增加，13 个血清型中的 10 个在接种后 1 个月时达到疫苗反应标准（OPA 滴度≥1:8）。中位值为 9/13 个血清型（53%）在接种后 1 个月达到疫苗反应标准，45%在接种后 12 个月达到该标准。接种后 1 个月，年龄匹配的健康对照组人群的 OPA 滴度中位数比 KTR 高 5-10 倍。OPA 滴度与全抗和血清型特异性抗-PCP IgG ELISA 结果高度相关。较低的 OPA 滴度与白蛋白尿（p<0.05）、接种与移植之间的时间间隔<12 个月、年龄和霉酚酸酯治疗显著相关。接种后 1 个月和 12 个月时，全 IgG、IgG2、IgM 和 IgA 以及血清型特异性抗-PCP 抗体浓度（12/13 个血清型）均显著增加。
肾移植受者接种 PCV13 后可产生显著的体液免疫反应。功能性抗体反应存在，但不如健康成年人活跃。
