Linnemann C C, First M R, Schiffman G
Arch Intern Med. 1986 Aug;146(8):1554-6.
Two years after pneumococcal vaccine was given to patients on a university renal transplant and hemodialysis service, vaccine failures began to occur. Serologic studies showed a threefold decrease in antibody levels during this period, from 913 ng of antibody nitrogen per milliliter to 315 ng/mL. The decrease was greater in patients undergoing hemodialysis than in renal transplant recipients (879 to 215 ng/mL vs 932 to 385 ng/mL). The lowest antibody levels were to types 4, 6A, and 19F. Patients were revaccinated, without serious reactions, and pneumococcal infections decreased as they had after the original vaccination program. After revaccination, there was a twofold increase in antibody levels (315 to 602 ng/mL), but the levels did not reach those seen after primary vaccination. The increase was greater in hemodialysis than in renal transplant recipients (215 to 757 ng/mL vs 385 to 536 ng/mL). This experience indicates that pneumococcal vaccines may be effective in patients undergoing hemodialysis and in asplenic renal transplant recipients, but these groups will require revaccination sooner than normal subjects to maintain immunity.
在一所大学的肾脏移植和血液透析服务中心为患者接种肺炎球菌疫苗两年后，开始出现疫苗接种失败的情况。血清学研究显示，在此期间抗体水平下降了三倍，从每毫升913纳克抗体氮降至315纳克/毫升。血液透析患者的抗体水平下降幅度大于肾移植受者（分别从879降至215纳克/毫升和从932降至385纳克/毫升）。抗体水平最低的是4型、6A 型和19F型。患者再次接种疫苗，未出现严重反应，肺炎球菌感染也如最初接种疫苗计划实施后那样减少了。再次接种疫苗后，抗体水平增加了两倍（从315升至602纳克/毫升），但未达到初次接种疫苗后的水平。血液透析患者的抗体水平增加幅度大于肾移植受者（分别从215升至757纳克/毫升和从385升至536纳克/毫升）。这一经验表明，肺炎球菌疫苗可能对血液透析患者和无脾肾移植受者有效，但这些人群需要比正常受试者更早地再次接种疫苗以维持免疫力。
