Cross-immunogenicity of pneumococcal group 9 capsular polysaccharides in adult volunteers.

Group 9 organisms (types 9N, 9A, 9L, and 9V) account for about 3 to 4% of pneumococcal disease isolates throughout the world. Types 9N and 9V comprise about 90% of the group 9 disease isolates. Type 9N is more common than type 9V in adults, and type 9V predominates in infants and children. In the United States there have been eight reported cases due to group 9 pneumococci in individuals previously vaccinated; six were type 9V and two were type 9N. To ascertain the cross-immunogenicity of group 9 polysaccharides, volunteers were injected with vaccines of monovalent types 9N, 9A, 9V, or 9L, or bivalent (9N and 9A) or trivalent (9N, 9A, and 9V) polysaccharide vaccines. Monovalent types 9N, 9V, and 9L each stimulated a 5.8- to 7.5-fold geometric mean rise, and at least 80% of the volunteers responded with a twofold or greater homologous antibody rise. Type 9V induced a 5.8-fold geometric mean rise, but only 66% of the volunteers responded with a twofold or greater homologous antibody rise. Type 9N induced only a 2.1-fold geometric increase, and only 54% of the volunteers responded with a twofold or greater rise in anti 9V antibodies. Types 9L and 9A were the most cross-immunogenic. The trivalent preparation (9N, 9A, and 9V) gave the highest geometric mean titer and seroconversion rate to each of the group 9 polysaccharides. These results suggest that the polyvalent pneumococcal vaccine with its type 9N does not induce a satisfactory anti-type 9V response and should contain additional components in order to achieve greater protection against group 9 organisms.