King J C, Vink P E, Farley J J, Parks M, Smilie M, Madore D, Lichenstein R, Malinoski F
University of Maryland School of Medicine, Baltimore, USA.
Pediatr Infect Dis J. 1996 Mar;15(3):192-6. doi: 10.1097/00006454-199603000-00003.
To compare the safety and immunogenicity of a 5-valent pneumococcal conjugate vaccine to a licensed 23-valent polysaccharide pneumococcal vaccine in HIV-infected and non-HIV-infected children > or = 2 years old.
Thirty HIV-infected and 30 non-HIV-infected children > or = 2 years old were randomized to receive either a 5-valent pneumococcal conjugate vaccine (PCV) or a 23-valent pneumococcal polysaccharide vaccine (PPV) intramuscularly. Children who received PCV initially were given PPV after 6 weeks. Sera were obtained before and at 6 and 12 weeks after the first vaccination to determine IgG pneumococcal antibody titers by enzyme-linked immunosorbent assay to the 5 serotypes represented in the PCV.
Both vaccines were well-tolerated with no significant differences in the rates of fever (0 to 14%) or local reactions (0 to 40%) noted between PCV and PPV recipients. Pre-first vaccination geometric mean antibody titers (combined PCV and PPV recipients) to 3 of the 5 pneumococcal types tested were significantly lower in HIV-infected than in non-HIV-infected children (in microgram/ml: type 6B, 0.179 vs. 0.565; type 14, 0.026 vs. 0.060; type 23F, 0.025 vs. 0.119, respectively; P < 0.05). Fewer > or = 4-fold titer rises were observed in HIV vs. non-HIV-infected children whether they received PCV initially (60% vs. 79%, P < 0.05) or PPV (31% vs. 59%, P < 0.05). Also PCV elicited more > or = 4-fold titer rises compared with PPV in HIV-infected (60% vs. 31%, P < 0.05) and non-HIV-infected (79% vs. 59%, P < 0.05) children. No consistent antibody-boosting effect was noted in subjects who received PPV after PCV.
We conclude that antibody responses to natural infection, PCV and particularly PPV are poorer in HIV-infected than in non-HIV-infected children. PCV is as safe as and more immunogenic than the currently licensed PPV among HIV-infected and non-HIV-infected children.
比较5价肺炎球菌结合疫苗与已获许可的23价肺炎球菌多糖疫苗在2岁及以上感染HIV和未感染HIV儿童中的安全性和免疫原性。
将30名2岁及以上感染HIV的儿童和30名未感染HIV的儿童随机分为两组，分别肌肉注射5价肺炎球菌结合疫苗（PCV）或23价肺炎球菌多糖疫苗（PPV）。最初接受PCV的儿童在6周后接种PPV。在首次接种疫苗前、接种后6周和12周采集血清，通过酶联免疫吸附测定法测定针对PCV中所含5种血清型的IgG肺炎球菌抗体滴度。
两种疫苗耐受性均良好，PCV和PPV接种者的发热率（0%至14%）或局部反应率（0%至40%）无显著差异。在接受检测的5种肺炎球菌类型中，3种类型在首次接种疫苗前的几何平均抗体滴度（PCV和PPV接种者合并计算）在感染HIV的儿童中显著低于未感染HIV的儿童（以微克/毫升计：6B型，0.179对0.565；14型，0.026对0.060；23F型，0.025对0.119，P<0.05）。无论最初接受PCV（60%对79%，P<0.05）还是PPV（31%对59%，P<0.05），感染HIV的儿童中观察到的滴度升高≥4倍的情况均少于未感染HIV的儿童。此外，在感染HIV的儿童（60%对31%，P<0.05）和未感染HIV的儿童（79%对59%，P<0.05）中，PCV诱导的滴度升高≥4倍的情况比PPV更多。在PCV后接种PPV的受试者中未观察到一致的抗体增强效应。
我们得出结论，感染HIV的儿童对自然感染、PCV尤其是PPV的抗体反应比未感染HIV的儿童更差。在感染HIV和未感染HIV的儿童中，PCV与目前已获许可的PPV一样安全，且免疫原性更强。
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