Sorensen R U, Leiva L E, Giangrosso P A, Butler B, Javier F C, Sacerdote D M, Bradford N, Moore C
Department of Pediatrics, Louisiana State University Medical Center, New Orleans 70112-2822, USA.
Pediatr Infect Dis J. 1998 Aug;17(8):685-91. doi: 10.1097/00006454-199808000-00005.
To determine whether children with recurrent respiratory infections who failed to respond to the conventional polysaccharide vaccine would respond to a pneumococcal conjugate vaccine.
Children referred to our clinic for recurrent respiratory infections who had no known primary or secondary immunodeficiencies were immunized with a 23-valent pneumococcal polysaccharide vaccine. IgG antibodies to pneumococcal serotypes 1, 3, 4, 6B, 9V, 14, 18C, 19F and 23F were determined by enzyme-linked immunosorbent assay before and 4 to 6 weeks after immunization. An adequate IgG antibody response to an individual serotype was arbitrarily defined as a postimmunization antibody titer > or =1.3 microg/ml or at least 4 times the preimmunization value. Immunization with an experimental CRM197-heptavalent pneumococcal conjugate vaccine was offered to patients without an adequate response to 4 or more vaccine serotypes (nonresponders). Post-conjugate immunization antibody concentrations were measured 4 to 6 weeks later.
In nonresponder patients (n = 17) geometric mean post-conjugate immunization (C) serum antibody concentrations (microg/ml) compared with post-polysaccharide (PS) concentrations were: (serotype, C vs. PS) 4, 1.11 vs. 0.30 (P = 0.000227); 6B, 0.46 vs. 0.20 (P = 0.017267); 9V, 0.82 vs. 0.29 (P = 0.002163); 14, 1.88 vs. 0.27 (P = 0.000615); 18C, 0.98 vs. 0.32 (P = 0.021962); 19F, 1.24 vs. 0.34 (P = 0.002844); and 23F, 0.87 vs. 0.16 (P = 0.000194). In responder patients (n = 67), after 1 dose of the polysaccharide vaccine, geometric mean antibody concentrations were: 4, 1.05; 6B, 0.96; 9V, 1.55; 14, 1.65; 18C, 1.62; 19F, 1.30; and 23F, 1.02.
Our results show that a pneumococcal conjugate vaccine is capable of inducing an IgG response in patients with recurrent infections who had failed to mount an adequate response to the polysaccharide vaccine. Conjugate vaccines may be of value in the management of children with recurrent pneumococcal respiratory infections.
确定对传统多糖疫苗无反应的反复呼吸道感染儿童是否会对肺炎球菌结合疫苗产生反应。
将因反复呼吸道感染前来我们诊所就诊且无已知原发性或继发性免疫缺陷的儿童用23价肺炎球菌多糖疫苗进行免疫。在免疫前及免疫后4至6周，通过酶联免疫吸附测定法测定针对肺炎球菌血清型1、3、4、6B、9V、14、18C、19F和23F的IgG抗体。对单个血清型的充分IgG抗体反应被任意定义为免疫后抗体滴度≥1.3μg/ml或至少为免疫前值的4倍。向对4种或更多疫苗血清型无充分反应的患者（无反应者）提供实验性CRM197-七价肺炎球菌结合疫苗进行免疫。4至6周后测量结合免疫后的抗体浓度。
在无反应患者（n = 17）中，结合免疫后（C）血清抗体浓度（μg/ml）与多糖免疫后（PS）浓度相比为：（血清型，C vs. PS）4，1.11 vs. 0.30（P = 0.000227）；6B，0.46 vs. 0.20（P = 0.017267）；9V，0.82 vs. 0.29（P = 0.002163）；14，1.88 vs. 0.27（P = 0.000615）；18C，0.98 vs. 0.32（P = 0.021962）；19F，1.24 vs. 0.34（P = 0.002844）；23F，0.87 vs. 0.16（P = 0.000194）。在有反应患者（n = 67）中，1剂多糖疫苗后，几何平均抗体浓度为：4，1.05；6B，0.96；9V，1.55；14，1.65；18C，1.62；19F，1.30；23F，1.02。
我们的结果表明，肺炎球菌结合疫苗能够在对多糖疫苗无充分反应的反复感染患者中诱导IgG反应。结合疫苗可能对反复发生肺炎球菌呼吸道感染的儿童的管理有价值。
