Administration of Protein-Conjugate Pneumococcal Vaccine to Patients Who Have Invasive Disease after Splenectomy Despite Their Having Received 23-Valent Pneumococcal Polysaccharide Vaccine

• Published in: The Journal of infectious diseases Vol. 191; no. 7; pp. 1063 - 1067
• Main Authors: Musher, Daniel M., Ceasar, Heather, Kojic, Erna M., Musher, Benjamin L., Gathe, Joseph C., Romero-Steiner, Sandra, White, A. Clinton
• Format: Journal Article
• Language: English
• Published: Chicago, IL The University of Chicago Press 01.04.2005; University of Chicago Press; Oxford University Press
• Subjects: Adult; Antibodies; Antibodies, Bacterial - blood; Applied microbiology; Bacteremia - immunology; Bacteremia - therapy; Bacteria; Bacteriology; Biological and medical sciences; Disease risk; Fundamental and applied biological sciences. Psychology; Health care administration; Heptavalent Pneumococcal Conjugate Vaccine; Humans; Immunoglobulin G - blood; Infections; Infectious diseases; Male; Medical genetics; Medical sciences; Meningococcal Vaccines - administration & dosage; Meningococcal Vaccines - immunology; Microbiology; Middle Aged; Miscellaneous; Pneumococcal Infections - immunology; Pneumococcal Infections - therapy; Pneumococcal vaccine; Pneumococcal Vaccines - administration & dosage; Pneumococcal Vaccines - immunology; Postoperative Complications; Sepsis; Splenectomy; Streptococcus pneumoniae; Streptococcus pneumoniae - immunology; Vaccination; Vaccines, antisera, therapeutical immunoglobulins and monoclonal antibodies (general aspects); Human; Infection; Streptococcaceae; Microbiology; Bacteria; Micrococcales; Vaccine; Polysaccharide; Protein; Streptococcus pneumoniae
• DOI: 10.1086/428135
• ISSN: 0022-1899

Patients who undergo splenectomy are at greatly increased risk for overwhelming pneumococcal bacteremia and death. Twenty-three–valent pneumococcal polysaccharide vaccine (PPV-23), which contains capsular polysaccharides (PSs) from 23 common serotypes of Streptococcus pneumoniae is strongly recommended for such patients. The capacity to respond to PPV-23 by producing immunoglobulin (Ig) G is genetically regulated. Some proportion of adults do not respond and, despite postsplenectomy administration of PPV-23, may remain susceptible to recurrent pneumococcal sepsis. Here, we describe 2 patients who had recurring pneumococcal bacteremia after undergoing splenectomy despite having received numerous doses of PPV-23. Heptavalent protein-conjugate pneumococcal vaccine (PCPV-7) was then administered, and it induced high levels of IgG to all 7 PSs; in one of the patients, functional activity against 5 of the 7 PSs was demonstrable, both in vitro and in vivo. Recurrent pneumococcal bacteremia in patients who have undergone splenectomy may indicate a genetically regulated failure to respond to PPV-23; PCPV-7 may stimulate production of IgG to PSs in such patients