Immunogenicity and tolerance of a 7-valent pneumococcal conjugate vaccine in nonresponders to the 23-valent pneumococcal vaccine.

There is still a lack of effective vaccination strategies for patients with a deficient antibody response to bacterial polysaccharide antigens. In an open trial, we evaluated the immunogenicity and tolerance of a new 7-valent pneumococcal conjugate vaccine in 22 infection-prone nonresponders to pneumococcal polysaccharide vaccine and 21 controls. In the patient group, nonresponsiveness was confirmed by repeated vaccination with a 23-valent pneumococcal polysaccharide vaccine. The study protocol provided two doses of the pneumococcal conjugate vaccine, given 4 to 6 weeks apart, for both groups. The antibody response was determined before each vaccination and on follow-up by an enzyme-linked immunosorbent assay and compared to the response in a functional opsonophagocytosis assay. Patients showed a significantly lower postvaccination immune response for all serotypes than did controls. The postvaccination response was serotype dependent. A median titer of >1 microgram/ml in patients was recorded only for serotypes 4, 9V, 14, and 19F, which are known to be more immunogenic than serotypes 6B, 18C, and 23F. In the patient group, 70% responded to serotype 19F (Pnc 19F), 65% responded to Pnc 14 and 4, 60% responded to Pnc 9V, 55% responded to Pnc 18C, 50% responded to Pnc 23F, and 25% responded to Pnc 6B. In the control group >95% of individuals showed a titer of >1 microgram/ml to every serotype. The vaccine was tolerated well, and no major side effects have been reported. The new pneumococcal conjugate vaccine is clearly more immunogenic in previous nonresponders than is the 23-valent pneumococcal vaccine. Immunization with a pneumococcal conjugate vaccine should be considered as a strategy to protect high-risk patients.

Differential immune response to influenza and pneumococcal vaccination in immunosuppressed patients after heart transplantation.

INTRODUCTION: Patients after solid organ transplantation are at an increased risk for microbial infections. Due to therapeutic immunosuppression, the response to active immunizations may be reduced. The serological efficacy of pneumococcal and influenza vaccination was studied in heart transplant recipients. PATIENTS AND METHODS: Sixteen patients over 1 year after heart transplantation and control patients were immunized with a 23-valent pneumococcal vaccine and a triple-split influenza vaccine. Pre- and postvaccinal antibody titers were serologically determined, including quantitation of specific antibodies against nine pneumococcal serotypes. RESULTS: Both vaccines were well tolerated without systemic reactions or infectious complications. Median postvaccinal pneumococcal antibody titers in the transplant patients were comparable to controls (5513 U/ml, range: 694-41007, vs. 5490 U/ml, range: 1088-38042; P=NS); vaccination was successful in 23/23 (100%) of controls and in 15/16 (94% plus 1 borderline positive case) of the transplant recipients. Specific antibody titers were similar for eight of nine serotypes; only the immune response against serotype 3 was reduced after transplantation. The efficacy of influenza vaccination was significantly impaired in transplant patients against all three virus strains (62% vs. 97%, P<0.01/50% vs. 94%, P<0.001/37% vs. 80%, P<0.01), but 9/16 (56%) of patients still showed a sufficient immune response to two out of three virus strains. No clinical or demographic predictors of successful vaccination could be established. CONCLUSIONS: Pneumococcal vaccination under cyclosporine-based immunosuppression after heart transplantation is safe and equally effective as in healthy controls. In contrast, the immune response to influenza vaccination is significantly reduced, although not completely abolished. This differential response might be accounted for by T cell-independent antibody production against polysaccharide antigens contained in the pneumococcal vaccine.

[Pathogenesis, diagnosis, clinical and therapeutic aspects of ataxia telangiectasia]. / Pathogenese, Diagnostik, Klinik und therapeutische Aspekte der Ataxia teleangiektatika.

Ataxia-telangiectasia (AT) is an autosomal recessively inherited disease (one case in 40,000 to one case in 100,000 live births) whose principal features are oculocutaneous telangiectasia, progressive cerebellar ataxia, B- and T-cell immunodeficiency with recurrent sinopulmonary infections, sensitivity to ionizing radiation and cancer predisposition. The AT-gene (ATM) was recently identified by positional cloning on chromosome 11q22-23. In this paper the diagnostic, clinical and therapeutic problems of 9 AT-patients treated in our clinic are discussed in context with the current literature. Although all patients had discrete signs of cerebellar ataxia at infancy, there was a significant delay of definitive diagnosis (median 4, range 1.5-6.5). Elevated alpha fetoprotein levels clearly distinguish AT from other ataxias and immunodeficiency syndromes.

[Vaccination of chronically ill children]. / Impfungen bei chronisch erkrankten Kindern.

Children with chronic diseases (hematologic, metabolic and renal diseases, children with chronic heart and lung disease, children with cerebral defects and immunodeficient patients) have an increased risk to suffer from infectious diseases and should be immunized with priority. In addition to routine immunization, these high-risk children may benefit from influenza, pneumococcal and hepatitis A vaccination. In this paper, general recommendations for vaccination in children with chronic diseases are being discussed, with emphasis on certain disease entities. Furthermore, the importance and indications for influenza and pneumococcal vaccine are being presented.