Gerald Schiffman

Revaccination with pneumococcal vaccine of elderly persons 6 years after primary vaccination.

We vaccinated 15 persons, age 56 to 79 years, with 14-valent pneumococcal polysaccharide vaccine and revaccinated them with 23-valent vaccine 6 years later to assess adverse reactions and booster responses of anticapsular antibodies. No systemic reactions occurred after administration of either vaccine. After booster vaccination, five vaccinees developed only mild soreness or tenderness at the site of injection. The (arithmetic) mean antibody level to 12 capsular types measured by radioimmunoassay increased 3.1-fold 1 month after the first vaccine; the range was 1427-5124 ng antibody nitrogen per ml (N ml-1). Six years later, mean antibody levels waned to about half these levels. One month after administration of the second dose of vaccine, the mean antibody level increased 1.5-fold; the range was 1011-3954 ng antibody N ml-1. Revaccination with pneumococcal vaccine of elderly persons can be carried out safely; the levels of anticapsular antibody achieved after revaccination are about half the levels after primary vaccination.

RESPONSE TO PNEUMOCOCCAL POLYSACCHARIDE VACCINE IN PATIENTS WITH UNTREATED HODGKIN'S DISEASE: Children's Cancer Study Group Report

Patients with Hodgkins disease (HD) have a high risk of overwhelming pneumococcal infections after splenectomy. Previous studies have shown that HD patients given polyvalent pneumococcal polysaccharide (PPS) vaccine after immunosuppressive therapy have a suboptimum antibody response. This study shows significant antibody response in HD patients to PPS vaccine given before radiation and chemotherapy. The same response was obtained whether the vaccine was given before or after splenectomy.

Immunogenicity of the 23-valent pneumococcal polysaccharide vaccine in Alaska native chronic alcoholics compared with nonalcoholic native and non-native controls☆

PURPOSE This study was designed to evaluate the immunogenicity of the 23-valent pneumococcal polysaccharide vaccine in Alaska Native chronic alcoholics and compare these responses with those in age- and sex-matched nonalcoholic, Native and non-Native control subjects. PATIENTS AND METHODS Native alcoholic patients were recruited from the inpatient medical service and outpatient clinics. Healthy age- and sex-matched Alaska Native and non-Native nonalcoholics were recruited from hospital employees. At the initial visit, a standardized questionnaire, the Alcohol Dependency Scale, was administered to all participants. Participants were examined for liver diseases; blood was drawn for liver function tests and prevaccination pneumococcal antibody levels. Charts of all Native participants were reviewed for alcohol-related diseases. Participants received one dose of the 23-valent pneumococcal vaccine at the time of the initial visit and returned 20 to 55 days after immunization for liver function tests and pneumococcal antibody level measurement. Serotype-specific pneumococcal antibody levels were measured by radioimmunoassay. Logistic regression analysis was used to examine the proportion of persons whose serotype-specific antibody level doubled following vaccination. A model including adjustments for age, sex, and initial antibody level was used to examine the effect of alcohol status and ethnicity on response to the vaccine. Eighty-five persons completed the study. Of these, 41 were chronic alcoholics and 44 were nonalcoholic. Of these, 21 were Alaska Natives and 23 were non-Natives. RESULTS Before vaccination, the geometric mean titers (GMTs) were similar in all 3 groups but were slightly higher in Native alcoholic participants for 11 of 12 serotypes tested. For 11 or more serotypes tested, 46% of alcoholics and 27% of nonalcoholics had total antibody levels at or above 500 nanograms of antibody nitrogen per milliliter (p = 0.11). After vaccination, the GMTs were higher in nonalcoholic than in alcoholic participants for serotypes 3, 7F, and 19F (p < 0.05). When Natives and non-Natives were compared, non-Natives had higher antibody levels than Native participants for 10 of 12 serotypes. After vaccination, 83% of alcoholics and 91% of nonalcoholics had pneumococcal antibody levels of more than 500 nanograms of antibody nitrogen per milliliter for at least 11 serotypes. When responses consisting of a twofold or greater increase in antibody level were compared, a greater proportion of nonalcoholics than alcoholics responded to serotypes 3, 4, 7F, 8, and 19F. This difference was significant for types 3 and 19F only (p < 0.05). In alcoholics there was a direct correlation between pneumococcal antibody level and age both before and after vaccination. This was significant before vaccination for serotypes 4, 6B, 18C, and 23F, and after vaccination for these types and for types 1 and 19F. In nonalcoholics there was a correlation between age and antibody response, following vaccination, for serotype 9N and 18C. Alcoholic males had antibody levels higher than that in females for most serotypes, but significantly so only for serotype 12F before vaccination, and for type 14 after vaccination. There were no sex differences seen among nonalcoholics, and no differences in response to vaccine could be detected in patients with or without liver dysfunction. CONCLUSION In this study of Alaska Natives with chronic alcoholism, Native and non-Native participants responded adequately to immunization with the 23-valent pneumococcal vaccine, although significant differences in some serotypes were evident.

Selective deficiency of antibody responses to polysaccharide antigens in a child mosaic for partial trisomy 1 (46,XX,dir dup (1) (q12→q23)/46,XX)

The selective inabil i ty to mount ant ibody responses to polysaceharide ant igens occurs infrequently and usually is seen in association with other defects of the immune system, such as IgG subclass deficiency, funct ional asplenia, and Wiskot t -Aldr ich syndrome. 1 This report describes a selective deficiency of ant ipolysaccharide immuni ty in a child mosaic for part ial t r isomy 1. The association of these two extremely rare conditions in a single pat ient may suggest a role for a gene on chromosome 1 in the humora l immune response to polysaccharide antigens.

Antibody Response to Pneumococcal Polysaccharides in Insulin-dependent Diabetes Mellitus

Twenty-one insulin-dependent diabetics and 11 healthy control children were immunized with polyvalent pneumococcal polysaccharide vaccine. Serum antibody to pneumococcal polysaccharides was measured by radioimmunoassay before and after immunization. Although there were some differences in type-specific antibody concentrations between diabetic and control subjects, the overall antibody concentrations preimmunization, 3–4 wk postimmunization, and 6–7 wk postimmunization were similar in both populations. In both groups antibody response to immunization correlated strongly with preimmunization antibody concentration. Among the diabetic subjects there was no correlation between antibody responses and duration of disease, insulin dose, or concentration of glycosylated hemoglobin. Insulin-dependent diabetic subjects have a serum antibody response to pneumococcal polysaccharides equivalent to that of controls, and in both populations the magnitude of the antibody response correlates with preimmunization antibody levels.

A comparison of antibody concentration measured by mouse protection assay and radioimmunoassay in sera from patients at high risk of developing pneumococcal disease

The radioimmunoassay (RIA) of pneumococcal capsular polysaccharide antibodies is dependent on the association of radiolabeled antigen and pneumococcal antibody. However, it is not known whether the ability of the antibody to complex with antigen correlates with in vivo protection against infection. A method for evaluating protective ability of antibody vis-à-vis binding ability is to passively transfer a measured quantity of antibody into recipient mice followed by a lethal challenge with virulent pneumococci. Protection against a fatal outcome is then correlated with the amount of antibody (as measured by RIA) passively transferred. This comparison of quantitation by RIA and biological protection in mice was performed on 30 sera from humans. The sera were obtained from vaccinated healthy persons and vaccinated persons at high risk of developing pneumococcal infection, including people with nephrotic syndrome, chronic obstructive pulmonary disease and various forms of cancer. The results of these studies indicate that antibody as measured by RIA correlates with protective antibody against pneumococcal infection. These studies were conducted on pneumococcal serotype 3.

Antibody Responses after Immunization with Polyvalent Pneumococcal Vaccine Containing 10, 25, or 50 μg of 14 Polysaccharide Types per Dose

Abstract Immune responses were determined to three different doses of a pneumococcal vaccine which contained 10, 25, or 50 μg of 14 polysaccharide types (1, 3, 4, 6A, 6B, 7F, 8, 9N, 12F, 14, 18C, 19F, 20, and 23F) per dose. Pre- and 4-weeks postvaccination sera were examined by radioimmunoassay. Ratios of geometric mean titers (GMT) showed a greater than threefold increase of antibodies to each type of polysaccharide regardless of the dose of antigen. The post-GMT was highest to 12 of 14 types in recipients of the 25-μg vaccine. Subjects in the group receiving a 25-μg dose of each antigen showed more two- and fourfold titer increases than did subjects in the group receiving 10- and 50-μg doses, but, in general, seroconversion rates were similar in all the groups. All GMT values in the 25-μg vaccine group were well above what is currently considered to be the protective level of antibody. Local reactions, overall, were low in all groups. Pain, induration, and tenderness at the site of injection, which were greatest in recipients of the 50-μg dose/antigen, were progressively lower with the 25- and 10-μg dose/antigen.

The relationship of maternal antibody levels to post-cesarean section endometritis

One hundred eight pneumococcal polysaccharide antibody levels were determined by radioimmunoassay preoperatively in 18 patients who underwent elective repeat cesarean section. Eight patients developed post-cesarean section endometritis, and 10 did not. The endometritis group did not vary significantly from the noninfected group in preoperative hematocrit, social status, number of previous pregnancies, maternal and newborn weights, length of operation, and Apgar scores. Mean antibody levels in the endometritis group were significantly lower than those in the control group (49 versus 103 ng/ml; p less than 0.05). Mean antibody levels for the six serotypes in the endometritis group were significantly lower than those in the control group (p less than 0.05). This study indicated that a healthy maternal immune system may play an important role in preventing post-cesarean section morbidity. Pneumococcal polysaccharide antibody levels may be used in pregnancy to assess the risk for post-cesarean section infections.