Q:

10/4/2013
Is there any data on the persistence of pneumococcal titers over a 6-12 month period post vaccination? I have an 8yo child who was referred to me for history of recurrent URI and poor response to PCV23. I've decided to boost her immunity with Prevnar 13 which she responded appropriately based on 5wk post titers. However, 6 months later, her titers have dropped ~50%. Is there a level that is considered protective for pneumococcus similar to other reported levels for vaccines such as Hib and DT? Thank you.

A:

Thank you for your inquiry.

I am going to refer your inquiry to Dr. Mark Ballow, who is an internationally known expert in assessing the response to pneumococcal vaccination and who recently wrote an excellent review of this issue (Ballow M, Use of vaccines in the evaluation of presumed immunodeficiency. Annals of Allergy, Asthma, and Immunology, 2013 (September); 111(3):163-166). As soon as we receive Dr. Ballow’s response, we will forward it to you.

Thank you again for your inquiry.

Sincerely,
Phil Lieberman, M.D.

We have received a response from Dr. Mark Ballow. Thank you again for your inquiry.

Sincerely,
Phil Lieberman, M.D.

Response from Dr. Mark Ballow:
Many of our colleagues have been asking a similar question of how long (months/years) to specific antibodies to pneumococcal polysaccharides persist. There is a paper by Musher et al (J Infect Disease 201:516-24, 2010) that examined the persistence of antibody levels in middle-aged and older adults after primary immunization and revaccination with Pneumovax. Antibody levels persisted for at least 5 years except for serotype 3 that returned to baseline by year 2.

I am not aware that similar data is available in children although it may be in the infectious disease literature on vaccine development for conjugate vaccines. R Sorenson has written about patients that respond well to Pneumovax (at the 4-5 week post-immunization) but seem to lose their specific antibodies by 6 months. These patients may be a variant of Selective Antibody Deficiency (see Orange et al JACI 130(3), Sept 2012, Table IV), and have a deficiency of memory B-cells. (Leiva et al J Clin Immunol 33(supple): S57-S61, 2013).

Mark Ballow, MD

AAAAI - American Academy of Allergy Asthma & Immunology