Is lack of protective response to Prevnar-13 indication for PNEUMOVAX in a pediatric patient?
Question:
5/15/2017
If I have a pediatric patient who has completed Prevnar-13 vaccination series with a history of recurrent upper respiratory tract infections despite optimized allergy medications, would there be support for Pneumovax-administeration if the patient demonstrates suboptimal pneumoccal response (<70% to 14 serotype pneumo titers). If not, are there any supportive vaccination measures that may improve the patient's clinical outcome?
Answer:
The CDC guidelines for administration of the pneumococcal polysaccharide vaccine to patients 2-64 years old include those with a "weakened immune system." Your patient with less than a protective response to the protein vaccine and recurrent infections presumptively caused by pneumococcus could be considered to have a weakened immune system.
The abstract presented at the March AAAAI Annual Meeting below suggests that adult patients who did not respond to the polysaccharide vaccine did to the protein vaccine, raising the question is the reverse the case, too.
Do patients with recurrent infections aged 18-64 with suboptimal response to PNEUMOVAX®23 have improved response to protein based vaccine?
Sunday, March 5, 2017
Catherine Capo, MD, Blanka M. Kaplan, MD FAAAAI, Anastasiya Kleva, MD
Rationale: Specific antibody deficiency is defined as unresponsiveness to polysaccharide vaccines with an otherwise intact immune system. Our goal was to determine if patients with recurrent infections aged 18-64 with suboptimal response to PNEUMOVAX®23 (PPV) who’s clinical and laboratory presentation did not deem them eligible for IVIG, had an improved response to protein-based vaccines: Prevnar 13®/Prevnar 7®.
Methods: A retrospective review of 2,000 patient charts in our Allergy and Immunology Division was completed. Pneumococcal titer responses were evaluated before and after vaccinating with PPV and Prevnar. Only patients who received PPV followed by Prevnar were selected.
Results: Six patients were eligible. Two patients had a vaccine series twice; PPV followed by Prevnar 7®, and years later, PPV followed by Prevnar 13®. There was a 20.1 % increase in average response with Prevnar 13®. The two patients who received PPV followed by Prevnar 7®, had a 0% increase in response, but an average of 28.2% increase with Prevnar 13®. The time interval between both vaccines ranged widely (1.75 to 92 months). Patients that received the vaccines < 4 months apart had a 6.2% increase in response, but a 25.1 % increase in response if vaccines were administered >10 months apart.
Conclusions: Our data suggests that the described patient population benefited from receiving Prevnar 13®, and that a time interval of at least 10 months between vaccines enhanced immune response. Patients demonstrated potential to respond to a subsequent vaccination series, even if they did not respond initially.
We hope this helps,
Patricia McNally, MD, FAAAAI