Q:

1/29/2013
I was wondering if patients with common variable immunodeficiency, or, decreased antibodies, if giving these patients the meningitis vaccine would be appropriate. We are concerned about other bacterial infections involving both polysaccharide and protein antigens, and should one measure titers before and after. Thank you for your time.

A:

Thank you for your inquiry.

The use of meningococcal vaccine as preventive therapy in patients with common variable immunodeficiency has been controversial. However, recent studies, especially the study for which the abstract is copied below, have indicated that a significant number of patients with common variable immunodeficiency can produce an antibody response to meningococcal vaccine. Thus, consideration of its use as a preventive therapy is certainly warranted.

This article is available to you free of charge online. I have also copied below the link to the website should you wish to read about this issue in more depth.

The meningococcal vaccine has also been used to measure humoral immune function in patients with common variable immunodeficiency (1). It can be used in the clinical evaluation of immunodeficiency cases. In such cases, pre and post immunization titers are obtained. Details regarding its use are available to you in Reference Number 1.

Thank you again for your inquiry and we hope this response is helpful to you.

Nima Rezaei, et al. Serum Bactericidal Antibody Response 1 Year after Meningococcal Polysaccharide Vaccination of Patients with Common Variable Immunodeficiency. Clin Vaccine Immunol. 2010 April; 17(4): 524¨C528.
Abstract
Some patients with common variable immunodeficiency (CVID) can generate an antibody response following vaccination with Neisseria meningitidis polysaccharide, but the duration of this protection is unknown. In this study, serum bactericidal antibody (SBA) responses to serogroup C N. meningitidis of 23 patients with CVID and 23 sex- and age-matched controls were measured 1 year after vaccination with the plain A/C meningococcal polysaccharide vaccine. The fold rise in serum bactericidal antibody geometric mean titers of the control group from prevaccination to 1 year postvaccination was significantly higher than that of the patient group (5.41- versus 2.96-fold, P = 0.009). Of 23 CVID patients, 8 had a poor response to vaccine (<4-fold rise) 3 weeks after vaccination, and low titers remained when measured 1 year later. Of the 15 CVID patients who had a normal response to vaccine (¡Ý4-fold rise) 3 weeks after vaccination, 6 cases failed to maintain protective SBA titers, whereas the remaining 9 had protective titers 1 year after vaccination. Only one of the 23 controls, who developed protective SBA titers after 3 weeks, lost the protective titers after 1 year. Among the patients, the presence of bronchiectasis and/or splenomegaly at enrollment was associated with poor SBA response to vaccine at 3 weeks and/or failure to maintain protective levels at 1 year. The results of this study demonstrate that a number of CVID patients can produce protective antibody titers that can persist for 1 year after vaccination, which lends strong support to the inclusion of polysaccharide vaccine in the immunization program for CVID patients.

Reference:
1. Orange JS, et al. Use and interpretation of diagnostic vaccination in primary immunodeficiency: a working group report of the basic and clinical immunology interest section of the American Academy of Allergy, Asthma, and Immunology. J Allergy Clin Immunol 2012; 130(3):S1-S24.

Sincerely,
Phil Lieberman, M.D.

AAAAI - American Academy of Allergy Asthma & Immunology