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Rapid decline of anti-pneumococcal antibody levels in nephrotic children
Ayfer Gür Güven1, Sema Akman, Elif Bahat
1Departments of Pediatric Nephrology and Pediatric Immunology, School of Medicine, Akdeniz University, Antalya, Turkey.
Insights
Children with nephrotic syndrome show poor long-term antibody levels after pneumococcal polysaccharide vaccination (PPV). This suggests continued infection risk despite initial immune response.
Area of Science:
- Pediatric Nephrology
- Immunology
- Vaccinology
Background:
- Nephrotic syndrome increases susceptibility to pneumococcal infections.
- Antibody responses to pneumococcal polysaccharide vaccine (PPV) in these children are variable.
- Long-term antibody maintenance after PPV is not well understood.
Purpose of the Study:
- To assess total IgG antibody levels against pneumococcal polysaccharides in children with nephrotic syndrome.
- To evaluate antibody persistence at various time points after PPV administration.
- To understand the implications for infection risk in vaccinated nephrotic children.
Main Methods:
- Nine children with steroid-responsive nephrotic syndrome in remission were studied.
- Total IgG antibody levels were measured before and 1, 6, 12, and 36 months after PPV.
- Antibody levels were determined using quantitative assays.
Main Results:
- Initial antibody titers increased significantly post-vaccination (mean 165.4 mg/l).
- Antibody levels declined by 6 months in most patients (mean 94.6 mg/l).
- By 36 months, four patients had levels below baseline or early post-vaccination values.
Conclusions:
- Nephrotic children may not sustain adequate antibody levels post-PPV, despite initial responses.
- Vaccinated children with nephrotic syndrome may remain susceptible to pneumococcal infections.
- Further research into optimal vaccination strategies for this population is warranted.
Abstract:
Nephrotic children are at increased risk for pneumococcal infections. Antibody responses to the currently recommended pneumococcal polysaccharide vaccine have been variable and maintenance of adequate antibody levels over time has not been well documented. In this study, we determined total IgG antibody levels against pneumococcal polysaccharides before and 1, 6, 12 and 36 months after 23-valent pneumococcal polysaccharide vaccine (PPV) administration in nine children with steroid-responsive nephrotic syndrome during remission while off corticosteroids. The baseline antibody levels were between 4 and 86 mg/l. Four weeks after vaccination, the titer increased at least twofold in all patients with a mean arithmetic value of 165.4 mg/l. At the 6th month, the levels decreased in six out of nine subjects to a mean of 94.6 mg/l. At the 36th month, the control antibody levels were below the baseline or below the early postvaccination values in four out of nine subjects. Only two patients had stable high concentrations through the study period. Our data show that nephrotic patients may not retain their antibody levels despite reasonably good initial responses to the pneumococcal vaccine and that susceptibility to infections may continue in vaccinated children.
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