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Lower response to early T-cell-dependent vaccination after neurotrauma or neurosurgery in adults
Anna Ljunghill Hedberg1, Karlis Pauksens1, Elisabeth Ronne-Engström2
1Dept of Medical Sciences, Section of Infectious Diseases, Uppsala University, Sweden.
Insights
Early vaccination against Haemophilus influenza type b (Hib) after neurotrauma or neurosurgery may reduce vaccine effectiveness. Further research is needed to determine optimal pneumococcal conjugate vaccine timing in these patients.
Area of Science:
- Immunology
- Neuroscience
- Vaccinology
Background:
- International guidelines recommend 13-valent pneumococcal conjugate vaccine for meningitis prevention post-neurotrauma with cerebrospinal fluid leak.
- Optimal antibody response and timing for vaccination remain unestablished.
- Early vaccination is preferred due to the high risk of meningitis shortly after trauma.
Purpose of the Study:
- To investigate the antibody response to a T-cell-dependent conjugate vaccine shortly after central nervous system injury.
- To assess if neurotrauma-induced immunodepression affects vaccine response.
- To evaluate the antibody response to Haemophilus influenza type b (Hib) conjugate vaccine in neurotrauma and neurosurgery patients.
Main Methods:
- A Haemophilus influenza type b (Hib) conjugate vaccine was administered to 33 neurotrauma and 23 neurosurgery patients within 10 days of injury/surgery.
- 29 control patients were vaccinated at least three weeks post-injury/surgery.
- Serum anti-Hib concentrations were measured pre- and post-vaccination.
Main Results:
- A higher proportion of non-responders was observed in the early vaccination groups (31% neurotrauma, 25% neurosurgery) compared to controls (10%).
- Log10 anti-Hib concentrations were lower in neurotrauma (1.52 ± 0.15 μg/ml) and neurosurgery (1.38 ± 0.15 μg/ml) groups compared to controls (1.81 ± 0.12 μg/ml).
- Four patients with pre-existing target antibody concentrations were excluded from analysis.
Conclusions:
- Vaccination early after neurotrauma or neurosurgery resulted in a decreased number of responders and lower antibody concentrations.
- These findings suggest potential immunodepression affecting vaccine response in the early post-injury period.
- Urgent investigation into pneumococcal conjugate vaccine response in neurotrauma patients is warranted.
Background:
Recent international guidelines recommend vaccination with a 13-valent pneumococcal conjugate vaccine to reduce the risk of meningitis after neurotrauma with cerebrospinal fluid leak. The antibody response and optimal time point for vaccination have not been established and because the risk of meningitis is at the highest shortly after trauma, early vaccination is preferable. This study aimed to investigate the antibody response and to ensure that central nervous system injury-induced immunodepression did not affect the response to a T-cell-dependent conjugate vaccine when administered shortly after the injury.
Methods:
So as not to interfere with routine pneumococcal vaccination, a conjugate vaccine against Haemophilus influenza type b (Hib) was chosen for the study. Thirty-three patients with basilar skull fracture and 23 patients undergoing transsphenoidal pituitary gland surgery were vaccinated within 10 days after trauma/surgery and 29 control patients at least three weeks after trauma/surgery. Sera were collected pre- and post-vaccination for analysis of anti-Hib concentration.
Results:
Four patients with post-vaccination target antibody concentration before vaccination were excluded from analysis. In the neurotrauma and neurosurgery groups 10/32 (31%) and 5/20 (25%) patients, respectively, were non-responders compared with 3/29 (10%) in the control group. Log10 anti-Hib concentrations in the neurotrauma, neurosurgery and control groups were 1.52 ± 0.15, 1.38 ± 0.15 and 1.81 ± 0.12 μg/ml, respectively.
Conclusions:
The majority of the patients responded to vaccination. However, the number of responders was significantly decreased and antibody concentration significantly lower in patients vaccinated early after the trauma/surgery. Investigation of the pneumococcal conjugate vaccine response in neurotrauma patients is therefore urgent.
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