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Impact of pneumococcal vaccine response on asthma exacerbation frequency in young children
Claudia P Eisenlohr1, Esther M Chartrand1, Marta R Barzaga1
1AAADRS Clinical Research Center, Coral Gables, Florida.
Insights
Children with severe asthma have a poor antibody response to pneumococcal vaccines, even after initial vaccination. Readministration of pneumococcal vaccines (PV) improved antibody titers and reduced asthma exacerbations in some children, particularly those with lower baseline eosinophil counts.
Area of Science:
- Pediatric Allergy and Immunology
- Respiratory Medicine
- Vaccinology
Background:
- Chronic asthma is a complex condition with varying exacerbation triggers.
- Increased eosinophil counts are linked to more frequent asthma exacerbations in adults.
- Current guidelines suggest pneumococcal polysaccharide vaccine (PPV-23) for older children with chronic asthma.
Purpose of the Study:
- To investigate antibody responses to Streptococcus pneumoniae in preschool children with exacerbation-prone asthma.
- To evaluate the impact of pneumococcal vaccinations on asthma exacerbation frequency in this pediatric population.
Main Methods:
- A case-cohort study involving 127 preschool children with a history of frequent asthma exacerbations.
- Baseline assessment of antibody titers to Streptococcus pneumoniae post-initial pneumococcal conjugate vaccine (PCV) series.
- Readministration of PCV-13 booster and/or PPSV-23, followed by postvaccination titer assessment.
- Correlation of vaccination response and changes in asthma exacerbation frequency (corticosteroid and antibiotic use) with baseline eosinophil counts.
Main Results:
- Children exhibited low baseline antibody titers to Streptococcus pneumoniae despite prior PCV vaccination.
- Postvaccination with PCV-13 booster and/or PPSV-23, antibody titers significantly improved.
- A subset of 75 children reported reduced corticosteroid and antibiotic use after pneumococcal vaccination.
- This improvement was associated with lower baseline eosinophil counts (211 ± 36/µL) compared to those without improvement (371 ± 123/µL).
Conclusions:
- Preschool children with exacerbation-prone asthma demonstrate inadequate antibody responses to pneumococcal vaccines.
- Pneumococcal vaccination may offer a targeted approach to reduce exacerbations in a specific asthma phenotype.
- Identifying children with low antibody responses could guide personalized therapeutic strategies for managing pediatric asthma.
Introduction:
Chronic asthma is a heterogeneous disease, and increased eosinophils have been shown to predict increased asthma exacerbations, especially in adults. Recent recommendations suggest the need for supplemental PPV-23 vaccination in older children with chronic asthma.
Methods:
To investigate differences in preschool asthma, our case-cohort study comprised of 127 children, mean age 47 months (32-65), with a history of asthma exacerbations requiring more than three courses of systemic steroid bursts and more than six antibiotics courses in the previous year.
Results:
At baseline, mean antibody titer response to Streptococcus pneumoniae was decreased at 2.6 ± 2 out of 14 serotypes, despite prior complete pneumococcal conjugate vaccine (PCV) vaccinations. All children were readministered pneumococcal vaccinations with PCV-13 booster and/or PPSV-23. Mean postvaccination pneumococcal vaccine (PV) titer response was 16 ± 5 out of 23 serotypes. After contacting 91 parents/caretakers, 75 responded with less frequency of corticosteroids and antibiotic use for asthma exacerbations after PV. This group had baseline eosinophil counts of 211 ± 36/µL, while those without improvement were significantly higher at 371 ± 123/µL,*P < .05. There were no significant differences (P > .05) between the two groups from other baseline measures including demography or atopic status.
Conclusions:
This subset of children with exacerbation-prone asthma had poor antibody titer response to Streptococcus pneumoniae, even with prior complete PCV-13 immunization. Identification of low antibody responses to PV serotypes may provide a targeted therapeutic approach to reduce wheezing exacerbations in a precise asthma phenotype in children.
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