Decline of vaccine-induced antipneumococcal antibody in children with nephrotic syndrome
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Children with nephrotic syndrome experience faster antibody decline after pneumococcal vaccination, especially during relapse. Monitoring specific antibody types is crucial for assessing immunity in these vulnerable patients.
Area of Science:
- Immunology
- Pediatrics
- Nephrology
Background:
- Idiopathic nephrotic syndrome (INS) is a kidney disorder affecting children.
- Children with INS often experience relapses and may have altered immune responses.
- Pneumococcal vaccination is recommended, but antibody persistence can be a concern.
Purpose of the Study:
- To evaluate antipneumococcal capsular polysaccharide antibody persistence in children with INS.
- To compare antibody levels between children who relapse and those who do not.
- To assess antibody decline at various time points post-vaccination.
Main Methods:
- Studied 25 children with steroid-responsive INS.
- Administered 14-valent pneumococcal vaccine.
- Measured antibody levels during relapse, remission, and at 1, 6, and 12 months post-vaccination.
Main Results:
- Children experiencing relapses showed a more rapid decline in total anticapsular antibody (5.3% per month) compared to non-relapsers (2.4% per month).
- Antibody decline rates varied significantly among different pneumococcal capsular types.
- One year post-vaccination, 50% of patients had low antibody levels (<300 ngAbN/mL) against specific types (4, 6A, 7F, 8, 19F).
- During relapse, antibody concentrations were below 300 ngAbN/mL for these types in seven patients.
Conclusions:
- Antibody persistence following pneumococcal vaccination is variable in children with INS and depends on the capsular type.
- Relapses are associated with a faster decline in protective antibody levels.
- Type-specific monitoring of serum antibody levels is recommended for vaccinated children with nephrotic syndrome.
Abstract:
Twenty-five children with steroid-responsive idiopathic nephrotic syndrome were studied for persistence of antipneumococcal capsular polysaccharide antibody during relapse of their disease and at 1, 6, and 12 months after vaccination with the 14-valent pneumococcal vaccine. Nonrelapsers (group I) were compared to those who had at least one relapse but whose sera were obtained during remission (group II). Group II had a more rapid decline in total anticapsular antibody per month than group I (5.3% v 2.4%). Analysis by individual anticapsular types showed that differences between groups approached significance only for type 4 (P = .07). Rates of decline of antibody against pneumococcal capsular polysaccharide varied among types. One year after vaccination, 50% of patients had less than 300 ngAbN/mL against types 4, 6A, 7F, 8, and 19F. Sera obtained from seven patients during relapse had geometric mean antibody concentrations less than 300 ngAbN/mL against those same types; two of these types have been reported to cause disease in vaccinated patients with nephrosis. Decline of antibody against pneumococcal capsular polysaccharide following vaccination varies by capsular type. Type-specific analysis should be used when monitoring serum antibody levels in these patients after vaccination.