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Published on: February 23, 2014
Non-protective immunity after standard pneumococcal vaccination series identified as a potential contributing risk
Caroline A Bonaventure1, Adele K Evans1,2
1Department of Pediatric Otolaryngology-Head and Neck Surgery, Louisiana State University Health Sciences Center, New Orleans, LA, USA.
Insights
Inadequate pneumococcal vaccine response in children with refractory ear infections may indicate underlying immune deficiencies. Further testing can reveal these conditions for better diagnosis and treatment.
Area of Science:
- Pediatric Infectious Diseases
- Immunology
- Otolaryngology
Background:
- Refractory otolaryngologic infections in children can be challenging to manage.
- Standard pneumococcal vaccination (PCV) aims to prevent infections but may fail in some individuals.
Purpose of the Study:
- To investigate the link between conferred immunity from pneumococcal vaccination and refractory otolaryngologic infections in pediatric patients.
- To identify underlying conditions that may be revealed when vaccination fails to provide protective immunity.
Main Methods:
- Retrospective case series (2013-2021) of pediatric patients (0-21 years) with specific otolaryngologic diagnoses.
- Analysis of post-vaccination pneumococcal antibody titers (PCV 7 or 13) and response to subsequent vaccination (PPSV).
- Review of electronic medical records for diagnoses and vaccination history.
Main Results:
- Only 27.0% of subjects had protective antibody titers prior to re-vaccination.
- After Pneumococcal Polysaccharide Vaccine (PPSV) re-vaccination, 91.8% achieved protective immunity.
- Seven subjects showed inadequate responses, with five having recurrent acute otitis media; underlying conditions like antibody deficiency and hypogammaglobulinemia were identified in some.
Conclusions:
- Inadequate response to pneumococcal vaccination in pediatric patients with recurrent otolaryngologic disease may signal underlying immune issues.
- This finding suggests a diagnostic pathway for identifying and treating immune deficiencies in this population.
Objective:
To examine the relationship between conferred immunity after standard pneumococcal series and refractory otolaryngologic infections in pediatric patients using post-vaccination antibody titers, and to identify contributory underlying conditions revealed when vaccination/re-vaccination fails to confer protective immunity.
Study Design:
IRB-reviewed and "exempt" retrospective case series with chart review using the Epic® Electronic Medical Record system from 2013 to 2021.
Setting:
Dedicated tertiary referral children's hospital.
Methods:
Pneumococcal antibody titer results were assessed for children ages 0 to 21 years and: (1) at least 1 of 7 otolaryngologic disease diagnoses and (2) having received the 4-dose schedule of pneumococcal conjugate vaccine (PCV 7 or 13).
Results:
A total of 241 subjects met inclusion criteria with 356 laboratory tests. Recurrent acute otitis media, chronic rhinitis, and chronic otitis media with effusion were the 3 most frequent diagnoses. At presentation, only 27.0% of subjects had titers conferring immunity from their prior vaccinations with PCV. About 85 subjects had been subsequently revaccinated with Pneumococcal Polysaccharide Vaccine (PPSV), and antibody responses conferring immunity reached 91.8%. Seven subjects never developed adequate responses; 5 of these had recurrent acute otitis media as the primary otolaryngologic diagnosis. Secondary "revealed" diagnoses included Juvenile Rheumatoid Arthritis (n = 1), unresolved specific antibody deficiency (n = 2), and Hypogammaglobulinemia (n = 1).
Conclusion:
In pediatric patients with recurrent infectious otolaryngologic disease refractory to traditional medical and surgical therapy, inadequate responses to pneumococcal vaccination may be revealed. This correlation represents a potential pathway for diagnosis and therapy.
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