Persistence of protective pneumococcal antibody following vaccination in patients with the nephrotic syndrome
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Nephrotic children vaccinated against pneumococcal disease 5 years ago were studied. Those with minimal change nephrotic syndrome maintained protective antibody levels, unlike others with different nephrotic conditions.
Area of Science:
- Pediatric Nephrology
- Immunology
- Vaccinology
Background:
- Nephrotic syndrome increases susceptibility to infections, particularly pneumococcal disease.
- Long-term antibody persistence after pneumococcal vaccination in nephrotic children is not well-established.
- Understanding antibody levels is crucial for managing infection risk in these vulnerable patients.
Purpose of the Study:
- To determine the level of persisting pneumococcal antibody 5 years after vaccination in children with nephrotic syndrome.
- To compare antibody levels in patients with minimal change nephrotic syndrome versus other forms of nephrotic disease.
- To assess the clinical relevance of antibody levels by observing infection rates.
Main Methods:
- Radioimmunoassay was used to measure antibody response to pneumococcal vaccine types in sera from 16 vaccinated children.
- Geometric Mean Titer (GMT) was calculated and compared to a protective threshold of 300 ng/mL.
- Infection rates (pneumococcal peritonitis, sepsis) were compared between vaccinated and unvaccinated nephrotic children.
Main Results:
- 56% (9/16) of vaccinated children maintained adequate antibody levels (GMT ≥ 300 ng/mL) 5 years post-vaccination.
- All patients with adequate antibody levels had minimal change nephrotic syndrome.
- 44% (7/16) had inadequate antibody levels; one developed pneumococcal peritonitis. Unvaccinated nephrotic children had significantly higher rates of pneumococcal peritonitis (p<0.05).
Conclusions:
- Children with minimal change nephrotic syndrome maintain adequate pneumococcal antibody levels long-term after vaccination.
- Nephrotic children with other diagnoses (focal sclerosis, membranoproliferative glomerulonephritis, IgM nephropathy) fail to maintain adequate antibody levels.
- Vaccination appears protective, but careful monitoring for infections is warranted in nephrotic patients with suboptimal antibody responses.
Abstract:
We have determined the level of persisting pneumococcal antibody in a group of nephrotic children vaccinated by us 5 years ago. Of the 19 vaccinated children, 2 have died and 1 has moved away. Sera from the remaining 16 patients were examined by radioimmunoassay to determine the antibody response to 11 of the 14 types contained in the polyvalent pneumococcal vaccine. The lowest protective level of geometric mean titre (GMT) of antibody in our laboratory is 300 ng antibody nitrogen per millilitre. 56% (9/16) of the patients showed adequate GMT 5 years after vaccination. All 9 patients had minimal change nephrotic syndrome. 44% (7/16) of the children had a GMT less than 300 ng antibody nitrogen per millilitre. 3 of these patients had focal sclerosis, 3 had membranoproliferative glomerulonephritis, and 1 patient had IgM nephropathy. Of these 7 patients, 1 with the lowest GMT (23 ng antibody nitrogen per millilitre) developed pneumococcal peritonitis. During this same period, in 20 other unvaccinated nephrotic patients followed continuously from 1976 to 1981, 7 cases of pneumococcal peritonitis occurred (p less than 0.05). Additionally, 1 unvaccinated child died of pneumococcal sepsis. Our study indicates that patients with minimal change nephrotic syndrome continue to maintain adequate amounts of antibody, but those with disease other than minimal change nephrotic syndrome are unable to maintain an adequate level of antibody.