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Response to pneumococcal vaccination in children with nephrotic syndrome
Insights
Children with nephrotic syndrome receiving steroids showed normal antibody responses to pneumococcal vaccination. This vaccination provided good protection against vaccine-type pneumococcus, though other types still pose a risk.
Area of Science:
- Pediatric Nephrology
- Immunology
- Vaccinology
Background:
- Children with idiopathic nephrotic syndrome (INS) are at increased risk of infections, including pneumococcal peritonitis.
- Steroid therapy, commonly used for INS, may potentially impact vaccine efficacy.
Purpose of the Study:
- To evaluate the serologic response to a 14-valent pneumococcal vaccine in children with steroid-responsive INS.
- To assess the protective efficacy of the vaccine against pneumococcal peritonitis in this patient population.
Main Methods:
- Twenty children with steroid-responsive INS, free of proteinuria and on prednisone, were vaccinated.
- Antibody titers were measured pre-vaccination and 3-6 weeks post-vaccination.
- Clinical follow-up for 3 years monitored for episodes of pneumococcal peritonitis.
Main Results:
- A normal mean fold rise in antibody titers was observed post-vaccination compared to pre-vaccination levels.
- None of the vaccinated children developed peritonitis caused by pneumococcal types included in the vaccine.
- Three cases of pneumococcal peritonitis occurred; two involved non-vaccine serotypes (6b, 10a).
Conclusions:
- Pneumococcal vaccination provides good protection against vaccine-included serotypes in children with nephrotic syndrome on steroids.
- Despite vaccination, pneumococcus remains an important cause of peritonitis in nephrotic children, especially non-vaccine types.
Abstract:
Serologic responses to a 14-valent pneumococcal vaccine were measured in 20 children with steroid-responsive idiopathic nephrotic syndrome. All patients were free of proteinuria and receiving either daily (five patients) or alternate-day (15 patients) prednisone in a dosage of 1-2 mg/kg/day at the time of vaccination. Patients on alternate-day steroids received the vaccine on a day prednisone was not given. The mean fold rise in antibody titer was found to be normal in these children when antibody levels measured 3-6 wk post-vaccination were compared to prevaccination levels. This serologic response has correlated well with a 3-yr follow-up of the patients, none of whom has developed peritonitis secondary to any pneumococcal types in the vaccine. Also described are three patients who developed pneumococcal peritonitis during this period despite prior vaccination; in two of these patients, the pneumococcal type was not included in the vaccine (types 6b and 10a) and in one patient the organism was not typed. It is concluded that in children with nephrotic syndrome pneumococcal vaccination confers good protection against types included in the vaccine despite the concomitant administration of steroids. However, the patients who developed peritonitis secondary to other pneumococcal types remind us that pneumococcus must still be considered as an etiologic agent for peritonitis in nephrotic children who have been vaccinated.