Antibody responses after sequential vaccination with PCV13 and PPSV23 in kidney transplant recipients

Abstract

Purpose Vaccination against Streptococcus pneumoniae is recommended in transplant recipients to reduce the morbidity and mortality from invasive pneumococcal disease. Previous studies indicate that transplant recipients can produce specific antibodies after vaccination with the 13-valent pneumococcal conjugate vaccine Prevenar 13 (PCV13) or the pneumococcal polysaccharide vaccine Pneumovax 23 (PPSV23). National guidelines recommend sequential vaccination with PCV13 followed by PPSV23 in kidney transplant patients. However, there are currently no data on the serological response in kidney transplant recipients, who received a sequential vaccination with PCV13 and PPSV23. Methods In the current study, we sequentially vaccinated 46 kidney transplant recipients with PCV13 and PPSV23 and determined global and serotype-specific anti-pneumococcal antibody responses in the year following vaccination. Results Serotype-specific and global anti-pneumococcal antibody concentrations were significantly higher compared to baseline. We observed that serotype-specific antibody responses varied by serotype (between 2.2- and 2.9-fold increase after 12 months). The strongest responses after 12 months were detected against the serotypes 9N (2.9-fold increase) and 14 (2.8-fold increase). Global antibody responses also varied with respect to immunoglobulin class. IgG2 revealed the highest increase (2.7-fold), IgM the lowest (1.7-fold). Sequential vaccination with both vaccines achieved higher antibody levels in comparison with a historical cohort studied at our institute, that was vaccinated with PCV13 alone. During the 12-months follow-up period, none of the patients developed pneumococcal-associated pneumonia or vaccination-related allograft rejection. Conclusion In conclusion, we strongly recommend sequential vaccination over single immunization in kidney transplant recipients.

Antibody responses after sequential vaccination with PCV13 and PPSV23 in patients with moderate to severe plaque psoriasis under immunosuppressive therapy

“…When assessing the serotype-specific immune response, it is striking that serotype 3 neither exceeds the geometric mean threshold of 1.3 mg/L nor that a more than fourfold increase in concentration compared to the initial value is observed. With a mean peak value of 0.9 mg/L, plaque psoriasis patients had a higher immune response than kidney transplant recipients (0.6 mg/L) but nevertheless only slightly less than half of what was achieved in a healthy reference cohort after a single vaccination ( 11 , 22 ). Under these aspects, vaccination success for serotype 3 appears to have occurred in only a few patients.…”

“… Kinetics of pneumococcal antibodies in plaque psoriasis (Pso) and kidney transplant patients (KTP) as previously carried out in our center ( 11 ). The study included patients who were vaccinated sequentially with PCV13 and PPSV23 (month 0 and month 6, respectively).…”

“…The global change in antibodies in immunocompromised psoriasis patients can be compared to another study conducted at our university hospital in Essen ( 11 ). This study analyzed global antibody concentrations in KTP undergoing calcineurin-inhibitor-based therapy with or without mycophenolic acid (MPA) intake during sequential pneumococcal vaccination.…”

“…The vaccination responses in psoriasis patients were also compared with data from a similar study in kidney transplant patients (KTP) carried out at our center ( 11 ). This study included 46 kidney transplant patients between November 2018 and October 2019.…”

“…They highly recommend the administration of PCV13 followed by PPSV23 ( 9 ). Additionally, clinical studies demonstrate the beneficial effects of sequential pneumococcal vaccination in solid-organ recipients ( 10 , 11 ).…”