Antibody responses to pneumococcal and hemophilus vaccinations in splenectomized patients with hematological malignancies or trauma

Abstract

In this study we addressed the question of whether an underlying hematological malignancy may affect the immune response to vaccination against bacterial polysaccharide antigens (e.g. Haemophilus influenzae type b, Streptococcus pneumoniae) in splenectomized patients. Between 1993 and 2003, 44 splenectomized adults from the outpatient clinic for infectious diseases were prospectively included in the study: 23 patients suffered from hematological malignancies (HM) and had undergone splenectomy; 21 were splenectomized following trauma (T) and served as the control group. Each patient received an intradeltoid injection with 0.5 ml of a single lot of a 23-valent pneumococcal polysaccharide vaccine, and 0.5 ml of a polyribosyl ribitol phosphate capsular polysaccharide vaccine of H. influenzae type b (Hib) into the opposite arm. Blood samples for determination of pneumococcal and Hib antibodies were taken prior to vaccination and again 6-8 weeks later. In assessing responses to the 23-valent pneumococcal polysaccharide vaccine, we found significant differences in antibody titer increase between the HM and T groups (median IgG increase 1.27 [0.7; 2.39] vs. 3.9 [2.1; 15.3], P < 0.001; and median IgM increase 1.33 [1.0;2.67] vs. 5.25 [2.3; 7.78], P < 0.001). In the HM group, only 8/23 and 6/23 showed a titer increase of twice or more the base value for IgG and IgM respectively, whereas in the trauma group an adequate response was shown by 16/21 and 16/20 respectively. Patients with splenectomy and hematological malignancies responded poorly to the 23-valent polysaccharide vaccine. Response to the conjugated Hib vaccine was slightly better, but still significantly lower than in individuals with posttraumatic splenectomy. Data suggest that vaccination response to the polysaccharide vaccines should be evaluated at least in the high-risk group.

Immune response to pneumococcal conjugate vaccination in asplenic individuals

“…22 However, in this study, patients splenectomized due to a malignant condition responded to PCV7 as well as the trauma group for serotypes 14, 18C and 19F.…”

High seroprevalence of varicella, measles, mumps, rubella and pertussis antibodies in first-grade medical students

“…In HCWs, including medical students, seropositivity for measles, mumps and rubella ranges from 84% to 98.5% [20][21][22][23][24][25][26]. This variation in immunity is due to differences in vaccination coverage and intensive circulation of wild type virus in some areas.…”

Vaccination in the prevention of infectious respiratory diseases in adults

“…This benefit was not found for age ranges other than that described, as there were no significant differences in the IPD rate in patients over 5 after use of the conjugate vaccine (161 to 99 cases in 100,000 people/ year, with p=0.36) 94 96 (B). Patients splenectomized due to hematologic malignancies respond worse to the polysaccharide pneumococcus vaccines compared to those splenectomized due to trauma, and require closer monitoring 97 (B). Given that smoking is associated with an increased risk of respiratory infections, with populations of smokers, former smokers and nonsmokers have been studied to evaluate adherence to the use of flu and pneumococcus vaccines.…”

“…The association between vaccines for Haemophius influenzae B and and pneumococcus reduces the cases of IPD by 5% in patients with asplenia or those splenectomized for all reasons 96 (B), with a worse response for those splenectomized due to hematologic malignancies 97 (B). …”