Short communicationImmunogenicity of conjugate Meningococcus C vaccine in pediatric solid organ transplant recipients
Introduction
Fortunately, the improvement of surgical techniques, of immunosuppressive regimens and of clinical monitoring strategies allows pediatric and adolescent solid organ transplantation (SOT) patients an almost normal life quality with school attendance and travel activities. However, these life-style factors bear also the increased risk of contacts with Men C carriers and infected individuals. An impaired antibody production after vaccinations have been described in SOT patients [1], [2], [3] and in children on dialysis considered for kidney transplantation [3], [4]. So far, no prospective data exist on immunogenicity and safety of conjugated Meningococcus C (Men C) vaccination in pediatric SOT patients or patients with renal insufficiency. Severe cases of meningococcal disease were reported in immunocompromised patients [5]. Some experience with the administration of conjugate vaccines in immunocompromised patients exist from studies with vaccinations against Streptococcus pneumoniae in SOT recipients which was proven to induce protective antibody levels [6], [7], [8], [9], [10], and with conjugate Men C vaccination in hematopoetic stem cell transplantation [11] with 100% of patients achieving humoral protection against Men C. However, 13 of 25 leukemia patients were found to be bactericidal non-responders to conjugated Men C vaccination [12]. Despite the uncertain beneficial effect of Men C vaccination in immunocompromised children, the risk of relapses in chronic kidney disease, such as nephrotic syndrome by conjugate Men C vaccine, has been discussed controversially [13], [14]. All the more, immunogenicity and safety aspects in risk populations are important for the administration of newly licensed conjugate vaccines addressing not only Men C, but also infections with other serogroups, such as A, Y or W135.
The serum bactericidal assay (SBA) titer against Men C is the generally accepted surrogate of protection against Men C-induced disease [15], [16]. Evidence of an antibody response to the vaccine was defined by a SBA titer of ≥1:8 [17]. In healthy children and also preterm infants, vaccination with NeisVac-C (Baxter, Vienna, Austria) has been proven to be well tolerated [17], [18], [19], [20].
The present single-center study was aimed to evaluate the immunogenicity and safety of vaccinating pediatric SOT patients with conjugated Men C vaccine (NeisVac-C) by analyzing the SBA titers after vaccination.
Section snippets
Study population
In 2007, 10 patients (chronological age: mean 156 ± 54 months, range 70–216) were prospectively included based on following inclusion criteria: end-stage renal failure (after Schwartz formular <30 ml/min/m2), kidney or liver transplantation, normal age-adjusted serum immunoglobuline values, normal age-adjusted absolute lymphocyte counts (2.47 × 103/μl ± 0.86, range 1.10–3.43) with a CD4/CD8 ratio between 1.3 and 2.5 and normal age-adjusted proportions of CD19 + B cells (24 ± 12%, range 11–31). Only
Immunogenicity
The immunogenicity of conjugate Men C vaccination was assessed in all SOT patients. Four patients, namely, patient 1 (after 2 months), 3 (after 1 month), 4 (after 1 month) and 7 (after 3 months) showed a slightly delayed increase of SBA titers in the first weeks after vaccination. In 8 patients, SBA titers were evaluated 3 months after vaccination. All of them demonstrated a significant increase of SBA titers at least 3 months after vaccination (Fig. 1) (day 0 versus month 3: p < 0.001). For all
Discussion
The present case series revealed a variable response to conjugate Men C vaccine in pediatric SOT patients who had received a single dose shortly before or after transplantation. Following the generally accepted definition of protective SBA titers [16], all patients demonstrated an increase of SBA titers after vaccination and maintained protective SBA titers at least 18 months after a single dose of conjugate Men C vaccine, with one patient not completing the follow-up course. The data were
Acknowledgement
The study was supported by a research grant by Baxter, Vienna, Austria. We like to thank Dr. Robert Petermann for critical discussion of the paper. Conflict of interest: All authors report no conflicts of interest relevant to this article. Funding: The National Reference Laboratory for Meningococci in Würzburg, Germany, is funded by the Robert Koch-Institute. The expert technical assistance by Angelika Külsheimer and Christin Staar is gratefully acknowledged.
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