Administration of protein-conjugate pneumococcal vaccine to patients who have invasive disease after splenectomy despite their having received 23-valent pneumococcal polysaccharide vaccine

Daniel M. Musher, Heather Ceasar, Erna M. Kojic, Benjamin L. Musher, Joseph C. Gathe, Sandra Romero-Steiner, A. Clinton White

Research output: Contribution to journalArticle

33 Citations (Scopus)

Abstract

Patients who undergo splenectomy are at greatly increased risk for overwhelming pneumococcal bacteremia and death. Twenty-three-valent pneumococcal polysaccharide vaccine (PPV-23), which contains capsular polysaccharides (PSs) from 23 common serotypes of Streptococcus pneumonias, is strongly recommended for such patients. The capacity to respond to PPV-23 by producing immunoglobulin (Ig) G is genetically regulated. Some proportion of adults do not respond and, despite postsplenectomy administration of PPV-23, may remain susceptible to recurrent pneumococcal sepsis. Here, we describe 2 patients who had recurring pneumococcal bacteremia after undergoing splenectomy despite having received numerous doses of PPV-23. Heptavalent protein-conjugate pneumococcal vaccine (PCPV-7) was then administered, and it induced high levels of IgG to all 7 PSs; in one of the patients, functional activity against 5 of the 7 PSs was demonstrable, both in vitro and in vivo. Recurrent pneumococcal bacteremia in patients who have undergone splenectomy may indicate a genetically regulated failure to respond to PPV-23; PCPV-7 may stimulate production of IgG to PSs in such patients.

Original languageEnglish (US)
Pages (from-to)1063-1067
Number of pages5
JournalJournal of Infectious Diseases
Volume191
Issue number7
DOIs
StatePublished - Apr 1 2005
Externally publishedYes

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Conjugate Vaccines
Pneumococcal Vaccines
Splenectomy
Polysaccharides
Bacteremia
Proteins
Immunoglobulin G
Streptococcus pneumoniae
Sepsis

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Immunology

Cite this

Administration of protein-conjugate pneumococcal vaccine to patients who have invasive disease after splenectomy despite their having received 23-valent pneumococcal polysaccharide vaccine. / Musher, Daniel M.; Ceasar, Heather; Kojic, Erna M.; Musher, Benjamin L.; Gathe, Joseph C.; Romero-Steiner, Sandra; White, A. Clinton.

In: Journal of Infectious Diseases, Vol. 191, No. 7, 01.04.2005, p. 1063-1067.

Research output: Contribution to journalArticle

Musher, Daniel M. ; Ceasar, Heather ; Kojic, Erna M. ; Musher, Benjamin L. ; Gathe, Joseph C. ; Romero-Steiner, Sandra ; White, A. Clinton. / Administration of protein-conjugate pneumococcal vaccine to patients who have invasive disease after splenectomy despite their having received 23-valent pneumococcal polysaccharide vaccine. In: Journal of Infectious Diseases. 2005 ; Vol. 191, No. 7. pp. 1063-1067.
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