The total IgM, IgA and IgG antibody responses to pneumococcal polysaccharide vaccination (Pneumovax®23) in a healthy adult population and patients diagnosed with primary immunodeficiencies

Antony R. Parker, Miguel Park, Stephen Harding, Roshini S. Abraham

Research output: Contribution to journalArticle

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Abstract

Background: Interpretation of the responses to the pneumococcal polysaccharide vaccine (Pneumovax®23, PPV) has proven challenging. In addition, there are few studies documenting the longevity of these responses. Methods: The age-specific PPV IgM, IgA, IgG and IgG2 concentrations were determined pre, 4–6 weeks and 6 years post-vaccination in the serum of Prevnar®-naïve adults using VaccZyme™ pneumococcal capsular polysaccharide ELISAs. Results: The median pre-vaccination concentrations were; PPV IgM 53 U/mL (5–95% CI: 16-169 U/mL), IgA 23 U/mL (6-103 U/mL), IgG 41 mg/L (10-184 U/mL) and IgG2 18 mg/L (3-95 U/mL). 4–6 weeks post-vaccination there was a median 6-fold (5–95% CI: 2–24) increase in PPV IgM (median 315 U/mL (5–95% CI: 60-1133 U/mL), 18-fold (4–74) increase in IgA (369 U/mL (78-1802 U/mL)), 9-fold (2–19) increase in IgG (375 mg/L (77–1238 mg/L)) and 8-fold (1–20) increase in IgG2 (141 mg/L (25–573 mg/L)). This was significant for all isotypes in all age ranges (p < 0.0001). Six years post-vaccination median PPV concentrations were; IgM 54 U/mL (17–128), IgA 85 U/mL (19–279), IgG 148 mg/L (30–997) and IgG2 57 mg/L (9–437). The median concentrations for all ages 6 years post-vaccination were significantly elevated compared to the pre-vaccination titres for PPV IgA, IgG and IgG2 isotypes only. The PPV IgM and IgA responses were influenced by age. At 6 years post vaccination, in individuals with normal PPV IgG, 34 individuals had PPV IgM and/or IgA concentrations below the lower limit of the healthy adult ranges. We also used the healthy adult reference ranges developed in this study to assess a cohort of primary immunodeficiency (PID) patients. Conclusion: These ranges will help to provide a framework for assessment and definition of normal response to PPV, which will facilitate clinical interpretation of a deficient polysaccharide response in those suspected of antibody deficiency.

Original languageEnglish (US)
Pages (from-to)1350-1355
Number of pages6
JournalVaccine
Volume37
Issue number10
DOIs
StatePublished - Feb 28 2019

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immunosuppression
Immunoglobulin A
Antibody Formation
Polysaccharides
Immunoglobulin M
Vaccination
polysaccharides
Immunoglobulin G
vaccination
antibodies
Population
Pneumococcal Vaccines
enzyme-linked immunosorbent assay
vaccines
Reference Values
Enzyme-Linked Immunosorbent Assay

Keywords

  • IgA
  • IgG
  • IgM
  • Normal
  • Pneumococcal
  • Pneumovax
  • PPV

ASJC Scopus subject areas

  • Molecular Medicine
  • Immunology and Microbiology(all)
  • veterinary(all)
  • Public Health, Environmental and Occupational Health
  • Infectious Diseases

Cite this

The total IgM, IgA and IgG antibody responses to pneumococcal polysaccharide vaccination (Pneumovax®23) in a healthy adult population and patients diagnosed with primary immunodeficiencies. / Parker, Antony R.; Park, Miguel; Harding, Stephen; Abraham, Roshini S.

In: Vaccine, Vol. 37, No. 10, 28.02.2019, p. 1350-1355.

Research output: Contribution to journalArticle

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abstract = "Background: Interpretation of the responses to the pneumococcal polysaccharide vaccine (Pneumovax{\circledR}23, PPV) has proven challenging. In addition, there are few studies documenting the longevity of these responses. Methods: The age-specific PPV IgM, IgA, IgG and IgG2 concentrations were determined pre, 4–6 weeks and 6 years post-vaccination in the serum of Prevnar{\circledR}-na{\"i}ve adults using VaccZyme™ pneumococcal capsular polysaccharide ELISAs. Results: The median pre-vaccination concentrations were; PPV IgM 53 U/mL (5–95{\%} CI: 16-169 U/mL), IgA 23 U/mL (6-103 U/mL), IgG 41 mg/L (10-184 U/mL) and IgG2 18 mg/L (3-95 U/mL). 4–6 weeks post-vaccination there was a median 6-fold (5–95{\%} CI: 2–24) increase in PPV IgM (median 315 U/mL (5–95{\%} CI: 60-1133 U/mL), 18-fold (4–74) increase in IgA (369 U/mL (78-1802 U/mL)), 9-fold (2–19) increase in IgG (375 mg/L (77–1238 mg/L)) and 8-fold (1–20) increase in IgG2 (141 mg/L (25–573 mg/L)). This was significant for all isotypes in all age ranges (p < 0.0001). Six years post-vaccination median PPV concentrations were; IgM 54 U/mL (17–128), IgA 85 U/mL (19–279), IgG 148 mg/L (30–997) and IgG2 57 mg/L (9–437). The median concentrations for all ages 6 years post-vaccination were significantly elevated compared to the pre-vaccination titres for PPV IgA, IgG and IgG2 isotypes only. The PPV IgM and IgA responses were influenced by age. At 6 years post vaccination, in individuals with normal PPV IgG, 34 individuals had PPV IgM and/or IgA concentrations below the lower limit of the healthy adult ranges. We also used the healthy adult reference ranges developed in this study to assess a cohort of primary immunodeficiency (PID) patients. Conclusion: These ranges will help to provide a framework for assessment and definition of normal response to PPV, which will facilitate clinical interpretation of a deficient polysaccharide response in those suspected of antibody deficiency.",
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