Nonprotective Responses to Vaccines in Otitis Prone Children
Objective: We recently found that children who experience recurrent otitis media despite individualized care (stringently-defined otitis prone [sOP]) do not develop an antibody response to several vaccine candidate protein antigens expressed by Streptococcus pneumonia (Spn) and Haemophilus influenzae. Here we sought to determine if these same children also failed to develop antibody to routine pediatric vaccinations.
Study Design: One hundred forty sera collected from children age 6–24 months were analyzed. sOP (n = 34) and age-matched non-sOP (n = 34) children were assessed for IgG concentrations to diphtheria toxoid, tetanus toxoid, pertussis toxoid, filamentous hemagglutinin, pertactin (DTaP), polio, hepatitis B, H. influenzae type b capsule polyribosyl-ribitol-phosphate (PRP) and Spn capsular polysaccharide conjugate vaccine.
Results: IgG protective titers to diphtheria toxoid (P = 0.006), tetanus toxoid (P < 0.0001), pertussis toxoid (P < 0.0001), filamentous hemagglutinin (P = 0.001), pertactin (P = 0.005), hepatitis B (P < 0.0001), polio 3 (P = 0.03) and Spn 23F (P = 0.01) but not polio 1,2, PRP or Spn 6B, and 14 were decreased in sOP versus non-sOP children using generalized estimating equations. A high percentage of sOP children had nonprotective antibody values that persisted until 24 months of age despite routine boosters.
Conclusion: sOP children may fail to achieve protective antibody concentrations after several routine vaccinations.
All young children receive multiple priming doses and booster vaccinations in the 1st and 2nd year of life to prevent infections by viral and bacterial pathogens. Despite high vaccine compliance, outbreaks of vaccine-preventable infections are occurring in the United States and worldwide.
In neonates, the generation of antibody responses to vaccines is known to be frequently lower than observed in older children or adults after vaccinations. We recently identified immature, neonatal-like antibody responses to otopathogen vaccine candidate protein antigens in a subset of children prone to frequent ear infections. The poor immune responses were observed to many but not all antigens expressed by Streptococcus pneumoniae (Spn) and Haemophilus influenzae (Hi). As a clinical phenotype this special population experiences frequent, recurrent ear infections despite individualized care, as recently described in The Pediatric Infectious Disease Journal. Thus, these children were identified within a subset of otitis prone (OP) children we refer to as stringently-defined OP (sOP) children.
Based on our recent findings of an immature immunologic response to bacterial respiratory pathogens in sOP children, we hypothesized that these children might manifest poor responses to routine pediatric vaccines. To evaluate this question, we measured antibody levels to: diphtheria toxoid (DT), tetanus toxoid (TT), pertussis toxoid (PT), pertussis filamentous hemagglutinin (FHA), pertussis pertactin (PRN), polio, hepatitis B (HepB), Hi type b capsule polyribosyl-ribitol-phosphate (PRP) and Spn pneumococcal polysaccharides.
Abstract and Introduction
Abstract
Objective: We recently found that children who experience recurrent otitis media despite individualized care (stringently-defined otitis prone [sOP]) do not develop an antibody response to several vaccine candidate protein antigens expressed by Streptococcus pneumonia (Spn) and Haemophilus influenzae. Here we sought to determine if these same children also failed to develop antibody to routine pediatric vaccinations.
Study Design: One hundred forty sera collected from children age 6–24 months were analyzed. sOP (n = 34) and age-matched non-sOP (n = 34) children were assessed for IgG concentrations to diphtheria toxoid, tetanus toxoid, pertussis toxoid, filamentous hemagglutinin, pertactin (DTaP), polio, hepatitis B, H. influenzae type b capsule polyribosyl-ribitol-phosphate (PRP) and Spn capsular polysaccharide conjugate vaccine.
Results: IgG protective titers to diphtheria toxoid (P = 0.006), tetanus toxoid (P < 0.0001), pertussis toxoid (P < 0.0001), filamentous hemagglutinin (P = 0.001), pertactin (P = 0.005), hepatitis B (P < 0.0001), polio 3 (P = 0.03) and Spn 23F (P = 0.01) but not polio 1,2, PRP or Spn 6B, and 14 were decreased in sOP versus non-sOP children using generalized estimating equations. A high percentage of sOP children had nonprotective antibody values that persisted until 24 months of age despite routine boosters.
Conclusion: sOP children may fail to achieve protective antibody concentrations after several routine vaccinations.
Introduction
All young children receive multiple priming doses and booster vaccinations in the 1st and 2nd year of life to prevent infections by viral and bacterial pathogens. Despite high vaccine compliance, outbreaks of vaccine-preventable infections are occurring in the United States and worldwide.
In neonates, the generation of antibody responses to vaccines is known to be frequently lower than observed in older children or adults after vaccinations. We recently identified immature, neonatal-like antibody responses to otopathogen vaccine candidate protein antigens in a subset of children prone to frequent ear infections. The poor immune responses were observed to many but not all antigens expressed by Streptococcus pneumoniae (Spn) and Haemophilus influenzae (Hi). As a clinical phenotype this special population experiences frequent, recurrent ear infections despite individualized care, as recently described in The Pediatric Infectious Disease Journal. Thus, these children were identified within a subset of otitis prone (OP) children we refer to as stringently-defined OP (sOP) children.
Based on our recent findings of an immature immunologic response to bacterial respiratory pathogens in sOP children, we hypothesized that these children might manifest poor responses to routine pediatric vaccines. To evaluate this question, we measured antibody levels to: diphtheria toxoid (DT), tetanus toxoid (TT), pertussis toxoid (PT), pertussis filamentous hemagglutinin (FHA), pertussis pertactin (PRN), polio, hepatitis B (HepB), Hi type b capsule polyribosyl-ribitol-phosphate (PRP) and Spn pneumococcal polysaccharides.