Impaired response to pneumococcal vaccine in children with recurrent respiratory infections

Paediatric patients with recurrent respiratory infections (RRI) and/or chronic cough (CC) have a higher incidence of impaired response to the 13-valent pneumococcal conjugate vaccine (PCV13) compared with the general population. Booster vaccination may be recommended for this patient group.

While most healthy infants and children develop antibodies to the majority of serotypes included in PCV13, children with immunodeficiencies are known for their impaired response. Functional antibodies (FAB) tests measure specific IgG against vaccines to diagnose deficiencies and can be used to evaluate clinical responses to vaccination. The current study examined the incidence of impaired PCV13 response in children with RRI and/or CC referred to a tertiary paediatric respiratory centre compared to the general population [1].

A retrospective review was performed of patient notes of children between the age of 2 and 15 years with a relevant history of RRI and/or CC that were referred to the paediatric clinic and had FAB testing in a previous 2-year period (between January 2018 and December 2019).

Data of 137 patients was included. Most children were male (53.3%), and the mean age was 5.9 years. Of patients included, 100 (73%) had a history of RRI, 105 (76.6%) had a history of CC, and 68 (49.6%) had a history of both RRI and CC. All patients were identified with RRI and/or CC during a previous FAB test 2 years previously. Asthma and preschool wheeze were frequently identified (37% and 42%, respectively).

A specific antibody concentration of 0.35 µg/mL or higher to <7 PCV13 serotypes was considered to be an impaired response. Of 137 patients, 45 (33%) had an impaired response to PCV13. Children on moderate or high dose of inhaled corticosteroids were more likely to have an impaired response (OR 2.8; 95% CI 0.94–7.77). Patients on regular azithromycin were also more likely to have an impaired response (OR 1.51; 95% CI 0.53–4.27).

Conclusively, paediatric patients referred to tertiary centres with RRI or CC have a high incidence of an impaired response to PCV13 compared to the general population. Children who fail to develop an immune response against PCV13 might be considered for a booster dose.

1. Elashmawy M, et al. Impaired response to 13-valent pneumococcal conjugate vaccine (PCV13) in children with recurrent respiratory infections and chronic cough. Abstract 3150. ERS 2021, 5–8 September.

 

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Posted on 9 November, 2021