Validation of current joint American Academy of Allergy, Asthma & Immunology and American College of Allergy, Asthma and Immunology guidelines for antibody response to the 23-valent pneumococcal vaccine using a population of HIV-infected children - 20/08/11
Reprint requests: Nutthapong Tangsinmankong, MD, Division of Allergy and Immunology, University of South Florida/All Children’s Hospital, 801 Sixth St S, St Petersburg, FL 33701.St Petersburg, Fla
Abstract |
Background |
Measuring antibody responses to 23-valent pneumococcal polysaccharide vaccines (PPV) is crucial to evaluation of humoral immune function. However, data are limited comparing responses in immunodeficient subjects.
Objective |
A case-controlled study comparing changes in PPV antibody titer in immunocompetent and immunodeficient children was performed to validate current guidelines.
Methods |
A cohort of 95 immunocompetent children and 22 HIV-infected children, ages 2 to 15 years, was vaccinated with PPV, and before and after vaccination, IgG titers against capsular polysaccharides for 12 pneumococcal serotypes were measured. Results were used to calculate the receiver operator characteristic curve, sensitivity, and specificity of various interpretation criteria for their accuracy in detecting suboptimal responders.
Results |
Immunodeficient subjects had lower CD4%, antidiphtheria, antitetanus titers, and mean post-PPV titers (2.5 ± 1.7 vs 4.5 ± 2.1 μg/mL; P < .001) compared with immunocompetent subjects. The interpretation, using individual post-PPV titer of ≥4-fold increase over prevaccination as a positive response, yielded the highest accuracy as measured by area under the curve value (receiver operator characteristic curve = .755). For this criterion, the numbers of serotypes with positive responses of ≤5 of 12 serotypes measured yielded 72.7% sensitivity and 56.8% specificity in detecting antibody-deficient subjects.
Conclusion |
Current guidelines using ≥4-fold increase in post-PPV titers has sufficient sensitivity and specificity to identify antibody deficiency. The minimal positive responses should be at least 50% of serotypes tested.
Clinical implications |
Measurement of PPV antibody response based on the current guidelines accurately identify children with humoral immunodeficiency.
El texto completo de este artículo está disponible en PDF.Key words : Pneumococcal antibody, humoral deficiency, children, polysaccharide vaccine, HIV
Abbreviations used : PCV7, PPV, ROC
Esquema
| Supported by the National Institutes of Health R01 AI47723-04A1 (J. W. S.) and the Eleanor Naylor Dana Charitable Trust, and in part by the Pediatric Clinical Research Center of All Children’s Hospital and the University of South Florida, and the Maternal and Child Health Bureau, R60 MC 00003-01, Department of Health and Human Services, Health Resources and Services Administration. Disclosure of potential conflict of interest: The authors have declared that they have no conflict of interest. |
Vol 118 - N° 6
P. 1336-1341 - décembre 2006 Regresar al número
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