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Repeat pneumococcal polysaccharide vaccine in Indigenous Australian adults is associated with decreased immune responsiveness.
Vaccine. 2017 05 19; 35(22):2908-2915.V

Abstract

BACKGROUND

Indigenous adults residing in the Northern Territory of Australia experience elevated rates of invasive pneumococcal disease despite the routine use of 23-valent pneumococcal polysaccharide vaccine (23vPPV). We hypothesised that the limited protection from 23vPPV may be due to hyporesponsiveness as a result of vaccine failure from repeated vaccination. To explore this possibility, we evaluated the immune response to a first and second dose of 23vPPV in Indigenous adults and a first dose of 23vPPV in non-Indigenous adults.

METHODS

Serotype-specific IgG was measured by ELISA for all 23 vaccine serotypes at baseline and at one month post-vaccination. Individuals were considered to have an adequate immune response if paired sera demonstrated either: a four-fold rise in antibody concentration; a two-fold rise if the post vaccination antibody was >1.3μg/ml but <4.0μg/ml; or a post-vaccination antibody concentration >4.0μg/ml for at least half of the serotypes tested (12/23). Our per-protocol analysis included the comparison of outcomes for three groups: Indigenous adults receiving a second 23vPPV dose (N=20) and Indigenous (N=60) and non-Indigenous adults (N=25) receiving their first 23vPPV dose.

RESULTS

All non-Indigenous adults receiving a first dose of 23vPPV mounted an adequate immune response (25/25). There was no significant difference in the proportion of individuals with an adequate response using our definition (primary endpoint), with 88% of Indigenous adults mounted an adequate response following first dose 23vPPV (53/60) compared to 70% having an adequate response following a second dose of 23vPPV (14/20; p=0.05). The risk difference between Indigenous participants receiving first dose compared to non-Indigenous participants receiving first dose was significant when comparing a response threshold of at least 70% (-27%, 95% CI: -43% to -11%; p=0.01) and 90% (-38%, 95% CI: -60% to -16%; p=0.006) of serotypes with a positive response.

CONCLUSION

Indigenous participants demonstrated a poorer response to a first dose 23vPPV compared to their non-Indigenous counterparts, with lower IgG following a second 23vPPV dose. These findings highlight the critical need to evaluate the efficacy of future pneumococcal vaccine programs in the Australian Indigenous populations that recommend repeated doses of 23vPPV.

Authors+Show Affiliations

Menzies School of Health Research, Child Health Division, Charles Darwin University, Northern Territory, Australia.Pneumococcal Research Group, Murdoch Childrens Research Institute, Royal Children's Hospital, Victoria, Australia; Department of Paediatrics, University of Melbourne, Victoria, Australia.Pneumococcal Research Group, Murdoch Childrens Research Institute, Royal Children's Hospital, Victoria, Australia.Menzies School of Health Research, Child Health Division, Charles Darwin University, Northern Territory, Australia. Electronic address: ross.andrews@menzies.edu.au.Menzies School of Health Research, Child Health Division, Charles Darwin University, Northern Territory, Australia.Menzies School of Health Research, Child Health Division, Charles Darwin University, Northern Territory, Australia.Menzies School of Health Research, Child Health Division, Charles Darwin University, Northern Territory, Australia.Pneumococcal Research Group, Murdoch Childrens Research Institute, Royal Children's Hospital, Victoria, Australia; London School of Hygiene and Tropical Medicine, London, United Kingdom.Telethon Kids Institute, University of Western Australia, Perth, Australia.Department of Allergy and Immunology, Royal Children's Hospital, Victoria, Australia; Allergy and Immune Disorders Group, Murdoch Childrens Research Institute, Victoria, Australia; Department of Paediatrics, University of Melbourne, Victoria, Australia.School of Paediatrics and Child Health, University of Western Australia, Perth, Australia; Department of Clinical Research, Princess Margaret Hospital for Children, Perth, Australia.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28455171

Citation

Moberley, Sarah, et al. "Repeat Pneumococcal Polysaccharide Vaccine in Indigenous Australian Adults Is Associated With Decreased Immune Responsiveness." Vaccine, vol. 35, no. 22, 2017, pp. 2908-2915.
Moberley S, Licciardi PV, Balloch A, et al. Repeat pneumococcal polysaccharide vaccine in Indigenous Australian adults is associated with decreased immune responsiveness. Vaccine. 2017;35(22):2908-2915.
Moberley, S., Licciardi, P. V., Balloch, A., Andrews, R., Leach, A. J., Kirkwood, M., Binks, P., Mulholland, K., Carapetis, J., Tang, M. L. K., & Skull, S. (2017). Repeat pneumococcal polysaccharide vaccine in Indigenous Australian adults is associated with decreased immune responsiveness. Vaccine, 35(22), 2908-2915. https://doi.org/10.1016/j.vaccine.2017.04.040
Moberley S, et al. Repeat Pneumococcal Polysaccharide Vaccine in Indigenous Australian Adults Is Associated With Decreased Immune Responsiveness. Vaccine. 2017 05 19;35(22):2908-2915. PubMed PMID: 28455171.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Repeat pneumococcal polysaccharide vaccine in Indigenous Australian adults is associated with decreased immune responsiveness. AU - Moberley,Sarah, AU - Licciardi,Paul V, AU - Balloch,Anne, AU - Andrews,Ross, AU - Leach,Amanda J, AU - Kirkwood,Marie, AU - Binks,Paula, AU - Mulholland,Kim, AU - Carapetis,Jonathan, AU - Tang,Mimi L K, AU - Skull,Sue, Y1 - 2017/04/25/ PY - 2016/10/06/received PY - 2017/04/08/revised PY - 2017/04/13/accepted PY - 2017/4/30/pubmed PY - 2018/2/6/medline PY - 2017/4/30/entrez KW - Adequate immune response KW - Hyporesponsiveness KW - Immunogenicity KW - Indigenous KW - Pneumococcal polysaccharide vaccine SP - 2908 EP - 2915 JF - Vaccine JO - Vaccine VL - 35 IS - 22 N2 - BACKGROUND: Indigenous adults residing in the Northern Territory of Australia experience elevated rates of invasive pneumococcal disease despite the routine use of 23-valent pneumococcal polysaccharide vaccine (23vPPV). We hypothesised that the limited protection from 23vPPV may be due to hyporesponsiveness as a result of vaccine failure from repeated vaccination. To explore this possibility, we evaluated the immune response to a first and second dose of 23vPPV in Indigenous adults and a first dose of 23vPPV in non-Indigenous adults. METHODS: Serotype-specific IgG was measured by ELISA for all 23 vaccine serotypes at baseline and at one month post-vaccination. Individuals were considered to have an adequate immune response if paired sera demonstrated either: a four-fold rise in antibody concentration; a two-fold rise if the post vaccination antibody was >1.3μg/ml but <4.0μg/ml; or a post-vaccination antibody concentration >4.0μg/ml for at least half of the serotypes tested (12/23). Our per-protocol analysis included the comparison of outcomes for three groups: Indigenous adults receiving a second 23vPPV dose (N=20) and Indigenous (N=60) and non-Indigenous adults (N=25) receiving their first 23vPPV dose. RESULTS: All non-Indigenous adults receiving a first dose of 23vPPV mounted an adequate immune response (25/25). There was no significant difference in the proportion of individuals with an adequate response using our definition (primary endpoint), with 88% of Indigenous adults mounted an adequate response following first dose 23vPPV (53/60) compared to 70% having an adequate response following a second dose of 23vPPV (14/20; p=0.05). The risk difference between Indigenous participants receiving first dose compared to non-Indigenous participants receiving first dose was significant when comparing a response threshold of at least 70% (-27%, 95% CI: -43% to -11%; p=0.01) and 90% (-38%, 95% CI: -60% to -16%; p=0.006) of serotypes with a positive response. CONCLUSION: Indigenous participants demonstrated a poorer response to a first dose 23vPPV compared to their non-Indigenous counterparts, with lower IgG following a second 23vPPV dose. These findings highlight the critical need to evaluate the efficacy of future pneumococcal vaccine programs in the Australian Indigenous populations that recommend repeated doses of 23vPPV. SN - 1873-2518 UR - https://www.unboundmedicine.com/medline/citation/28455171/Repeat_pneumococcal_polysaccharide_vaccine_in_Indigenous_Australian_adults_is_associated_with_decreased_immune_responsiveness_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0264-410X(17)30518-2 DB - PRIME DP - Unbound Medicine ER -