"Variation on antibody (Ab) Pneumococcus rate after vaccination with Pneumo 23 in predialysis patients."

G Barril1, S Cigarrán1, F Molero2, C Casal3, R Selgas1, J Casal2

S. Nephrology1 and Microbiology2,3,Hospital Universitario de La Princesa e Instituto Carlos III2. Madrid. ESPAÑA


cigarran@ctv.es

Patients with chronic renal failure is a well recognized group on risk for bacterial and virus infections. When vaccination is suitable, the antibody response rate differs from patient to patient and from vaccine to vaccine (poor response to virus B hepatitis vs. good response to polysaccharide neumococcus.

We used a formula of pneumococcus vaccine containing 23 serotypes .

We performed the present study to analyse the rate of response to Pneumo23 vaccination in 33 patients with chronic renal failure in predialysis phase. Ccr<30ml/min/1´73m2, mean age=70,42±9,5 years, 19 (57,5%) male.

The renal function parameters were: Ccr=19±6,8 ml/min/1,73m2, weekly Kt/v 2,26±0,73 and MDRD 15,37±4,7.

Serum albumin was 3,88±0,33, PCR 0,95±1,43 (range 0,1-6,4). At this purpose, the baseline Ab rate and one month after vaccination were measured, using ELISA-protocol /CDC-Workshop,Atlantza), testing for the serotypes more frequent (Srt3, Srt6,Srt14,and Srt23F).

The values are expressed in µgr/ml of IgG (serotype-specific).

Although the protective concentration of Ab to pneumococcus has not been determined, supported by other experiences we have considered as protection rate > 1 µgr/ml of IgG specific (much more accurate >2).

Consequently, we defined the seroconversion index that showing double Ab level after vaccination.

The values for different groups are shown as mean±SD and range.

Mean ± Dst Range

x Srt3 prevaccine

2,40 ± 1,27

0,53-5,44

x Srt3 post-1month

4,86 ± 3,58

0,90-18,28

x Srt6 prevaccine

3,67 ± 3,04

0,56-13,83

x Srt6 post-1 month

7,02 ± 4,57

0,91-18,71

x Srt14 prevaccine

7,61 ± 7,70

1,32-> 29,22

x Srt14 post-1month

19,03 ± 10,98

1,77->29,22

x Srt23 prevaccine

3,50 ± 2,85

0,23->10

x Srt23 post-1month

6,06 ± 3,48

0,57->10

We found significant differences between the values pre- and post-vaccination in the four groups (p=0,000).

The response rate was different according the four groups of polysacharides and also was different among the patients.

For Srt3 <1 baseline 2 patients did not respond (6,1%) and non duplicate 8 patients. For Srt23F <1 baseline, 18patients (24%) 16 patients did not doubled the Ab rate.

We found a significant correlation between the pre and post rates for the four serotypes. Also between Ab rate and PCR, in some serotypes but not for Ab rate and age, albumin, and renal function (except Srt3 basal with MDRD p<0.05 , and Srt3 post vaccination with Kt/v weekly). 21 of these patients received HBV vaccination (3 doses 40 µgs Recombivax in short schedule, 21 days); the response rate in terms of Hb Ab appeared only in 3 patients with x 32,73±129,3 (range 0-593,5).

Conclusions:

  1. We found a positive response in Antibodies after one month post vaccination with 23 polysacharide vaccine, although a small group of patients did not respond
  2. The response rate is higher for the Srt6 and Srt3 antigens
  3. The response in the same patient is higher for this vaccine than for the HBV vaccine
  4. It remains to be evaluated if the Ab rate in these patients is lost more quickly than the general population
  5. The 23 polysacharide pneumococcus vaccine seems to be indicated in predialysis patients but the response should be monitored.