Focusing on good responders to pneumococcal polysaccharide vaccination in general hospital patients suspected for immunodeficiency: A decision tree based on the 23-valent pneumococcal IgG assay

L.M.A. Janssen, M. Heron, J-L. Murk, A.C.A.P. Leenders, G.T. Rijkers, E. de Vries*

*Corresponding author for this work

Research output: Contribution to journalArticleScientificpeer-review

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Abstract

Background and Aim:
Recently, the 23-valent IgG-assay was suggested as screening assay to identify poor responders to pneumococcal polysaccharide (PnPS)-vaccination with the serotype-specific assay as a second-line test. However, in a low pre-test probability general hospital setting predicting good responders could be more valuable to reduce the number of samples needing serotyping.

Methods:
Serotype-specific PnPS antibody-assays were performed for suspected immunodeficiency in two Dutch general hospitals (Jeroen Bosch Hospital, 's-Hertogenbosch; Elisabeth Tweesteden Hospital, Tilburg). 23-Valent PnPS antibody-assays were subsequently performed in archived material. Data were analyzed using receiver operating characteristic curves (AUC) and agreement indices (ICC).

Results:
Sera of 284 patients (348 samples) were included; 23-valent IgG-titres and the corresponding sum of PnPS-serotype specific antibodies showed moderate correlation (ICC = 0.63). In 232 conjugated-pneumococcal-vaccine-naïve patients (270 samples), a random 23-valent IgG-titer could discriminate between samples with and without ≥7/11, ≥7/13, or ≥6/9 pneumococcal serotypes when both cut-off values 0.35 and 1.0 μg/ml were used (AUC 0.86 and 0.92, respectively). All patients with a pre-immunization-titer ≥38.2 μg/ml and/or post-immunization-titer ≥96.1 μg/ml and none with a post-immunization-titer ≤38.5 μg/ml exhibited a good response to PnPS vaccination. Using these breakpoints as screening test to predict good responders, only 24% of patients would require further serotyping, as opposed to 68% if breakpoints to predict poor responders would have been used.

Conclusion:
In a low pre-test probability setting, the 23-valent IgG-assay proved to be a reliable screening test for good responders in conjugated-pneumococcal-vaccine-naïve patients, reducing the overall number of patient samples needing further serotyping, thus reducing overall costs of pneumococcal vaccination response assessment.
Original languageEnglish
Article number2496
Number of pages10
JournalFrontiers in Immunology
Volume10
DOIs
Publication statusPublished - 2019

Keywords

  • 23-valent IgG assay
  • ANALYTICAL VARIABILITY
  • ANTIBODY-RESPONSE
  • CAPSULAR POLYSACCHARIDE
  • CLINICAL INTERPRETATION
  • HEALTHY-CHILDREN
  • VaccZyme (TM)
  • humoral immunodeficiency
  • pneumococcal polysaccharide response
  • pneumococcal vaccination response
  • polysaccharide response
  • primary immunodeficiency
  • serotype-specific assay

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