Published ahead of print on June 25, 2009, doi:10.1164/rccm.200903-0488OC Am. J. Respir. Crit. Care Med., Volume 180, Number 6, September 2009, 499-505 A more recent version of this article appeared on September 15, 2009
Submitted on March 31, 2009 Superior Immune Response to Protein-conjugate vs. Free Pneumococcal Polysaccharide Vaccine in COPDMark T Dransfield1*,1 University of Alabama at Birmingham, Birmingham, Alabama, United States, 2 University of Michigan, Ann Arbor, Michigan, United States, 3 University of Minnesota, Minneapolis, Minnesota, United States, 4 Temple University, Philadelphia, Pennsylvania, United States, 5 Mayo Clinic, Rochester, Minnesota, United States, 6 University of California, San Francisco, San Francisco, California, United States, 7 Brigham and Women's Hospital, Boston, Massachusetts, United States, 8 University of Manitoba, Winnipeg, Canada * To whom correspondence should be addressed. E-mail: mdransfield99{at}msn.com.
Rationale: Debate exists about the immunogenicity and protective efficacy of antibodies produced by the 23-valent pneumococcal polysaccharide vaccine (PPSV23) in COPD. The 7-valent diphtheria-conjugated pneumococcal polysaccharide vaccine (PCV7) induces a more robust immune response than PPSV23 in healthy elderly adults. Objectives: We hypothesized that serotype-specific IgG antibody concentration and functional antibody activity would be superior after PCV7 vaccination compared to PPSV23 in moderate to severe COPD. We also posited that older age and prior PPSV23 vaccination would be associated with reduced vaccine responsiveness. Methods: 120 COPD patients were randomized to PPSV23 (63 subjects) or PCV7 (57 subjects). IgG concentrations were determined by ELISA; functional antibody activity was assayed with a standardized opsonophagocytosis assay and reported as an opsonization killing index (OPK). Increases in serotype-specific IgG and OPK at one month post vaccination were compared within and between vaccine groups. Main results: Both vaccines were well tolerated. Within each study group, post-vaccination IgG and OPK were higher than baseline (P<0.01) for all serotypes. Adjusted for baseline levels, post-vaccination IgG were higher in the PCV7 group than the PPSV23 group for all seven serotypes, reaching statistical significance for five (p<0.05). PCV7 resulted in a higher OPK for six of seven serotypes (statistically greater for four) compared to PPSV23. In multivariate analyses, younger age, vaccine naivety and receipt of PCV7 were associated with increased OPK responses. Conclusions: PCV7 induces a superior immune response at one month post vaccination compared to PPSV23 in COPD. Older age and prior PPSV23 reduce vaccine responsiveness. Key words: pneumococcal vaccines • vaccination • COPD • immune responses • immunization
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