An impact of pneumococcal vaccination on exacerbations of occupational lung diseases

Abstract

Dust-related diseases are the most common occupational diseases with significant economic burden. The purpose of this study was to assess an impact of pneumococcal vaccination on exacerbation rate of occupational lung diseases. Methods. Patients with occupational lung diseases were vaccinated with pneumococcal polysaccharide 23-valent vaccine (PPV23) or pneumococcal conjugate vaccine (PCV13) and then were followed-up for long time. We analyzed the rate of exacerbations of occupational lung diseases at baseline and during 5 years after the vaccination. The immune status, anti-IgG antibodies and antibodies against PPV23 polysaccharides were measured in blood; lactoferrin and IgA were measured in saliva. Exacerbations were determined retrospectively based on outpatient medical records. Results. A rate of exacerbations significantly decreased over two years after the vaccination with PPV-23 followed by an increase to the end of the third year and a significant increase to the end the fourth year; the latter exceeded the pre-vaccination exacerbation rate. After re-vaccination with PPV23, the exacerbation rate decreased and reached the lowest rate two years after the revaccination. This result was maintained over five years with a slight transient decrease during the fourth year. This could be explained by lack of immune memory cells after the re-vaccination compared to primary vaccination and to the risk of B-cell pool depletion. When PCV13 vaccine was used for re-vaccination a year after primary vaccination with PPV23, the exacerbation rate sharply decreased a year after the re-vaccination with maintenance of the effect during three subsequent years and a significant decrease to the end of the fourth year. In a subgroup of patients with pneumoconiosis who were primarily vaccinates with PCV13 without further re-vaccination, the exacerbation rate significantly reduced a year after the vaccination with further reduction during five years. The exacerbation rates were similar in this subgroup and in patients vaccinated sequentially with PCV13 and PPV23. Conclusion. The long-term immune response could be provided by conjugation caused the memory cell formation compared to PPV23 vaccine.