The response to Typhi Vi vaccination is compromised in individuals with primary immunodeficiency.

Jeevani Kumarage,Bandu Gunasena,Stephen Harding,Suranjith L Seneviratne,Sudath Peiris,Vijitha Senaratne,Kirthi Gunasekera,Antony R Parker,Amitha Fernando,Nilhan Rajiva De Silva,Padmalal Gurugama

doi:10.1016/j.heliyon.2017.e00333

Abstract

Measurement of an individuals ability to respond to polysaccharide antigens is a crucial test to determine adaptive immunity. Currently the response to Pneumovax® is utilized but with the success of Prevnar®, measurement of the response to Pneumovax may be challenging. The aim of the study was to assess the response to Typhi Vi vaccination in both children and adult control groups and patients with primary immunodeficiency (PID). In the control groups, >95% of the individuals had pre Typhi Vi vaccination concentrations <100 U/mL and there was significant increase in concentration post Typhi Vi vaccination (p<0.0001) with>94% achieving ≥3 fold increase in concentration (FI). The response to Typhi Vi vaccination was significantly lower in both children (p = 0.006) and adult (p = 0.002) PID groups when compared to their control groups. 11% and 55% of the children and adult PID groups respectively did not obtain a response >3FI. There were no significant differences between the responses obtained in the children and adult PID groups. When all individuals with PID were separated into those with either hypogammaglobulinemia (HYPO) or common variable immunodeficiency (CVID), both groups had a significantly lower median FI than the control group (19, 95%CI 5–56 vs 59, 95%CI 7–237; p = 0.01 and 1, 95%CI 1–56 vs 32, 95%CI 5–136; p = 0.005). Further, a >3FI differentiated the antibody responses between both the CVID and HYPO groups and their control groups (AUC: 0.83, 95%CI: 0.65–1.00, p = 0.005 and 0.81, 95% CI: 0.65–0.97, p = 0.01). The data suggests that measurement of the response to Typhi Vi vaccination could represent a complementary assay for the assessment of the response to a polysaccharide vaccine.

Highlights

Defective production of specific antibodies in response to polysaccharide antigens is a major risk for infection and other complications in patients with antibody deficiencies
Serum IgG, IgA and IgM concentrations were significantly lower for both primary immunodeficiencies (PID) groups compared to their appropriate control groups
The failure to respond to a polysaccharide vaccine is a reflection of a defective adaptive immune system in response to polysaccharide antigens and may leave an individual at risk of recurrent infections

Summary

Introduction

Defective production of specific antibodies in response to polysaccharide antigens is a major risk for infection and other complications in patients with antibody deficiencies. Specific antibody responses to Pneumovax are measured in individuals with symptoms suggestive of a deficiency of antibody production [1]. Interpretation of the response to pneumococcal vaccination is becoming more challenging. High pneumococcal pre-immunization levels in the general population may limit the response to vaccination [2]. Cross-reacting antibodies [3] and different immunogenicities of the large number of different serotypes may complicate interpretation of the response further. The undoubted success of the polysaccharide-protein conjugated vaccine Prevnar may hide the response to the pure polysaccharide vaccine and with the initial reports of a polysaccharide-protein conjugated vaccine developed for 15 serotypes, availability of Pneumovax may become limited [4]

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