Pneumococcal vaccination responses in adults with subnormal IgG subclass concentrations

• Research article
• OPEN ACCESS

BMC Immunology

• Antony R. Parker, 
• Markus Skold, 
• Stephen Harding, 
• J. Clayborn Barton, 
• Luigi F. Bertoli & 
• James C. Barton 

BMC Immunologyvolume 20, Article number: 29 (2019) | 

Abstract

Background

We sought to compare Pneumovax®23 responses in adults with subnormal IgG subclass concentrations. We studied adults with normal total IgG, frequent/severe respiratory infection, and subnormal IgG1, IgG3, or IgG1 + IgG3 before and after Pneumovax®23. We defined response as serotype-specific IgG > 1.3 μg/mL and aggregate response as IgG > 1.3 μg/mL for ≥70% of all serotypes tested. We compared patients with and without serotype-specific responses and performed logistic regression on aggregate responses using: age; male sex; body mass index; autoimmune condition(s); atopy; other allergies; subnormal IgGSc immunophenotypes; IgA; and IgM.

Results

Summation of S. pneumoniae serotype-specific IgG antibodies.
We measured the concentration of all serotype-specific antibodies
per patient in subnormal IgGSc groups in a PPSV23 responders
(IgG1, n = 6; IgG3, n = 15; and IgG1 + IgG3, n = 7) and b PPSV23 non-responders
(IgG1, n = 7; IgG3, n = 18; and IgG1 + IgG3, n = 6)

There were 59 patients (mean age 44 ± 13 (SD) years; 83.1% women). Median days between pre- and post-Pneumovax®23 testing was 33 (range 19–158). The median post-vaccination summated concentration of serotype-specific IgG was higher in patients with subnormal IgG1 than subnormal IgG3 (responders and non-responders). All subnormal IgG1 + IgG3 non-responders responded to serotypes 8, 9 and 26, unlike other non-responders. Subnormal IgG3 responders had lower responses to serotypes 1, 4, 12, 23, 26, and 51. Subnormal IgG3 non-responders had higher responses to serotypes 1, 3, 8, 9, 12, 14, 19, 51, and 56. Response rates decreased with increasing age. Aggregate responders were: subnormal IgG1, 54%; IgG3, 46%; and IgG1 + IgG3, 46%. Regression on aggregate response revealed lower response with male sex (odds ratio 0.09 [95% CI 0.01, 0.77]) and atopy (0.17 [0.03, 0.83]).

Conclusions

Serotype-specific IgG responses to Pneumovax®23 were greater in patients with subnormal IgG1 than subnormal IgG3. Male sex and atopy were associated with lower aggregate responses.

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