Source: Annual Congress 2002 - Aspects of respiratory disease in primary care
Disease area: Airway diseases

Abstract

Pneumococcal vaccination with the 23-valent vaccine is recommended by health authorities but few studies have regarded the antibody response in COPD patients. We compared the rise in anti-pneumococcal antibody levels (ABL) (serotypes (ST) 4,6,9,14,18,19,23) before, 12 weeks (12w) and one year (1yr.) after vaccination (0,5 ml Pneumopur(r)) in three groups: a) patients with a steroid dependent COPD (SS) (>10 mg of prednisolone/day), b) COPD patients receiving inhalative steroids (IS) and c) a control group (CG). Measurements were done by modified ELISA plates (CovaLink NH(r)). We defined sufficient AB-response as an twofold increase of AB-levels and absolute concentration over 1μg/ml. Of 119 initially enrolled patients 70 completed the study (57% male, 43% female, mean age SS 64 yrs, IS 62, CG 64). We found no differences in the pre-vaccination ABL. Absolute ABL increase to ST14 after 12w and 1yr. differed comparing IS and CG (12w: CG mean (m) 12,1 μg/ml ±] 6 vs. IS 23,5±] 7,7, p=0.025; 1 yr. CG 8,4 μ g/ml ±] 3,8 vs. IS 16,4 ±] 4,2). AB-levels to ST4 (12w) differed between CG and SS (CG m4,1 μg/ml ±] 1,1; SS 1.9 ±] 0.9). We found non-responders (NR) in all groups (12 w: max 61% SS (ST23), min 23% IS (ST14); 1yr. max 83% CG (ST4), min 30 % CG 30%). There were more non-responders in the CG compared to IS (ST14 1 yr., CG 63% vs. IS 25%, p=0.014, ST18 CG 30%, IS 62% p=0.047). We found more NR in SS (78%, ST4) vs. 43% CG after 12w, p=0.014. Conclusion: AB-response varied among ST and groups. ST14 AB-levels were less imunogenic in controls compared to IS. Prednisolone did increase the rate of non-responders to ST4 compared to controls. We found no significant differences between the IS and SS.

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A. de Roux, N. Schmidt, N. Strnad, P. Zielen, H. Lode (Berlin, Frankfurt am Main, ; Bonn, Germany). Pneumococcal polysaccharide vaccination in COPD patients - some problems with antibody-response. Eur Respir J 2002; 20: Suppl. 38, 2981

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