• Michelle Barton, Samia Wasfy, Anne I Dipchand, Diane Hébert, Vicky Ng, Melinda Solomon, Anne Fecteau, Derek Stephen, and Upton Allen.
• Division of Infectious Diseases, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario.
• Pediatr. Infect. Dis. J. 2009 Aug 1; 28 (8): 688-92.

ObjectivesTo determine the safety and immunogenicity of the conjugate pneumococcal vaccine (PCV7) in pediatric solid organ transplant recipients.Patients And MethodsPediatric solid organ transplant recipients were prospectively enrolled at > or =4 months following transplantation. Eligible pneumococcal vaccine-naive subjects received 3 doses of PCV7 at 8 week intervals, followed 8 weeks later by a dose of the 23-valent vaccine (PV23). Serology was done at baseline, 8 weeks following doses 2 and 3 of PCV7 and 8-12 weeks after PV23. Repeated measures analyses were done using SAS 9.ResultsEighty-one recipients commenced immunization at a median age of 7.8 (0.6-17.5) years and a median time from transplantation to immunization of 1.3 (0.3-6.0) years. There were 31 heart, 18 liver, 5 lung, and 27 kidney recipients. Reported adverse events following vaccine doses included local reactions (PCV7: PV23 = 19%:16%) and fever (PCV7: PV23 = 3.8%:4.9%) and there were no serious reactions. Two doses of PCV7 induced > or =2 fold increases in geometric mean concentrations (GMCs) in all organ groups. Cardiac and lung recipients demonstrated additional benefit from a third dose of PCV7. The cardiac recipients showed most benefit from boosting with PV23 with significant increases in GMC's (P < or = 0.008). The time of initiation of the vaccine strategy posttransplantation predicted seroprotection.ConclusionPCV7 was safe and immunogenic in solid organ recipients. Three doses of this vaccine appear beneficial for selected organ groups. PV23 when administered at >/=1 year posttransplantation was useful in boosting antibody responses in patient groups demonstrating lower rates of responsiveness.

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