Delphine R Nelson1, Jeffrey Fadrowski2, Alicia Neu2. 1. Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, 225 E Chicago Ave MS #37, Chicago, IL, 60611, USA. denelson@luriechildrens.org. 2. Johns Hopkins Children's Hospital, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Abstract
BACKGROUND: Immunosuppressed kidney transplant patients may have suboptimal response to vaccinations. The aim of this study was to determine antibody response to a quadrivalent meningococcal conjugate vaccine (MenACWY-D) in adolescents with a kidney transplant. METHODS: This was a prospective, single-center, cohort study. Adolescent patients (11-22 years old) with a functioning kidney transplant for at least 3 months and no previous meningococcal vaccination were eligible for enrollment. Antibody levels to all serogroups were measured before vaccination (baseline) and at 4 weeks and 1, 2 and 3 years after vaccination. Seropositivity was defined as a titer ≥ 1:8 at baseline, and seroconversion as a fourfold or greater increase in antibody titer from baseline at 4 weeks post-vaccination. Geometric mean titers (GMTs) were calculated at each time point and compared to published GMTs from vaccinated healthy adolescents. RESULTS: Nineteen patients were enrolled. No patient had seroprotective titers against all four serogroups at baseline. At 4 weeks post-vaccination 41% of patients seroconverted to all four serogroups, with seroconversion rates of 88, 53, 71 and 94% for serogroups A, C, W and Y, respectively. GMTs were significantly lower in adolescents with a kidney transplant than in healthy adolescents at 1 month (p = 0.02) and 3 years (p = 0.04) post-vaccination. There were no significant adverse events, episodes of rejection or death in any patient. CONCLUSIONS: Adolescents with a kidney transplant may not respond adequately to MenACWY-D and may experience more rapid declines in antibody titers than healthy adolescents. Further study is needed to determine if alternative dosing schedules can improve antibody response in this population.
BACKGROUND: Immunosuppressed kidney transplant patients may have suboptimal response to vaccinations. The aim of this study was to determine antibody response to a quadrivalent meningococcal conjugate vaccine (MenACWY-D) in adolescents with a kidney transplant. METHODS: This was a prospective, single-center, cohort study. Adolescent patients (11-22 years old) with a functioning kidney transplant for at least 3 months and no previous meningococcal vaccination were eligible for enrollment. Antibody levels to all serogroups were measured before vaccination (baseline) and at 4 weeks and 1, 2 and 3 years after vaccination. Seropositivity was defined as a titer ≥ 1:8 at baseline, and seroconversion as a fourfold or greater increase in antibody titer from baseline at 4 weeks post-vaccination. Geometric mean titers (GMTs) were calculated at each time point and compared to published GMTs from vaccinated healthy adolescents. RESULTS: Nineteen patients were enrolled. No patient had seroprotective titers against all four serogroups at baseline. At 4 weeks post-vaccination 41% of patients seroconverted to all four serogroups, with seroconversion rates of 88, 53, 71 and 94% for serogroups A, C, W and Y, respectively. GMTs were significantly lower in adolescents with a kidney transplant than in healthy adolescents at 1 month (p = 0.02) and 3 years (p = 0.04) post-vaccination. There were no significant adverse events, episodes of rejection or death in any patient. CONCLUSIONS: Adolescents with a kidney transplant may not respond adequately to MenACWY-D and may experience more rapid declines in antibody titers than healthy adolescents. Further study is needed to determine if alternative dosing schedules can improve antibody response in this population.
Authors: B Wyplosz; O Derradji; E Hong; H François; A Durrbach; J-C Duclos-Vallée; D Samuel; L Escaut; O Launay; D Vittecoq; M K Taha Journal: Transpl Infect Dis Date: 2015-03-06 Impact factor: 2.228
Authors: Harry Keyserling; Thomas Papa; Katalin Koranyi; Robert Ryall; Ehab Bassily; Michael J Bybel; Kevin Sullivan; Gregory Gilmet; Al Reinhardt Journal: Arch Pediatr Adolesc Med Date: 2005-10
Authors: Amanda C Cohn; Jessica R MacNeil; Lee H Harrison; Cynthia Hatcher; Jordan Theodore; Mark Schmidt; Tracy Pondo; Kathryn E Arnold; Joan Baumbach; Nancy Bennett; Allen S Craig; Monica Farley; Ken Gershman; Susan Petit; Ruth Lynfield; Arthur Reingold; William Schaffner; Kathleen A Shutt; Elizabeth R Zell; Leonard W Mayer; Thomas Clark; David Stephens; Nancy E Messonnier Journal: Clin Infect Dis Date: 2010-01-15 Impact factor: 9.079
Authors: Sandra L Watkins; Steven R Alexander; Eileen D Brewer; Teresa M Hesley; David J West; Ivan S F Chan; Paul Mendelman; Shelia M Bailey; Jane L Burns; Ronald J Hogg Journal: Am J Kidney Dis Date: 2002-08 Impact factor: 8.860
Authors: Amanda C Cohn; Jessica R MacNeil; Thomas A Clark; Ismael R Ortega-Sanchez; Elizabeth Z Briere; H Cody Meissner; Carol J Baker; Nancy E Messonnier Journal: MMWR Recomm Rep Date: 2013-03-22