Immunologic response to pneumococcal polysaccharide vaccine in infants.

The serum antibody response to purified pneumococcal capsular polysaccharides (PCP) was detrmined in four groups of infants ranging in age from 3 to 24 months. Group 1 consisted of eight infants immunized with an octavalent vaccine containing serotypes 1, 3, 6, 7, 14, 18, 19 and 23 (PCP-8). Group 1 received 25 microgram of each serotype at 3-6 months of age and again at 18-24 months. The antibody response after the second immunization was compared to a group of nine patients receiving a primary immunization at 18-24 months and to a group of ten age-matched controls receiving saline placebo. There were no significant differences in mean serum antibody levels between the two groups receiving the PCP-8. A fourth group of 44 infants between 6 and 21 months of age received either PCP-7 or PCP-8 and were followed for two years, at which time simultaneous injections of both vaccines were administered. Types 2, 3, 7, and 8 were most immunogenic but levels six months after immunization were approximately the same as for unimmunized controls with the exception of serotypes 3 and 7 which persisted for about two years. The class of antibody induced either by natural infection or by immunization was preferentially IgG and it was more often induced by the former. There were no significant differences between the serotypes of pneumococci isolated from nasopharyngeal cultures regardless of which vaccine was administered. Finally, the least immunogenic serotypes include 4, 6, 14, 19, and 23 and these are the only serotypes thus far associated with otitis media after immunization. The results suggest that PCP do not induce a lasting immune tolerance at the dose administered in this study; PCP are not very immunogenic in the young infant; PCP antibody tends to rise naturally; IgG antibody is preferentially induced; nasopharyngeal colonization is not altered by PCP immunization; and an association may exist between PCP immunogenicity and subsequent onset of otitis media.