The association between antibody levels before and after 7-valent pneumococcal conjugate vaccine immunization and subsequent pneumococcal infection in chronic arthritis patients. Nagel, J., Geborek, P., Saxne, T., Jonsson, G., Englund, M., Petersson, I. F., Nilsson, J., Truedsson, L., & Kapetanovic, M. C. 17:124.
doi  abstract   bibtex   
INTRODUCTION: The aim of present study is to inverstigate the association between antibody levels after vaccination with 7-valent pneumococcal conjugate vaccine (PCV7) and subsequent serious pneumococcal infections in rheumatoid arthritis (RA) and spondylarthropathy (SpA) patients. METHODS: A cohort of 497 patients (RA=248 and SpA=249) received a single dose of PCV7. At vaccination, patients were treated with methotrexate (MTX; n=85), anti-tumour necrosis factor (anti-TNF) + MTX (n=169), anti-TNF monotherapy (n=158) and non-steroidal anti-inflammatory drugs (NSAIDs)/analgesics (n=85). Antibody levels of serotypes 6B and 23B were analyzed before and 4 to 6 weeks after vaccination using standard enzyme-linked immunosorbent assay (ELISA). Serious pneumococcal infections (pneumonia/lower respiratory tract infection, meningitis, sepsis, septic arthritis) occurring within 4.5 years after vaccination were identified in the Skane Healthcare Register using the International Classification of Diseases, tenth revision (ICD-10) codes. The association between post-vaccination antibody levels and protection against infections and determination of protective cutoff levels was explored using receiver operating characteristic (ROC) curves. Predictors of infection were studied using regression analyses. RESULTS: Eighteen infections were registered in 15 patients before vaccination and 27 infections in 23 patients after vaccination. Patients with serious infections after vaccination had significantly lower post-vaccination antibody titres for both 6B (P=0.04) and 23 F (P=0.04). Post-vaccination antibody levels of at least 1.29 mg/L and 1.01 mg/L for 6B and 23, respectively, were associated with better protection from serious infections. Higher age, concomitant prednisolone but not MTX or anti-TNF were associated with such infections. CONCLUSIONS: Patients with more robust antibody responses after vaccination with pneumococcal conjugate vaccine were less likely to suffer from serious infections. High age and prednisolone at vaccination were associated with putative serious pneumococcal infections in this cohort. TRIAL REGISTRATION NUMBER: EudraCT EU 2007-006539-29 and NCT00828997 . Registered 23 January 2009.
@article{nagel_association_2015,
	title = {The association between antibody levels before and after 7-valent pneumococcal conjugate vaccine immunization and subsequent pneumococcal infection in chronic arthritis patients.},
	volume = {17},
	issn = {1478-6362 1478-6354},
	doi = {10.1186/s13075-015-0636-z},
	abstract = {{INTRODUCTION}: The aim of present study is to inverstigate the association between antibody levels after vaccination with 7-valent pneumococcal conjugate vaccine ({PCV}7) and subsequent serious pneumococcal infections in rheumatoid arthritis ({RA}) and spondylarthropathy ({SpA}) patients. {METHODS}: A cohort of 497 patients ({RA}=248 and {SpA}=249) received a single dose of {PCV}7. At vaccination, patients were treated with methotrexate ({MTX}; n=85), anti-tumour necrosis factor (anti-{TNF}) + {MTX} (n=169), anti-{TNF} monotherapy (n=158) and non-steroidal anti-inflammatory drugs ({NSAIDs})/analgesics (n=85). Antibody levels of serotypes  6B and 23B were analyzed before and 4 to 6 weeks after vaccination using standard enzyme-linked immunosorbent assay ({ELISA}). Serious pneumococcal infections (pneumonia/lower respiratory tract infection, meningitis, sepsis, septic arthritis) occurring within 4.5 years after vaccination were identified in the Skane Healthcare Register using the International Classification of Diseases, tenth revision ({ICD}-10) codes. The association between post-vaccination antibody  levels and protection against infections and determination of protective cutoff levels was explored using receiver operating characteristic ({ROC}) curves. Predictors of infection were studied using regression analyses. {RESULTS}: Eighteen infections were registered in 15 patients before vaccination and 27 infections in 23 patients after vaccination. Patients with serious infections after vaccination had significantly lower post-vaccination antibody titres for both 6B (P=0.04) and 23 F (P=0.04). Post-vaccination antibody levels of at least 1.29 mg/L and 1.01 mg/L for 6B and 23, respectively, were associated with better protection from serious infections. Higher age, concomitant prednisolone but not {MTX} or anti-{TNF}  were associated with such infections. {CONCLUSIONS}: Patients with more robust antibody responses after vaccination with pneumococcal conjugate vaccine were less likely to suffer from serious infections. High age and prednisolone at vaccination were associated with putative serious pneumococcal infections in this cohort. {TRIAL} {REGISTRATION} {NUMBER}: {EudraCT} {EU} 2007-006539-29 and {NCT}00828997 . Registered 23 January 2009.},
	pages = {124},
	journaltitle = {Arthritis research \& therapy},
	shortjournal = {Arthritis Res Ther},
	author = {Nagel, Johanna and Geborek, Pierre and Saxne, Tore and Jonsson, Goran and Englund, Martin and Petersson, Ingemar F. and Nilsson, Jan-Ake and Truedsson, Lennart and Kapetanovic, Meliha C.},
	date = {2015},
	pmid = {25986458},
	pmcid = {PMC4436875},
	keywords = {Aged, Aged, 80 and over, Antibodies, Bacterial/*blood, Arthritis, Rheumatoid/blood/*complications/immunology, Chronic Disease, Enzyme-Linked Immunosorbent Assay, Female, Heptavalent Pneumococcal Conjugate Vaccine/*therapeutic use, Humans, Immunization/*methods, Immunologic Factors/therapeutic use, Male, Middle Aged, Pneumococcal Infections/complications/microbiology/*prevention \& control, Young Adult}
}
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