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Immunogenicity of the meningococcal polysaccharide conjugate vaccine in pediatric kidney transplant patients

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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.

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Acknowledgements

Vaccine and the antibody measurement were provided by Sanofi Pasteur. The work was also supported by a mini-grant from the National Kidney Foundation of Maryland.

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Authors and Affiliations

  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

    Delphine R. Nelson

  2. Johns Hopkins Children’s Hospital, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Jeffrey Fadrowski & Alicia Neu

Authors
  1. Delphine R. Nelson
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  2. Jeffrey Fadrowski
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  3. Alicia Neu
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Corresponding author

Correspondence to Delphine R. Nelson.

Ethics declarations

Informed consent was obtained from all individual participants included in the study, and consent was provided by the parent/guardian if the patient was a minor. All study procedures were performed in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Conflict of interest

Dr. Alicia Neu receives research funding from Amgen, Luitpold, Genzyme, Relypsa and Retrophin, and serves as a consultant to Bayer. Dr. Jeffrey Fadrowski and Dr. Delphine Nelson have no conflict of interest to report.

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Nelson, D.R., Fadrowski, J. & Neu, A. Immunogenicity of the meningococcal polysaccharide conjugate vaccine in pediatric kidney transplant patients. Pediatr Nephrol 33, 1037–1043 (2018). https://doi.org/10.1007/s00467-017-3878-y

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  • DOI: https://doi.org/10.1007/s00467-017-3878-y

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