Wiener klinische Wochenschrift

, Volume 119, Issue 7–8, pp 228–234 | Cite as

Antibody responses to pneumococcal and hemophilus vaccinations in splenectomized patients with hematological malignancies or trauma

  • Karin Eigenberger
  • Christian Sillaber
  • Manfred Greitbauer
  • Harald Herkner
  • Hermann Wolf
  • Wolfgang Graninger
  • Rainer Gattringer
  • Heinz Burgmann
Original Article

Summary

In this study we addressed the question of whether an underlying hematological malignancy may affect the immune response to vaccination against bacterial polysaccharide antigens (e.g. Haemophilus influenzae type b, Streptococcus pneumoniae) in splenectomized patients. Between 1993 and 2003, 44 splenectomized adults from the outpatient clinic for infectious diseases were prospectively included in the study: 23 patients suffered from hematological malignancies (HM) and had undergone splenectomy; 21 were splenectomized following trauma (T) and served as the control group. Each patient received an intradeltoid injection with 0.5 ml of a single lot of a 23-valent pneumococcal polysaccharide vaccine, and 0.5 ml of a polyribosyl ribitol phosphate capsular polysaccharide vaccine of H. influenzae type b (Hib) into the opposite arm. Blood samples for determination of pneumococcal and Hib antibodies were taken prior to vaccination and again 6–8 weeks later. In assessing responses to the 23-valent pneumococcal polysaccharide vaccine, we found significant differences in antibody titer increase between the HM and T groups (median IgG increase 1.27 [0.7; 2.39] vs. 3.9 [2.1; 15.3], P < 0.001; and median IgM increase 1.33 [1.0;2.67] vs. 5.25 [2.3; 7.78], P < 0.001). In the HM group, only 8/23 and 6/23 showed a titer increase of twice or more the base value for IgG and IgM respectively, whereas in the trauma group an adequate response was shown by 16/21 and 16/20 respectively. Patients with splenectomy and hematological malignancies responded poorly to the 23-valent polysaccharide vaccine. Response to the conjugated Hib vaccine was slightly better, but still significantly lower than in individuals with posttraumatic splenectomy. Data suggest that vaccination response to the polysaccharide vaccines should be evaluated at least in the high-risk group.

Keywords

Splenectomy Immunosuppression 23-valent pneumococcal polysaccharide vaccination Haemophilus influenzae type b vaccination Immune response 

Immunantwort nach Pneumokokken- und Hämophilus-Impfung bei splenektomierten Patienten mit maligner hämatologischer Erkrankung oder Trauma

Zusammenfassung

Ziel der vorliegenden Studie war es zu untersuchen, ob eine zu Grunde liegende maligne hämatologische Erkrankung bei splenektomierten Patienten Einfluss auf die Immunantwort nach Impfung mit einem Bakterienpolysaccharid-Antigene (Streptococcus pneumoniae, Haemophilus influenzae) hat. Zwischen 1993 und 2003 wurden 44 splenektomierte Erwachsene in diese prospektive Studie eingeschlossen. 23 Patienten litten an einer malignen hämatologischen Erkrankung und waren zusätzlich splenektomiert (HM); 21 Patienten waren aufgrund eines Traumas splenektomiert (T) und dienten als Kontrollgruppe. Jeder Patient erhielt eine einmalige intramuskuläre Impfung mit 0,5 ml eines 23-valenten Pneumokokken Polysaccharid-Impfstoffes, sowie am anderen Arm 0,5 ml eines an Tetanus Toxid konjugierten Haemophilus influenzae Typ b Kapselpolysaccharid Impfstoffes. Betreffend die Impfantwort auf den 23-valenten Pneumokokken Impfstoff fand sich ein signifikant geringerer IgG und IgM Titeranstieg in der HM Gruppe verglichen mit der T-Gruppe (medianer IgG Anstieg: 1.27 [25 to 75% interquartile range: 0.7; 2.39] vs. 3.9 [2.1; 15.3] p < 0.001; medianer IgM Anstieg: 1.33 [1.0; 2.67] vs. 5.25 [2.33; 7.78], p < 0.001). In der HM Gruppe zeigten 8/23 und 6/23 Patienten einen zumindest zweifachen Titeranstieg von IgG und IgM, während die entsprechenden Werte für die T-Gruppe 16/21 und 16/20 betrugen. Der Antikörperanstieg in der HM Gruppe nach Hib-Impfung war zwar etwas ausgeprägter als nach der Pneumokokken-Polysaccharid Impfung, aber signifikant geringer als in der T-Gruppe. Zusammenfassend kann diskutiert werden, dass bei splenektomierten Patienten mit hämatologischer Grunderkrankung der Impferfolg nach Pneumokokken- aber auch nach Haemophilus influenzae-Impfung durch Bestimmung der Antikörper evaluiert werden sollte.

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Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • Karin Eigenberger
    • 1
  • Christian Sillaber
    • 2
  • Manfred Greitbauer
    • 4
  • Harald Herkner
    • 3
  • Hermann Wolf
    • 5
  • Wolfgang Graninger
    • 1
  • Rainer Gattringer
    • 1
  • Heinz Burgmann
    • 1
  1. 1.Department of Internal Medicine I, Division of Infectious DiseasesMedical University of ViennaViennaAustria
  2. 2.Division of HematologyMedical University of ViennaViennaAustria
  3. 3.Department of Emergency MedicineMedical University of ViennaViennaAustria
  4. 4.Department of TraumatologyMedical University of ViennaViennaAustria
  5. 5.Immunology Outpatient ClinicViennaAustria

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