Skip to main content

Advertisement

SpringerLink
Log in

High serological response to pneumococcal vaccine in nephrotic children at disease onset on high-dose prednisone

  • Original Article
  • Published:
Pediatric Nephrology Aims and scope Submit manuscript

Abstract

Our objective was to demonstrate that nephrotic children at disease onset and under high-dose prednisone respond to vaccination with 23-valent pneumococcal vaccine (PV). We compared the serological response after PV in 30 children with nephrotic syndrome, directly after initiation of prednisone therapy (60 mg/m2 body surface area) at disease onset (group 1), with the response in 13 patients who received the vaccine while in remission (group 2). Safety was studied, comparing disease course in group 1 with those in patients who did not receive any PV (group 3). In group 1, 23-valent PV antibody (Ab) levels increased tenfold after 1 month and remained increased after 1 year (P < 0.01). Ab response in the short term and in the long term was not different from that of patients in group 2. Serum albumin, age, or immunosuppressive drugs did not influence Ab response. Disease courses in groups 1 and 3 were not different. In conclusion, nephrotic children on high-dose glucocorticoid therapy respond to a 23-valent anti-PV. Children with steroid dependent/resistant forms acquire high Ab levels, even if early relapses delay the tapering of steroids or if immunosuppressive agents are introduced. Patients who relapse during the tapering of steroids already have increased anti-pneumococcal Ab at the time of relapse.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Abbreviations

Ab:

Antibody

EOD:

Every other day

NS:

Nephrotic syndrome

PV:

Pneumococcal vaccine

SEM:

Standard error of the mean

References

  1. van den Berg JG, Weening JJ (2004) Role of the immune system in the pathogenesis of idiopathic nephrotic syndrome. Clin Sci (Lond) 107:125–136

    Article  Google Scholar 

  2. Krensky AM, Ingelfinger JR, Grupe WE (1982) Peritonitis in childhood nephrotic syndrome: 1970–1980. Am J Dis Child 136:732–736

    Article  CAS  Google Scholar 

  3. Liponski I, Cochat P, Gagnadoux MF, Parchoux B, Niaudet P, David L, Broyer M (1995) Bacterial complications of nephrotic syndrome in children. Presse Med 24:19–22

    CAS  PubMed  Google Scholar 

  4. Hsu K, Pelton S, Karumuri S, Heisey-Grove D, Klein J (2005) Population-based surveillance for childhood invasive pneumococcal disease in the era of conjugate vaccine. Pediatr Infect Dis J 24:17–23

    Article  Google Scholar 

  5. Matsell DG, Roy S 3rd, Bin JA, Wyatt RJ (1990) Nephrosis, peritonitis and complement deficiency. Pediatr Nephrol 4:575

    Article  CAS  Google Scholar 

  6. Winkelstein JA (1984) Complement and the host’s defense against the pneumococcus. Crit Rev Microbiol 11:187–208

    Article  CAS  Google Scholar 

  7. Ilyas M, Roy S 3rd, Abbasi S, Leggiadro RJ, English BK, Wyatt RJ (1996) Serious infections due to penicillin-resistant Streptococcus pneumoniae in two children with nephrotic syndrome. Pediatr Nephrol 10:639–641

    Article  CAS  Google Scholar 

  8. Whitney CG, Farley MM, Hadler J, Harrison LH, Lexau C, Reingold A, Lefkowitz L, Cieslak PR, Cetron M, Zell ER, Jorgensen JH, Schuchat A (2000) Increasing prevalence of multidrug-resistant Streptococcus pneumoniae in the United States. N Engl J Med 343:1917–1924

    Article  CAS  Google Scholar 

  9. Abeyagunawardena AS, Goldblatt D, Andrews N, Trompeter RS (2003) Risk of relapse after meningococcal C conjugate vaccine in nephrotic syndrome. Lancet 362:449–450

    Article  CAS  Google Scholar 

  10. Guven AG, Akman S, Bahat E, Senyurt M, Yuzbey S, Uguz A, Yegin O (2004) Rapid decline of anti-pneumococcal antibody levels in nephrotic children. Pediatr Nephrol 19:61–65

    Article  Google Scholar 

  11. Spika JS, Halsey NA, Fish AJ, Lum GM, Lauer BA, Schiffman G, Giebink GS (1982) Serum antibody response to pneumococcal vaccine in children with nephrotic syndrome. Pediatrics 69:219–223

    CAS  PubMed  Google Scholar 

  12. Lahood N, Emerson SS, Kumar P, Sorensen RU (1993) Antibody levels and response to pneumococcal vaccine in steroid-dependent asthma. Ann Allergy 70:289–294

    CAS  PubMed  Google Scholar 

  13. Kemper MJ, Meyer-Jark T, Lilova M, Muller-Wiefel DE (2003) Combined T- and B-cell activation in childhood steroid-sensitive nephrotic syndrome. Clin Nephrol 60:242–247

    Article  CAS  Google Scholar 

  14. Wilkes JC, Nelson JD, Worthen HG, Morris M, Hogg RJ (1982) Response to pneumococcal vaccination in children with nephrotic syndrome. Am J Kidney Dis 2:43–46

    Article  CAS  Google Scholar 

  15. Hammitt LL, Bruden DL, Butler JC, Baggett HC, Hurlburt DA, Reasonover A, Hennessy TW (2006) Indirect effect of conjugate vaccine on adult carriage of Streptococcus pneumoniae: an explanation of trends in invasive pneumococcal disease. J Infect Dis 193:1487–1494

    Article  Google Scholar 

  16. Millar EV, O’Brien KL, Watt JP, Bronsdon MA, Dallas J, Whitney CG, Reid R, Santosham M (2006) Effect of community-wide conjugate pneumococcal vaccine use in infancy on nasopharyngeal carriage through 3 years of age: a cross-sectional study in a high-risk population. Clin Infect Dis 43:8–15

    Article  Google Scholar 

  17. Hanage WP, Huang SS, Lipsitch M, Bishop CJ, Godoy D, Pelton SI, Goldstein R, Huot H, Finkelstein JA (2007) Diversity and antibiotic resistance among nonvaccine serotypes of Streptococcus pneumoniae carriage isolates in the post-heptavalent conjugate vaccine era. J Infect Dis 195:347–352

    Article  Google Scholar 

  18. Veenhoven RH, Bogaert D, Schilder AG, Rijkers GT, Uiterwaal CS, Kiezebrink HH, van Kempen MJ, Dhooge IJ, Bruin J, Ijzerman EP, de Groot R, Kuis W, Hermans PW, Sanders EA (2004) Nasopharyngeal pneumococcal carriage after combined pneumococcal conjugate and polysaccharide vaccination in children with a history of recurrent acute otitis media. Clin Infect Dis 39:911–919

    Article  CAS  Google Scholar 

  19. Millar EV, O’Brien KL, Bronsdon MA, Madore D, Hackell JG, Reid R, Santosham M (2007) Anticapsular serum antibody concentration and protection against pneumococcal colonization among children vaccinated with 7-valent pneumococcal conjugate vaccine. Clin Infect Dis 44:1173–1179

    Article  CAS  Google Scholar 

  20. Romero-Steiner S, Musher DM, Cetron MS, Pais LB, Groover JE, Fiore AE, Plikaytis BD, Carlone GM (1999) Reduction in functional antibody activity against Streptococcus pneumoniae in vaccinated elderly individuals highly correlates with decreased IgG antibody avidity. Clin Infect Dis 29:281–288

    Article  CAS  Google Scholar 

  21. Cunard R, Kelly CJ (2002) T cells and minimal change disease. J Am Soc Nephrol 13:1409–1411

    Article  Google Scholar 

  22. Sahali D, Pawlak A, Valanciute A, Grimbert P, Lang P, Remy P, Bensman A, Guellaen G (2002) A novel approach to investigation of the pathogenesis of active minimal-change nephrotic syndrome using subtracted cDNA library screening. J Am Soc Nephrol 13:1238–1247

    CAS  PubMed  Google Scholar 

  23. Mansour H, Cheval L, Elalouf JM, Aude JC, Alyanakian MA, Mougenot B, Doucet A, Deschenes G (2005) T-cell transcriptome analysis points up a thymic disorder in idiopathic nephrotic syndrome. Kidney Int 67:2168–2177

    Article  CAS  Google Scholar 

  24. Jefferson T, Demicheli V (2002) Polysaccharide pneumococcal vaccines. BMJ 325:292–293

    Article  Google Scholar 

  25. Jackson LA, Benson P, Sneller VP, Butler JC, Thompson RS, Chen RT, Lewis LS, Carlone G, DeStefano F, Holder P, Lezhava T, Williams WW (1999) Safety of revaccination with pneumococcal polysaccharide vaccine. JAMA 281:243–248

    Article  CAS  Google Scholar 

  26. Vernacchio L, Neufeld EJ, MacDonald K, Kurth S, Murakami S, Hohne C, King M, Molrine D (1998) Combined schedule of 7-valent pneumococcal conjugate vaccine followed by 23-valent pneumococcal vaccine in children and young adults with sickle cell disease. J Pediatr 133:275–278

    Article  CAS  Google Scholar 

  27. Obaro SK, Huo Z, Banya WA, Henderson DC, Monteil MA, Leach A, Greenwood BM (1997) A glycoprotein pneumococcal conjugate vaccine primes for antibody responses to a pneumococcal polysaccharide vaccine in Gambian children. Pediatr Infect Dis J 16:1135–1140

    Article  CAS  Google Scholar 

  28. Obaro S, Adegbola R (2002) The pneumococcus: carriage, disease and conjugate vaccines. J Med Microbiol 51:98–104

    Article  Google Scholar 

Download references

Acknowledgements

We are grateful to Nadjette Mourdi for help with covariance analysis and Marie-José Costantini for secretarial assistance.

Author information

Authors and Affiliations

  1. Department of Paediatric Nephrology, Armand-Trousseau Hospital, AP-HP & University of Paris VI, 26 Avenue du Docteur Arnold Netter, 75012, Paris, France

    Tim Ulinski, Sandrine Leroy, Marie Dubrel & Albert Bensman

  2. Department of General Paediatrics, Armand-Trousseau Hospital, AP-HP & University of Paris VI, Paris, France

    Sylvie Danon

Authors
  1. Tim Ulinski
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sandrine Leroy
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Marie Dubrel
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Sylvie Danon
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Albert Bensman
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Tim Ulinski.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ulinski, T., Leroy, S., Dubrel, M. et al. High serological response to pneumococcal vaccine in nephrotic children at disease onset on high-dose prednisone. Pediatr Nephrol 23, 1107–1113 (2008). https://doi.org/10.1007/s00467-008-0782-5

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00467-008-0782-5

Keywords

Search

Navigation