[CIS PIDD] [cis-pidd] pneumococcal vaccine strategy in adolescents & adults with immune deficiency

[Richard Wasserman]

I strongly agree with Jennifer. I have a 53 yo man with IgA Deficiency and
a marginal response to PSV23 who came to me with active bronchiectasis and
an FEV1 of 27% of predicted about 20 years ago. He was getting 20mg of
prednisone per day (for more than five years) and inhaled medications. I
weaned him off prednisone and treated him with IGIV. Although he still gets
infected 2-3 times a year, his HRCT and FEV1 have remained stable.
Richard Wasserman
Dallas


On Wed, Dec 4, 2013 at 7:48 PM, Heimall, Jennifer
<heimallj at email.chop.edu>wrote:


>  I think the answer may depend on if she has recently  had pneumovax

> already and has poorly protective titers. If that is the case I would argue

> to stop reimmunizing and start immunoglobulin replacement especially in

> light of underlying bronchiectasis .

> Jen

>

> Sent from my iPhone

>

> On Dec 4, 2013, at 6:38 PM, "John Ziegler" <j.ziegler at unsw.edu.au> wrote:

>

>   That’s correct but the concern is that use of PPV will blunt later

> responses to Pn antigens.

>

>

>

> Professor John B. Ziegler

>

> Department of Immunology & Infectious Diseases

>

> Sydney Children's Hospital

>

> High St., Randwick NSW 2031 Australia

>

> T: (02) 93821515

>

> F: + 61 + 2 93821580

>

> E: j.ziegler at unsw.edu.au

>

>

>

> *From:* Soheil Chegini [mailto:schegini at yahoo.com <schegini at yahoo.com>]

> *Sent:* Thursday, 5 December 2013 10:06 AM

> *To:* CIS-PIDD

> *Subject:* Re: [cis-pidd] pneumococcal vaccine strategy in adolescents &

> adults with immune deficiency

>

>

>

> Hello,

>

>

>

> The right answer to that question very much depends on the objective of

> vaccination. You and all who commented so far would be perfectly right,

> if you only aim to provide immunity (therapeutic intent).

>

>

>

> If you, however wish to use vaccination as a diagnostic tool to gain

> insight into her underlying immunodeficiency and assess her ability to

> produce specific anti-polysaccharide antibodies in addition to

> a prophylactic intent to induce immunity and reduce her frequency of

> pneumococcal infections, you will have to use pure polysaccharide antigens

> (Pneumovax) and conjugation with a potent protein immune

> stimulant (Prevnar) will obscure the diagnostic aspect of this

> intervention.

>

>

>

> Best wishes,

>

>

>

> Soheil Chegini, M.D.

> Exton Allergy & Asthma Associates

> 656 West Lincoln Hwy.

> Exton, PA 19341

> Phone: (610) 269-3066

> Fax: (610) 269-8615

>

>

>

> On Wednesday, December 4, 2013 5:19 PM, "Verbsky, James" <jverbsky at mcw.edu>

> wrote:

>

> Stan

>

>

>

> For our patients in rheumatology on immunosuppression it is recommend to

> receive the PCV13 then the PPSV23.  We are doing this on all of our patients

>

>

>

> Best

>

> James

>

>

>

> James Verbsky MD/PhD

> Associate Professor of Pediatrics and Microbiology and Molecular Genetics

> Medical College of Wisconsin

> Milwaukee, WI  53226

>

> ________________________________

> From: Stan Ress [stan.ress at uct.ac.za]

> Sent: Wednesday, December 04, 2013 3:04 PM

> To: CIS-PIDD

> Subject: [cis-pidd] pneumococcal vaccine strategy in adolescents & adults

> with immune deficiency

>

> Hi all,

>

> I have been referred a 15 year-old patient with extremely severe IgA

> deficiency, recurrent respiratory infections, & bronchiectasis on CT chest.

> Her baseline vaccine status revealed low IgG ELIZA antibodies against 4/5

> antigens, including S. pneumonia & H. Influenza B. Our policy has been to

> vaccinate such patients with 23-valent pneumococcal polysaccharide vaccine.

> However, I saw a reference to ACIP recommendation that children & adults

> with immune compromising conditions or asplenia, should receive 13-valent

> conjugate vaccine 1st, followed 8 weeks later by unconjugated PPSV23.

>

> Is this the general current practise?

>

> Thanks.

> --

> Stanley Ress

> Associate Professor of Medicine

> Head: Division of Clinical Immunology

> Department of Medicine

> H47 Old Main Building-room 26

> Groote Schuur Hospital and UCT

> Observatory 7925

> Cape Town

> South Africa

> TEL:INTERN. + 2721-4066201 or 4066197

> FAX:  "    + 2721-(0)865173095

> Cell: 0833115482

> email: stan.ress at uct.ac.za<mailto:stan.ress at uct.ac.za>

>

> ________________________________

> UNIVERSITY OF CAPE TOWN

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-- 
Richard L. Wasserman, MD, PhD
DallasAllergyImmunology
7777 Forest Lane, Suite B-332
Dallas, Texas 75230
Office (972) 566-7788
Fax (972) 566-8837
Cell (214) 697-7211

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