[CIS PIDD] [cis-pidd] 18yo M with antibody deficiency

[CIS-PIDD]

Tom:

The only reference I could find in MMWR 3013;62(RR2) regarding concomitant administration of these two vaccines was on page 18, and it seems to refer to asplenic patients only.

Please advise if this is incorrect.

Joe Church



From: CIS-PIDD [mailto:cis-pidd at lists.clinimmsoc.org]
Sent: Thursday, September 10, 2015 8:32 AM
To: CIS-PIDD
Subject: RE:[cis-pidd] 18yo M with antibody deficiency

Hi Joe,

Concomitant Menactra and Prevnar administration are contraindicated due to interference with immunogenicity of the latter when administered at the same time as Menactra.  It is recommended that Menactra be given a minimum of 4 weeks after all PCV-13 doses.

MMWR 2013;62(RR2):1-28.

Tom


Thomas G. Boyce, MD, MPH
Pediatric Infectious Diseases and Immunology
Mayo Clinic
Rochester, MN 55905
phone: 507-255-8464
fax: 507-255-7767


From: CIS-PIDD [mailto:cis-pidd at lists.clinimmsoc.org]
Sent: Thursday, September 10, 2015 9:05 AM
To: CIS-PIDD
Subject: [cis-pidd] 18yo M with antibody deficiency

Colleagues:

I have followed an 18yo male who had a history of recurrent URIs associated with IgA deficiency and poor antibody responses to pneumococcal polysaccharide antigens (Pneumovax).

He has had no significant infections for at least 5 years.

His primary MD wanted to check his immune status prior to the young man going to college.  The patient received Menactra (conjugated N. men A, C, Y, W-135 polysaccharides) and Prevnar (conjugated 13 serotypes of S. pneumo polysaccharides) on July 28.

Labs drawn on September 1 showed:

-       Positive antibodies to N. men A only

-       Positive antibodies to ONE serotype of S. pneumo

-       Normal IgG and Ig M levels.

The lack of response to conjugated polysaccharide vaccines is of concern to me.

Would you suggest:

-       Continue observation and urgent use of antibiotics for febrile episodes?

-       Antibiotic prophylaxis?

-       Immunoglobulin replacement?

-       Other?

-
Thank you for your consideration.

Joe Church
Children's Hospital Los Angeles

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