Type-specific antibodies to pneumococcal capsular polysaccharide acquired either naturally or after vaccination with Prevenar in children with underlying chronic or recurrent lung diseases.

The antibody response to capsular polysaccharides of pneumococcal serotypes 4, 6B, 9V, 14, 18C, 19F, and 23F elicited either naturally or after vaccination with Prevenar was investigated in a cohort of children (n = 163) with underlying chronic or recurrent lung diseases at risk of developing pneumococcal pneumonia and ultimately invasive disease. Serum concentrations of serotype-specific antibodies, as measured by enzyme-linked immunosorbent assay, in unvaccinated children (n = 88) were higher in nasopharyngeal carriers (n = 10) than in noncarriers (n = 78) both at baseline and during follow-up. However, the antibody levels depended on the serotype and age of the children. During the study period, 35% of unvaccinated noncarriers and 60% of unvaccinated carriers displayed serum antibodies to all serotypes above the reported WHO working group putative protective serum concentration against invasive disease (0.2 mug/ml). Overall, children vaccinated with Prevenar before enrollment (n = 61), irrespective of their carrier status, displayed significantly higher serum levels of antibodies to all serotypes than unvaccinated children. More than 85% of the vaccinated children had protective serum antibody concentrations at baseline; although antibody titers tended to decrease over time, the above-mentioned figure remained without change at the end of follow-up. The vaccine Prevenar elicited a significant rise in serum antibody concentrations against all serotypes in 14 children vaccinated at entry. All of these children acquired and maintained serum antibody levels of >0.2 microg/ml throughout the study (a mean of 13 months of follow-up). These data support the systematic use of the vaccine Prevenar in children with underlying chronic or recurrent lung diseases and stress the fact that a percentage of vaccinated children may need to be revaccinated in order to achieve protection against pneumococcal disease.