Evaluation of postimmunization pneumococcal titers in children with recurrent infections and normal levels of immunoglobulin.

Seven children were evaluated who had recurrent sinusitis, acute otitis media, pneumonia, and mastoiditis. All children had normal or near normal levels of IgG, IgA, and IgM. One child displayed a poor antibody response following tetanus and diphtheria immunization. Another child was noted to be atopic as determined by allergy skin tests. A polyvalent pneumococcal vaccine was administered to all children after 24 months of age, with the average age of administration being 33 months. Titers were obtained 3 to 6 weeks following immunization and were evaluated to 12 serotypes using radioimmunoassay. All seven patients failed to mount an adequate response to immunization and were treated with a course of intravenous gammaglobulin. Five of seven children showed a distinct improvement in clinical course. Children with recurrent infections and normal levels of IgG may have a depressed ability to respond to pneumococcal antigen. Evaluation of their response to pneumococcal vaccine can be used as a marker to determine their ability to make antibody specific responses to multiple infectious agents. The failure to make a specific antibody response may be one factor in the susceptibility of these patients to recurrent infections.