Qualitative and quantitative immune response to bacterial capsular polysaccharides and their conjugates in mouse and man

Safety and tolerability of pneumococcal vaccines in children

INTRODUCTION

A number of pneumococcal vaccines have long been available and have been used to reduce the medical, social, and economic problems associated with Streptococcus pneumoniae-related diseases.

AREAS COVERED

The main purpose of this review was to analyze what has been, until recently, the established doctrine regarding the safety and tolerability of pneumococcal vaccines that have been used in the past and are currently being used in children.

EXPERT OPINION

Pneumococcal vaccines available on the market are all safe and are highly recommended in clinical practice. In children, pneumococcal conjugate vaccines (PCVs) are considered the preparations of choice because of their enhanced immunogenicity and superior ability to impact nasopharyngeal carriage. All PCVs are considered safe because the incidence of severe adverse events (AEs) is marginal. Nonetheless, evidence has emerged from post-marketing surveillance regarding the occurrence of very rare but significant potential AEs following PCV administration. Therefore, post-marketing surveillance should be maintained to confirm the existence of these AEs. Over the next few years, other pneumococcal vaccines will be developed. When these new products are licensed and reach the market, new technologies and innovative epidemiological methods will permit a more rapid and more effective evaluation of AEs.

Vaccination as infection control: a pilot study to determine the impact of Staphylococcus aureus vaccination on nasal carriage

BACKGROUND

There is a critical need for an effective Staphylococcus aureus vaccine for the prevention of staphylococcal disease. In this study, we investigated the impact of S. aureus conjugate vaccine comprised of capsular polysaccharides 5 and 8 (CP5, CP8) on nasal colonization with S. aureus.

METHODS

Healthy adults recruited from one academic medical center to participate in a lot consistency trial of StaphVAX (S. aureus capsular polysaccharide 5 and 8 conjugate vaccine) were assessed for S. aureus nasal colonization at two weekly points prior to vaccination and again at six weeks post-vaccination. Serum anti-capsular antibody titers to CP5 and CP8 were obtained prior to vaccination and 42 days post-vaccination and measured by ELISA.

RESULTS

Thirty of 88 enrolled subjects (34%) had S. aureus isolated from at least one of the pre-immunization cultures. Of these, 20 were termed persistent carriers due to two positive cultures one week apart; 19 of the 20 were evaluable at Day 42. Baseline anti-CP8 concentrations were higher in persistent carriers of CP8+ S. aureus; however, baseline anti-CP5 levels were not significantly higher in individuals persistently colonized with CP5+ S. aureus. Statistically significant rises in antibody concentrations were noted after vaccination. At Day 42, 14 of 19 persistent carriers remained colonized; 5 subjects did not have evidence of S. aureus colonization. Ten additional subjects were positive for S. aureus at Day 42 who were not persistently colonized at baseline. Serum antibody concentrations were not statistically different between those with persistent carriage vs. those that lost carriage or those with newly acquired carriage.

CONCLUSIONS

Immune responses to vaccine were brisk and comparable in subjects with or without persistent colonization. Despite a substantial rise in anti-CP5 and anti-CP8 antibody concentrations post-vaccination, S. aureus nasal colonization rates did not significantly change.

Anti-beta-glucan antibodies in healthy human subjects

Previous data by our group demonstrated the antifungal efficacy of a vaccine consisting of laminarin (beta-(1,3)-glucan), conjugated with diphtheria toxoid, which generated protective anti-laminarin antibodies in mice. In this paper, we sought for the presence, isotype and subclass composition of natural anti-laminarin antibodies in an unselected population of human healthy subjects, in a comparison with antibodies directed against beta-(1,6)-glucan (pustulan) and branched beta-(1,3/1,6)-glucan (Pool 1) and mannan from Candida albicans. Almost all subjects showed detectable levels of anti-beta-glucan antibodies, with IgG largely prevailing on IgM, little, if any, IgA and no IgE. However, the titer of anti-beta-glucan antibodies was overall about 1log lower than that of anti-mannan antibodies of the corresponding isotype. In particular, the level of anti-laminarin IgG was the lowest one, its geometrical mean titer (95% confidence interval, CI) being 1838 (1245-2714) as compared to 8157 (6067-10,931) and 3940 (2911-5332) for pustulan and Pool 1 fungal glucan, respectively. Analysis of IgG subclass composition showed that IgG2 was the prevalent subclass against any antigen, and again the concentration of anti-laminarin IgG2 was the lowest one, its geometrical mean concentration being 0.13 (0.07-0.24)microg/ml as compared to anti-pustulan and anti-Pool 1 glucan and mannan IgG2 levels, which were 0.33 (0.2-0.5), 1.35 (0.9-2.0), and 36.1 (25.2-51.3)microg/ml, respectively. These data show that anti-laminarin antibodies are present at low levels in humans as compared to other anti-beta-glucan and, mostly, anti-mannan antibodies, and suggest that a protective antifungal vaccination in humans should attempt to tip the balance of antifungal antibodies in favour of the anti-laminarin ones.