Background/Purpose: Pneumococcal vaccination is an important part of the care of pediatric and adult patients with systemic lupus erythematosus, and is recommended as a quality indicator for management of children with SLE. Literature on the immunogenicity of pneumococcal vaccines in children is scant. As part of a quality improvement project to increase the rates of pneumococcal vaccination in our center, we sought to evaluate immunogenicity to the 13-valent pneumococcal vaccine in our patients with lupus, and also to identify patients that may be at higher risk of infection due to non response.

Methods: Patients undergoing vaccination with 13-valent pneumococcal vaccine had pre-vaccination antibody levels to serotypes obtained when possible, and then post-vaccination antibody levels were obtained 4 weeks after vaccination. The percentage and number of patients with pre and post vaccination protective levels (defined as >70% serotypes >/= 1.3 mcg/dl) were evaluated. Medication status, disease activity and demographic information was obtained from these patients as well.

Results: 15 patients had pre and post pneumococcal antibody levels avaialble for evaluation, and a further 5 had post pneumococcal antibody levels only. 5 of 15 patients had pre-vaccination protective levels of pneumococcal antibody despite no known previous vaccination. 8 of 10 patients with both pre and post pneumococcal antibody levels available demonstrated conversion to protective status, while 2 did not; a further 3 of the 5 patients who had post pneumococcal levels only available did not demonstrate achievement of protective levels. Thus in total, 15 of 20 patients achieved protected status. Patients not achieving protected status had a higher rate of recent rituximab or higher dose mycophenolate treatment, while patients with previous cytoxan exposure generally achieved protected status.

Conclusion: While the 13-valent pneumococcal vaccine achieves protective status for a majority of pediatric lupus patients, a significant number of these patients do not achieve this status after this vaccine. Further evaluation for responses after 23-valent vaccination is ongoing, but these results suggest that patient responses to vaccination may be important to evaluate in order to identify patients that are at higher risk of future infection.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/immunogenicity-of-13-valent-pneumococcal-vaccine-in-children-with-lupus-single-center-experience-in-south-texas/