Persistence of Protective Pneumococcal Antibody following Vaccination in Patients with the Nephrotic Syndrome

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Abstract
The level of persisting pneumococcal antibody was determined in a group of nephrotic children vaccinated 5 yr ago. Of the 19 vaccinated children, 2 have died and 1 has moved away. Sera from the remaining 16 patients were examined by radioimmunoassay to determine the antibody response to 11 of the 14 types contained in the polyvalent pneumococcal vaccine. The lowest protective level of geometric mean titer (GMT) of antibody in the laboratory is 300 ng antibody nitrogen/ml. Fifty-six percent (9/16) of the patients showed adequate GMT 5 yr after vaccination. All 9 patients had minimal change nephrotic syndrome. Of the children, 44% (7/16) had a GMT < 300 ng antibody nitrogen/ml. Three of these patients had focal sclerosis, 3 had membranoproliferative glomerulonephritis and 1 patient had IgM nephropathy. Of these 7 patients, 1 with the lowest GMT (23 ng antibody nitrogen/ml) developed pneumococcal peritonitis. During this same period, in 20 other unvaccinated nephrotic patients followed continuously from 1976-1981, 7 cases of pneumococcal peritonitis occurred (P < 0.05). One unvaccinated child died of pneumococcal sepsis. Three patients with minimal change nephrotic syndrome continue to maintain adequate amounts of antibody, but those with disease other than minimal change nephrotic syndrome are unable to maintain an adequate level of antibody.

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