Nonprotective responses to pediatric vaccines occur in children who are otitis prone

Abstract

Objective: We recently found that children who experience recurrent otitis media despite individualized care (stringently-defined otitis prone [sOP]) do not develop an antibody response to several vaccine candidate protein antigens expressed by Streptococcus pneumonia (Spn) and Haemophilus influenzae. Here we sought to determine if these same children also failed to develop antibody to routine pediatric vaccinations.

Study design: One hundred forty sera collected from children age 6-24 months were analyzed. sOP (n=34) and age-matched non-sOP (n=34) children were assessed for IgG concentrations to diphtheria toxoid, tetanus toxoid, pertussis toxoid, filamentous hemagglutinin, pertactin (DTaP), polio, hepatitis B, H. influenzae type b capsule polyribosyl-ribitol-phosphate (PRP) and Spn capsular polysaccharide conjugate vaccine.

Results: IgG protective titers to diphtheria toxoid (P=0.006), tetanus toxoid (P<0.0001), pertussis toxoid (P<0.0001), filamentous hemagglutinin (P=0.001), pertactin (P=0.005), hepatitis B (P<0.0001), polio 3 (P=0.03) and Spn 23F (P=0.01) but not polio 1,2, PRP or Spn 6B, and 14 were decreased in sOP versus non-sOP children using generalized estimating equations. A high percentage of sOP children had nonprotective antibody values that persisted until 24 months of age despite routine boosters.

Conclusion: sOP children may fail to achieve protective antibody concentrations after several routine vaccinations.

Figure 1. Percent of sOP children (red color) and non-sOP children (black color) with antibody below protective levels plotted against age of the child

sOP children more frequently had non-protective levels of antibody but no time gradient for DT, TT, PRN and HepB (see Table 2b for statistics). The sOP children more frequently had non-protective levels of antibody for PT, FHA, polio 3 and Spn 23F, but the group effect varied with age (see Table 2c for statistics). sOP and non-sOP children responded similarly to polio 1, polio 2, PRP or Spn polysaccharide serotypes 6B and 14 (see Table 2a for statistics) when calculated using the GEE model.