Sex: U
Vaccine: PPV
Symptoms: No therapeutic response
Clinical narrative: This literature marketed report as obtained from a published literature article, refers to the clinical and serological response of 72 children and adolescents with recurrent upper respiratory tract infections and low antipneumococcal immunity. In this retrospective, descriptive study, the authors report the clinical and serological response to PPV23 (PNEUMOVAX) 23 in 72 patients older than 2 years, 62 percent of which (45 of 72) had received  PCV7 (PREVNAR 7). These patients were seen in the clinic with recurrent upper respiratory tract infections, mainly otitis media and rhinosinusitis, and had evidence of deficiency of pneumococcal antibodies with data over a follow-up period of at least 6 months. Institutional review board approval was obtained before the review of the patient data. Patients with 4 or more upper respiratory tract infections treated with antibiotics per year, 4 or more acute otitis media episodes treated with antibiotics per year or 2 or more episodes of sinusitis per year fulfilled the criteria for recurrent upper respiratory infections and were included in the study. All patients had a 12-14 serotype pneumococcal antibody panel drawn to assess their pneumococcal antibody status as part of the initial evaluation. The pneumococcal antibody titers for each of the serotypes were analyzed by the reference laboratory using the Multi-Analyte Immunodetection panel based on the Luminex flow cytometric system. The procedure included absorption of sera with cross-reactive polysaccharide C and serotype polysaccharide 22F. The antibody levels were considered protective if the specific IgG titer was > or equal to 1.3 microg/mL in at least 50% of the serotypes in children aged 2-5 years and in >70% of children aged 6 years and older. On the basis of these criteria, patients with non protective pneumococcal antibodies levels were given a dose of PNEUMOVAX 23. The vaccine (0.5mL) was applied intramuscularly in the anterolateral thigh for toddlers aged 24-35 months and in the deltoid muscle of the arm for children aged 3 years and older. Written parental consent for treatment was obtained before PPV23 administration. Clinical and serological responses to PPV23 were recorded in the 1- to 6-month interval after immunization. Overall, 69 patients (96%) had a positive clinical response to PPV23 with resolution of the upper respiratory infections in most cases, whereas only 3 patients (4%) had no clinical response. Four (5%) patients were given a booster of PPV23: 3 (4%) because of recurrence of the upper respiratory infections and loss of antibodies over time and 1 (1%) because of lack of clinical response with partial serology. Two patients (3%) were given intravenous IgG for 6 months because of lack of clinical and serological response to the PPV23 booster. Three (4%) other patients were given intravenous IgG after no clinical or serological responses to the first dose of PPV23 were observed. Outcome of 'no therapeutic response' was not reported. The authors considered 'no therapeutic response' to be related to therapy with PNEUMOVAX 23. Additional information has been requested.