Age: 22.0
Sex: M
Vaccine: PPV
Symptoms: Sepsis, Serology negative, Streptococcus test positive, Vaccination failure, White blood cell count increased
Clinical narrative: Information has been received from the author of a published article. This literature marketed report as received from a other health professional refers to a 22 year old male patient. Patient's current conditions include hemoglobin SD disease with gram-positive meningitis, sepsis, pneumonia and vasa-occlusive pain crisis after experiencing a headache and fever for 1 week. Lumbar puncture gram stain demonstrated gram-positive cocci in pairs and was treated with meningitic doses of ceftriaxone, vancomycin, and dexamethasone. Four days after admission, his respiratory status progressively worsened with persistent fever and a leukocytosis of >30,000, which led to additional antimicrobial coverage change to piperacillin/tazobactarn and meropenem. His CSF cultures from the local hospital grew S. pneumoniae sensitive to vancomycin, ceftriaxone, and penicillin. Four of four blood cultures also from the admitting hospital grew S. pneumoniae sensitive to ceftriaxone, moxifloxacin, penicillin, and vancomycin. Follow-up blood cultures on days 14, 16, and 18 of his illness were negative. The patient was started on prophylactic penicillin at the time of discharge. His medical history was significant for the diagnosis of sickle cell disease (double heterozygosity for hemoglobins S and D) and asplenia was incidentally noted at eleven years of age. At age 13, he had an episode of multiorgan system failure including severe acute chest syndrome. Additionally, his history included osteomyelitis, avascular necrosis of bilateral femoral heads, and leg ulcers. He had two additional episodes of acute chest syndrome following multiorgan system failure. He was noted to be noncompliant with hydroxyurea. His childhood immunizations were complete. He was last immunized with PPSV23 6 months prior to admission. Prior to this he had received the PPSV23 at ages 7 and 13. His immunologic evaluation showed elevated IgG (1730 mg/dL) and IgG subclasses, normal IgM and IgA levels. C3 was just below the lower limit of normal (81 and 85 ng/dL with LLN being 88). C4 was normal. IgG responses to diphtheria and tetanus were normal. HIV -1 antigen and antibody and HIV-2 antibody were not found in his serum. His immunoglobin levels for the pneumococcal strains in PPSV23 are shown on Serotype 1 on Hospital day 7 was 4.1, 4 months post hospitalization was 6.2, 10 months post hospitalization was 12.1, Serotype 2 on Hospital day 7 was 0.6, 4 months post hospitalization was 2.1, 10 months post hospitalization was 6.0 Serotype 3 on Hospital day 7 was 0.2, 4 months post hospitalization was 1.4, 10 months post hospitalization was 3.6 Serotype 4 on Hospital day 7 was 2.2, 4 months post hospitalization was 4.6, 10 months post hospitalization was 4.8 Serotype 5 was 4 6, 4 months post hospitalization was .51, 10 months post hospitalization was 4.1 Serotype 8 was 2.4, 4 months post hospitalization was 6.6, 10 months post hospitalization was 13.1 Serotype 9N was 1.1, 4 months post hospitalization was 3.9, 10 months post hospitalization was 17.0, Serotype 12F was 1, 4 months post hospitalization was 1.8, 10 months post hospitalization was 1.7, Serotype 14 was 3.6, 4 months post hospitalization was 6.6, 10 months post hospitalization was 9.0, Serotype 17F was 6.7, 4 months post hospitalization was 19.0, 10 months post hospitalization was 31.6, Serotype 19F was 4.2, 4 months post hospitalization was 8.0, 10 months post hospitalization was 8.7, Serotype 20 was 0.6, 4 months post hospitalization was 3.6, 10 months post hospitalization was 5.1, Serotype 22F was 6, 4 months post hospitalization was 31.0, 10 months post hospitalization was 62.4, Serotype 23F was 5.8, 4 months post hospitalization was 34.6, 10 months post hospitalization was 83.6, Serotype 6B was 2, 4 months post hospitalization was 7.9, 10 months post hospitalization was 29.4, Serotype 10A was 2, 4 months post hospitalization was 12.2, 10 months post hospitalization was 24.7, Serotype 11A was 1.2, 4 months post hospitalization was 4.0, 10 months post hospitalization was 4.2 Serotype 7F was 3.6, 4 months post hospitalization was 17.2, 10 months post hospitalization was 30.9, Serotype 15B was 2.6, 4 months post hospitalization was 3.7, 10 months post hospitalization was 3.2, Serotype 18C was 0.2, 4 months post hospitalization was 0.6, 10 months post hospitalization was 1.6, Serotype 19A 3.4, 4 months post hospitalization was 7.7, 10 months post hospitalization was 22.8 Serotype 9V was 2.7, 4 months post hospitalization was 14.5, 10 months post hospitalization was 27.1, Serotype 33F was 0.7, 4 months post hospitalization was 1.8, 10 months post hospitalization was 2.2. These levels were found to be lower than expected, with eight of the serotypes having levels well below 1.3 microgram/mL, which is considered to be the minimum protective level. The outcome of Vaccination failure was unknown. The reporter considered Vaccination failure to be related to PNEUMOVAX23. The reporter stated that despite having received his most recent PPSV23 vaccination within the year, the patient had inadequate specific IgG levels against eight of the strains in the vaccine. A copy of the published article is attached as further documentation of the patient's experience. Additional information has been requested.