Lack of Persistent Antibodies Underlies Meningococcal Vaccine Failure

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http://www.medscape.com/viewarticle/549731

" The meningococcal serogroup C conjugate vaccine was approved in the UK on

the basis of immunogenicity data, the authors explain, but no evidence of

protection was presented from an efficacy trial. "

Lack of Persistent Antibodies Underlies Meningococcal Vaccine Failure

NEW YORK (Reuters Health) Dec 20 - Meningococcal vaccine failure may result

from the lack of persistent antibodies rather than an inadequate anamnestic

response, according to a report in the December 15th issue of The Journal

of Infectious Diseases.

The meningococcal serogroup C conjugate vaccine was approved in the UK on

the basis of immunogenicity data, the authors explain, but no evidence of

protection was presented from an efficacy trial.

In light of evidence of waning efficacy of the vaccine over time, Dr.

from Health Protection Agency, London, and colleagues

investigated the serologic response to meningococcal serogroup C disease in

patients with vaccine failure and in unvaccinated subjects.

They reviewed all cases of laboratory-confirmed meningococcal serogroup C

infections reported between January 2000 and December 2003 in England and

Wales.

Fifty-six patients experienced vaccine failure a median 17 months after

completion of their vaccination course, the authors report, but their case

fatality ratio (7.5%) was lower than that among unvaccinated subjects (10.6%).

Patients who experienced vaccine failure had higher serum bactericidal

activity titers in convalescent serum samples and higher IgG avidity in

acute serum samples than did unvaccinated patients, the results indicate.

In contrast, the researchers note, acute serum bactericidal activity titers

and serogroup C-specific IgG levels did not differ significantly between

patients with vaccine failure and unvaccinated patients.

" The present study confirms that the ability to generate a memory response

to the capsular polysaccharide of meningococcal serogroup C

organisms...does not necessarily confer protection, " the investigators

write. " This is presumably because the booster response is not sufficiently

rapid to prevent the invasion that usually occurs within a few days of

colonization. "

" Reliance on evidence of avidity maturation and a booster response to plain

polysaccharide can no longer be regarded as an immunologic correlate of

long-term protection for conjugate vaccines, " the authors conclude. " More

studies that focus on antibody persistence as a putative correlate are

necessary. "

J Infect Dis 2006;194:1745-1752.

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Sheri Nakken, R.N., MA, Hahnemannian Homeopath

Vaccination Information & Choice Network, Nevada City CA & Wales UK

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