Assessing the immunologic response to vaccination
- Ricardo U Sorensen, MD
Ricardo U Sorensen, MD
- Clinical Professor of Pediatrics
- LSU Health Science Center
- Kenneth Paris, MD, MPH
Kenneth Paris, MD, MPH
- Associate Professor of Pediatrics
- LSU Health Sciences Center New Orleans
The evaluation of a patient's immune response to specific vaccinations serves as a correlate to his/her ability to fight natural infections and is essential in the assessment of the humoral immune system.
This topic review will describe normal immunologic responses to vaccinations, patterns of abnormal responses, and methods for assessing these responses. More general evaluation of the immune system, including measurement of antibody levels and functional assessments of different immune cells, is presented elsewhere. (See "Laboratory evaluation of the immune system" and "Primary humoral immunodeficiencies: An overview".)
INDICATIONS FOR ASSESSING VACCINE RESPONSE
The clinical indications for assessing vaccine responsiveness include frequent and recurrent sinopulmonary or otic infections, chronic gastrointestinal infections, any severe or unusual infections, and abnormal need for antibiotics (table 1).
In 2012, a working group of the American Academy of Allergy, Asthma, and Immunology published recommendations on the interpretation of vaccine responses in the evaluation of patients with possible immunodeficiency . The material in this review is consistent with those recommendations.
Evaluation of primary immunodeficiency — Vaccine responsiveness is central to the diagnosis of several primary immunodeficiencies, including (but not limited to):
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- Sorensen RU, et al, unpublished observations.
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- INDICATIONS FOR ASSESSING VACCINE RESPONSE
- Evaluation of primary immunodeficiency
- Evaluation of secondary immunodeficiency
- TYPES OF VACCINES
- Patterns of nonresponse
- VACCINATION HISTORY
- Vaccinated patients
- Naïve patients
- LABORATORY ISSUES
- Timing of pre- and postvaccination measurements
- Interfering factors
- ASSESSING RESPONSE TO PROTEIN ANTIGENS
- Tetanus and diphtheria
- - Protective titers
- Conjugate polysaccharide vaccines
- - Pneumococcal conjugate vaccine
- - Hemophilus influenzae type B vaccine
- ASSESSING POLYSACCHARIDE RESPONSES IN CHILDREN UNDER TWO YEARS
- Isohemagglutinin testing
- ASSESSING POLYSACCHARIDE RESPONSES IN ADULTS AND CHILDREN OVER TWO YEARS
- Definition of protective titers
- - Normal vaccine response by age
- Unimmunized adults
- Timing of administration of pneumococcal vaccines
- Inadequately vaccinated children
- Analysis of pre- and postvaccination titers
- - Relative increases in individual titers
- - Additional doses
- DISORDERS ASSOCIATED WITH PATTERNS OF VACCINE RESPONSE
- Protein and polysaccharide nonresponse
- Polysaccharide nonresponse
- Nonresponse to conjugate polysaccharides
- Antibody disorders with normal vaccine response
- SUMMARY AND RECOMMENDATIONS