Active vaccination in patients with common variable immunodeficiency (CVID)

Clin Immunol. 2007 Sep;124(3):294-303. doi: 10.1016/j.clim.2007.04.011. Epub 2007 Jun 29.

Abstract

Active vaccination of CVID patients with standard vaccines has rarely been studied in depth although some patients have been shown to develop transient vaccine-specific immunity. We addressed the question whether these patients can be identified by functional classification of their B cell subsets in vitro. Twenty-one CVID patients receiving regular IgG substitution were immunized with anti-peptide and anti-polysaccharide vaccines. Humoral vaccination responses were compared to the numbers of circulating memory B cells, CD21(low) B cells and the capacity to produce antibodies in vitro. Our findings allow four conclusions: (1) positive vaccination responses are not contradictory to the diagnosis of CVID; they occurred against polypeptide vaccines in 23% and against polysaccharide antigens in 18% of all vaccinations. (2) Class-switched antibody responses occur preferentially in patients of CVID group II. (3) A normal percentage of IgM memory B cells is necessary but not sufficient for a vaccination response to polysaccharide antigens. (4) Active vaccination in addition to IgG replacement therapy should be performed in patients of CVID type II - especially in case of vaccines for which passive protection cannot be guaranteed.

Publication types

  • Clinical Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Antibody Formation / immunology
  • B-Lymphocytes / classification
  • B-Lymphocytes / immunology*
  • Common Variable Immunodeficiency / classification
  • Common Variable Immunodeficiency / immunology*
  • Common Variable Immunodeficiency / therapy
  • Female
  • Humans
  • Immunoglobulin G / blood
  • Immunoglobulin M / blood
  • Immunologic Memory
  • Lymphocyte Subsets / classification
  • Lymphocyte Subsets / immunology
  • Male
  • Middle Aged
  • Peptides / therapeutic use*
  • Pneumococcal Vaccines / therapeutic use
  • Polysaccharides / therapeutic use*
  • Streptococcus pneumoniae / immunology
  • Vaccination*

Substances

  • Immunoglobulin G
  • Immunoglobulin M
  • Peptides
  • Pneumococcal Vaccines
  • Polysaccharides