Measurement and interpretation of pneumococcal IgG levels for clinical management

Authors

  • P. BALMER,

    1. Manchester Public Health Laboratory, Withington Hospital, Manchester,
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      Current addresses: P Balmer, E Stanford, EB Kaczmarski and R Borrow – Manchester Medical Microbiology Partnership, PO Box 209, Clinical Sciences Building, Manchester Royal Infirmary, Manchester, M13 9WZ, UK. A Melegaro and E Miller – Immunization Division, Health Protection Agency, Communicable Disease Surveillance Centre, 61 Colindale Avenue, London NW9 5EQ, UK.

  • J. NORTH,

    1. Department of Immunology, City Hospital NHS Trust, Birmingham,
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  • D. BAXTER,

    1. St Thomas’ Hospital, Shaw Heath, Stockport,
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  • E. STANFORD,

    1. Manchester Public Health Laboratory, Withington Hospital, Manchester,
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      Current addresses: P Balmer, E Stanford, EB Kaczmarski and R Borrow – Manchester Medical Microbiology Partnership, PO Box 209, Clinical Sciences Building, Manchester Royal Infirmary, Manchester, M13 9WZ, UK. A Melegaro and E Miller – Immunization Division, Health Protection Agency, Communicable Disease Surveillance Centre, 61 Colindale Avenue, London NW9 5EQ, UK.

  • A. MELEGARO,

    1. Immunization Division, Public Health Laboratory Service, Communicable Disease Surveillance Centre, London , UK
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      Current addresses: P Balmer, E Stanford, EB Kaczmarski and R Borrow – Manchester Medical Microbiology Partnership, PO Box 209, Clinical Sciences Building, Manchester Royal Infirmary, Manchester, M13 9WZ, UK. A Melegaro and E Miller – Immunization Division, Health Protection Agency, Communicable Disease Surveillance Centre, 61 Colindale Avenue, London NW9 5EQ, UK.

  • E. B. KACZMARSKI,

    1. Manchester Public Health Laboratory, Withington Hospital, Manchester,
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      Current addresses: P Balmer, E Stanford, EB Kaczmarski and R Borrow – Manchester Medical Microbiology Partnership, PO Box 209, Clinical Sciences Building, Manchester Royal Infirmary, Manchester, M13 9WZ, UK. A Melegaro and E Miller – Immunization Division, Health Protection Agency, Communicable Disease Surveillance Centre, 61 Colindale Avenue, London NW9 5EQ, UK.

  • E. MILLER,

    1. Immunization Division, Public Health Laboratory Service, Communicable Disease Surveillance Centre, London , UK
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      Current addresses: P Balmer, E Stanford, EB Kaczmarski and R Borrow – Manchester Medical Microbiology Partnership, PO Box 209, Clinical Sciences Building, Manchester Royal Infirmary, Manchester, M13 9WZ, UK. A Melegaro and E Miller – Immunization Division, Health Protection Agency, Communicable Disease Surveillance Centre, 61 Colindale Avenue, London NW9 5EQ, UK.

  • R. BORROW

    1. Manchester Public Health Laboratory, Withington Hospital, Manchester,
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      Current addresses: P Balmer, E Stanford, EB Kaczmarski and R Borrow – Manchester Medical Microbiology Partnership, PO Box 209, Clinical Sciences Building, Manchester Royal Infirmary, Manchester, M13 9WZ, UK. A Melegaro and E Miller – Immunization Division, Health Protection Agency, Communicable Disease Surveillance Centre, 61 Colindale Avenue, London NW9 5EQ, UK.


Dr Ray Borrow, Manchester Medical Microbiology Partnership, PO Box 209, Clinical Sciences Building, Manchester Royal Infirmary, Manchester, M13 9WZ, UK.  E-mail: ray.borrow@hpa.org.uk,

SUMMARY

The detection of pneumococcal IgG antibodies is helpful for the evaluation of response to pneumococcal vaccination and need for revaccination. Results generated by the clinical assay which is currently used, in which the 23 valent polysaccharide vaccine is the antigen, were compared to those obtained by a capsular polysaccharide serotype-specific assay that measures IgG antibodies to 9 common serotypes causing invasive disease. Discrepancies in 21/47 (45%) of the results were observed in a direct comparison between the two assays. In each case a positive titre was obtained on the clinical assay but IgG levels on the serotype-specific assay were below the putative protective level of 0·2 µg/ml for at least one of the 9 serotypes assayed. The generation of false positives by the current clinical assay is due to its lack of specificity. Antibodies to C-polysaccharide and all of the 23 serotypes included in the pneumococcal polysaccharide vaccine are incorporated into the final titre whereas the serotype-specific assay adsorbs out noncapsular polysaccharide antibodies. The discrepancies between the two assays highlight the importance of standardized assays that measure putative correlates of protection and demonstrate the need to re-evaluate the current clinical assay. A tool that allows the interpretation of the results of the serotype-specific assay is provided and its potential for assessing individual susceptibility levels to vaccine preventable pneumococcal infection is discussed.

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