When persistent immunity was assessed at 6?months postvaccination, seven patients were responders based on the ELISA (IgG) criteria and six based on OPA

When persistent immunity was assessed at 6?months postvaccination, seven patients were responders based on the ELISA (IgG) criteria and six based on OPA. healthy individuals.2-6 Some estimates show over one quarter of all cases of invasive pneumococcal disease (IPD) occur in PNPP immunocompromised individuals, with the highest risk occurring among individuals with hematological malignancies.5 Studies have shown that individuals with multiple myeloma (MM) have the highest risk for IPD compared with individuals with other immunocompromising conditions, with the risk reported to be up to 176 times greater in patients with MM compared with immunocompetent individuals.2-5 Individuals with sickle cell disease and chronic renal failure on dialysis have also been shown to be at 25 and 19 times greater risk of IPD than immunocompetent individuals, respectively.5 Another study estimated that adults with HIV infection experienced an IPD incidence 49 times higher than individuals without HIV; moreover, contamination reoccurrence is usually up to 9 occasions more frequent in HIV-infected individuals.7-8 PNPP Two vaccines are available in the United States to prevent pneumococcal disease. The 13-valent pneumococcal conjugate vaccine (PCV13; Prevnar 13?/Prevenar 13?, Pfizer Inc, Philadelphia, PA) contains pneumococcal capsular polysaccha-rides 1, 3, 4, 5, 6A, 6B, 7F, 9V, 14, 18C, 19A, 19F, and 23F individually conjugated to a nontoxic diphtheria protein CRM197.9 Chemical linkage to a carrier protein stimulates a T cell?dependent response.10 The 23-valent pneumococcal polysaccharide vaccine (PPSV23; Pneumovax? 23, Merck and Co., Inc., Whitehouse Station, NJ) contains 12 of the serotypes included in PCV13 (all but 6A) plus serotypes 2, 8, 9N, 10A, 11A, 12F, 15B, 17F, 20, 22F, and 33F; capsular polysaccharides in this vaccine are unconjugated and stimulate a T cell?impartial response that does not induce immunological memory.11-13 Since June 2012, the US Advisory Committee on Immunization Practices (ACIP) has been recommending the use of PCV13 in addition to PPSV23 in individuals 19?y of age with underlying conditions perceived as a high risk for IPD, including functional or anatomic asplenia, cerebrospinal fluid (CSF) leaks, cochlear implants, and specified immunocompromising conditions (Table 1). In February 2013, the routine use of PCV13 for individuals with the same high-risk conditions was also recommended in children aged 6 to 18?y.14 Table 1. Underlying medical conditions for which both PCV13 and PPSV23 are currently recommended by ACIP for individuals 6 y of age.14-16 ?.01 and 48% vs 36%, ?.01, respectively).28 An additional study by Ohtola and colleagues compared a PCV13/PPSV23 prime-boost routine (8-week interval) with a single dose of PPSV23 in 51 HIV-infected adults aged 49 to 64?y?(84% PNPP had PPSV23? 5?y?prior) on antiretroviral therapy for 1 y; the PCV13/PPSV23 group was also compared with a PCV13/PPSV23 HIV-negative control group.32 Among HIV-infected individuals, IgG and OPA responses to serotypes 14 and 23F were measured, showing similar increases after vaccination with PCV13/PPSV23 compared with PPSV23 alone, with no significant difference between the groups. Compared with HIV-negative individuals, HIV-infected individuals experienced reduced IgG responses to serotype 14 and reduced OPA responses to serotype 23F.31 The authors also assessed B-cell responses through experimental assays, with results suggesting that PCV13 may not PNPP enhance responses to subsequent PPSV23 vaccination in older HIV-infected adults.32 Serotype-specific B-cell responses were measured 1?week postvaccination after administration of PCV13 followed 8?weeks later by PPSV23 or PPSV23 alone in HIV-infected adults (aged 51C59?y) on antiretroviral therapy for 1?y. Serotype-specific B cell percentages were significantly increased for only serotype 23F after PCV13 and for both serotype 23F and 14 after PPSV23 in the PCV13/PPSV23 group compared to prevaccination levels; significant increases occurred for both serotypes in the PPSV23-only group. Transmembrane activator and calcium-modulating cyclophilin ligand interactor-positive B-cell percentages were significantly lower in the PCV13/PPSV23 HIV-infected MGC34923 group compared with the PPSV23-only HIV-infected group.32 3.2.3. PCV13 after PPSV23 A study by Rossheim and colleagues in 96 HIV-infected adults aged 20 to 65?y receiving combination antiretroviral therapy evaluated the effect of time since PPSV23 receipt on antibody responses to subsequent PCV13 vaccination.29 At 1?month after vaccination with PCV13, the foldrise in IgG GMCs for.