The Danger of Vaccination By Autopilot

Rationale:

As part of a small pre-clinical study of stage-specific antibody responses to pneumococcal vaccination, we enrolled a 22 year old female with a history of asthma.  At recruitment she denied previous vaccination.  She received 23-valent Pneumovax and within seven days developed a large local reaction lasting seven days; she was unable to work for three days due to limited range of motion and pain.  After the event, medical records from a hospitalization for severe asthma three months prior to study entry were obtained and, upon review, she had received Pneumovax®23.  

Methods:

Blood was collected on day 0 (prior to vaccination), and on day 7 and day 35 post vaccination.  Flow cytometry was performed on PBMC, and IgG anti-pneumococcal capsule antibody levels and opsonophagocytosis titers were measured with serum.

Results:

At day 7, the subject failed to produce a robust plasmablast response.  IgM+ CD27+ memory B cells, the ratio of ASC to PC, and the numbers of CD4 and CD8 T cells were unchanged.  At day 35, IgG anti-capsule antibody levels and pneumococcal opsonophagocytosis titers were unchanged.

Conclusions:

CDC guidelines recommend that patients who are at risk for pneumococcal infection and are unaware of a previous vaccination should receive the vaccine.  By these guidelines, this 22 year old asthmatic was appropriately given Pneumovax.  A repeat vaccination elicited neither increases in memory B cell and plasmacyte numbers, nor increases in IgG levels or opsonophagocytic titers against pneumococci. The adverse reaction she suffered illustrates the importance of making patients aware of their vaccination status.