EVALUATION OF POSTIMMUNIZATION PNEUMOCOCCAL TITERS IN CHILDREN WITH RECURRENT INFECTIONS AND NORMAL LEVELS OF IMMUNOGLOBULIN

Seven children were evaluated who had recurrent sinusitis, acute otiti s media, pneumonia, and mastoiditis. All children had normal or near n ormal levels of IgG, IgA, and IgM. One child displayed a poor antibody response following tetanus and diphtheria immunization. Another child was noted to be atopic as determined by allergy skin tests. A polyval ent pneumococcal vaccine was administered to all children after 24 mon ths of age, with the average age of administration being 33 months. Ti ters were obtained 3 to 6 weeks following immunization and were evalua ted to 12 serotypes using radioimmunoassay. All seven patients failed to mount an adequate response to immunization and were treated with a course of intravenous gammaglobulin. Five of seven children showed a d istinct improvement in clinical course. Children with recurrent infect ions and normal levels of IgG may have a depressed ability lo respond to pneumococcal antigen. Evaluation of their response to pneumococcal vaccine can be used as a marker to determine their ability to make ant ibody specific responses to multiple infectious agents. The failure to make a specific antibody response may be one factor in the susceptibi lity of these patients to recurrent infections.