Immunogenicity of pneumococcal vaccine in persons with spinal cord injury

Objective: To determine immunogenicity and optimum timing for administering the 23-valent pneumococcal vaccine after spinal cord injury (SCI). Design: Double-blind, randomized, placebo control study. Setting: SCI unit in a tertiary care medical center and community. Participants: Eighty-seven persons with recent SCI, Intervention: Participants were randomized to receive either placebo or pne umococcal vaccine at 16 to 18 days versus 4 to 6 months postinjury. Main Outcome Measures: Antibody concentrations were measured prior to inter vention and 1, 2, and 12 months afterward to evaluate the immune response t o five serotypes of Streptococcus pneumoniae. Effects of demographic and in jury-related variables on immune response were also evaluated. Results: Timing of vaccination did not influence mean antibody concentratio ns for any serotype (p > .05). Ninety-five percent of vaccinated persons ha d twofold or greater increases in antibody concentration for at least one s erotype when measured I month after vaccination versus 35% of placebo group s (p < .01). After 12 months, 93% of vaccinated persons in both groups main tained antibody concentrations twofold or greater than baseline values, Conclusions: Most participants developed an immune response to at least one serotype that was maintained for at least 12 months, Immune response varie d according to serotype. Given the favorable immune response and no effect of timing, persons with SCI should receive pneumococcal vaccine during init ial hospitalization. (C) 1998 by the American Congress of Rehabilitation Me dicine nod the American Academy of Physical Medicine and Rehabilitation.