ORIGINAL ARTICLE Evaluation of antibody response to the heptavalent pneumococcal conjugate vaccine in pediatric chronic kidney disease Simone Vieira & Evandro Roberto Baldacci & Magda Carneiro-Sampaio & Ulysses Doria Filho & Vera Hermina Koch Received: 21 June 2008 / Revised: 9 August 2008 / Accepted: 12 August 2008 / Published online: 17 September 2008 # IPNA 2008 Abstract Pneumococcal vaccination has been recommended for immunocompromised children, including patients with chronic kidney disease. We determined pneumococcal immunoglobulin (Ig)G antibodies to serotypes 4, 6B, 9V, 14, 18C, 19F, and 23F before and after 48 pediatric patients with chronic renal failure were administered heptavalent conjugated pneumococcal vaccine. The patients were between 1 and 9 years of age and were separated into a conservative treatment group (Group 1) and a dialysis group (Group 2). The antibody response to the vaccinal serotypes was evaluated by measuring antibody concentrations before the first dose and 60 days after the second one. Pre-vaccinal IgG concentrations ≥0.35 μg/ml were detected for all serotypes in at least 50% of the patients in both groups. Patients from both groups showed a statistically indistinguish- able behavior in terms of the medians of post-vaccination IgG levels. An “adequate” vaccine response was defined as a post- immunization level of specific pneumococcal serotype anti- body ≥0.35 μg/ml, based on the World Health Organization’ s (WHO) protective antibody concentration definition for pneumococcal conjugate vaccines, or on a fourfold increase over baseline for at least five of the seven antigens of the vaccine. An “adequate” vaccinal response was obtained in 100% of the patients of both groups using WHO’ s definition, or in 45.8% of Group 1 patients and 37.5% of Group 2 patients when the criterion was a fourfold antibody increase over baseline antibody concentrations. Keywords Child . Chronic kidney disease . Pneumococcal conjugate vaccine . Streptococcus pneumoniae . Vaccinal response Introduction According to United States Renal Data System (USRDS) data, in 2005, the mortality rate in all-cause end stage renal disease (ESRD) children was 55.3 per 1000 patient-years, while the mortality due to infection was 8.5 per 1000 patient-years, accounting for 11.7% of the total mortality burden of pediatric ESRD [1]. The risk of invasive pneumococcal disease (IPD) is increased among children with some chronic diseases [2]. A recent study based on a Pediatr Nephrol (2009) 24:83–89 DOI 10.1007/s00467-008-0989-5 DO00989; No of Pages S. Vieira Pediatric Nephrology Unit, Instituto da Criança do Hospital das Clinicas da Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil E. R. Baldacci Pediatric Infectious Diseases Unit, Instituto da Criança do Hospital das Clinicas da Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil M. Carneiro-Sampaio Laboratório de Imunologia, Instituto de Ciências Biomédicas, Universidade de São Paulo, São Paulo, Brazil U. Doria Filho Biostatistics Unit, Instituto da Criança do Hospital das Clinicas da Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil V. H. Koch Pediatric Nephrology Unit, Instituto da Criança do Hospital das Clínicas da Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil V. H. Koch (*) Rua das Mangabeiras 91/81, 01233–010, São Paulo, Brazil e-mail: vkoch@terra.com.br