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Infection and Immunity, January 2004, p. 332-337, Vol. 72, No. 1
0019-9567/04/$08.00+0     DOI: 10.1128/IAI.72.1.332-337.2004
Copyright © 2004, American Society for Microbiology. All Rights Reserved.

Immune Response to Meningococcal Serogroup C Conjugate Vaccine in Asplenic Individuals

Paul Balmer,1* Michelle Falconer,2 Paula McDonald,2 Nick Andrews,3 Emily Fuller,1 Christine Riley,1 Edward Kaczmarski,1 and Raymond Borrow1

Manchester Laboratory, Health Protection Agency North West, Manchester Medical Microbiology Partnership, Manchester M13 9WZ,1 Cheshire and Merseyside Health Protection Team, Chester Microbiology Laboratory, Chester CH2 1UL,2 Immunisation Division, Health Protection Agency, CDSC, London NW9 5EQ, United Kingdom3

Received 30 June 2003/ Returned for modification 3 September 2003/ Accepted 30 September 2003

Asplenic individuals are known to be at increased risk of infection with encapsulated bacteria. Recent United Kingdom recommendations stated that this at-risk group should receive one dose of the meningococcal serogroup C conjugate (MCC) vaccine. However, the immune response of asplenic individuals to MCC vaccine is unknown. The immune response of asplenics (n = 130) to immunization with the MCC vaccine was investigated. Asplenic individuals had a significantly lower geometric mean titer (GMT) (157.8; 95% confidence interval [CI], 94.5 to 263.3) of bactericidal antibody in serum (SBA) than an age-matched control group (n = 48) (1448.2; 95% CI, 751.1 to 2792.0). However, 80% of asplenic individuals achieved the proposed protective SBA titer of >=8. No differences were observed between the two groups in the serogroup C-specific immunoglobulin G geometric mean concentration. A significant reduction in SBA GMT or the number of responders achieving an SBA titer of >=8 was observed if the reason for splenectomy was a medical cause or if MCC vaccination occurred <10 years after splenectomy. Individuals (n = 29) who did not achieve an SBA titer of >=16 were offered a second dose of MCC vaccine. Analysis of the SBA response revealed that 61% (14 of 23) of the individuals who received a second dose achieved a protective titer. In total, 93% of asplenic individuals achieved a titer of >=8 following MCC vaccination (one or two doses combined). We recommend that, following vaccination of asplenics, either the level of functional antibody should be determined, with a second dose of MCC vaccine offered to nonresponders, or two doses of MCC vaccine should be routinely offered.

* Corresponding author. Mailing address: Health Protection Agency North West, Manchester Laboratory, Manchester Medical Microbiology Partnership, P.O. Box 209, Clinical Sciences Building, Manchester Royal Infirmary, Manchester M13 9WZ, United Kingdom. Phone: 44-1612765697. Fax: 44-1612766792. E-mail: paul.balmer{at}hpa.org.uk.

Editor: S. H. E. Kaufmann

Infection and Immunity, January 2004, p. 332-337, Vol. 72, No. 1
0019-9567/04/$08.00+0     DOI: 10.1128/IAI.72.1.332-337.2004
Copyright © 2004, American Society for Microbiology. All Rights Reserved.



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