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Discussion Starter · #1 ·
DISCLAIMER: DD is fully vaxed, and I am not interested in discussing that, or her medical treatment, at this time. Thanks. <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/smile.gif" style="border:0px solid;" title="smile"> However, I know there is a lot of knowledge in the forum and I would appreciate some info. If you would rather not respond, that's fine, too.<br><br>
My DD is being worked up for immune deficiencies. One reason is that her doctors discovered high levels of strep pneumonia and Haemophilus influenza in her lungs (I posted about that here when this was found). She is having trouble getting better, so they ran these tests. Her Ig levels are normal, but they found that she had not responded to her Prevnar vax. Specifically, the nurse said that she only showed an antibody response to one of 14 strains, and that this may be a sign that there is, in fact, an immune system problem.<br><br>
However, I know that immunes are far from 100% effective. Does anyone have any numbers on the actual efficacy of Prevnar--that is, not how many sicknesses it prevents, but how many people fail to respond to the vax?<br><br>
Thanks.
 

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I'd post more, but I have to change a baby.<br><br>
From Mt. Sinai's Dept of Microbiology: <a href="http://microbiology.mtsinai.on.ca/faq/prevnar.shtml" target="_blank">FAQ: Prevnar</a>, with a section on efficacy.
 

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Discussion Starter · #4 ·
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<table border="0" cellpadding="6" cellspacing="0" width="99%"><tr><td class="alt2" style="border:1px inset;">There are only 7 serotypes in Prevnar. Are you sure the nurse said 14?</td>
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It's weird, because, of course, you're right, but I really thought she said 14. <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/headscratch.gif" style="border:0px solid;" title="headscratch"> I may be insane. I know she said only one response was adequate.<br><br>
Crisstiana (and others), does this indicate that 90% of kids respond?<br><br><div style="margin:20px;margin-top:5px;">
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<table border="0" cellpadding="6" cellspacing="0" width="99%"><tr><td class="alt2" style="border:1px inset;">In contrast, the new conjugated heptavalent pneumococcal vaccine induces good antibody responses in 90% to 100% of children to all seven vaccine serotypes, after administration of 3 doses.</td>
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Yeah, Prevnar is one of the most effective vaccines ever made when it comes to the vaccine serotypes. Not responding to the conjugate vaccine is very unusual.
 

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Hi, Loraxc:<br><br>
I agree with Mamakay: Prevnar is very effective. The studies I've seen have consistently shown a response in 90-100% of recipients.<br><br>
As for the serotype confusion, perhaps the nurse meant that your daughter showed a response to serotype 14, one of the seven included in the vax?<br><br>
I'm sorry to hear that your daughter is still having problems. I hope you get some answers and you both get relief soon. <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/hug.gif" style="border:0px solid;" title="hug">
 

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Loraxc,<br>
There are cases being reported that some children are demonstrating lower than protective titres to 1 or more strains contained in Prevnar; all but one would be very uncommon. Do you know if your daughter's titres to Hib are adequate? This would help determine if it is the vaccine or an innate immune system disorder. No offense to nurses but information can get lost or misinterpreted so have you spoken directly to your physician? Have him/her explain the test results six ways to Sunday if you need to in order to understand. Also, your daughter should be responding to antibiotic treatment; I know you didn't want to discuss her medical treatment but what is the antibiotic regimen?<br><br>
SM
 

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Discussion Starter · #8 ·
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<div class="smallfont" style="margin-bottom:2px;">Quote:</div>
<table border="0" cellpadding="6" cellspacing="0" width="99%"><tr><td class="alt2" style="border:1px inset;">As for the serotype confusion, perhaps the nurse meant that your daughter showed a response to serotype 14, one of the seven included in the vax?</td>
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I think that might be it. Maybe she said "She responded to one--14", and not "She responded to one of 14."<br><br><div style="margin:20px;margin-top:5px;">
<div class="smallfont" style="margin-bottom:2px;">Quote:</div>
<table border="0" cellpadding="6" cellspacing="0" width="99%"><tr><td class="alt2" style="border:1px inset;">There are cases being reported that some children are demonstrating lower than protective titres to 1 or more strains contained in Prevnar; all but one would be very uncommon.</td>
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I am 90% sure she said that her numbers were adequate for one strain and borderline for one more, but the rest were all too low (I think she said "pretty much zero"). I am kicking myself for not asking better questions or taking better notes, but a coworker was standing in my office waiting for me as I took the call.<br><br>
However, can you tell me anything more about these cases? My husband was asking if it was possible she'd gotten a bad lot of vaccine or if the ped could have accidentally missed a dose.<br><br><div style="margin:20px;margin-top:5px;">
<div class="smallfont" style="margin-bottom:2px;">Quote:</div>
<table border="0" cellpadding="6" cellspacing="0" width="99%"><tr><td class="alt2" style="border:1px inset;">Do you know if your daughter's titres to Hib are adequate?</td>
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No. I don't know if they tested that. I could ask. The nurse only mentioned the pneumo vax.<br><br>
The nurse admitted freely that she isn't an expert in these immune test results; she called me with them because I had called to ask if they were back (I'm a little anxious, obviously). The doctor will call us next week to discuss. (The doctor is away this week.) I heard a bit of the cagey "The doctor needs to talk to you, because this is not good" in her tone, but I may be overinterpreting.<br><br><div style="margin:20px;margin-top:5px;">
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<table border="0" cellpadding="6" cellspacing="0" width="99%"><tr><td class="alt2" style="border:1px inset;">Also, your daughter should be responding to antibiotic treatment; I know you didn't want to discuss her medical treatment but what is the antibiotic regimen?</td>
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She was on 10 days of Augmentin and responded very well, but as soon as she finished the course, her symptoms (deep, junky cough and green nose) returned. They put her on another 10-day course and ordered these tests. Symptoms disappeared again as soon as she was back on the abx. She jus finished this round, so we'll see.<br><br>
(Again, please no flames about the abx.)
 

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<div style="margin:20px;margin-top:5px;">
<div class="smallfont" style="margin-bottom:2px;">Quote:</div>
<table border="0" cellpadding="6" cellspacing="0" width="99%"><tr><td class="alt2" style="border:1px inset;">However, can you tell me anything more about these cases? My husband was asking if it was possible she'd gotten a bad lot of vaccine or if the ped could have accidentally missed a dose.</td>
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Prevnar is so effective, even 2 doses should provide a pretty good immune response. So if she's had the 4 shot series, I don't think that could be it.
 

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<div style="margin:20px;margin-top:5px;">
<div class="smallfont" style="margin-bottom:2px;">Quote:</div>
<table border="0" cellpadding="6" cellspacing="0" width="99%"><tr><td class="alt2" style="border:1px inset;">
<div>Originally Posted by <strong>mamakay</strong> <a href="/community/forum/post/7947879"><img alt="View Post" class="inlineimg" src="/community/img/forum/go_quote.gif" style="border:0px solid;"></a></div>
<div style="font-style:italic;">Prevnar is so effective, even 2 doses should provide a pretty good immune response. So if she's had the 4 shot series, I don't think that could be it.</div>
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<br>
Just to expand on what mamakay said. Here's a snippet from a trial being conducted in the U.S.:<br><br><i><b>Effect of Two Versus Three Pneumococcal Conjugate Vaccinations<br>
This study is currently recruiting patients</b><br><br>
Two vaccinations with pneumococcal conjugate vaccine Prevnar in infants before age 6 months is presumed to provide over 90% protection against invasive pneumococcal disease (IPD) for those pn. serotypes included in the vaccine. Licensure of the vaccine however is based on studies with 3 vaccinations before 6 months and a booster vaccinations half a year later (3+1 scheme).<br><br>
Apart from cost-effectiveness, a 2-doses scheme therefore has major advantages.</i><br><br><br>
FTR, last I read, the UK was looking to change their Prevnar dosing schedule to a two-dose primary schedule of 2 and 4 months with a booster at 13 months. From the minutes of the UK's equivalent to our ACIP meeting:<br><br><i>The NVEC PCV trials in infants provided evidence that a 2 dose primary vaccination schedule, with an interval of 2 months between doses, is comparable to a 3 dose primary immunisation course with respect to antibody levels post vaccination and induction of immunological memory.<br><br>
The Committee is asked to consider a 2-dose schedule, with an interval of 2 months between doses, as appropriate for the primary schedule as it has been shown to provide satisfactory primary immunogenicity and prime for memory responses to a booster dose in the second year of life.</i>
 

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Loraxc,<br>
It is possible but unlikely that your daughter received a vaccine from a bad lot since she did demonstrate an adequate response to 1 type. Also, as has been stipulated, a 2 shot series prior to 6 months old should confer threshold titres so again it is highly unlikely that all of the vaccines were from a bad lot.<br><br>
Most of the cases of invasive <i>S. pneumoniae</i> from vaccine failure were due to inadequate coverage but a fair number did occur in children with 3 and even 4 boosters. It is too soon and there is not enough information to speculate about your daughter's immune system so don't torture yourself.<br><br>
Based on the information you provided, I would suggest the following questions to ask the physician:<br>
1.) What are the organisms and strains you have cultured?<br>
2.) Have you tested those for antibiotic sensitivity? (You want this done to treat accordingly i.e. if there is an antibiotic resistant strain, the antibiotic regimen will have to be adjusted.)<br>
3.) Where does the disease pathology stand at this point? Is she or has she been septic? Is there a risk for meningitis?<br>
4.) Has a CBC been done to determine the immune response? Are there any red flags?<br>
5.) Please explain the atypical response to Prevnar.<br>
6.) If she is non-responsive to the second course of Augmentin ask your physician if s/he would confer with an infectious disease specialist or refer you to one.<br><br>
Again I will emphasize, have a list of questions and write down the responses and don't hesitate to ask the doctor to explain until you understand. I wish you and your daughter well and please report back.<br><br>
SM
 

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Discussion Starter · #12 ·
Thank you for clarifying that even 2 doses would probably be enough. Her ped's office is sometimes a bit flaky, but I doubt that even they would have missed more than one dose.<br><br>
Science Mom, my understanding is that they did test the strep penumonia and haemophilus to determine which abx they were sensitive to before prescribing the Augmentin.<br><br>
I don't know about CBCs. She is not currently acutely ill, nor was she ever ill enough to be hospitalized.<br><br>
I suspect the pulmonologist who ran the tests will be transferring us to an immunologist, but it may be that first they will revax and test her titers again. When I called to say that she was symptomatic again, the pulmonologist almost immediately said "I want to run her vaccine titers...sometimes we get these kids who don't respond to that vaccine, and she's sounding like one of those." He went on to say that "often" revaccinating will produce antibodies.<br><br>
I am on a wild tear trying to research this, and have come up with the possibility of "‘specific antibody deficiency with normal immunoglobulins’ (SADNI)". It sounds plausible. Unfortunately.<br><br>
I do have a great deal of faith in her pulmonlogist--this is a pediatric pulmonology practice at a large university hospital, and they have given nothing but good, responsive care. Actually, I can honestly say that I think this is the best practice I have EVER used in my life. I can reach a doctor 24/7 within 5 minutes.
 

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<img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/hug.gif" style="border:0px solid;" title="hug"> I hope you figure things out soon!<br><br>
In the meantime though, it sounds as though you should proceed as though she is entirely unvaxed (because if she didn't respond to prevnar, she probably didn't respond to any others either)<br><br>
What that means to you, I don't know.<br><br><img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/hug.gif" style="border:0px solid;" title="hug"><br><br>
-Angela
 

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Discussion Starter · #14 ·
<div style="margin:20px;margin-top:5px;">
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<table border="0" cellpadding="6" cellspacing="0" width="99%"><tr><td class="alt2" style="border:1px inset;">In the meantime though, it sounds as though you should proceed as though she is entirely unvaxed (because if she didn't respond to prevnar, she probably didn't respond to any others either)</td>
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Well, not if she has this SADNI thing. It's a specific defect where the person does not produce antibodies to a specific kind of bacteria. I think my reading indicated that kids with this do respond to most other vaxes (I'm not sure about HiB).
 

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Loraxc, It sounds as though you are on top of things and I am glad to hear your daughter hasn't had severe pathology, concerning and stressful nonetheless. Keep us posted, I am curious now as to how this pans out and your suspicion of SADNI would be worth pursuing with your physicians.<br><br>
SM
 

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Just wanted to say, a girlfriend of mine's son did not respond to his complete series of Prevnar (he had been tested due to immune issues, etc)<br><br>
they had decided to give him another dose & retest him a few months after. I do not know the results of that as of yet.<br>
I guess he fell in that 10%
 

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In the studies the manufacturer of the chickenpox vaccine designed, monitored and decided what information would be published, it appeared that the vaccine was close to 90% effective.<br><br>
However, an outbreak in a daycare revealed the effectiveness in this case to be about 44%.<br><br>
Bottom line,<br><br>
most children are not tested post vaccine to determine "effectiveness" for any vaccine they are given.<br><br>
Think of all the parents who have this false sense of security, thinking their child is protected because they were vaccinated, when in many cases, their vaccinated child may be no more protected than an unvaccinated one.<br><br>
Also keep in mind that proper vaccine storage can play a part as well, who gets an exact history of the storage of each vaccine being given. How many children are given vaccines that weren't stored properly, rendering the vaccine ineffective...
 

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<div style="margin:20px;margin-top:5px;">
<div class="smallfont" style="margin-bottom:2px;">Quote:</div>
<table border="0" cellpadding="6" cellspacing="0" width="99%"><tr><td class="alt2" style="border:1px inset;">
<div>Originally Posted by <strong>suschi</strong> <a href="/community/forum/post/7991600"><img alt="View Post" class="inlineimg" src="/community/img/forum/go_quote.gif" style="border:0px solid;"></a></div>
<div style="font-style:italic;">In the studies the manufacturer of the chickenpox vaccine designed, monitored and decided what information would be published, it appeared that the vaccine was close to 90% effective.<br><br>
However, an outbreak in a daycare revealed the effectiveness in this case to be about 44%.<br><br>
Bottom line,<br><br>
most children are not tested post vaccine to determine "effectiveness" for any vaccine they are given.<br><br>
Think of all the parents who have this false sense of security, thinking their child is protected because they were vaccinated, when in many cases, their vaccinated child may be no more protected than an unvaccinated one.<br><br>
Also keep in mind that proper vaccine storage can play a part as well, who gets an exact history of the storage of each vaccine being given. How many children are given vaccines that weren't stored properly, rendering the vaccine ineffective...</div>
</td>
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<br>
I remember the original claim for the CP vaccine being that it was 99% effective.<br><br>
The thing about vaccines is, (and really, all pharmaceuticals, period)...<br>
When they think they've got a good product, and they move it into phase III, if it ends up having issues (with safety or effectiveness) then they might end up pulling out the statistical tomfoolery to obscure the truth.<br>
But sometimes, they just get lucky, and the product really does work well, and they don't have to make things up.<br>
When it comes to the effectiveness of Prevnar, I think it's the latter. We wouldn't have that phenomenal serotype replacement happening if it didn't work that well.
 

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FWIW, I know several people who have immune system issues and vaccines don't 'take' for them - so your daughter's immune system problems could be why Prevnar didn't take.
 
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