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Kinetics of the long-term antibody response after meningococcal C vaccination in patients with juvenile idiopathic arthritis: a retrospective cohort study
  1. Susanne P Stoof1,2,
  2. Marloes W Heijstek2,
  3. Karen M Sijssens2,
  4. Fiona van der Klis1,
  5. Elisabeth A M Sanders2,
  6. Peter F M Teunis3,4,
  7. Nico M Wulffraat2,
  8. Guy A M Berbers1
  1. 1Laboratory for Infectious Diseases and Screening, Centre for Infectious Disease Control Netherlands, National Institute of Public Health and the Environment (RIVM), Bilthoven, The Netherlands
  2. 2Department of Paediatric Immunology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands
  3. 3Epidemiology and Surveillance Unit, National Institute of Public Health and the Environment (RIVM), Bilthoven, The Netherlands
  4. 4Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
  1. Correspondence to Dr Marloes W Heijstek, Department of Paediatric Immunology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Room number KC 03.063.0, PO Box 85090, Utrecht 3508 AB, The Netherlands; m.w.heijstek{at}umcutrecht.nl

Abstract

Objectives The kinetics of the antibody response induced by meningococcal serogroup C (MenC) conjugate vaccination was analysed in patients with juvenile idiopathic arthritis (JIA) to assess their long-term protection against MenC disease.

Methods In The Netherlands, a nationwide catch-up campaign was performed in 2002 during which children aged 1–19 years, including JIA patients, received the MenC conjugate vaccination. From 127 JIA patients, IgG antibody concentrations against MenC-polysaccharide were determined by a fluorescent-bead-based immunoassay in 402 serum samples collected between 2002 and 2010. Using a hierarchical linear regression model, the 8 years course of MenC-specific antibodies was analysed in four age groups (13–19, 9–12.9, 5–8.9 and 1–4.9 years), and in patients starting with methotrexate or biologicals. In 65 randomly selected samples, the correlation of MenC-specific IgG concentrations with serum bactericidal assay (SBA) titres was assessed. MenC-specific IgG concentrations at 4.2 years after vaccination were compared with those of 1527 age-matched healthy controls.

Results MenC-specific IgG concentrations postvaccination were highest in patients aged 13–19 years at time of vaccination. Antibodies gradually waned over time in patients, but their estimated concentrations at 4.2 years postvaccination were similar to those measured in controls. MenC-specific IgG concentrations correlated well with SBA titres (r=0.72, p<0.001). By contrast with methotrexate, starting treatment with biologicals induced a trend towards accelerated decline of MenC-specific antibodies.

Conclusions Persistence of MenC-specific IgG antibodies in JIA patients is similar to healthy controls, but treatment with biologicals may induce accelerated antibody waning, resulting in unprotected patients who may need revaccination.

  • Juvenile Idiopathic Arthritis
  • Vaccination
  • Methotrexate
  • Anti-TNF

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