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Clinical and Vaccine Immunology, April 2008, p. 607-611, Vol. 15, No. 4
1071-412X/08/$08.00+0     doi:10.1128/CVI.00489-07
Copyright © 2008, American Society for Microbiology. All Rights Reserved.

Serum Bactericidal Antibody Responses to Meningococcal Polysaccharide Vaccination as a Basis for Clinical Classification of Common Variable Immunodeficiency

Immunology, Asthma and Allergy Research Institute, Medical Sciences/University of Tehran, Tehran, Iran,¹ Section of Infection, Inflammation and Immunity, School of Medicine and Biomedical Sciences, The University of Sheffield, Sheffield, United Kingdom,² Department of Bacterial Vaccine and Antigen Production, Pasteur Institute of Iran, Tehran, Iran³

Received 16 December 2007/ Returned for modification 9 January 2008/ Accepted 15 January 2008

Common variable immunodeficiency (CVID) is a heterogeneous group of disorders characterized by hypogammaglobulinemia and increased susceptibility to recurrent pyogenic infections. This study was performed to subclassify CVID on the basis of the bactericidal antibody responses of patients to polysaccharide meningococcal vaccine. Twenty-five patients with CVID (18 male and 7 female) and 25 healthy volunteers received meningococcal polysaccharide vaccine A + C. Serum bactericidal antibody (SBA) titers were measured at baseline and after 3 weeks. Response was correlated with clinical and immunological manifestations of CVID. Twenty-four (96%) of the 25 normal controls had a protective SBA titer of 8 postvaccination, whereas only 16 (64%) of the 25 CVID patients had a protective titer (P value = 0.013). Among the patients with CVID who were nonresponders, there were significantly increased rates of bronchiectasis (P = 0.008), splenomegaly (P = 0.016), and autoimmunity (P = 0.034) in comparison with patients who had protective SBA titers. A reversed CD4/CD8 ratio was more common in the nonresponder group of patients (P = 0.053). We conclude that individuals with CVID who cannot produce protective postvaccination titers after receiving meningococcal polysaccharide vaccine are more likely to exhibit bronchiectasis, splenomegaly, and autoimmune diseases. Vaccination response may define subgroups of patients with CVID, enabling more effective monitoring and therapeutic strategies.

Published ahead of print on 30 January 2008.