immunogenicity of 23-valent pneumococcal vaccine in children with systemic lupus erythematosus

background: systemic lupus erythematosus (sle) is a chronic autoimmune disease which is characterized by b-cell abnormality and auto-antibody generation. since bacterial infections are the most important causes of mortality in these patients, pneumococcal vaccination is recommended for children with sle. objective: to investigate humoral immunity and specific-antibody formation in response to a 23-valent polysaccharide pneumococcal vaccination in sle children and asthmatic control group. method: the case and control groups consisted of 30 children with the mean age of 13 years who were matched by sex and age. anti-pneumococcal antibody titers were determined using enzyme-linked immunosorbent assay (elisa) before the vaccination with the 23-valent pneumococcal vaccine and 3 weeks later in both groups. also the correlation between anti-pneumococcal antibody titer and different factors including age, sex, lupus activity, disease duration, medications, history of recurrent infections, and laboratory data were investigated. results: both groups showed significant increases in anti-pneumococcal antibody level after vaccination (p≤0.001). the increase in antibody level were almost the same in both groups (p≥0.05) such that 77.7% of sle children and 86.2% of control children showed at least 2-fold increase in anti-pneumococcal antibody titer following immunization. significant correlations were seen between the level of post-immunization anti-pneumococcal antibody with the age of children with sle (p=0.02) and their age of disease onset (p=0.02). conclusion: it is concluded that pneumococcal vaccination is generally immunogenic in children with sle. however, a small group of patients show impaired response to the vaccine.