Article Text

Download PDFPDF
Persistence of pneumococcal antibodies after primary immunisation with a polysaccharide–protein conjugate vaccine
  1. Petra Zimmermann1,2,3,4,
  2. Kirsten P Perrett5,6,7,
  3. Guy Berbers8,
  4. Nigel Curtis1,2,3
  1. 1 Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
  2. 2 Royal Childrens Hospital, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
  3. 3 Infectious Diseases Unit, The Royal Children’s Hospital Melbourne, Parkville, Victoria, Australia
  4. 4 Department of Paediatrics, Fribourg Hospital HFR and Faculty of Science and Medicine University of Fribroug, Fribourg, Switzerland
  5. 5 Population Allergy Research Group and Melbourne Children’s Trial Centre, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
  6. 6 Department of Allergy and Immunology and General Medicine, The Royal Children’s Hospital Melbourne, Parkville, Victoria, Australia
  7. 7 School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
  8. 8 Center for Infectious Disease Control, Rijksinstituut voor Volksgezondheid en Milieu, Bilthoven, The Netherlands
  1. Correspondence to Dr Petra Zimmermann, Department of Paediatrics, The University of Melbourne, Royal Children’s Hospital Melbourne, Parkville, VIC 3052, Australia; petra.zimmermann{at}


Introduction Despite immunisation, antibiotics and intensive care management, infection with Streptococcus pneumoniae remains a major cause of morbidity and mortality in children. The WHO currently recommends vaccinating infants with either a 3+0 schedule (6 weeks, 3–4 and 4–6 months of age) or 2+1 schedule (2 doses before 6 months of age, plus a booster dose at 9–15 months of age). This study investigated pneumococcal antibody responses, including persistence of antibodies, after immunisation of healthy infants with a 3+0 schedule.

Methods We measured pneumococcal antibody concentrations to all 13 antigens included in the 13-valent pneumococcal conjugate vaccine (PCV13) after immunisation with a 3+0 schedule in 91 infants at 7 months and in 311 infants at 13 months of age. The geometric mean concentrations (GMCs) and the proportion of infants with an antibody concentration above the standard threshold correlate of protection (seroprotection rate) were calculated at both time points.

Results At 7 months of age, GMCs varied between 0.52 µg/mLand 11.52 µg/mL, and seroprotection rates varied between 69% and 100%. At 13 months of age, GMCs had decreased to between 0.22 µg/mLand 3.09 µg/mL, with the lowest responses against serotype 4, followed by 19A, 3, 6B and 23F. Seroprotection rates at 13 months of age were below 90% for most serotypes, with the lowest rates for serotype 4 (23%) followed by 19A (50%), 23F (61%) and 6B (64%).

Conclusion Our study shows that at 13 months of age, many infants vaccinated with a 3+0 schedule have pneumococcal antibody concentrations below the standard threshold correlate of protection. To optimise protection against pneumococcal disease through early childhood and to improve antibody persistence and indirect protective effects, immunisation schedules with booster doses might be necessary.

  • vaccine
  • humoral
  • immunoglobulin
  • titre
  • pneumococcus
  • streptococcus pneumoniae
  • prevenar

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Contributors PSZ did the statistical analysis and drafted the initial manuscript. KPP, GB and NC critically revised the manuscript, and all authors approved the final manuscript as submitted.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Ethics approval The study was approved by the Royal Children’s Hospital Human Research Ethics Committee (HREC authorisation 38124A).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Parental/guardian consent obtained.