The effect of pneumococcal immunization on total and antigen-specific B cells in patients with severe chronic kidney disease

BMC Immunol. 2019 Nov 12;20(1):41. doi: 10.1186/s12865-019-0325-9.


Background: While the 23-valent pneumococcal polysaccharide vaccine (PPV23) is routinely used in Canada and some other countries to prevent pneumococcal infection in adults with chronic kidney disease (CKD), patients develop a suboptimal antibody response to PPV23 due to their immune dysfunction. The 13-valent pneumococcal conjugate vaccine (PCV13) has superior immunogenicity in some categories of immunocompromised adults; however, its effect on the immune response in CKD patients has only been addressed by two recent studies with conflicting results. The effect of PPV23 or PCV13 on B cells in these patients has not been previously studied. We studied the absolute numbers and proportions of B cells and subpopulations in two groups of adult patients with severe CKD pre- and 7 days post-immunization with PCV13: pneumococcal vaccine naïve and previously immunized with PPV23 (over one year ago).

Results: PPV23 immunized patients had significantly lower proportions and absolute numbers of class switched memory (CD19 + CD27 + IgM-), as well as lower absolute numbers of IgM memory (CD19 + CD27 + IgM+) and class switched B cells (CD19 + CD27-IgM-) compared to PPV23 naïve patients. Following PCV13 immunization, the differences in absolute numbers of B-cell subpopulations between groups remained significant. The PPV23 immunized group had higher proportions of CD5- B cells along with lower proportions and absolute numbers of CD5+ B cells compared to PPV23 naïve patients both pre- and post-immunization with PCV13. However, previous PPV23 immunization did not have a noticeable effect on the numbers of total IgG or serotype 6B and 14 specific antibody-secreting cells detected 7 days post-immunization with PCV13. Nevertheless, fold increase in anti-serotype 14 IgG concentrations 28 days post-PCV13 was greater in PPV23 naïve than in previously immunized patients.

Conclusions: The results suggest that immunization with PPV23 may result in long-term changes in B-cell subpopulations such as increased prevalence of CD5- B cells and decreased prevalence of class switched memory B cells in the peripheral blood. Because previous immunization with PPV23 in patients with CKD is associated with a significant decrease in the total class switched memory B cells in response to subsequent immunization with PCV13, this may reduce PCV13 immunogenicity in the setting of PPV23 followed by PCV13.

Trial registration: Registered February 24, 2015 at (NCT02370069).

Keywords: 13-valent pneumococcal conjugate vaccine (PCV13); 23-valent pneumococcal polysaccharide vaccine (PPV23); B cells; Chronic kidney disease (CKD); Enzyme-linked immunospot assay (ELISPOT); Flow cytometry; Memory B cells; Streptococcus pneumoniae; T-cell dependent response; T-cell independent response.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Antibodies, Bacterial / blood
  • Antibodies, Bacterial / immunology
  • B-Lymphocyte Subsets / immunology
  • B-Lymphocyte Subsets / metabolism
  • B-Lymphocytes / immunology*
  • B-Lymphocytes / metabolism
  • Epitopes, B-Lymphocyte / immunology*
  • Female
  • Humans
  • Immunization
  • Immunophenotyping
  • Male
  • Middle Aged
  • Pneumococcal Infections / epidemiology
  • Pneumococcal Infections / etiology*
  • Pneumococcal Infections / prevention & control*
  • Pneumococcal Vaccines / immunology*
  • Renal Insufficiency, Chronic / complications*
  • Renal Insufficiency, Chronic / diagnosis
  • Renal Insufficiency, Chronic / epidemiology
  • Renal Insufficiency, Chronic / immunology
  • Severity of Illness Index
  • Streptococcus pneumoniae / immunology*
  • Vaccination
  • Young Adult


  • 23-valent pneumococcal capsular polysaccharide vaccine
  • Antibodies, Bacterial
  • Epitopes, B-Lymphocyte
  • Pneumococcal Vaccines

Associated data