Evaluation of Antibodies Against Haemophilus influenzae Type b in Korean Adults

Ji Hyen Lee; Han Wool Kim; Soyoung Lee; Kyung-Hyo Kim

doi:10.14776/piv.2017.24.3.125

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Lee, Kim, Lee, and Kim: Evaluation of Antibodies Against Haemophilus influenzae Type b in Korean Adults

Original Article

Pediatric Infection & Vaccine 2017; 24(3): 125-133.

Published online: 21 December 2017

DOI: https://doi.org/10.14776/piv.2017.24.3.125

Evaluation of Antibodies Against Haemophilus influenzae Type b in Korean Adults

Ji Hyen Lee^1,², Han Wool Kim², Soyoung Lee², Kyung-Hyo Kim^1,²

¹Department of Pediatrics, Medical Research Institute, Ewha Womans University School of Medicine, Seoul, the Republic of Korea.

²Center for Vaccine Evaluation and Study, Medical Research Institute, Ewha Womans University School of Medicine, Seoul, the Republic of Korea.

Corresponding author (kaykim@ewha.ac.kr)

Received 3 March 2017 Revised 30 May 2017 Accepted 10 June 2017

Abstract

Purpose

After the introduction of Haemophilus influenzae type b (Hib) vaccine in 1995 in Korea, it was included in the national immunization program in 2013. In the post-Hib vaccine era, some studies in other countries reported that invasive Hib disease affects adults, especially the elderly and immunocompromised persons, more often than it affects children. To evaluate disease susceptibility, quantitative and qualitative analysis of anti-polyribosylribitol phosphate (PRP) antibodies were carried out in Korean adults aged 20 to 85 years.

Methods

Sera were collected from 39 healthy adults (20 to 50 years of age) and from 30 elderly adults (75 to 85 years of age) who did not have immune-compromising conditions. The concentration of anti-PRP immunoglobulin G (IgG) and serum bactericidal indices (SBIs) were measured by enzyme-linked immunosorbent assay and serum bactericidal assay.

Results

Geometric mean concentrations of anti-PRP IgG and geometric mean SBIs were 0.88 µg/mL (95% confidence interval [CI], 0.17 to 3.85) and 354 (95% CI, 50 to 2,499) in young adults and 1.67 µg/mL (95% CI, 0.53 to 5.24) and 449 (95% CI, 146 to 1,376) in elderly adults, respectively. When the threshold of seropositivity for anti-PRP IgG was applied as 0.15 or 1.0 µg/mL, which is the protective antibody level in children, seropositive rates were 87.2% or 53.8% in young adults and 100% or 60% in elderly adults. The seropositivity rates of the SBI (SBI ≥4) were 82.1% and 100% in the groups, respectively.

Conclusions

Most subjects in the adult and elderly adult groups display immunity to Hib based on quantitative and qualitative antibody levels, but not all. Because high immunization and low Hib circulation rates may reduce the natural Hib immunity in the population, monitoring Hib immunity as well as disease are needed continuously.

Keywords: Haemophilus influenzae type b, Antibodies, Adult, Aged

Figures and Tables

Fig. 1

Anti-polyribosylribitol phosphate (PRP) immunoglobulin G (IgG) concentrations and serum bactericidal indices in healthy adult (n=39) and elderly (n=30). Black bars are geometric means and 95% confidence intervals and long horizontal lines represent anti-PRP IgG of 0.15 µg/mL and serum bactericidal index of 4. Abbreviations: ELISA, enzyme-linked immunosorbent assay; SBA, serum bactericidal assay; Hib Ab, Haemophilus influenzae type b antibody.

Fig. 2

Analysis of healthy adult (n=39) and elderly (n=30) sera to look for correlations between levels of anti-polyribosylribitol phosphate (PRP) immunoglobulin G (IgG) (X axis) and serum bactericidal index (Y axis). The correlation between anti-PRP IgG levels to serum bactericidal indices (SBIs) was moderately linear correlation (r=0.32, P=0.007) in all subjects (n=69). The results were the same when analyzed separately in only adult group (r=0.42, P=0.009). However, the correlation between anti-PRP IgG levels to SBIs was no correlation (r=0.36, P=0.052) in elderly group. The vertical dashed lines represent the protective anti-PRP IgG of 0.15 or 1 µg/mL, respectively and the horizontal dotted line represent serum bactericidal index 4.

Table 1

Demographic Characteristics of the Subjects

Values are presented as number (%).

^*Subjects with two or more of the following underlying conditions: diabetes, cardiac disease, lung disease, and cirrhosis.

Abbreviation: NS, not significant.

Table 2

Geometric Mean Concentrations/Indices and Seropositive Rates of Anti-PRP IgG Levels and Serum Bactericidal Indices in Adult and Elderly Groups

Values are presented as 95% confidence interval.

Abbreviations: PRP, polyribosylribitol phosphate; IgG, immunoglobulin G; GMC, geometric mean concentration; NS, not significant; SBI, serum bactericidal indices; GMI, geometric mean indices.

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