Serologic responses to a 14-valent pneumococcal vaccine were measured in 20 children with steroidresponsive idiopathic nephrotic syndrome. All patients were free of proteinuria and receiving either daily (five patients) or alternate-day (15 patients) prednisone in a dosage of 1–2 mg/kg/day at the time of vaccination. Patients on alternate-day steroids received the vaccine on a day prednisone was not given. The mean fold rise in antibody titer was found to be normal in these children when antibody levels measured 3–6 wk postvaccination were compared to prevaccination levels. This serologic response has correlated well with a 3-yr follow-up of the patients, none of whom has developed peritonitis secondary to any pneumococcal types in the vaccine. Also described are three patients who developed pneumococcal peritonitis during this period despite prior vaccination; in two of these patients, the pneumococcal type was not included in the vaccine (types 6b and 10a) and in one patient the organism was not typed. It is concluded that in children with nephrotic syndrome pneumococcal vaccination confers good protection against types included in the vaccine despite the concomitant administration of steroids. However, the patients who developed peritonitis secondary to other pneumococcal types remind us that pneumococcus must still be considered as an etiologic agent for peritonitis in nephrotic children who have been vaccinated.
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