Evaluation of pneumococcal vaccination status in pediatric patients with lupus nephritis: a cohort study

Since bacterial infections are the primary cause of death for children with systemic lupus erythematosus (SLE), which is a chronic autoimmune disease characterized by B-cell abnormality and auto-antibody generation, a lack of response to the vaccine may be secondary to induced or inherent functional impairment in these patients. The aim of our work was to determine if children with SLE responded to pneumococcal immunization and to examine/address clinical and biochemical parameters influencing this response. This was a single center prospective cohort study including 30 children diagnosed with lupus nephritis, aged between 7 and 15 years old, divided into 2 groups: Group I: 18 kids recently diagnosed with lupus nephritis who were receiving high doses of steroids (more than 30 mg per day maximum 60 mg per day). Group II: 12 lupus nephritis patients with ongoing immunosuppressive treatment yet receiving a minimal dose of steroids (less than 30 mg per day). All participants underwent thorough clinical evaluation and laboratory testing. Enzyme-linked immunosorbent assay (ELISA) was used to measure the concentrations of anti-pneumococcal Immunoglobulin G (IgG) antibodies at both 1-month and 3-month intervals. There was a notable distinction between Group I and Group II in their antibody titers at both 1-month and 3-month intervals post-vaccination (p < 0.001), with Group II showing consistently higher antibody levels. Pneumococcal immunization is frequently immunogenic in children with lupus nephritis. According to the study’s findings, the response is significantly influenced by steroid dose, disease activity, and laboratory parameters such as serum albumin and albumin/creatinine ratio.