---
title: "Immunogenicity of Sequential Conjugate and Non-Conjugate Pneumococcal Vaccination in Dialysis and"
id: "frontiers-in-immunology-16-immunogenicity-of-sequential-conjugate-and-non-conjugate-pneumococcal"
canonical_url: "https://medichelpline.com/clinical-feed/frontiers-in-immunology-16-immunogenicity-of-sequential-conjugate-and-non-conjugate-pneumococcal"
content_type: "clinical_feed_article"
specialty: "Infectious Disease"
source_name: "Frontiers in Immunology"
source_url: "https://www.frontiersin.org/articles/10.3389/fimmu.2026.1906893"
published_at: "2026-10-08T00:00:00.000Z"
evidence_level: "Journal Feed"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Immunogenicity of Sequential Conjugate and Non-Conjugate Pneumococcal Vaccination in Dialysis and
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/frontiers-in-immunology-16-immunogenicity-of-sequential-conjugate-and-non-conjugate-pneumococcal
- **Specialty:** [Infectious Disease](https://medichelpline.com/clinical-feed/infectious-disease.md)
- **Primary Source:** Frontiers in Immunology
- **Source URL:** [Original Journal Publication](https://www.frontiersin.org/articles/10.3389/fimmu.2026.1906893)
- **Published At:** 2026-10-08T00:00:00.000Z
- **Evidence Rating:** Journal Feed
## Executive GIST (TL;DR)
- The article title reports an original research study in Frontiers in Immunology on the **immunogenicity** of sequential conjugate and non-conjugate **pneumococcal vaccination**. - The study population named in the title includes **dialysis patients** and **kidney transplant recipients**. - The follow-up period stated in the title is a **12-month serological follow-up**. - The vaccination strategy investigated was sequential administration of a conjugate vaccine followed by a non-conjugate vaccine (as indicated by the title). - The source provided for this task contains only journal header and navigation content; the full article body, methods, numeric results, conclusions, and other study details were not included in the supplied material. - Because the source material supplied here lacks the article text, no study-specific data (sample size, vaccination schedule, serological endpoints, immunogenicity outcomes, statistical analyses, adverse events, or authorship) can be reported or summarized. - Readers should consult the full Frontiers in Immunology article for complete methods, results, and conclusions; those details were not reported in the provided source extract.
## Clinical Analysis & Structured Key Points
Frontiers | Immunogenicity of sequential conjugate and non-conjugate pneumococcal vaccination in dialysis patients and kidney transplant recipients: a 12-month serological follow-up 1 µg/mL) for each serotype.ResultsOverall, the immune response was stronger in DP than in KTR. IgG titers and seroconversion rates were higher in DP than in KTR, except for serotypes 6B, 19F and 23F. The cumulative probability of global response in KTR vs. DP was 32.3% vs. 62.2% at 3 months, 35.5% vs. 73.6% at 6 months and 39.3% vs. 73.6% at 12 months.ConclusionThe serological response to this pneumococcal vaccination schedule in individuals with end-stage kidney disease was modest overall but tended to be higher in DP than in KTR."> ORIGINAL RESEARCH article Front. Immunol. , 08 October 2026 Sec. Vaccines and Molecular Therapeutics Volume 17 - 2026 | https://doi.org/10.3389/fimmu.2026.1906893 Published in Frontiers in Immunology Vaccines and Molecular Therapeutics 7 impact factor 11.3 citescore Editor & Reviewers Edited by T M T. Mark Doherty Reviewed by S P Swayam Prakash C P Christos Pleros H W Hui Wei You Outline Figures and Tables Figure 1 View in article Table 1 Participant characteristics. View in article Table 2 Changes in IgG titers in dialysis and transplant participants. View in article Table 3 Percentages (95% confidence interval) of global responders. View in article Table 4 Percentage of global responders achieving both seroconversion and seroprotection for each serotype. View in article ORIGINAL RESEARCH article Front. Immunol. , 08 October 2026 Sec. Vaccines and Molecular Therapeutics Volume 17 - 2026 | https://doi.org/10.3389/fimmu.2026.1906893 Immunogenicity of sequential conjugate and non-conjugate pneumococcal vaccination in dialysis patients and kidney transplant recipients: a 12-month serological follow-up S N Sophie Novelli 1,2 A N Aimé Nun 1 A C Antoine Cases 2 M B Mathilde Bahuaud 3 L C Lucie Chevrier 3 S B Séverine Beaudreuil 4 * 1. AP-HP, Hôpital Bicêtre, Service de Santé Publique, Le Kremlin-Bicêtre, France 2. Université Paris-Saclay, UVSQ, Inserm, CESP, Le Kremlin-Bicêtre, France 3. AP-HP-Centre Université de Paris, Hôpital Cochin, Service d’immunologie biologique, Paris, France 4. Nephrology Dialysis Transplantation Department, Bicetre Hospital, University Hospital Paris Saclay, AP-HP, Le Kremlin-Bicêtre, France See more Article metrics View details Abstract Background: Pneumonia is the second most common infection in individuals with end-stage kidney disease and is associated with poor prognosis. The most frequently implicated pathogen is Streptococcus pneumoniae . Vaccine coverage is therefore essential. Different vaccination strategies have been implemented over time, depending on the period and availability of vaccines in each country. Aim: In a single-center observational study, we describe the serological response for 7 serotypes in dialysis patients (DP) and kidney transplant recipients (KTR) following a standard vaccination schedule against Streptococcus pneumoniae , consisting of one dose of the 13-valent conjugate vaccine (Prevenar 13 ® ) followed 2 months later by one dose of the 23-valent non-conjugate vaccine (Pneumo 23 ® ). Methods: We analyzed 61 participants (DP n=30, KTR n=31) who had completed the full vaccination schedule between January 2015 and December 2016. IgG titers against 7 pneumococcal serotypes (4, 6B, 9V, 14, 18C, 19F, 23F) were measured by ELISA before each vaccine dose and at 3, 6 and 12 months thereafter. We modeled changes in IgG levels over time. We estimated the probability of seroconversion and seroprotection (IgG titers > 1 µg/mL) for each serotype. Results: Overall, the immune response was stronger in DP than in KTR. IgG titers and seroconversion rates were higher in DP than in KTR, except for serotypes 6B, 19F and 23F. The cumulative probability of global response in KTR vs. DP was 32.3% vs. 62.2% at 3 months, 35.5% vs. 73.6% at 6 months and 39.3% vs. 73.6% at 12 months. Conclusion: The serological response to this pneumococcal vaccination schedule in individuals with end-stage kidney disease was modest overall but tended to be higher in DP than in KTR. Introduction Pneumonia is the second most common infection among individuals with end-stage kidney disease (ESKD), after bloodstream infections, and is associated with high mortality and poor long-term prognosis ( 1 – 3 ). Streptococcus pneumoniae is the most common pathogen causing community-acquired pneumonia. Pneumococcal immunization is recommended for patients with chronic kidney disease (CKD), particularly those treated with maintenance dialysis and kidney transplantation. Vaccination has been shown to reduce mortality in individuals with cardiac disease ( 4 ) and in those undergoing hemodialysis ( 5 – 8 ). A vaccination strategy involving two types of pneumococcal vaccine is available against the most common pneumococcal serotypes: i) Pneumo 23 ® (Sanofi), a non-conjugate polysaccharide vaccine covering 23 serotypes (PPSV23: 1, 2, 3, 4, 5, 6B, 7F, 9N, 9V, 10A, 11A, 12F, 14, 15B, 17F, 18C, 19A, 19F, 20, 22F, 23F, 33F), and ii) Prevenar 13 ® (Pfizer), a protein-conjugate vaccine covering 13 serotypes (PCV13: 1, 3, 4, 5, 6A 6B, 7F, 9V, 18C, 19A, 19F, 14, 23F). Initially, only a single dose of PPSV23 was recommended. PPSV23 reduces the incidence of invasive pneumococcal disease ( 9 ); however, it is poorly immunogenic in young children, the elderly and immunocompromised individuals ( 10 ). Pneumococcal conjugate vaccines were then developed to improve pneumococcal vaccine immunogenicity. Previous French guidelines recommended a sequential vaccination schedule consisting of one dose of PCV13 followed 2 months later by one dose of PPSV23. Although this strategy has demonstrated efficacy in the general population, its effectiveness is reduced in immunocompromised patients, as reported, for example, in HIV patients ( 11 ), and remains poorly studied in individuals with ESKD. Moreover, no comparison of dialysis (hemodialysis or peritoneal dialysis) patients (DP) and kidney transplant recipients (KTR) is available. Vaccine response is expected to be reduced in KTR, as observed with the COVID-19 and influenza vaccines, due to immunosuppressive treatment ( 12 , 13 ). Newer conjugate vaccines covering 20 serotypes are now available. However, evaluating the previously recommended sequential schedule of PCV13 followed by PPSV23 offers valuable insights into the immune response in immunocompromised kidney populations and provides a useful context for interpreting the potential benefits of newer conjugate vaccines. Below, we describe the serological response for seven serotypes in patients undergoing dialysis or living with a kidney transplant. The novelty of our study lies in the longitudinal, serotype-specific assessment, the comparison between DP and KTR, and the use of combined endpoints, including seroconversion and seroprotection, following the sequential PCV13 followed by PPSV23 schedule. Materials and methods Study population This single-center prospective observational study was conducted between January 2015 and December 2016 as part of routine care in the Nephrology Department at Bicêtre Hospital, AP-HP Université Paris-Saclay, France. Eligible participants were adults aged ≥ 18 years who had been receiving hemodialysis or peritoneal dialysis for more than 3 months or had undergone kidney transplantation more than 6 months earlier, with no documented history of pneumococcal vaccination, based on patient report and/or the absence of vaccination records. Patients with an ongoing infection or other contraindication to vaccination were excluded. All eligible participants were included. Vaccination As part of standard care, participants received an initial intramuscular dose of PCV13 (Prevenar 13 ® ; Pfizer) at baseline, followed 2 months later by a single intramuscular dose of PPSV23 (Pneumo 23 ® ; Sanofi), in accordance with the guidelines in effect at that time ( 14 ). Participants attended monthly follow-up visits. Blood samples for serological assessment were collected before vaccination (month 0), immediately before PPSV23 administration (month 2), and at 3 months (approximately 1 month after PPSV23), 6 months and 12 months. Serological assessments were performed as part of routine clinical care and prospectively analyzed for this study. Serological assessment All serological assessments were performed at the Immunology Laboratory of Hôpital Cochin, France. Immunoglobulin G (IgG) antibody concentrations for seven serotypes targeted by both PCV13 and PPSV23 (4, 6B, 9V, 14, 18C, 19F, 23F) were determined using a modified enzyme-linked immunosorbent assay. The seven serotypes were chosen for the reproducibility and robustness of the assay. In summary, 96-well plates (Corning, Inc., Corning, NY) were coated with a serotype-specific pneumococcal polysaccharide (PS) antigen (American Type Culture Collection, Manassas, VA) and incubated for 5 hours at 37 °C. Reference sera (007sp) and test specimens were pre-absorbed with 5 μg/ml pneumococcal C-polysaccharide (Statens Serum Institut, Copenhagen, Denmark) and 10 μg/ml serotype 22F capsular polysaccharide (American Type Culture Collection) for 30 minutes at room temperature before being serially diluted. After washing, serially diluted serum was added and the plates were incubated at room temperature for two hours. The plates were then washed again and alkaline phosphatase-conjugated goat anti-human IgG (Southern Biotech, Birmingham, AL) was added. Following a second two-hour incubation and washing, substrate (p-nitrophenyl phosphate in diethanolamine buffer, pH 9.8) was added. After final incubation, optical density was measured at 405 nm. Anti-pneumococcal antibody levels in each specimen were quantified by comparing linear regression plots with the reference serum (007sp) (National Institute for Biological Standards and Control [NIBSC]). The lower limits of quantification were 0.1 µg/mL for all serotypes, except serotype 14, for which the limit was 0.3 µg/mL. Any value below 0.1 was reported as 3 months after the first, and 1 had no serological data at baseline. Baseline characteristics were also compared between included and excluded participants. A higher proportion of DP was observed among those included in the study than among those excluded (31/61 [51%] vs. 4/19 [21%]), whereas no differences were observed for age, sex, BMI, or the prevalence of diabetes or cancer. Among the 61 participants analyzed, 30 were DP (9 on peritoneal dialysis and 21 on hemodialysis), and 31 were KTR. Their median age was 59 (IQR, 48-64), and 74% were male. 10 patients had a history of cancer: skin tumors (n=2) treated by surgical excision only, kidney cancer (n=3) treated by nephrectomy only, multiple myeloma (n=1) in remission for 5 years, colon cancer (n=1) treated by colectomy 10 years ago, breast cancer (n=1) in remission for more than 20 years, in situ bladder tumor (n=1) for more than 10 years, and cervical cancer (n=1) in remission for more than 10 years. Baseline characteristics are shown in ( Table 1 ). No statistically significant difference was observed between the DP and KTR groups, except for hemoglobin and albumin levels, which were higher in KTR. Table 1 Characteristic Overall, N = 61 Dialysis, N = 30 Transplant, N = 31 P-value 1 Sex 0.94 Female 16 (26%) 8 (27%) 8 (26%) Male 45 (74%) 22 (73%) 23 (74%) Age, years 59 (48, 64) 58 (45, 64) 61 (49, 64) 0.50 18 – 40 7 (11%) 6 (20%) 1 (3.2%) 41 – 60 26 (43%) 12 (40%) 14 (45%) 61 – 80 26 (43%) 10 (33%) 16 (52%) > 80 2 (3.3%) 2 (6.7%) 0 (0%) Body mass index 23.9 (22.0, 27.3) 24.1 (21.5, 27.2) 23.7 (22.1, 27.4) 0.76 Normal (18.5 – 25) 34 (57%) 18 (62%) 16 (52%) Underweight ( 30) 7 (12%) 2 (6.9%) 5 (16%) Overweight (25 – 30) 17 (28%) 9 (31%) 8 (26%) Charlson’s score 5.0 (3.0, 7.0) 5.0 (2.3, 7.8) 4.0 (3.0, 7.0) 0.76 Nephropathy 0.61 Diabetes 8 (13%) 4 (13%) 4 (13%) Glomerulopathy 14 (23%) 8 (27%) 6 (19%) Undetermined 11 (18%) 5 (17%) 6 (19%) Myeloma 1 (1.6%) 0 (0%) 1 (3.2%) Chronic interstitial nephritis 2 (3.3%) 2 (6.7%) 0 (0%) Polycystic kidney disease 5 (8.2%) 1 (3.3%) 4 (13%) Uropathy 6 (9.8%) 4 (13%) 2 (6.5%) Vascular nephropathy 14 (23%) 6 (20%) 8 (26%) Cancer 10 (16%) 3 (10%) 7 (23%) 0.30 Diabetes 20 (33%) 8 (27%) 12 (39%) 0.32 Dialysis duration, months 9.3 (4.7, 19) Not applicable Time since transplantation, months Not applicable 3.2 (1.7, 10.2) Immunosuppressive regimen Belatacept/mycophenolate ofet
## Related Clinical Research

- [FDA approves Moderna’s mRNA flu vaccine mFLUSIVA for adults 50+: what clinicians should know](https://medichelpline.com/clinical-feed/medical-news-today-0-moderna-s-mrna-flu-vaccine-approved-by-fda-when-is-it-available.md)
- [MMR vaccines: separating measles, mumps, rubella shots — myths and facts](https://medichelpline.com/clinical-feed/medical-news-today-0-should-the-measles-mumps-rubella-vaccines-be-separate-myths-vs-facts.md)
- [Helen Branswell, veteran infectious disease reporter at STAT, dies at 69](https://medichelpline.com/clinical-feed/stat-news-0-helen-branswell-whose-reporting-on-infectious-diseases-and-public-health-drew.md)
- [Life Biosciences updates on glaucoma cellular reprogramming drug — STAT+ report (paywalled)](https://medichelpline.com/clinical-feed/stat-news-2-stat-life-biosciences-share-glaucoma-study-updates-for-its-cellular.md)
- [Caregiver intentions for childhood and adolescent vaccination after COVID-19 in Lusaka, Zambia](https://medichelpline.com/clinical-feed/medrxiv-21-childhood-and-adolescent-immunisation-intentions-post-covid-19-in-lusaka-zambia.md)

## Navigation
- [← Back to Infectious Disease Feed](https://medichelpline.com/clinical-feed/infectious-disease.md)
- [← All Clinical Specialties](https://medichelpline.com/clinical-feed.md)
## Medical & Regulatory Disclaimer

> [!CAUTION]
> MedicHelpline content is structured for research, educational, and professional discovery purposes. It does not constitute individual medical advice, clinical diagnosis, or treatment recommendations.
> Always verify dosing, contraindications, and regulatory alerts against official product labeling and primary regulatory sources before clinical decision-making.