Prevention Of Pneumococcal Disease Research Articles

Meeting the challenge: prevention of pneumococcal disease with conjugate vaccines.

Streptococcus pneumoniae is one of the leading causes of both invasive and noninvasive diseases in the pediatric population and continues to represent a significant public health burden worldwide. The increasing incidence of antibioticresistant strains of the pathogen has complicated treatment and management of the various pneumococcal disease manifestations. Thus, the best management strategy may be the prevention of pneumococcal diseases through vaccination. Although several pneumococcal conjugate vaccines have been clinically studied in infants and children, only a 7-valent conjugate vaccine (PNCRM7; Prevnar/Prevenar) is currently approved for the prevention of invasive disease. Vaccination with PNCRM7 is safe and effective in infants and young children. Routine vaccination with the conjugate vaccine could improve outcomes by safeguarding against the development of antibiotic-resistant strains of S. pneumoniae, thus simplifying the management of pneumococcal disease. Additionally, the overall costs associated with the treatment of pneumococcal diseases could be substantially reduced, particularly in developing countries. The time has come for fully applying this new advancement against S. pneumoniae, to benefit the children of the world. The English version of this paper is available at: http://www.insp.mx/salud/index.html

Pneumococcal vaccination: current and future issues.

Infection with Streptococcus pneumoniae remains a major global health burden meaning the development of effective vaccines is urgently needed. The current 23-valent polysaccharide vaccine has been shown to prevent pneumococcal pneumonia in immunocompetent young adults, but not in elderly persons. However, in prevention of invasive pneumococcal disease, the vaccine is efficacious in the elderly and may also be effective in some groups of immunocompromised patients. The polysaccharide vaccine is, therefore, recommended in all older (> or = 55-65 yrs of age) adults and in young children (>2 yrs of age) who have a high risk for pneumococcal disease. Revaccination can be safely performed and is recommended 5 yrs after the first dose. In children <2 yrs of age, the new polysaccharide-protein conjugate vaccines, including 7-11 serotypes, seem to be effective in the prevention of invasive disease, severe pneumonia and serotype-specific (and vaccine-related types) otitis media. The low serotype coverage, need for repeated doses, and high price, may decrease the usefulness of the new conjugates. However, the included serotypes correspond to those most often associated with penicillin resistance and vaccination is, therefore, a possible tool in limiting the spread of antibiotic-resistant pneumococci.

Prevention of pneumococcal disease in children. Pneumococcal conjugate vaccines: their use globally could have a major impact on public health

Pneumococcal disease is a major cause of morbidity and mortality in infants and young children worldwide. New pneumococcal conjugate vaccines include 7 to 11 serotypes, which are the most common cause of paediatric disease in most parts of the world. The efficacy of a 7-valent conjugate vaccine was 97.4% (95% CI, 82.7-99.9) against invasive pneumococcal disease, and 57% (95% CI, 44-67) against otitis media, caused by vaccine serotypes. Evidence shows that the vaccine has the potential to prevent pneumonia. Pneumococcal conjugate vaccination has also been shown to reduce nasopharyngeal carriage of vaccine serotypes (particularly serotypes associated with antibiotic resistance). Thus widespread use of pneumococcal conjugate vaccine could substantially reduce the burden of invasive disease and would have the potential to control the global spread of antibiotic resistance in pneumococci. It is important that these highly effective vaccines should be made available to children in the developing countries.

Prevention of pneumococcal disease in children. Pneumococcal conjugate vaccines: their use globally could have a major impact on public health

Prevention of pneumococcal disease in children. Pneumococcal conjugate vaccines: their use globally could have a major impact on public health

Prevention of pneumococcal disease in children. Pneumococcal conjugate vaccines: their use globally could have a major impact on public health

Prevention of pneumococcal disease in children. Pneumococcal conjugate vaccines: their use globally could have a major impact on public health

Pneumococcal Conjugate Vaccine

In February 2000, the new 7-valent pneumococcal polysaccharide-protein conjugate vaccine (PCV7) (Prevnar; Wyeth Lederle Vaccines, Pearl River, NY) was approved by the Food and Drug Administration (FDA) for the prevention of invasive pneumococcal disease (eg, meningitis and bacteremia) in infants and young children. This long-awaited event has received widespread applause from pediatric infectious disease experts who anticipate a dramatic decrease in these potentially fatal serious infections as the infants and young children who are at high risk become immunized. 1,2 The Centers for Disease Control and Prevention Advisory Committee on Immunization Practices (ACIP) recommends that the vaccine be given to all infants aged 2 to 23 months and to children aged 24 to 59 months who are at increased risk for pneumococcal disease, such as those who have sickle cell disease, human immunodeficiency disease virus infection, and other immunocompromising or chronic medical conditions.3 The ACIP also recommends that the vaccine be considered for all other children aged 24 to 59 months, with priority given to (1) those who are 24 to 35 months old; (2) those who are of Alaska Native, American Indian, or African American descent; and (3) those who attend group day care centers. Even though the vaccine has been demonstrated to be safe and effective in preventing invasive pneumococcal infections, the prevention of otitis media is another potential advantage. However, there is uncertainty among clinicians as to the impact this vaccine will have in preventing pneumococcal otitis media; thus, we otolaryngologists should be knowledgeable when we counsel parents and caregivers of infants and children who have acute otitis media (AOM) on what to realistically expect from the immunization.

The Prevention of Pneumococcal Disease by Vaccines: Promises and Challenges

This article reviews the epidemiology of pneumococcal disease and the current data on pneumococcal vaccine efficacy, discusses promising new data regarding development of new protein-conjugate pneumococcal vaccines, and addresses controversies surrounding the widespread population use of these vaccines. Armed with these data, physicians, nurses, third party payers, and health care systems should develop systems and eliminate unintentional barriers so as to achieve widespread use of these life-saving vaccines. As history has demonstrated to us, control of pneumococcal disease is highly unlikely to occur from heavy investments in newer and ever more expensive antibiotics, as opposed to better methods of preventing disease through the rational and widespread population use of vaccines.

Prevention of pneumococcal disease: Does serotypes replacement matter?

Prevention of pneumococcal disease: Does serotypes replacement matter?

Acute otitis media in the era of effective pneumococcal conjugate vaccine: will new pathogens emerge?

The immunogenicity of pneumococcal conjugate vaccine (PCV) in young infants and its serotype-specific efficacy in otitis media (OM) results in a modest reduction in total episodes of OM and a more substantial reduction in disease due to the most frequent pneumococcal serotypes. Since PCV will only prevent disease due to the most common serotypes, concerns about potential changes in the microbiology of OM have emerged. Insight into potential changes can be obtained from reviewing middle ear and nasopharyngeal isolates from studies of antimicrobial prophylaxis and bacterial polysaccharide immune globulin for prevention of OM and PCV for prevention of invasive pneumococcal disease, respectively. In children receiving PCV, a shift in serotypes of SP colonizing the nasopharynx has been observed. Since non-vaccine serotypes are already present in the community as the etiology of acute purulent OM, it is predictable that these non-vaccine serotypes will become more common especially in children less than two years of age.

Prevention of pneumococcal disease by vaccination: does serotype replacement matter?

Prevention of pneumococcal disease by vaccination: does serotype replacement matter?

Severe pneumococcal pneumonia in previously healthy children: the role of preceding influenza infection.

An outbreak of severe pneumococcal pneumonia among children occurred in Iowa from November 1995 through January 1996. An associated outbreak of influenza disease was predominantly caused by influenza A (H1N1) for the first time since 1989. We conducted a case-control study to determine whether preceding influenza infection was directly associated with pneumococcal illness. We identified 13 children with severe pneumococcal pneumonia. Patients were more likely than control subjects to report experiencing an influenza-like illness in the 7-28 days preceding admission (matched odds ratio [OR], 12.4; 95% confidence interval [CI], 1.7-306). Likewise, family members of patients were more likely than those of control subjects to report experiencing an influenza-like illness in the 28 days preceding their admission date (OR, 2.6; 95% CI, 1.0-6. 3). Patients were more likely than control subjects to have a positive influenza A (H1N1) convalescent serology (matched OR, 3.7; 95% CI, 1.0-18.1). This study provides direct and indirect evidence that influenza infection led to severe pneumococcal pneumonia among these children. Prevention of pneumococcal disease should be included among the potential benefits of influenza vaccination.

Efficacy of pneumococcal conjugate vaccines in large scale field trials.

Each year Streptococcus pneumoniae causes approximately 1.2 million deaths worldwide from pneumonia. In the United States S. pneumoniae is estimated to cause 500,000 cases of pneumonia and 7 million episodes of acute otitis media annually. The current pneumococcal polysaccharide vaccine is ineffective in children <2 years old and may not produce an adequate antibody response until children reach the age of 5 years. Pneumococcal conjugate vaccines are immunogenic after primary and booster vaccination in young children and in children and adults with immunodeficiencies. Immunization with conjugate vaccines also induces a strong and rapid anamnestic response and enhanced functional activity of antibodies. Two large scale field trials of pneumococcal conjugate vaccines were initiated in 1995, 1 in California and 1 in Finland. The California trial, involving 37,868 children, evaluated the efficacy of a 7-valent conjugate for the prevention of invasive pneumococcal disease and secondarily evaluated its efficacy for acute otitis media and pneumonia. Preliminary results indicate 94% efficacy against invasive pneumococcal disease caused by serotypes included in the vaccine in fully or partially vaccinated children. Preliminary evidence from large scale field trials indicates that pneumococcal conjugate vaccines are effective in reducing invasive pneumococcal disease as well as acute otitis media and pneumonia in children and represents a significant advance in the prevention of childhood infectious diseases.

Pneumococcal vaccine: an update.

* Abbreviation: HIV = : human immunodeficiency virus Streptococcus pneumoniae is the most common cause of invasive bacterial infection in children. In addition, the organism causes 30% to 50% of cases of acute otitis media; 24 million visits to pediatricians per year in the United States are referable to this diagnosis.1 It is also responsible for a significant amount of morbidity and mortality in children and adults in the United States and in other countries. A majority of cases of invasive disease caused by S pneumoniae occur in children <2 years of age and adults 65 years of age and older.1 The current 23-valent pneumococcal vaccine has been shown to be ineffective in children <2 years old.2In addition, resistance of S pneumoniae to penicillin, cephalosporins, and other antibiotics has become a serious problem.3 These factors prompted investigations that have culminated in the development of conjugated polysaccharide-protein vaccines. These new vaccines are similar in design to the already licensed Haemophilus influenzae, type b conjugate vaccine. Widespread deployment of the conjugate H influenzae vaccine in 1987 has been followed by a major decrease in morbidity and mortality of H influenzae infection.4 In this commentary, we will review briefly pneumococcal infection and discuss the roles of current and future vaccines in the prevention of pneumococcal disease. Nasopharyngeal colonization with S pneumoniae occurs in a majority of children and is most common in children <4 years of age.2 Colonization may be followed by acute otitis media and other upper respiratory infections, as well as by pneumonia. Severe infection, including bacteremia and meningitis, also may occur with significant attendant morbidity and mortality.1 Children 6 to …

Aetiology and clinical signs of bacterial meningitis in children admitted to Goroka Base Hospital, Papua New Guinea, 1989-1992.

Children aged 1-59 months admitted to Goroka Base Hospital with signs suggestive of meningitis were recruited to determine what proportion of such children have clinical or bacterial meningitis and to investigate the bacterial aetiology. A laboratory classification of definite, probable, possible, indeterminate and no meningitis was established. Thirty per cent of 697 children had a final clinical diagnosis of meningitis, 12% had culture-proven bacterial meningitis (case fatality rate 34%) and 10% had probable or possible meningitis. Inability to feed, vomiting, drowsiness, "staring eyes" and haemoglobin < 9 g/dl in addition to the classical signs of meningitis were associated with increased mortality. Isolates from cerebrospinal fluid were 62 pneumococci, 22 Haemophilus influenzae type b (Hib) and one Neisseria meningitidis. Including blood culture-proven and antigen-proven Hib disease, Hib and pneumococci accounted for 44% and 46% of bacterial meningitis, respectively, and 23% of pneumococci were intermediately resistant to penicillin. Inability to feed, bulging fontanelle, convulsions in young children, neck stiffness, fever and "staring eyes" were all independently associated with bacterial meningitis. Conjugate Hib vaccine must be given to infants as early as possible. Conjugate pneumococcal vaccines, maternal immunization with 23-valent vaccine and pneumococcal protein vaccines are under investigation for prevention of pneumococcal disease.

Prevention of Pneumococcal Disease: An Update on the Belgian Consensus Report

An ad hoc working party on pneumococcal vaccine with representatives of the Belgian Society for Infectiology and Clinical Microbiology, the Belgian Society of Pulmonology and Scientific Societies of General Practitioners reviewed new data on the epidemiology of S. pneumoniae infections in Belgium, on the efficacy and the cost-effectiveness of the 23-valent capsular polysaccharide vaccine. We discuss recent data on vaccination with a new conjugate pneumococcal vac-cine, shown to be highly effective in children.The Working Group of the Belgian Scientific Societies endorses the recommendations issued by the Hoge Gezond-heidsraad in 1993 and described in a consensus report in 1996.

Oncology management by the "new" Veterans Health Administration

The Veterans Health Administration (VHA) of the Department of Veterans Affairs (VA) manages the largest integrated health care system in the U.S. Cancer is second only to cardiovascular disease as a cause of patient mortality and morbidity. In the fiscal year 1996, malignancies accounted for 49,270 primary diagnoses at the time of discharge from acute hospitals.VHA recently developed a national, uniform benefits package that provides oncologic services of prevention and screening, inpatient and outpatient services, rehabilitative care, reconstructive surgery, home health care, respite, and hospice care. VA classifies all hospitals according to American College of Surgeons (ACS) Commission on Cancer criteria and standards. One hundred four of 173 facilities are ACS-approved cancer centers. Eighty-six VA hospitals have cancer registries.VHA has developed a Prevention Index (PI) that consists of nine measures for prevention and early detection of influenza and pneumococcal diseases, tobacco consumption, alcohol abuse, and cancers of the breast, cervix, colon, and prostate. All cancer interventions in the PI showed substantial increases between 1996 and 1997, and all exceeded U.S. Public Health Healthy People 2000 goals. The Veterans Health Administration's performance measure regarding end-of-life planning calls for 95% of eligible patients to receive ongoing care. Current baseline performance is 52% nationally. Measures of patient satisfaction for oncology patients show overall satisfaction at 87%.The VA healthcare system has substantial expertise in the diagnosis and management of cancer. VHA's unprecedented transformation into a system of integrated networks supports and promotes that expertise. The VHA initiatives described in this article are synergistically working to enhance the consistency and comprehensiveness of high-quality, patient-centered oncologic services.

Oncology management by the "new" Veterans Health Administration.

The Veterans Health Administration (VHA) of the Department of Veterans Affairs (VA) manages the largest integrated health care system in the U.S. Cancer is second only to cardiovascular disease as a cause of patient mortality and morbidity. In the fiscal year 1996, malignancies accounted for 49,270 primary diagnoses at the time of discharge from acute hospitals. VHA recently developed a national, uniform benefits package that provides oncologic services of prevention and screening, inpatient and outpatient services, rehabilitative care, reconstructive surgery, home health care, respite, and hospice care. VA classifies all hospitals according to American College of Surgeons (ACS) Commission on Cancer criteria and standards. One hundred four of 173 facilities are ACS-approved cancer centers. Eighty-six VA hospitals have cancer registries. VHA has developed a Prevention Index (PI) that consists of nine measures for prevention and early detection of influenza and pneumococcal diseases, tobacco consumption, alcohol abuse, and cancers of the breast, cervix, colon, and prostate. All cancer interventions in the PI showed substantial increases between 1996 and 1997, and all exceeded U.S. Public Health Healthy People 2000 goals. The Veterans Health Administration's performance measure regarding end-of-life planning calls for 95% of eligible patients to receive ongoing care. Current baseline performance is 52% nationally. Measures of patient satisfaction for oncology patients show overall satisfaction at 87%. The VA healthcare system has substantial expertise in the diagnosis and management of cancer. VHA's unprecedented transformation into a system of integrated networks supports and promotes that expertise. The VHA initiatives described in this article are synergistically working to enhance the consistency and comprehensiveness of high-quality, patient-centered oncologic services.

Effect of xylitol on growth of nasopharyngeal bacteria in vitro.

Xylitol is known to reduce caries by inhibiting the growth of Streptococcus mutans. We hypothesized that xylitol could also affect the growth of other nasopharyngeal bacterial flora, which could be important when considering respiratory infections caused by these bacteria. We studied this in vitro by adding xylitol to the medium and observed that 1 and 5% xylitol reduced markedly the growth of alpha-hemolytic streptococci, including S. pneumoniae. It reduced slightly the growth of beta-hemolytic streptococci but not that of Haemophilus influenzae or Moraxella catarrhalis. The inhibitory growth pattern was similar to that previously seen with S. mutans, which may indicate a similarity in the enzymatic processing of five-carbon sugars such as xylitol. This sugar alcohol is a widely used sweetener, and the concentrations used in our experiments are easily achieved in the oral cavity. If xylitol reduces the growth of S. pneumoniae in the nasopharynx, it could also reduce the carriage of this pathogen and thus have clinical significance in the prevention of pneumococcal diseases.

Regional networking promotes pneumococcal disease prevention: A success story: V. Hay, RN, CIC.∗ C.V.P.H. Medical Center, Plattsburgh, NY

Regional networking promotes pneumococcal disease prevention: A success story: V. Hay, RN, CIC.∗ C.V.P.H. Medical Center, Plattsburgh, NY

Pneumococcal conjugate vaccines: review and update.

Microbial Drug ResistanceVol. 1, No. 1 Pneumococcal Conjugate Vaccines: Review and UpdateDAVID L. KLEINDAVID L. KLEINSearch for more papers by this authorPublished Online:29 Jan 2009https://doi.org/10.1089/mdr.1995.1.49AboutSectionsPDF/EPUB ToolsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail FiguresReferencesRelatedDetailsCited ByPolyester as Antigen Carrier toward Particulate Vaccines24 May 2019 | Biomacromolecules, Vol. 20, No. 9Decrease in Hospitalizations for Pneumonia in Children under Five Years of Age in an Indian Reservation in Panama after the Introduction of the Heptavalent Pneumococcal Conjugate Vaccine (PCV7)International Journal of Pediatrics, Vol. 2013The viridans group streptococciReviews in Medical Microbiology, Vol. 21, No. 4Glycoconjugate vaccines and immune interference: A reviewVaccine, Vol. 28, No. 34Automation of the Anthrone Assay for Carbohydrate Concentration Determinations2 February 2010 | Analytical Chemistry, Vol. 82, No. 5PNEUMOCOCCAL INFECTIONSComparison of secular trends in pneumococcal serotypes causing invasive disease in Denver, Colorado (1971–2004) and serotype coverage by marketed pneumococcal vaccinesClinical Microbiology and Infection, Vol. 12, No. 11Serotypes of carriage and invasive isolates of Streptococcus pneumoniae in Brazilian children in the era of pneumococcal vaccinesClinical Microbiology and Infection, Vol. 12, No. 1Identification of Invasive Serotype 1 Pneumococcal Isolates That Express Nonhemolytic PneumolysinJournal of Clinical Microbiology, Vol. 44, No. 1Determination of saccharide content in pneumococcal polysaccharides and conjugate vaccines by GC-MSDAnalytical Biochemistry, Vol. 347, No. 2Heptavalent pneumococcal conjugate vaccine: current and future impact9 January 2014 | Expert Review of Vaccines, Vol. 2, No. 57. 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Series B: Biological Sciences, Vol. 354, No. 1384The burden of pneumococcal disease: the role of conjugate vaccinesVaccine, Vol. 17, No. 13-14Vaccines Against Streptococcus pneumoniaeSerotyping and antibiotic resistance of Streptococcus pneumoniae isolated from pediatric infections in central GreeceClinical Microbiology and Infection, Vol. 4, No. 12Antimicrobial susceptibility of Streptococcus pneumoniae from children attending day-care lefts in a central Italian cityClinical Microbiology and Infection, Vol. 4, No. 11Emergence of Penicillin Resistance in Recurrent Pneumococcal Endocarditis in an HIV-Infected Patient CHRISTOPHER GONZAGA and LISA L. DEVER29 January 2009 | Microbial Drug Resistance, Vol. 4, No. 1Limiting the Spread of Penicillin-Resistant Streptococcus pneumoniae: Experiences from the South Swedish Pneumococcal Intervention Project KARL EKDAHL, HANS BERTIL HANSSON, SIGVARD MÖLSTAD, MARGARETA SÓDERSTRÖM, MATS WALDER, and KRISTINA PERSSON29 January 2009 | Microbial Drug Resistance, Vol. 4, No. 2Vaccination Against Middle-ear Bacterial and Viral PathogensAnnals of the New York Academy of Sciences, Vol. 830, No. 1 Immunologic DSafety and immunogenicity of tetravalent pneumococcal vaccines containing 6B, 14, 19F and 23F polysaccharides conjugated to either tetanus toxoid or diphtheria toxoid in young infants and their boosterability by native polysaccharide antigensThe Pediatric Infectious Disease Journal, Vol. 16, No. 11Reduction of pneumococcal nasopharyngeal carriage in early infancy after immunization with tetravalent pneumococcal vaccines conjugated to either tetanus toxoid or diphtheria toxoidThe Pediatric Infectious Disease Journal, Vol. 16, No. 11Safety and Immunogenicity of Three Doses of a Five-Valent Pneumococcal Conjugate Vaccine in Children Younger Than Two Years With and Without Human Immunodeficiency Virus Infection1 April 1997 | Pediatrics, Vol. 99, No. 4Effect of Antimicrobial Use and Other Risk Factors on Antimicrobial Resistance in Pneumococci KARL G. KRISTINSSON29 January 2009 | Microbial Drug Resistance, Vol. 3, No. 2Epidemiology of Pneumococcal Serotypes and Conjugate Vaccine Formulations JAY C. BUTLER29 January 2009 | Microbial Drug Resistance, Vol. 3, No. 2Combination VaccinesAntimicrobial Resistance of Invasive Streptococcus pneumoniae in Slovenia, 1993-19958 July 2009 | Scandinavian Journal of Infectious Diseases, Vol. 29, No. 3CURRENT PERSPECTIVES ON MULTIDRUG-RESISTANT BACTERIAInfectious Disease Clinics of North America, Vol. 10, No. 4Infections Due to Drug-Resistant Pneumococci, Enterococci, and Mycobacterium tuberculosisPediatric Annals, Vol. 25, No. 9Comparison of the safety and immunogenicity of a pneumococcal conjugate with a licensed polysaccharide vaccine in human immunodeficiency virus and non-human immunodeficiency virus-infected childrenThe Pediatric Infectious Disease Journal, Vol. 15, No. 3 Volume 1Issue 1Jan 1995 To cite this article:DAVID L. KLEIN.Pneumococcal Conjugate Vaccines: Review and Update.Microbial Drug Resistance.Jan 1995.49-58.http://doi.org/10.1089/mdr.1995.1.49Published in Volume: 1 Issue 1: January 29, 2009PDF download