Use Of Pneumococcal Polysaccharide Vaccine Research Articles

Efficacy of pneumococcal vaccine in immunocompetent and immunocompromised patients

The article presents the analysis of numerous scientific studies carried out in Russia with the use of pneumococcal polysaccharide vaccine in immunocompetent and immunocompromised patients. New data are available to assess the impact of vaccines on clinical and immunological aspects in a particular pathology in children, which allows to reveal the mechanisms associated with the effectiveness of vaccination.

The evidence for the use of pneumococcal polysaccharide vaccine to prevent invasive pneumococcal disease in adults and its implications for the developing world

The pneumococcal polysaccharide vaccine was effective in preventing invasive pneumococcal disease in healthy adults, as well as both culture-confirmed and presumptive pneumococcal pneumonia. The present review offers the best evidence so far on the benefit of the vaccine, which is already recommended for use in industrialized countries for those at risk of pneumococcal infection and its complications. In the resource-limited setting with competing public health priorities, introduction of the polysaccharide vaccine faces several obstacles including the absence of data on disease burden and cost-effectiveness. Pneumococcal polysaccharide vaccine may be offered to those at risk while decisions are made on the best possible strategies for preventing pneumococcal disease in this population.

Use of pneumococcal polysaccharide vaccine in children

Pneumococcal glycoconjugate vaccines (PCVs) are now widely used in infant immunization schedules. These vaccines are also recommended for those at increased risk of pneumococcal infection and to provide optimal serotype coverage to those at increased risk of disease. The 23-valent polysaccharide vaccine (PPV23) is often advised from the second birthday to provide broader serotype coverage. The use of pneumococcal polysaccharide vaccines (PPVs) has in recent years become a topic of much debate, especially for use in children. Although no effect of PPV23 on carriage has been reported, some protection against invasive pneumococcal disease (IPD) is possible. There is a theoretical risk of memory B-cell depletion to PCV serotypes following PPV23 vaccination, even in PCV-primed children, but the clinical significance is currently unknown. This risk is increased by PPV23 revaccination. Whether the immune response to PPV23, non-PCV13 serotypes is sufficient to confer clinical benefit to at-risk children depends on their age, underlying disease and the immunogenicity of individual serotypes. Given the theoretical risk of memory B-cell depletion following PPV23 vaccination, it is not clear how best to maintain protection in those at-risk children who remain susceptible to IPD.

Recommended Adult Immunization Schedule: United States, 2012*

Recommended Adult Immunization Schedule: United States, 2012*

EDITORIAL WHAT ROLE FOR PROTEIN‐CONJUGATE PNEUMOCOCCAL VACCINE IN OLDER ADULTS? Invasive pneumococcal disease is a significant cause of morbidity and mortality among persons aged 65 years and older. Pneumococcal disease burden also remains high among adults over 50 years of age. In this editorial the authors discuss the priority of continued 23‐valent pneumococcal polysaccharide vaccine use in older adults, whilst

EDITORIAL WHAT ROLE FOR PROTEIN‐CONJUGATE PNEUMOCOCCAL VACCINE IN OLDER ADULTS? Invasive pneumococcal disease is a significant cause of morbidity and mortality among persons aged 65 years and older. Pneumococcal disease burden also remains high among adults over 50 years of age. In this editorial the authors discuss the priority of continued 23‐valent pneumococcal polysaccharide vaccine use in older adults, whilst

The epidemiologic evidence underlying recommendations for use of pneumococcal polysaccharide vaccine among American Indian and Alaska Native populations

Alaska Native and some American Indian (AI/AN) populations suffer disproportionately high rates of invasive pneumococcal disease (IPD) in both the pediatric and adult populations compared to the general U.S. population. Two pneumococcal vaccines are currently available in the U.S.: a 23-valent pneumococcal polysaccharide vaccine (PPSV23), available since 1983 and recommended for the elderly and those over 2 years of age with underlying medical conditions, and a 13-valent pneumococcal conjugate vaccine (PCV13), used in the routine infant immunization schedule since 2010. The U.S. Advisory Committee on Immunization Practice (ACIP) previously recommended use of PPSV23 for persons living in special environments or social settings, including AN and certain AI persons 2–64 years of age, on the basis of higher disease rates. The recommendation for routine PPSV23 use among AI/AN persons <65 years of age, regardless of underlying conditions, was removed in 2008, although the option for use among those 50–64 years of age living in areas with high pneumococcal disease rates was maintained. The rationale for the revised recommendations lay in the recognition that much of the excess disease burden occurs among those with an existing medical indication for PPSV23. Other considerations for the change were the potential risks of giving multiple PPSV23 doses and the considerable heterogeneity in pneumococcal disease risk among American Indian populations requiring a more tailored approach to local recommendations based on local epidemiology.

Recommendations for the Prevention of Streptococcus pneumoniae Infections in Infants and Children: Use of 13-Valent Pneumococcal Conjugate Vaccine (PCV13) and Pneumococcal Polysaccharide Vaccine (PPSV23)

Routine use of the 7-valent pneumococcal conjugate vaccine (PCV7), available since 2000, has resulted in a dramatic reduction in the incidence of invasive pneumococcal disease (IPD) attributable to serotypes of Streptococcus pneumoniae contained in the vaccine. However, IPD caused by nonvaccine pneumococcal serotypes has increased, and nonvaccine serotypes are now responsible for the majority of the remaining cases of IPD occurring in children. A 13-valent pneumococcal conjugate vaccine has been licensed by the US Food and Drug Administration, which, in addition to the 7 serotypes included in the original PCV7, contains the 6 pneumococcal serotypes responsible for 63% of IPD cases now occurring in children younger than 5 years. Because of the expanded coverage provided by PCV13, it will replace PCV7. This statement provides recommendations for (1) the transition from PCV7 to PCV13; (2) the routine use of PCV13 for healthy children and children with an underlying medical condition that increases the risk of IPD; (3) a supplemental dose of PCV13 for (a) healthy children 14 through 59 months of age who have completed the PCV7 series and (b) children 14 through 71 months of age with an underlying medical condition that increases the risk of IPD who have completed the PCV7 series; (4) "catch-up" immunization for children behind schedule; and (5) PCV13 for certain children at high risk from 6 through 18 years of age. In addition, recommendations for the use of pneumococcal polysaccharide vaccine for children at high risk of IPD are also updated.

Updated recommendations for the use of pneumococcal polysaccharide vaccine

Updated recommendations for the use of pneumococcal polysaccharide vaccine

Pneumococcal Vaccination for Patients With COPD: Current Practice and Future Directions

Despite a level "A" recommendation by the Centers for Disease Control and Prevention, the use of pneumococcal polysaccharide vaccination in patients with COPD is supported by limited data. Clinical and laboratory studies have suggested that the currently approved vaccine is less effective in the population of COPD patients than in healthier patients, and to date no randomized-controlled trial of pneumococcal vaccination for COPD patients has demonstrated any beneficial effect. The implementation of a pneumococcal vaccine trial in the COPD population is problematic because of the large sample size required for studies examining clinical outcomes and the fact that no adequate in vitro assays have been available to serve as surrogate measures of vaccine protection. However, new laboratory methods have been developed and more accurate determination of the immunogenicity of pneumococcal vaccines is now possible. There is considerable interest in the development of an improved pneumococcal vaccine for patients with COPD, and advances in vaccine design hold considerable promise for improved prevention against pneumonia and acute exacerbations caused by Streptococcus pneumoniae. The following discussion will examine the available data supporting pneumococcal polysaccharide vaccine use, the currently available laboratory methods to measure immunogenicity, and advances in the development of an improved pneumococcal vaccine that could better protect patients with COPD against this pathogen.

The effectiveness of pneumococcal polysaccharide vaccines in adults: a systematic review of observational studies and comparison with results from randomised controlled trials

The use of pneumococcal polysaccharide vaccine has remained controversial since licensure, especially in the elderly. Observational studies form much of the evidence base. We conducted a systematic review of observational studies and compared results with those obtained from an earlier review of randomised controlled trials (RCTs). Estimates of protection against invasive disease from observational studies were consistent, homogenous and compatible with sparse information obtained from RCTs. Studies were of moderate quality. From 13 observational studies the estimate of vaccine efficacy against invasive disease was 53% (46–59%) compared with 38% (−4 to 63%) from nine RCTs. Estimates of protection against all-cause pneumonia were based on fewer, heterogeneous studies that were not consistent with the findings from RCTs for this outcome. From five studies combined efficacy was 32% (7–50%) compared with 3% (−16 to 19%) from 13 RCTs.

Selective abnormal response to Streptococcus pneumoniae heptavalent conjugate vaccine in patients with recurrent infections and normal immunoglobulin concentrations

Rationale The persistence of unresponsiveness to polysaccharide antigens in children older than 2 years defines an antibody abnormality. So far, a deficient response to polysaccharide antigens is usually determined by measuring the response to immunization with the 23-valent pneumococcal polysaccharide vaccine, since antibodies to Haemophilus influenzae polysaccharides induced by conjugate vaccines are considered to reflect the ability to respond to proteins rather than to polysaccharides. We have assessed the impact of pneumococcal conjugate vaccine on the evaluation of deficient specific antibody response. Methods As standard part of the evaluation of patients with recurrent infections and/or unusual infections in 58 children (age range 25 mo-59 mo.) the response to immunization with pneumococcal heptavalent conjugate vaccine (Anti-PCP) have been measured. All patients had normal immunoglobulin and IgG subclass levels and were concomitantly tested for total IgG anti-Haemophilus Influentiae, anti-Tetanus and Anti-PCP antibody levels (The Binding Site, UK). Results Anti-PCP deficiency was found in 5/58 patients; 3/5 of these patients had received a second dose with no incremental increase. All 58 patients did have adequate antibody responses to tetanus and Hemophilus i.vaccines. Conclusions The evaluation of the response to pneumococcal conjugate vaccine is a good alternative to the use of pneumococcal polysaccharide vaccine to identify selective antibody defects. Further, this approach might be particularly important with the introduction of heptavalent conjugate pneumococcal vaccine to protect infants and children <2 years of age for a very early high-risk group identification.

Efficacy of pneumococcal polysaccharide vaccine in immunocompetent adults: a meta-analysis of randomized trials

The use of pneumococcal polysaccharide vaccine (PPV) is low in some countries, maybe because of doubts regarding its efficacy. This meta-analysis aims at combining evidence from randomized trials of PPV assessing its efficacy in preventing Streptococcus pneumoniae related diseases in immunocompetent adults. In the fourteen trials totalling 48,837 patients retrieved, PPV prevents definite pneumococcal pneumonia by 71%, presumptive pneumococcal pneumonia by 40%, and mortality due to pneumonia by 32%, but not all-cause pneumonia or death. No preventive effect was seen in the subgroup of patients aged 55 years or more, possibly due to a lack of statistical power.

Efficacy and effectiveness of pneumococcal polysaccharide vaccines and their use in industrialised countries.

Use of pneumococcal polysaccharide vaccines remains controversial, even though clinical trials have shown their efficacy in preventing invasive disease caused by vaccine serotypes in immunocompetent adults. Retrospective studies indicate these vaccines have about 50%-80% effectiveness for preventing invasive disease caused by vaccine serotypes, although effectiveness wanes over time and with age. The elderly, people living in institutions and those with chronic cardiac or respiratory disease, alcoholism or diabetes mellitus who are in relatively good health would benefit from vaccination; a polysaccharide vaccine program in the elderly has been shown to be cost-effective. In young children, polysaccharide vaccine should be evaluated as a booster to conjugate pneumococcal vaccines, which are likely to be available soon in industrialised countries. In view of the high rates of hospitalisation and of antimicrobial resistance in pneumococci, every effort should be made to increase coverage by pneumococcal polysaccharide vaccine in Australia, according to guidelines of the National Health and Medical Research Council.

Pneumococcal Vaccination in the United States and 20 Other Developed Countries, 1981–1996

This survey describes patterns of pneumococcal polysaccharide vaccine use, vaccine registration, vaccination recommendations, and reimbursement for vaccination in the United States and 20 other developed countries during the period 1981 through 1996. The United States was the only country to use appreciable amounts of the vaccine throughout the study period. Annual vaccine use was staple from 1982 through 1990 but then increased sharply. In the 20 other countries, very little pneumococcal vaccine was used until the 1990s, when new registrations and/or national recommendations were followed by dramatic increases in vaccine use in Iceland (1991), the United Kingdom (1994), Sweden (1995), and Norway, Belgium, and the province of Ontario in Canada (1996). In 1996, pneumococcal vaccine was still not licensed in three and not recommended in four of the 21 countries. Of the seven countries that used the most pneumococcal vaccine, public reimbursement for vaccination was provided in the United States, Canada, and the United Kingdom but not in Iceland, Sweden, Norway, or Belgium.

Prevention of lung infections associated with human immunodeficiency virus infection.

Current evidence indicates that the length of survival for patients with the acquired immunodeficiency syndrome (AIDS) is increasing, thereby affording a greater opportunity for strategies designed to prevent the infectious diseases that mark the syndrome. Because these infections may occur at different stages of immunosuppression caused by the human immunodeficiency virus (HIV), effective application of preventive measures depends not only on detection of HIV infection but also on the use of staging indicators. The diseases that serve to define AIDS, such as Pneumocystis carinii pneumonia, tend to occur late in the course of HIV infection and often when the T helper lymphocyte (CD4+ cells) count is less than 0.2 x 10(9)/l. Other infections, such as tuberculosis and pyogenic bacterial pneumonia, may develop at any point after HIV infection has occurred. Given this relation between the degree of immunosuppression and the occurrence of particular pulmonary infections, different preventive interventions should be applied at different times. It is now known that the incidence of several of the pulmonary infections that are common in patients with HIV infection can be reduced by prophylactic measures. Pneumocystis pneumonia is decreased in frequency by any one of several prophylactic agents, the best established being pentamidine administered as an inhaled aerosol. The role of isoniazid in the chemoprophylaxis of tuberculosis in patients not infected with HIV is well established. Although there is little evidence of benefit so far from isoniazid in HIV infected patients with a positive tuberculin skin test response, it is logical to assume that there could be some effect. The use of pneumococcal polysaccharide vaccine may also be of some benefit in reducing the frequency of pneumococcal pneumonia in patients with AIDS. In addition to these specific measures, the antiretroviral agent zidovudine decreases both the frequency and the severity of opportunist infections, at least during the first few months of treatment. A comprehensive strategy for prevention of HIV associated lung infection first requires detection of HIV seropositivity, staging the immunosuppression by the CD4+ cell count, and determining whether tuberculous infection is present by a tuberculin skin test. All seropositive individuals should be given pneumococcal vaccine and those with evidence of tuberculosis infection should be treated with isoniazid for one year. Zidovudine should probably be started when CD4+ cell counts are in the range 0.4-0.5 x 10(9)/l and prophylaxis against pneumocystis infection when CD4+ cell counts are in the range 0.2-0.3 x 10(9)/l.

Use of Pneumococcal Polysaccharide Vaccine in Preventing Otitis Media in Infants: Different Results Between Racial Groups

A total of 133 children between 6 and 11 months of age with at least one episode of otitis media were given one of two pneumococcal vaccines. One vaccine contained 25 microns of types 1, 3, 6, 7, 14, 18, 19, and 23 and the other vaccine (control) contained 25 microns of types 2, 4, 5, 8, 9, 12, and 25. Follow-up care of the 65 black infants revealed significantly more otitis media visits in those infants receiving the control vaccine. Among the 68 white infants there was no difference between control and vaccine groups after vaccination.

Pneumococcal Vaccine After Splenectomy

To the Editor.— A recent question and answer dealt with increased risk of sepsis following splenectomy in a 16-year-old patient. Since the most common organism causing such sepsis is D pneumoniae , I wonder why the use of pneumococcal polysaccharide vaccine was not suggested, as recommended by the Center for Disease Control. 1