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PubMed2001

Pneumococcal vaccine.

Pneumococcal infection is responsible for a wide range of diseases, including upper respiratory tract infections such as otitis media and sinusitis, pneumonia and other lower respiratory infections, and the disseminated infections of bacteremia and meningitis. Invasive pneumococcal disease and pneumonia, which represent the threat of serious morbidity and mortality, occur most frequently in certain age groups, selected ethnic populations, and individuals with chronic medical diseases or immunosuppression. There are two pneumococcal vaccines currently available, Pneumovax 23 and Pnu-Immune 23. Indications for vaccination include medical conditions that make individuals susceptible to invasive pneumococcal disease (eg, chronic cardiac, pulmonary, or hepatic disease; sickle-cell disease; insulin-dependent diabetes; immunosuppressive disorders; age >65 years; or history of splenectomy). Approximately 85%-90% of the pneumococcal serotypes that cause invasive infection in the United States are represented in the pneumococcal vaccine. Pneumococcal vaccines with improved immunogenicity and potentially improved efficacy against this deadly pathogen are currently under investigation. Millions of individuals at high risk for pneumococcal disease in the United States have not yet received the vaccine. After invasive infection, mortality is high, with an estimated 40,000 deaths annually in this country. With the pneumococcal vaccine's safety profile and proven efficacy against invasive disease in appropriate populations, it is imperative that the medical community improve its effort to vaccinate those individuals considered to be at risk for life-threatening pneumococcal disease.

Journal Article↗
PubMed1989

Pneumococcal vaccine.

Pneumococcal infections are common and serious infections, and their control is an important public health priority. A multivalent pneumococcal vaccine was introduced several years ago, but there is still controversy about its effectiveness in United States populations. One randomized controlled study in high-risk veterans did not demonstrate efficacy. The study has been criticized because the case definitions used for pneumococcal infection had uncertain specificity. Two large case control studies done in Pennsylvania and Connecticut hospitals have compared vaccination rates in patients with pneumococcal bacteremia with controls matched for disease severity and age. Bacteremic immunosuppressed patients who were unlikely to have responded to pneumococcal vaccine were excluded. These studies showed vaccine efficacy rates in the 60% to 70% range as did a prospective randomized controlled French trial that used episodes of pneumonia as an end point. Pneumococcal vaccine is effective when given to patients likely to respond immunologically and who are at increased risk from pneumococcal infection.

Administration, Cutaneous↗
PubMed2001

Pneumococcal vaccine for asthma.

BACKGROUND: Infection with Streptococcus pneumoniae is an important cause of pneumonia and other serious illnesses, particularly amongst those with certain high-risk medical conditions such as asthma. Although pneumococcal vaccine is routinely advocated for people with asthma, there is uncertainty about the evidence base that underpins this recommendation. OBJECTIVES: To determine the efficacy of pneumococcal vaccine in reducing mortality or morbidity from pneumococcal disease in asthmatics. SEARCH STRATEGY: Randomised controlled trials were identified using the Cochrane Airways Group's register derived from MEDLINE, EMBASE, and CINAHL electronic databases and hand searched respiratory journals and meeting abstracts. SELECTION CRITERIA: Randomised controlled trials, with or without blinding, in which pneumococcal vaccine has been compared with placebo or no treatment in people with clinician diagnosed asthma. DATA COLLECTION AND ANALYSIS: Two reviewers independently reviewed all abstracts and full papers of all articles of potential relevance were retrieved. Methodological quality was rated using the Cochrane approach and the Jadad rating scale. Data extraction was performed by one reviewer and checked independently by a second. We planned to perform quantitative analyses of outcomes on an intention-to-treat basis, where possible. MAIN RESULTS: Of the three papers retrieved, only one satisfied the inclusion criteria and the methodological quality of this study was low (unblinded and inadequate allocation concealment). None of the data could be aggregated in a meta-analysis. Comparisons in a sub-set of 30 asthmatic children prone to recurrent episodes of otitis media, showed that pneumococcal vaccination decreased the incidence of acute asthma exacerbations from 10 to 7 (per child per year). REVIEWER'S CONCLUSIONS: This review found very limited evidence to support the routine use of pneumococcal vaccine in people with asthma. A randomised trial of vaccine efficacy in children and adults with asthma is needed.

Asthma↗
PubMed2005

Impact of influenza vaccine on response to vaccination with pneumococcal vaccine in HIV patients.

The clinical effectiveness of 23-valent pneumococcal vaccine in human immunodeficiency virus (HIV)-infected patients is controversial, because of the low immunological response in these subjects. We studied the clinical response of pneumococcal vaccine and the relative impact of influenza vaccine by administering both pneumococcal and influenza vaccine in a group of 150 HIV patients belonging to all CDC categories. In the group of 90 HIV-infected patients vaccinated against both pneumonia and influenza virus, there was a low incidence of mild influenza (13.3%) and no case of pneumococcal pneumonia. On the contrary, among 60 nonvaccinated HIV patients, 61.6% underwent mild to severe influenza and two developed pneumococcal pneumonia. 23-valent pneumococcal vaccine (PV) seems to be clinically effective in preventing pneumonia in HIV-infected patients, and even more if strengthened by influenza vaccine.

Adult↗
PubMed1995

Should patients positive for HIV infection receive pneumococcal vaccine?

Pneumococcal vaccination effectively reduces the incidence of invasive pneumococcal disease in normal subjects. Such invasive pneumococcal disease is 100 times more common in patients with HIV infection than in healthy people, so it seems logical to target this group of patients for vaccination. Few clinics routinely vaccinate patients positive for HIV, despite Department of Health guidelines. This is because of uncertainty about the vaccine's efficacy in HIV disease. There are many reasons to suspect that the vaccine will fail to protect these patients, including the fact that antibodies alone may not be sufficient protection against all serogroups of Pneumococcus and the vaccine works in healthy people but not immunocompromised subjects. Vaccination of HIV positive patients may not be indicated, at least for the time being. The cost of vaccinating such patients in the absence of data showing efficacy may well be less than the cost of a necessarily large and lengthy trial. But the truth must be sought to end current indecision.

AIDS-Related Opportunistic Infections↗
PubMed1984

Reactivity and antibody responses of volunteers given two or three doses of pneumococcal vaccine.

Pneumococcal antibody responses and adverse reactions were assessed in 12 healthy volunteers who received either two (10 volunteers) or three (2 volunteers) doses of pneumococcal polysaccharide vaccines at 1 or 2 year intervals. The volunteers were given hexavalent (types 1, 3, 4, 7F, 8, 12F) octavalent (types 14, 19F added) nonavalent (type 5 added), and tridecavalent (types 6A, 6B, 9N, 18C, 23F added; type 5 removed) pneumococcal vaccines. Local and systemic reactions following any of the vaccines, either first, second, or third doses, were low, and these were mild; fever did not occur. Twelve volunteers received types 1, 3, 4, 7F, 8, and 12F in two doses of vaccine, and four volunteers received types 14 and 19F in two doses of vaccine. Primary immunization induced significant antibody rises to these antigens in most volunteers, but a second dose of vaccine did not further increase antibody levels to the same antigens; when it also contained new antigens, antibody rises usually developed to these antigens. Although the data are limited to detailed studies of only 12 persons, the results suggest that additional studies of this issue would seem appropriate.

Adult↗
PubMed1999

Clinical effectiveness, policies, and practices for influenza and pneumococcal vaccines.

Pneumococcal disease and influenza impact public health considerably. S pneumoniae probably accounts for almost 14,000 deaths and more than 23,000 admissions to National Health Service hospitals per annum. Influenza epidemics occur frequently and unpredictably with the potential to inflict morbidity and mortality on a massive scale. Both diseases pose maximum risks to persons with underlying chronic illnesses. Assessing the effectiveness of pneumococcal and influenza vaccines presents complex methodological problems. However, despite these difficulties, a body of evidence has accumulated suggesting that pneumococcal vaccines offer substantial protection against both bacteremia and pneumonia among healthy low-risk adults, but only against bacteremia in those considered high-risk. There is now strong evidence that the influenza vaccine protects high-risk patients from both hospitalization and death. Although most European countries now have national guidelines for vaccination of high-risk patients, both vaccines remain underused in modern clinical practice mainly due to poor organization.

Adult↗
PubMed2003

The potential indirect effect of conjugate pneumococcal vaccines.

Pneumococcal conjugate vaccines are highly effective in preventing invasive disease in infants and young children, with favorable safety and immunogenicity profiles. These pediatric vaccines have also shown efficacy in reducing cases of non-invasive disease (i.e. otitis media, pneumonia). Recently, pneumococcal conjugate vaccines have demonstrated additional protective qualities that may enhance their use worldwide. For example, they can reduce nasopharyngeal acquisition of vaccine-specific serotypes of Streptococcus pneumoniae, which may in turn reduce the incidence of pneumococcal disease among non-vaccinated individuals; this is termed indirect or herd immunity. Although the emergence of antibiotic-resistant strains has complicated disease management, pneumococcal conjugate vaccines have been shown to protect against pneumococcal disease caused by such strains because most antibiotic-resistant strains are of the serotypes included in these vaccines. Thus, widespread use of these conjugate vaccines may prevent disease by providing both direct and indirect immunity, and may reduce the use of antibiotics and the development of antibiotic resistance worldwide.

Child, Preschool↗
PubMed2006

Indirect effects of childhood pneumococcal vaccination on pneumococcal carriage among adults and older children in Australian Aboriginal communities.

Nasopharyngeal carriage of Streptococcus pneumoniae in unimmunised adults and older children in three remote Australian Aboriginal communities was compared in 2002 and 2004. Universal childhood pneumococcal vaccination with a catch-up program was introduced in late 2001. Carriage prevalence across all age groups of pneumococcal serotypes included in the 7-valent vaccine was 10% in both 2002 and 2004 (12 and 30 months after introduction of vaccination). This carriage prevalence was lower than anticipated. It is likely that indirect effects of childhood vaccination occurred before the 2002 survey. To further assess indirect effects on carriage of childhood pneumococcal vaccination, data prior to 2002 are required. Between 12 and 30 months following introduction of conjugate pneumococcal vaccination, indirect effects on carriage were unchanged.

Adolescent↗
PubMed2002

The new pneumococcal vaccine.

Pneumococcal disease is now the leading cause of vaccine-preventable bacterial disease in children worldwide. Although a pneumococcal polysaccharide vaccine has been available for over three decades, its use has been limited due to poor immunogenicity in the most vulnerable children, aged less than 2 years. The prevalence of pneumococcal disease worldwide and the alarming global escalation of multiresistant strains of Streptococcus pneumoniae (pneumococcus) during the past decade have provided the impetus for the development and application of a new pneumococcal vaccine. The outstanding success of Haemophilus influenzae type b (Hib) conjugate vaccine in the control of invasive Hib disease is a reason to be optimistic that the pneumococcal conjugate vaccines will achieve similar results for the control of invasive pneumococcal disease. Remarkable efficacy against invasive pneumococcal disease with a seven-valent pneumococcal conjugate vaccine was demonstrated in infants and toddlers in the USA, and in February 2000 the first pneumococcal conjugate vaccine was licensed. Licensure and widespread use is likely to follow in other countries in which there is a need and the means to afford this live-saving vaccine. Active disease surveillance must be sustained globally, while active research, development of other multivalent conjugate formulations and the search for new candidate protein-based vaccines are in progress.

Adolescent↗
PubMed1988

IgA, IgG and IgM anti-blood group A antibodies induced by pneumococcal vaccine.

Pneumococcal polysaccharide vaccine contaminated with blood group A-like substance stimulated long-lasting production of anti-A antibodies in 10 of 11 subjects with O or B blood group. ELISA using blood group A substance as antigen detected increased IgA anti-A levels 18 months after vaccination in 82% of O and B subjects, the corresponding values being 73% for IgG and 18% for IgM. In females of O or B blood group becoming pregnant with a fetus of group A or AB, prior immunization to blood group A substance may cause a potential risk for haemolytic disease of the newborn.

ABO Blood-Group System↗
PubMed2005

Effect of pneumococcal vaccination on quality of life in children with recurrent acute otitis media: a randomized, controlled trial.

BACKGROUND: Limited effectiveness of current treatment strategies for recurrent acute otitis media (RAOM) and increasing antibiotic resistance have diverted attention to prevention of AOM by vaccination. Pneumococcal vaccination for AOM seems to have only modest clinical efficacy. Thus far, the effects on health-related quality of life (HRQoL) or functional health status (FHS) have not been studied. OBJECTIVE: To assess the effect of vaccination on HRQoL or FHS. METHODS: In a double-blind, randomized, controlled trial, 383 children 1 to 7 years old with RAOM were vaccinated with either heptavalent pneumococcal conjugate vaccine followed by pneumococcal polysaccharide vaccine (pneumococcal group: n = 190) or with hepatitis A or B vaccines (control group: n = 193). Parents completed validated Dutch versions of 8 HRQoL and FHS instruments assessing generic FHS (Rand, Functional Status Questionnaire specific, and Functional Status Questionnaire generic), otitis media-specific FHS (OM-6), otitis media-specific child HRQoL (Numerical Rating Scale for Child), family functioning (Family Functioning Questionnaire), and otitis media-specific caregiver HRQoL (Numerical Rating Scale for Caregiver). Scores were compared at baseline and at 14 and 26 months' follow-up. RESULTS: At baseline, the average AOM incidence in the pneumococcal and control group was 5.0 (SD: 2.8) and 4.9 (SD: 2.6) episodes per year, respectively, with 38.4% and 36.8% having suffered from > or =6 episodes per year. AOM frequency decreased 4.4 episodes per year in both groups, with a considerable and comparable improvement in HRQoL and FHS. No substantial differences in HRQoL or FHS were found between the pneumococcal and the control group at baseline or at 14 or 26 months' follow-up. CONCLUSION: Pneumococcal vaccination has no beneficial effect compared with control vaccination on either HRQoL or FHS in children 1 to 7 years old with RAOM.

Child↗
PubMed1996

Belgian consensus on pneumococcal vaccine. Working Party on Pneumococcal Vaccine.

An ad hoc working party on pneumococcal vaccine with representatives of the Belgian Society for Infectiology and Clinical Microbiology, the Belgian Society for Pulmonology, and a Scientific Society of General Physicians confirms the recommendations on the use of the 23-valent capsular polysaccharide pneumococcal vaccine, as established by the "Hoge Gezondheidsraad--Conseil Supérieur d'Hygiène". The present consensus statement provides a review of the scientific data on which the indications for pneumococcal vaccine are based. These data are derived both from Belgian studies as well as from the international literature.

Aged↗
PubMed1986

Titers of antibody to pneumococci in allogeneic bone marrow transplant recipients before and after vaccination with pneumococcal vaccine.

To understand the susceptibility of allogeneic bone marrow transplant recipients to pneumococcal infection, we measured the level of type-specific antibodies to pneumococcal capsular polysaccharide in serum from ten marrow recipients. Seven recipients received marrow from matched sibling donors who had recently been vaccinated with polyvalent pneumococcal vaccine. Titers of IgG antibodies to two pneumococcal serotypes (7F and 14) declined significantly during the first year after transplantation. IgM antibodies remained low or declined after transplantation, but IgM antibodies to type 7F increased during the latter half of the first year. Pneumococcal vaccine was administered to seven marrow recipients approximately two years after transplantation. Vaccinated recipients had lower postvaccination titers of type-specific IgG antibody than did vaccinated normal adults and vaccinated sibling donors, and the recipients had normal levels of type-specific IgM antibodies. Thus, the susceptibility of marrow graft recipients to pneumococcal disease may be related to lowered concentrations of antibody to pneumococci after engraftment.

Adolescent↗
PubMed1998

[Efficacy of pneumococcal vaccination].

POLYVALENT VACCINE: Pneumococcal vaccination is based on the antigenic properties of polysides carried on the bacterial capsule which induce production of bactericidal serotype-specific antibodies. The 23 serotypes contained in the current vaccine cover 85 to 90% of all strains observed in pneumococcal infections in Europe. PROVEN EFFICACY: Prospective and retrospective studies have demonstrated that pneumococcal vaccination can prevent 60 to 80% of invasive pneumococcal infections in immunocompetent elderly subjects and/or persons in high-risk groups with underlying disorders. TARGET POPULATION: Immunocompetent persons in the 60-65 year and older age group comprise the target population for pneumococcal vaccination. Incidence and mortality of pneumococcal infections is high in this group. Simple vaccination strategies should be implemented.

Adult↗
PubMed2003

Effect of conjugate pneumococcal vaccine followed by polysaccharide pneumococcal vaccine on recurrent acute otitis media: a randomised study.

BACKGROUND: Pneumococcal conjugate vaccine prevents recurrent acute otitis media (AOM) in infants immunised at 2, 4, 6, and 12-15 months of age. We aimed to find out whether this vaccine also prevents AOM in older children who have had previous episodes of AOM. METHODS: In this double-blind, randomised study, we enrolled 383 patients aged 1-7 years who had had two or more episodes of AOM in the year before entry. Randomisation was stratified in four groups according to age (12-24 months vs 25-84 months) and the number of previous AOM episodes (two or three episodes vs four or more episodes). Children received either 7-valent pneumococcal conjugate vaccine followed by 23-valent pneumococcal polysaccharide vaccine, or hepatitis A or B vaccines. They were followed up for 18 months for recurrence of AOM. We also cultured samples of middle-ear fluid and nasopharyngeal swabs to assess association of pneumococcal serotypes with AOM after vaccination. FINDINGS: We noted no reduction of AOM episodes in the pneumococcal vaccine group compared with controls (intention-to-treat analysis: rate ratio 1.25, 95% CI 0.99-1.57). Although nasopharyngeal carriage of pneumococci of serotypes included in the conjugate-vaccine was greatly reduced after pneumococcal vaccinations, immediate and complete replacement by non-vaccine pneumococcal serotypes took place. INTERPRETATION: These data do not lend support to the use of pneumococcal conjugate vaccine to prevent otitis media in previously unvaccinated toddlers and children with a history of recurrent AOM.

Acute Disease↗
PubMed1997

Pneumococcal vaccine.

Pneumococcal infection is a major health problem in both developed and developing countries. Adult patients with a range of chronic illnesses are at increased risk of both morbidity and mortality from this condition. The currently available 23 valent vaccine is generally not effective in children under 2 years of age or adults with significant immunosuppression. However, case control and cohort studies have established the vaccine's effectiveness in patients with a number of chronic illnesses as well as those undergoing splenectomy. The vaccine is safe and should be more widely used by practitioners with patients who meet the current NHMRC guidelines.

Adolescent↗