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Colostrum obtained from women vaccinated with pneumococcal vaccine during pregnancy inhibits epithelial adhesion of Streptococcus pneumoniae.

Prevention of nasopharyngeal colonization may reduce the burden of pneumococcal infection during infancy. Colostrum obtained from Gambian mothers who had been vaccinated with either Pneumovax II or Mengivax A&C (n=8 per group) during pregnancy was examined for inhibition of adherence of Streptococcus pneumoniae serotypes 6B and 14 to pharyngeal epithelial cells in vitro. Pneumococcal adherence was significantly reduced in the presence of breast milk (P< or =.0001 for S. pneumoniae serotype 14; P=.036 for serotype 6B), independent of the concentration of secretory IgA antibodies. Maternal vaccination with polyvalent pneumococcal polysaccharide vaccine boosts the capacity of colostrum to inhibit adherence of pneumococci to pharyngeal epithelial cells. In breast-feeding populations, maternal vaccination might prevent pneumococcal disease in young infants.

Antibodies, Bacterial↗

Potential impact of conjugate pneumococcal vaccines on pediatric pneumococcal diseases.

Children younger than age 2 years have the highest rates of invasive pneumococcal disease and play an important role in its transmission. In the United States, seven pneumococcal serotypes cause approximately 80% of invasive disease and represent approximately 60% of middle-ear isolates in children younger than age 2 years; the majority of penicillin-resistant strains are confined to these same few serogroups. Although unconjugated polysaccharide pneumococcal vaccines have demonstrated effectiveness in preventing invasive disease in adults, these vaccines fail to protect against otitis media or nasopharyngeal carriage and are poorly immunogenic in children younger than age 2 years. A new generation of pneumococcal vaccines has been developed, linking the capsular polysaccharide of seven to 11 serotypes to a protein carrier. The only pneumococcal vaccine approved to date for children younger than age 2 years is a seven-valent conjugate vaccine (PnCRM-7) (Prevnar; Wyeth Vaccines, Pearl River, New York), which contains serotypes 4, 6B, 9V, 14, 18C, 19F, and 23F. PnCRM-7 is more immunogenic than the polysaccharide pneumococcal vaccines and is 80-100% effective against vaccine-type invasive disease and 50-60% effective against vaccine-type pneumococcal otitis media. Routine immunization with pneumococcal conjugate vaccines should substantially reduce the morbidity, mortality, and costs associated with pneumococcal disease in children.

Child, Preschool↗

Response of traumatized splenectomized patients to immediate vaccination with polyvalent pneumococcal vaccine.

In recent years the syndrome of overwhelming post-splenectomy sepsis has been increasingly reported in adults. Since more than 50% of these infections are caused by pneumococcus these post-splenectomy patients are considered a suitable group to receive the pneumococcal vaccine. Previous studies of the response obtained in post-splenectomy patients have been conflicting and we found no study that looked at the response to immediate vaccination in this group of patients. Sixteen consecutive multitraumatized patients received polyvalent pneumococcal vaccine 0.5 ml IM within 72 hours of splenectomy and 10 normal controls were given 0.5 cc polyvalent pneumococcal vaccine. Patients received an average of 19.2 units of blood and blood products; seven were on steroids for concomitant head injury. Antibody was measured by the radioimmune assay. Most of the subjects of both groups responded to at least seven of the 12 measured antigens and no patient in the control group and only one in the splenectomized group responded to all 12 antigens. When rate of response to individual serotypes was compared no difference was found between the two groups. Comparison of geometric mean fold rise and fold rise between the two groups for each of the 12 serotypes revealed essentially no difference. We conclude the response to polyvalent pneumococcal vaccine among polytrauma splenectomized patients is similar to that of normal controls, and that the vaccine can be administered immediately post-splenectomy.

Abdominal Injuries↗

Pneumococcal disease after pneumococcal vaccination: an alternative method to estimate the efficacy of pneumococcal vaccine.

Trials of pneumococcal vaccine in healthy young adult populations suggest 75 to 95 per cent type-specific efficacy. Trials have not been done, however, in groups for which pneumococcal vaccine is currently recommended in the United States. To assess efficacy in the immunocompromised groups now receiving the vaccine, we compared serotypes of 35 isolates of Streptococcus pneumoniae isolated from blood or cerebrospinal fluid one month or longer after the patient had received commercially available pneumococcal vaccine with serotypes of 392 isolates from unvaccinated persons surveyed in a study of the nationwide distribution of pneumococcal serotypes. Proportions of infections with vaccine serotypes were unexpectedly similar. An alternative approach to estimation of vaccine efficacy suggested an average efficacy of 36 per cent in persons of all ages. The estimated efficacy was lowest in children two to 10 years old (less than or equal to 0 per cent) and in persons with preexisting diseases that are thought to predispose to pneumococcal disease (less than or equal to 0 per cent), and highest in the group over 10 years old (60 per cent). The possibility that efficacy is low in high-risk, immunocompromised populations makes it important to evaluate clinical efficacy and not just serum antibody responses in such groups.

Adolescent↗

Side effects associated with pneumococcal vaccination.

BACKGROUND: Pneumococcal disease is a major cause of morbidity and death, especially among elders and other people at high risk. In spite of long-standing national recommendations for its use, pneumococcal vaccine is underused, with 70% or more of targeted persons as yet unimmunized. Concern about side effects is a barrier to successful vaccine delivery. METHODS: Persons attending a walk-in pneumococcal vaccination clinic were surveyed by use of structured telephone interviews. They were asked about health characteristics and local and systemic symptoms experienced during the week after their vaccination (postvaccination period). These responses were compared with the symptoms they reported for the 7 days immediately preceding their interview (the comparison period). RESULTS: A total of 1006 persons were interviewed a mean of 65.4 days after their vaccination. They had an average age of 69.9 years, and approximately 95% were in a high-risk group targeted for pneumococcal vaccination. For all systemic symptoms including fever, rash, myalgias, fatigue, malaise, and headache, subjects reported similar or lower rates during the postvaccination week than during the comparison week. Local reactions occurred in 28.2% of subjects. These local symptoms were mild to moderate for more than 90% of subjects and rarely resulted in the need to decrease the use of their arm. CONCLUSION: Pneumococcal vaccination was not associated with an increase in systemic symptoms but was associated with mild to moderate local symptoms in about one fourth of vaccine recipients. These findings should help health care providers and their patients address an important barrier to pneumococcal immunization.

Aged↗

Pneumococcal vaccine: a second look. Solution for SC or IM injection: pneumococcal vaccine.

Pneumo 23 degrees , like the pneumococcal vaccines tested in randomised comparative trials, may slightly reduce the incidence of pneumococcal pneumonia in subjects with no particular risk factors, but fails to alter the overall incidence of pneumonia or its related mortality. In subjects at high risk of infection, pneumococcal vaccines have not been proven clinically effective in well-conducted trials. According to available retrospective studies Pneumo 23 degrees may, at best, slightly reduce the risk of severe pneumococcal infection. It has, however, no demonstrated effect on mortality and does not protect against pneumococci with diminished sensitivity to penicillin.

Adolescent↗

Reactions following administration of influenza vaccine alone or with pneumococcal vaccine to the elderly.

BACKGROUND: Even though the efficacy of pneumococcal vaccine against invasive pneumococcal infections and other closely related infections has been established, its use in the United States is only one quarter of that of influenza vaccine. The simultaneous administration of the two vaccines could be expected to raise the coverage of pneumococcal vaccination to a considerable degree. There is a paucity of data regarding the reactions associated with the simultaneous administration of pneumococcal and influenza vaccines. METHODS: All persons aged 65 years or older living in 29 administrative districts in Northern Finland were offered influenza vaccine alone or influenza and pneumococcal vaccines. A total of 9336 persons (49.6% of the target population) accepted vaccination: 4581 persons born in odd years received influenza vaccine, and 4755 persons born in even years received influenza and pneumococcal vaccines. Local reactions were recorded in a diary by vaccines on the day of vaccination and for 4 days afterward according to the following scale: no reaction, mild reaction, strong reaction, and disabling reaction. The participants who felt feverish were asked to measure and record their temperature. Ninety-three percent of those vaccinated returned the diary. RESULTS: No serious reactions were observed. The incidence of local reactions was 284 per 1000 vaccinations in the influenza-vaccinated group and 441 per 1000 vaccinations in the influenza-pneumococcal-vaccinated group, a difference of 157 (95% confidence interval, 137 to 176), and that of fever (temperature, at least 37.5 degrees C) was 10 and 24 per 1000, respectively, for a difference of 14 (95% confidence interval, 9 to 19). The frequency of local reactions decreased with advancing age. CONCLUSION: Because the adverse reactions to the pneumococcal and influenza vaccines when given together were mild, we conclude that the simultaneous administration of the two vaccines to the elderly population, irrespective of age, is safe.

Aged↗

[Acceptance of the new conjugate vaccines. Meningococcal and pneumococcal vaccines, in the cohort born in 1999, in the North Region of Portugal].

The new conjugate vaccines against group C meningococcal infection and pneumococcal infection were introduced in Portugal in 2001. In 2001/2002, the media published several alarming news on meningococcal disease and there was an increased demand of those vaccines, not included in the Portuguese National Vaccination Programme. In order to assess the coverage with these new vaccines against Neisseria meningitidis and Streptococcus pneumoniae, we conducted a descriptive study of the cohort born in 1999, using a convenience sample, from eight health centres in the North of Portugal. Data was collected from the vaccination records of 1877 children born in 1999: 37.2% had received the group C meningococcal conjugate vaccine and 33.3% the pneumococcal conjugate vaccine, while 21,2% had received both. Most vaccinations with pneumococcal conjugate vaccine were performed after 23 months of age, above the recommended age range. The biggest number of group C meningococcal conjugate vaccines given in a month, was recorded in February of 2002, when the maximum number of reported cases of meningococcal disease was also observed. Correlation of both distributions over time was very high (R(2)=0.95). In February 2002 the number of pneumococcal conjugate vaccine doses given rose again, after having been decreasing since October 2001. This study suggested research hypothesis for the future.

Child, Preschool↗

Serum antibody responses to vaccination with 23-valent pneumococcal vaccine in splenectomized patients.

Sixty-three patients that have been splenectomized for various disorders were vaccinated with Pneumovax 23, the currently available pneumococcal vaccine. Before and one month after splenectomy, IgG antibodies against 8 pneumococcal polysaccharide antigens (types 3, 4, 6B, 7F, 10A, 14, 19F, and 20) were determined by a highly reproducible and type-specific enzyme-linked immunosorbent assay (ELISA). In order to increase the specificity of the assay, this method involved the use of a capture antibody (F(ab')2-fragments of a type-specific rabbit antipneumococcal hyperimmune serum) to bind the pneumococcal antigens to the plastic surface of microtiter plates and the absorption of these sera with the cross-reacting C polysaccharide. Rates of patients showing a two-fold antibody increase were dependent on pneumococcal type, ranging from 12.7% to 33.3%. Antibody responses of single patients were not uniform for all pneumococcal serotypes investigated. Only one patient responded to all of the eight antigens tested. In spite of relatively low response rates, splenectomized patients should be routinely vaccinated with the pneumococcal vaccine, especially when the low rate of adverse reactions is taken into consideration. It is emphasised that the results of the present study and those reported in the literature have to be compared and interpreted with caution, because the available data on the antibody response to pneumococcal vaccination are based on assays that differ substantially in methodology.

Adult↗

Pneumococcal vaccine in normal children. Primary and secondary vaccination.

A pneumococcal polysaccharide vaccine containing 50 micrograms of each of 14 pneumococcal types was administered to 79 children 2 to 5 years of age. In earlier studies, 52 of these children had received pneumococcal vaccine; 27 had received a placebo. Local reactions were significantly greater in the reimmunized group. Antibody response to the vaccine was similar in both groups. Mean fold rises to most vaccine components were at least twofold. The response to specific pneumococcal types was unrelated to the frequency with which each type causes illness. Response to type 6 continued to be poor for children up to age 5 years. A vaccine with improved immunogenicity must be developed before widespread use in normal children is advocated. However, the 14-valent pneumococcal polysaccharide vaccine currently available is moderately immunogenic in children by age 2 years and should be given to patients with increased risk of pneumococcal illness at that time.

Age Factors↗

New 23-valent pneumococcal vaccine in relation to pneumococcal serotypes in systemic and non-systemic disease.

The serotype distribution of 3631 strains of Streptococcus pneumoniae, isolated from various specimens obtained from patients was determined by coagglutination and included serotyping within a total of 13 serogroups. The results of serotyping of isolates from Scotland demonstrated that the new 23-valent pneumococcal vaccine includes serotypes which accounted for 91% strains associated with systemic disease and 79% strains isolated from other anatomical sites. Altogether, 114 strains (3.1%) were not typable because they did not possess a type-specific capsule; these were commonly isolated from eyes (12%).

Bacterial Vaccines↗

Effectiveness of a publicly funded pneumococcal vaccination program against invasive pneumococcal disease among the elderly in Victoria, Australia.

Within Australia, Victoria is the only jurisdiction where the 23-valent polysaccharide pneumococcal vaccine (23vPPV) has been publicly funded for the elderly (aged > or = 65 years). We compared age-specific rates of invasive pneumococcal disease (IPD) for periods before and after implementation of the program, and data from a comparable Australian population that does not have a funded program. Vaccine effectiveness (VE) was estimated using the screening and indirect cohort methods. Compared to the pre-program period, there was a 36% reduction in the reported rates of IPD among persons aged > or = 65 years. Adjusted for under-reporting in the referent rate, the decrease was equivalent to an annual reduction of 112 cases and an estimated 14 deaths among persons > or = 65 years. VE was 71% (95% CI 54-82) using the screening method and 79% (95% CI -14 to 96) by the indirect cohort method. Both point estimates were consistent with the VE expected among persons aged > or = 65 years, although the small number of isolates meant the indirect cohort method was inconclusive at the lower 95% confidence limit. Consideration should be given to publicly funding pneumococcal vaccine for this age group in other settings.

Aged↗

A hospital-based pharmacy intervention program for pneumococcal vaccination.

BACKGROUND: Current pneumococcal vaccination rates are well below national goals. OBJECTIVE: To determine whether pneumococcal vaccination rates could be increased with a hospital pharmacy-based program using simple chart reminders. METHODS: On a daily basis, inpatient records on general medicine and cardiology services at an academic medical center were reviewed to determine which patients were eligible to receive pneumococcal vaccine. Eligible inpatients were interviewed, and the percentage of nonvaccinated inpatients given vaccine during hospitalization was determined. During an intervention period, reminders were placed on charts after the interview requesting a vaccine when indicated. RESULTS: Of 447 inpatients, 224 (50.1%) had 1 or more indications for receiving pneumococcal vaccine. Only 64 (28.6%) had been previously vaccinated. One hundred fifty-eight (70.5%) of 224 vaccine-eligible patients had a prior hospitalization within the previous 5 years. Previous hospitalization was not significantly associated with having (48 [30.4%] of 158) or not having (16 [24.2%] of 66; P=.35) been vaccinated prior to admission. During the observational period, 0 of 80 vaccine-eligible, nonvaccinated inpatients were vaccinated before discharge. In comparison, 23 (28.8%) of 80 inpatients were vaccinated after a chart reminder (P<.001). During the intervention period, vaccination rates were 10-fold higher on general medicine services than on cardiology services. CONCLUSIONS: A hospital-based pharmacy vaccination program that relied on simple chart reminders was significantly associated with increased vaccination rates among inpatients at risk for invasive pneumococcal disease.

Bacterial Vaccines↗

Prior pneumococcal vaccination is associated with reduced death, complications, and length of stay among hospitalized adults with community-acquired pneumonia.

BACKGROUND: Vaccination with pneumococcal polysaccharide reduces the incidence of bacteremic pneumococcal disease in adults. We investigated the impact of prior pneumococcal vaccination on in-hospital mortality and the probability of respiratory failure among hospitalized adults with community-acquired pneumonia. METHODS: Consecutive individuals hospitalized with community-acquired pneumonia (diagnosed by International Classification of Diseases, Ninth Revision, Clinical Modification codes 480.0-487.0) at 109 community and teaching hospitals in the United States were identified using the Quality and Resource Management System, a database constructed by Tenet HealthCare to improve the quality of patient care. Vaccination status, comorbidities, and outcomes were abstracted by case managers concurrently with patient care. Associations between vaccination, survival, and respiratory failure were defined using multivariable logistic regression models. RESULTS: Of 62,918 adults hospitalized with community-acquired pneumonia between 1999 and 2003, 7390 (12%) had a record of prior pneumococcal vaccination. Vaccine recipients were less likely to die of any cause during hospitalization than were individuals with no record of vaccination (adjusted odds ratio [OR], 0.50; 95% confidence interval [CI], 0.43-0.59), even after adjustment for the presence of comorbid illnesses, age, smoking, and influenza vaccination and under varying assumptions about missing vaccination data. Vaccination also lowered the risk of respiratory failure (adjusted OR, 0.67; 95% CI, 0.59-0.76) and other complications and reduced median length of stay by 2 days, compared with nonvaccination (P<.001). CONCLUSIONS: Prior vaccination against pneumococcus is associated with improved survival, decreased chance of respiratory failure or other complications, and decreased length of stay among hospitalized patients with community-acquired pneumonia. These observations reinforce current efforts to improve compliance with existing pneumococcal vaccination recommendations for adults.

Adult↗

Comparison of secular trends in pneumococcal serotypes causing invasive disease in Denver, Colorado (1971-2004) and serotype coverage by marketed pneumococcal vaccines.

Invasive pneumococcal isolates from three hospitals in Denver, CO, USA were serotyped between 1971 and 2004. Serotype 14 was most common (13.2%), and other prevalent serotypes (3, 4, 6, 9 and 19) together accounted for 44.1% of the isolates. All prevalent serotypes and 91.3% of the total isolates were covered by pneumococcal polysaccharide vaccine, while 79.1% of prevalent serotypes and 56.7% of total isolates were covered by pneumococcal conjugate vaccine. Serotypes 6, 9 and 14 were more common in the final decade than in the first decade studied (37.3% vs. 20.2%), whereas serotypes 3 and 23 were more common in the first decade (18.5% vs. 11.0%).

Colorado↗