Epidemiologic Benefits of Pneumococcal Vaccine Introduction into Preventive Vaccination Programs
Vaccination against pneumococci is one of the most effective methods of preventing pneumococcal diseases. Currently, 10- and 13-valent conjugate vaccines (PCV10 and PCV13) and 23-valent polysaccharide vaccine (PPSV23) are used. Only the conjugate vaccines
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Epidemiologic Benefits of Pneumococcal Vaccine Introduction into Preventive Vaccination Programs Wojciech Malchrzak and Agnieszka Mastalerz-Migas Abstract
Vaccination against pneumococci is one of the most effective methods of preventing pneumococcal diseases. Currently, 10- and 13-valent conjugate vaccines (PCV10 and PCV13) and 23-valent polysaccharide vaccine (PPSV23) are used. Only the conjugate vaccines are used in children. The PCV can be used both in children and adults, but children can receive only PCV. A side effect of vaccination was that bacterial serotypes not included in a vaccine started increasingly emerging in pneumococcal infections, replacing the serotypes eliminated by the vaccine. The basic vaccination schedule consists of three or four doses, according to the country’s recommendation. In Poland, it consists of two primary doses followed by a supplementary dose of the PCV-10, with some modifications in case of specific risk factors. The use of preventive vaccinations has helped reduce antibiotic resistance, as serotypes characterized by a rapid acquisition of drug resistance are included in the vaccine serologic spectrum, making their environment prevalence decrease. The research is currently underway on conjugate vaccines that contain a greater number of bacterial serotypes and on more W. Malchrzak and A. Mastalerz-Migas (*) Department of Family Medicine, Faculty of Medicine, Wroclaw Medical University, Wrocław, Poland e-mail: [email protected]
universal vaccines that would eliminate the emergence of new serotypes. Keywords
Pneumococcal vaccine · Streptococcus pneumoniae · Invasive pneumococcal disease · Vaccination program
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Introduction
Pneumococcal diseases, especially invasive forms of infections, are a common cause of illness and death in patients of all ages. Children under the age of 5 and the elderly 60–65+ are at the greatest risk of developing a severe disease course. To prevent infection, vaccines are used to induce specific immunity against bacteria. The first was a polysaccharide vaccine that contained purified antigens from the bacterial envelope. Currently, the polysaccharide antigens are available in the 23-valent vaccine, PPSV23, that works through mechanisms other than T lymphocytes and, thus, is unable to induce adequate immunity in young children. To induce an effective immune response in children, a combination of bacterial polysaccharide with a carrier protein has been developed, a pneumococcal conjugate vaccine (PCV). This vaccine was initially available in a 7-valent form (Prevenar), in which the CRM197 protein was a carrier, followed by 10-valent (Synflorix) and 13-valent (Prevenar 13) forms in
W. Malchrzak and A. Mastalerz-Migas
which the protein D and CRM197 were used as carriers, respectively. There is also a 10-valent vaccine (Pneumosil) that uses the CRM197 protein, available on the Indian market. Two pneumococcal vaccines are in use in Poland: Synflorix (PCV10) and Prevenar 13 (PCV13). The first is indicated for the use in children from 6 wee
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