Clinical and Experimental Pediatrics

The Korean Pediatric Society (대한소아청소년과학회)
권호 표지

Efficacy and effectiveness of pneumococcal conjugate vaccine in children

폐구균 단백 결합 백신의 효능 및 효과

  • Lee, Hoan Jong (Department of Pediatrics, Seoul National University College of Medicine)
  • 이환종 (서울대학교 의과대학 소아과학교실)
  • Received : 2006.02.20
  • Accepted : 2006.02.22
  • Published : 2006.03.15
Download PDF
⟨ Previous Next ⟩

Abstract

Streptococus pneumoniae is an important cause of invasive infections as well as non-invasive infections such as acute otitis media and sinusitis both in children and adults. Resistance of S. pneumoniae to multiple antimicrobials is increasing and poses therapeutic challenges, and prevention became more important. 23-valent polysaccharide vaccine has been used for the last several decades, but is not effective in children <2 years of age, the highest risk group of invasive diseases. Recently, a 7-valent pneumococcal protein conjugate vaccine(PCV) which is effective in infants and young children has been developed. The efficacy of PCVs against invasive pneumococcal disease and pneumonia is well established and is documented in several well-conducted studies. However, the effect of PCVs on otitis media is less obvious and more complex. PCVs clearly reduce diseases caused by vaccine-type(VT) pneumococci, but replacement of VT serotypes by non-VT serotypes in nasopharyngeal carriage of S. pneumoniae is responsible for the increase in acute otitis media caused by non-VT serotypes. Three years after introduction of PCV in the US, some increase of invasive infections with serotype 19A possibly due to serotype switching within certain vaccine type strains has been noted. Since most antibiotic-resistance in S. pneumoniae is confined to VT serotypes, vaccine use also reduces antibiotic resistance. With development of PCV, there was a great advance in the prevention of pneumococcal diseases, but replacement with potential virulent organisms and development of antibiotic resistance in non-VT pneumococci is a possibility that needs careful monitoring.

Keywords

References

  1. O'Brien KL, Santosham M. Potential impact of conjugate pneumococcal vaccines on pediatric pneumococcal diseases. Am J Epidemiol 2004;159:634-44 https://doi.org/10.1093/aje/kwh082
  2. Dagan R, Jacobs MR, Greenberg D. Pneumococcal infections. In : Feigin RD, Cherry JD, Demmler GJ, Kaplan S (eds). Textbook of Pediatric Infectious Diseases. 5th ed. Vol. 1. Philadelphia : WB Saunders; 2004:1204-58
  3. American Academy of Pediatrics, Committee on Infectious Diseases. Policy statement : recommendations for the prevention of pneumococcal infections, including the use of pneumococcal conjugate vaccine(Prevnar), pneumococcal polysaccharide vaccine, and antibiotic prophylaxis. Pediatrics 2000;106:362-6 https://doi.org/10.1542/peds.106.2.362
  4. Centers for Disease Control. Preventing pneumococcal disease among infants and young children: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Morb Mortal Wkly Rep 2000;46:1-24
  5. Korean Pediatric Society, Committee on Infectious Diseases. Guideline for immunization in Korean infants and children. 5th edition, Kwang Moon Press, Seoul, Korea, 2002 p181-203
  6. O'Brien KL, Moulton LH, Reid R, Weatherholtz R, Oski J, Brown L, et al. Efficacy and safety of seven-valent conjugate pneumococcal vaccine in American Indian children : group randomised trial. Lancet 2003;362:355-61 https://doi.org/10.1016/S0140-6736(03)14022-6
  7. Lee HJ. Pneumococcal protein conjugate vaccine. Korean J Pediatr Infect Dis 2000;7:20-30
  8. Lee HJ. Immunogenicity and safety of pneumococcal protein conjugate vaccine. Korean J Pediatr Infect Dis 2003;10;145-52 https://doi.org/10.14776/kjpid.2003.10.2.145
  9. Black S, Shinefield H, Fireman B, Lewis E, Ray P, Hansen JR, et al. Efficacy, safety and immunogenicity of heptavalent pneumococcal conjugate vaccine in children. Pediatr Infect Dis J 2000;19:187-95 https://doi.org/10.1097/00006454-200003000-00003
  10. Klugman KP, Madhi SA, Huebner RE, Kohberger R, Mbelle N, Pierce N, et al. A trial of a 9-valent pneumococcal conjugate vaccine in children with and those without HIV infection. N Engl J Med 2003;349:1341-8 https://doi.org/10.1056/NEJMoa035060
  11. Madhi SA, Klugman KP : Vaccine Trialist Group. A role for Streptococcus pneumoniae in virus-associated pneumonia. Nat Med 2004;10:811-3 https://doi.org/10.1038/nm1077
  12. Cutts FT, Zaman SM, Enwere G, Jaffar S, Levine OS, Okoko JB, et al. Gambian Pneumococcal Vaccine Trial Group. Efficacy of nine-valent pneumococcal conjugate vaccine against pneumonia and invasive pneumococcal disease in The Gambia : randomised, double-blind, placebocontrolled trial. Lancet 2005;365:1139-46 https://doi.org/10.1016/S0140-6736(05)71876-6
  13. Whitney CG, Farley MM, Hadler J, Harrison LH, Bennett NM, Lynfield R, et al. Decline in invasive pneumococcal disease after the introduction of protein-polysaccharide conjugate vaccine. N Engl J Med 2003;348:1737-46 https://doi.org/10.1056/NEJMoa022823
  14. Pai R, Moore MR, Pilishvili T, Gertz RE, Whitney CG, Beall B, et al. Postvaccine genetic structure of Streptococcus pneumoniae serotype 19A from children in the United States. J Infect Dis 2005;192:1988-95 https://doi.org/10.1086/498043
  15. Dagan R, Melamed R, Muallem M, Piglansky L, Greenberg D, Abramson O, et al. Reduction of nasopharyngeal carriage of pneumococci during the second year of life by a heptavalent conjugate pneumococcal vaccine. J Infect Dis 1996;174:1271-8 https://doi.org/10.1093/infdis/174.6.1271
  16. O'Brien KL, Dagan R. The potential indirect effect of conjugate pneumococcal vaccines. Vaccine 2003;21:1815-25 https://doi.org/10.1016/S0264-410X(02)00807-1
  17. Bogaert D, De Groot R, Hermans PW. Streptococcus pneumoniae colonisation : the key to pneumococcal disease. Lancet Infect Dis 2004;4:144-54 https://doi.org/10.1016/S1473-3099(04)00938-7
  18. Dagan R, Givon-Lavi N, Zamir O, Fraser D. Effect of a nonavalent conjugate vaccine on carriage of antibiotic-resistant Streptococcus pneumoniae in day-care centers. Pediatr Infect Dis J 2003;22:532-40 https://doi.org/10.1097/00006454-200306000-00009
  19. Givon-Lavi N, Fraser D, Dagan R. Vaccination of day-care center attendees reduces carriage of Streptococcus pneumoniae among their younger siblings. Pediatr Infect Dis J 2003;22:524-32 https://doi.org/10.1097/00006454-200306000-00008
  20. Black S, Shinefield H, Baxter R, Austrian R, Bracken L, Hansen J, et al. Postlicensure surveillance for pneumococcal invasive disease after use of heptavalent pneumococcal conjugate vaccine in Northern California Kaiser Permanente. Pediatr Infect Dis J 2004;23:485-9 https://doi.org/10.1097/01.inf.0000129685.04847.94
  21. Schuchat A, Flannery B, Heffernan R. Invasive pneumococcal disease in HIV-AIDS : has introduction of 7-valent pneumococcal conjugate vaccine(PCV-7) reduced HIVrelated disease burden in the US? Paper presented at : 4th International Symposium on Pneumococci and Pneumococcal Diseases; 2004; Helsinki, Finland. Abstract EPI-05, May 9-13, 2004
  22. Bogaert D, van Belkum A, Sluijter M, Luijendijk A, de Groot R, Rumke HC. et al. Colonisation by Streptococcus pneumoniae and Staphylococcus aureus in healthy children. Lancet 2004;363:1871-2 https://doi.org/10.1016/S0140-6736(04)16357-5
  23. Regev-Yochay G, Dagan R, Raz M, Carmeli Y, Shainberg B, Derazne E, et al. Association between carriage of Streptococcus pneumoniae and Staphylococcus aureus in children. JAMA 2004;292:716-20 https://doi.org/10.1001/jama.292.6.716
  24. Dagan R, Sikuler-Cohen M, Zamir O, Janco J, Givon-Lavi N, Fraser D. Effect of a conjugate pneumococcal vaccine on the occurrence of respiratory infections and antibiotic use in day-care center attendees. Pediatr Infect Dis J 2001; 20:951-8 https://doi.org/10.1097/00006454-200110000-00008
  25. Fireman B, Black SB, Shinefield HR, Lee J, Lewis E, Ray P. Impact of the pneumococcal conjugate vaccine on otitis media. Pediatr Infect Dis J 2003;22:10-6 https://doi.org/10.1097/00006454-200301000-00006
  26. Kyaw MH. National trends in antibiotic resistant invasive pneumococcal disease in the conjugate vaccine era. Paper presented at : 43rd Interscience Conference on Antimicrobial Agents and Chemotherapy; 2003; Chicago, IL. Abstract G-2045
  27. Porat N, Barkai G, Jacobs MR, Trefler R, Dagan R. Four antibiotic resistant S. pneumoniae clones unrelated to the pneumococcal conjugate vaccine serotypes, including 2 new serotypes, causing acute otitis media in southern Israel. J Infect Dis 2004;189:385-92 https://doi.org/10.1086/381183
  28. Moore M, Park S, Hennessy T. Impact of a PCV7 vaccine on carriage of nonsuceptible pneumococci in urban Alaska children. Paper presented at : 4th International Symposium on Pneumococci and Pneumococcal Diseases; 2004; Helsinki, Finland
  29. Eskola J, Kilpi T, Palmu A, Jokinen J, Haapakoski J, Herva E. Efficacy of a pneumococcal conjugate vaccine against acute otitis media. N Engl J Med 2001;344:403-9 https://doi.org/10.1056/NEJM200102083440602
  30. Kilpi T, Ahman H, Jokinen J, Lankinen KS, Palmu A, Savolainen H. Protective efficacy of a second pneumococcal conjugate vaccine against pneumococcal acute otitis media in infants and children : randomized, controlled trial of a 7-valent pneumococcal polysaccharide-meningococcal outer membrane protein complex conjugate vaccine in 1666 children. Clin Infect Dis 2003;37:1155-64 https://doi.org/10.1086/378744
  31. Veenhoven R, Bogaert D, Uiterwaal C, Brouwer C, Kiezebrink H, Bruin J. Effect of conjugate pneumococcal vaccine followed by polysaccharide pneumococcal vaccine on recurrent acute otitis media : a randomized study. Lancet 2003; 361:2189-95 https://doi.org/10.1016/S0140-6736(03)13772-5
  32. Dagan R. The potential effect of widespread use of pneumococcal conjugate vaccines on the practice of pediatric otolaryngology : the case of acute otitis media. Current Opinion in Otolaryngology & Head and Neck Surgery 2004; 12:488-94 https://doi.org/10.1097/01.moo.0000145958.12395.ec
  33. Rennels MB, Edwards KM, Keyserling HL, Reisinger KS, Hogerman DA, Madore DV. Safety and immunogenicity of heptavalent pneumococcal vaccine conjugated to CRM197 in United States infants. Pediatrics 1998;101:604-11 https://doi.org/10.1542/peds.101.4.604
  34. Shinefield HR, Black S, Ray P, Chang I, Lewis N, Fireman B. Safety and immunogenicity of heptavalent pneumococcal CRM197 conjugate vaccine in infants and toddlers. Pediatr Infect Dis J 1999;18:757-63 https://doi.org/10.1097/00006454-199909000-00004