Current Infectious Disease Reports

, Volume 10, Issue 3, pp 182–191

The effect of vaccination on Streptococcus pneumoniae resistance

Article

Abstract

Following the introduction of the 7-valent pneumococcal conjugate vaccine (PCV-7) in the routine immunization schedule of US children, the morbidity and mortality associated with Streptococcus pneumoniae infections have changed considerably. Post-licensure data from the United States have confirmed that PCV-7 has significantly decreased the incidence of vaccine-type susceptible and antibiotic-resistant invasive pneumococcal diseases, community-acquired respiratory infections, and nasopharyngeal colonization in vaccinated individuals and their contacts. An unintended consequence of immunization with PCV-7 is the simultaneous increase in the carriage rates of non-vaccine-serotype pneumococci (some of which are highly antibiotic-resistant) among vaccinated children (ie, replacement phenomenon). Neither the implications of increased non-vaccine-type colonization nor the additional role of inappropriate antibiotic use in this process is clearly understood, but the greatest concern is that replacement colonization may result in replacement disease. Future vaccination with PCV-7 in European countries could provide additional information.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References and Recommended Reading

  1. 1.
    American Academy of Pediatrics: 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, 106:362–366.CrossRefGoogle Scholar
  2. 2.
    Advisory Committee on Immunization Practices: Preventing pneumococcal disease among infants and children. MMWR Morb Mort Wkly Rep 2000, 49(RR-9):1–35.Google Scholar
  3. 3.
    Black S, Shinefield H, Fireman B, et al.: Efficacy, safety and immunogenicity of heptavalent pneumococcal conjugate vaccine in children. Northern California Kaiser Permanente Vaccine Study Center Group. Pediatric Infect Dis J 2000, 19:187–195.CrossRefGoogle Scholar
  4. 4.
    Block SL: Causative pathogens, antibiotic resistance and therapeutic considerations in acute otitis media. Pediatr Infect Dis J 1997, 16:449–456.PubMedCrossRefGoogle Scholar
  5. 5.
    Jacobs MR, Dagan R, Appelbaum PC, Burch DJ: Prevalence of antimicrobial-resistant pathogens in middle ear fluid: multinational study of 917 children with acute otitis media. Antimicrob Agents Chemother 1998, 42:589–595.PubMedGoogle Scholar
  6. 6.
    Doern GV, Pfaller MA, Kugler K, et al.: Prevalence of antimicrobial resistance among respiratory tract isolates of Streptococcus pneumoniae in North America: 1997 results from the SENTRY antimicrobial surveillance program. Clin Infect Dis 1998, 27:764–770.PubMedCrossRefGoogle Scholar
  7. 7.
    Dagan R: Clinical significance of resistant organisms in otitis media. Pediatr Infect Dis J 2000, 19:378–382.PubMedCrossRefGoogle Scholar
  8. 8.
    Sagraves R: Increasing antibiotic resistance: its effect on the therapy for otitis media. J Pediatr Health Care 2002, 16:79–85.PubMedGoogle Scholar
  9. 9.
    Leibovitz E, Raiz S, Piglansly L, et al.: Resistance pattern of middle ear fluid isolates in acute otitis media recently treated with antibiotics. Pediatr Infect Dis J 1998, 17:463–469.PubMedCrossRefGoogle Scholar
  10. 10.
    Leibovitz E, Dagan R: Otitis media therapy and drug resistance. Part 1: Management principles. Infect Med 2001, 18:212–216.Google Scholar
  11. 11.
    Jacobs MR, Felmingham D, Appelbaum PC, Gruneberg RN: The Alexander Project 1998–2000: susceptibility of pathogens isolated from community-acquired respiratory tract infection to commonly used antimicrobial agents. J Antimicrob Chemother 2003, 52:229–246.PubMedCrossRefGoogle Scholar
  12. 12.
    Dagan R, Givon-Lavi N, Shkolnik L, et al.: Acute otitis media caused by antibiotic-resistant Streptococcus pneumoniae in Southern Israel: Implication for immunizing with conjugate vaccines. J Infect Dis 2000, 181:1322–1329.PubMedCrossRefGoogle Scholar
  13. 13.
    Hausdorff WP, Yothers G, Dagan R, et al.: Multinational study of pneumococcal serotypes causing acute otitis media in children. Pediatr Infect Dis J 2002, 21:1008–1016.PubMedCrossRefGoogle Scholar
  14. 14.
    Joloba ML, Windau A, Bajaksouzian S, et al.: Pneumococcal conjugate vaccine serotypes of Streptococcus pneumoniae isolates and the antimicrobial susceptibility of such isolates in children with otitis media. Clin Infect Dis 2001, 33:1489–1494.PubMedCrossRefGoogle Scholar
  15. 15.
    Klein JO: Microbiologic efficacy of antibacterial drugs for acute otitis media. Pediatr Infect Dis J 1993, 12:973–975.PubMedCrossRefGoogle Scholar
  16. 16.
    McIntosh K: Community-acquired pneumonia in children. N Engl J Med 2002, 346:429–437.PubMedCrossRefGoogle Scholar
  17. 17.
    Rudan I, Tomaskovic L, Boschi-Pinto C, Campbell H: Global estimate of the incidence of clinical pneumonia among children under five years of age. Bull World Health Organ 2004, 82:895–903.PubMedGoogle Scholar
  18. 18.
    Cutts FT, Zaman SM, Enwere G, et al.: Efficacy of nine-valent pneumococcal conjugate vaccine against pneumonia and invasive pneumococcal disease in The Gambia: randomized, double blind, placebo-controlled trial. Lancet 2005, 365:1139–1146.PubMedCrossRefGoogle Scholar
  19. 19.
    Juven T, Mertsola J, Toikka P, et al.: Clinical profile of serologically diagnosed pneumococcal pneumonia. Pediatr Infect Dis J 2001, 20:1028–1033.PubMedCrossRefGoogle Scholar
  20. 20.
    Michelow IC, Olsen K, Losano J, et al.: Epidemiology and clinical characteristics of community-acquired pneumonia in hospitalized children. Pediatrics 2004, 113:701–707.PubMedCrossRefGoogle Scholar
  21. 21.
    Byington CL, Samore MH, Stoddard GJ, et al.: Temporal trends of invasive disease due to Streptococcus pneumoniae among children in the intermountain west: emergence of nonvaccine serogroups. Clin Infect Dis 2005, 41:21–29.PubMedCrossRefGoogle Scholar
  22. 22.
    Whitney CG, Farley MM, Hadler J, et al.: Increasing prevalence of multidrug resistant Streptococcus pneumoniae in the United States. N Engl J Med 2000, 343:1917–1924.PubMedCrossRefGoogle Scholar
  23. 23.
    Kaplan SL, Mason EO Jr, Barson WJ, et al.: Outcome of invasive infections outside the central nervous system caused by Streptococcus pneumoniae isolates nonsusceptible to ceftriaxone in children treated with beta-lactam antibiotics. Pediatr Infect Dis J 2001, 20:392–396.PubMedCrossRefGoogle Scholar
  24. 24.
    Feikin DR, Schuchat A, Kolczak M, et al.: Mortality from invasive pneumococcal pneumonia in the era of antibiotic resistance: 1995–1997. Am J Public Health 2000, 90:223–229.PubMedCrossRefGoogle Scholar
  25. 25.
    Gay K, Baughman W, Miller Y, et al.: The emergence of Streptococcus pneumoniae resistant to macrolide antimicrobial agents: a six-year population-based assessment. J Infect Dis 2000, 182:1417–1424.PubMedCrossRefGoogle Scholar
  26. 26.
    Hyde TB, Gay K, Stephens DS, et al.: Macrolide resistance among invasive Streptococcus pneumoniae isolates. JAMA 2001, 286:1857–1862.PubMedCrossRefGoogle Scholar
  27. 27.
    Stephens DS, Zughaier SM, Whitney CG, et al.: Incidence of macrolide resistance in Streptococcus pneumoniae after introduction of the pneumococcal conjugate vaccine: population-based assessment. Lancet 2005, 365:855–863.PubMedCrossRefGoogle Scholar
  28. 28.
    Fuller JD, McGeer A, Low DE: Drug-resistant pneumococcal pneumonia: clinical relevance and approach to management. Eur J Clin Microbiol 2005, 24:780–788.CrossRefGoogle Scholar
  29. 29.
    Lujan M, Gallego M, Fontanals D, et al.: Prospective observational study of bacteremic pneumococcal pneumonia: effect of discordant therapy on mortality. Crit Care Med 2004, 32:625–631.PubMedCrossRefGoogle Scholar
  30. 30.
    Tan TQ, Mason BO Jr, Barson WJ, et al.: Clinical characteristics and outcome of children with pneumonia attributable to penicillin-susceptible and penicillin-nonsusceptible Steptococcus pneumoniae. Pediatrics 1998, 102:1369–1375.PubMedCrossRefGoogle Scholar
  31. 31.
    Paganini H, Guinzau JR, Hernandez C, et al.: Comparative analysis of outcome and clinical features in children with pleural empyema caused by penicillin-nonsusceptible and penicillin-susceptible Streptococcus pneumoniae. Int J Infect Dis 2001, 5:86–88.PubMedCrossRefGoogle Scholar
  32. 32.
    Lee GM, Harper MB: Risk of bacteremia for febrile young children in the post Haemophilus influenzae type B era. Arch Pediatr Adolesc Med 1999, 152:624–628.Google Scholar
  33. 33.
    Tan TQ: Antibiotic resistant infections due to Streptococcus pneumoniae: impact on therapeutic options and clinical outcome. Curr Opin Infect Dis 2003, 16:271–277.PubMedGoogle Scholar
  34. 34.
    Butler JC, Breiman RF, Lipman HB, et al.: Serotype distribution of Streptococcus pneumoniae infections among preschool children in the United States, 1978–1994: implications for development of a conjugate vaccine. J Infect Dis 1995, 171:885–889.PubMedGoogle Scholar
  35. 35.
    Black S, France EK, Isaacman D, et al.: Surveillance for invasive pneumococcal disease during 2000–2005 in a population of children who received 7-valent pneumococcal conjugate vaccine. Pediatr Infect Dis J 2007, 26:771–777.PubMedCrossRefGoogle Scholar
  36. 36.
    Turett GS, Blum S, Fazal BA, et al.: Penicillin resistance and other predictors of mortality in pneumococcal bacteremia in a population with high human immunodeficiency virus seroprevalence. Clin Infect Dis 1999, 29:321–327.PubMedCrossRefGoogle Scholar
  37. 37.
    Buckingham SC, McCullers JA, Lujan-Zilberman J, et al.: Pneumococccal meningitis in children: relationship of antibiotic resistance to clinical characteristics and outcomes. Pediatr Infect Dis J 2001, 20:837–843.PubMedCrossRefGoogle Scholar
  38. 38.
    Fiore AE, Moroney JF, Farley MM, et al.: Clinical outcome of meningitis caused by Streptococcus pneumoniae in the era of antibiotic resistance. Clin Infect Dis 2000, 30:71–77.PubMedCrossRefGoogle Scholar
  39. 39.
    Bogaert D, De Groot R, Hermans PW: Streptococcus pneumoniae colonisation: the key to pneumococcal disease. Lancet Infect Dis 2004, 4:144–154.PubMedCrossRefGoogle Scholar
  40. 40.
    Brueggemann AB, Griffiths DT, Meats E, et al.: Clonal relationship between invasive and carriage Streptococcus pneumoniae and serotype-and clone-specific differences in invasive disease potential. J Infect Dis 2003, 187:1424–1432.PubMedCrossRefGoogle Scholar
  41. 41.
    Fireman B, Black SB, Shinefield HR, et al.: Impact of the pneumococcal conjugate vaccine on otitis media. Pediatr Infect Dis J 2003, 22:10–16.PubMedCrossRefGoogle Scholar
  42. 42.
    Eskola J, Kilpi T, Palmu A, et al.: Efficacy of a pneumococcal conjugate vaccine against acute otitis media. N Engl J Med 2001, 344:403–409.PubMedCrossRefGoogle Scholar
  43. 43.
    Dagan R, Sikuler-Cohen M, Zamir O, et al.: Effect of a conjugate vaccine on the occurrence of respiratory infections and antibiotic use in day-care center attendees. Pediatr Infect Dis J 2001, 20:951–958.PubMedCrossRefGoogle Scholar
  44. 44.
    Prymula R, Peeters P, Chrobok V, et al.: Pneumococcal capsular polysaccharide conjugated to protein D for prevention of acute otitis media caused by both Streptococcus pneumoniae and non-typable Haemophilus influenzae: a randomized double-blind efficacy study. Lancet 2006, 367:740–748.PubMedCrossRefGoogle Scholar
  45. 45.
    Veenhoven R, Bogaert D, Uiterwaal C, et al.: Effect of conjugate pneumococcal vaccine followed by polysaccharide pneumococcal vaccine on recurrent acute otitis media: a randomized study. Lancet 2003, 361:2189–2195.PubMedCrossRefGoogle Scholar
  46. 46.
    Casey J, Pichichero ME: Changes in frequency and pathogens causing acute otitis media in 1995–2003. Pediatr Infect Dis J 2004, 23:824–828.PubMedCrossRefGoogle Scholar
  47. 47.
    Block SL, Hedrick J, Harrison CJ, et al.: Community-wide vaccination with the heptavalent pneumococcal conjugate alters the microbiology of acute otitis media. Pediatr Infect Dis J 2004, 23:829–833.PubMedCrossRefGoogle Scholar
  48. 48.
    Poehling KA, Lafleur BJ, Szilagyi PG, et al.: Population-based impact of pneumococcal conjugate vaccine in young children. Pediatrics 2004, 114:755–761.PubMedCrossRefGoogle Scholar
  49. 49.
    Poehling KA, Szilagyi PG, Grijalva CG, et al.: Reduction of frequent otitis media and pressure-equalizing tube insertions in children after introduction of pneumococcal conjugate vaccine. Pediatrics 2007, 119:707–715.PubMedCrossRefGoogle Scholar
  50. 50.
    Roddy MG, Glazier SS, Agrawal D: Pediatric mastoiditis in the pneumococcal conjugate vaccine era. Symptom duration guides empiric antimicrobial therapy. Pediatr Emerg Care 2007, 23:779–784.PubMedCrossRefGoogle Scholar
  51. 51.
    Brook I, Foote A, Hausfeld JN: Frequency of recovery of pathogens causing acute maxillary sinusitis in adults before and after introduction of vaccination with the 7-valent pneumococcal vaccine. J Med Microbiol 2006, 55:943–946.PubMedCrossRefGoogle Scholar
  52. 52.
    Brook I, Gober AE: Frequency of recovery of pathogens from the nasopharynx of children with acute maxillary sinusitis before and after the introduction of vaccination with the 7-valent pneumococcal vaccine. Int J Pediatr Otorhinolaryngol 2007, 71:575–579.PubMedCrossRefGoogle Scholar
  53. 53.
    Black SB, Shinefield HR, Ling S, et al.: Effectiveness of heptavalent pneumococcal conjugate vaccine in children younger than five years of age for prevention of pneumonia. Pediatr Infect Dis J 2002, 21:810–815.PubMedCrossRefGoogle Scholar
  54. 54.
    Madhi SA, Kuwanda L, Cutland C, Klugman KP: The impact of a 9-valent pneumococcal conjugate vaccine on the public health burden of pneumonia in HIV-infected and-uninfected children. Clin Infect Dis 2005, 40:1511–1518.PubMedCrossRefGoogle Scholar
  55. 55.
    Madhi SA, Klugman KP: A role for Streptococcus pneumoniae in virus-associated pneumonia. Nature Medicine 2004, 10:811–813.PubMedCrossRefGoogle Scholar
  56. 56.
    Grijalva CG, Nuorti JP, Arbogast PG, et al.: Decline in pneumonia admissions after routine childhood immunization with pneumococcal conjugate vaccine in the USA: a time-series analysis. Lancet 2007, 369:1179–1186.PubMedCrossRefGoogle Scholar
  57. 57.
    Hansen J, Black S, Shinefield H, et al.: Effectiveness of heptavalent pneumococcal conjugate vaccine in children younger than 5 years of age for prevention of pneumonia. Pediatr Infect Dis J 2006, 25:779–781.PubMedCrossRefGoogle Scholar
  58. 58.
    Byington CL, Korgenski K, Daly J, et al.: Impact of the pneumococcal conjugate vaccine on pneumococcal parapneumonic empyema. Pediatr Infect Dis J 2006, 25:250–254.PubMedCrossRefGoogle Scholar
  59. 59.
    O’Brien KL, Moulton LH, Reid R, et al.: Efficacy and safety of seven-valent conjugate pneumococcal vaccine in American Indian children: group randomized trial. Lancet 2003, 362:355–361.PubMedCrossRefGoogle Scholar
  60. 60.
    Whitney CG, Pilishvili T, Farley MM, et al.: Effectiveness of seven-valent pneumococcal conjugate vaccine against pneumococcal disease: a matched case-control study. Lancet 2006, 368:1495–1502.PubMedCrossRefGoogle Scholar
  61. 61.
    Poehling KA, Talbot TR, Griffin MR, et al.: Invasive pneumococcal disease among infants before and after introduction of pneumococcal conjugate vaccine. JAMA 2006, 295:1668–1674.PubMedCrossRefGoogle Scholar
  62. 62.
    Dagan R, Melamed R, Muallem M, et al.: Reduction of nasopharyngeal carriage during the second year of life by a heptavalent conjugate pneumococcal vaccine. J Infect Dis 1996, 174:1271–1278.PubMedGoogle Scholar
  63. 63.
    Dagan R, Givon-Lavi N, Zamir O, et al.: Reduction of nasopharyngeal carriage of Streptococcus pneumoniae after administration of a 9-valent pneumococcal conjugate vaccine in toddlers attending day care centers. J Infect Dis 2002, 185:927–936.PubMedCrossRefGoogle Scholar
  64. 64.
    Dagan R, Givon-Lavi N, Zamir O, Fraser D: Effect of a non-valent conjugate vaccine on carriage of antibiotic-resistant Streptococcus pneumoniae in day care centers. Pediatr Infect Dis J 2003, 22:532–539.PubMedCrossRefGoogle Scholar
  65. 65.
    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, 22:524–532.PubMedCrossRefGoogle Scholar
  66. 66.
    Ghaffar F, Barton T, Lozano J, et al.: Effect of the 7-valent pneumococcal conjugate vaccine on nasopharyngeal colonization by Streptococcus pneumoniae in the first 2 years of life. Clin Infect Dis 2004, 39:930–938.PubMedCrossRefGoogle Scholar
  67. 67.
    Frazao N, Brito-Avo A, Simas C, et al.: Effect of the seven-valent conjugate pneumococcal vacine on the carriage and drug resistance of Streptococcus pneumoniae in healthy children attending day-care centers in Lisbon. Pediatr Infect Dis J 2005, 24:243–252.PubMedCrossRefGoogle Scholar
  68. 68.
    McCraig LF, Besser RF, Hughes JM: Antimicrobial drug prescription in ambulatory care setting, United States, 1992–2000. Emerg Infect Dis 2003, 9:432–437.Google Scholar
  69. 69.
    Dagan R, Barkai G, Leibovitz E, et al.: Will reduction of antibiotic use reduce antibiotic resistance? The pneumococcus paradigm. Pediatr Infect Dis J 2006, 25:981–986.PubMedCrossRefGoogle Scholar
  70. 70.
    Cohen R, Levy C, de La Rocque F, et al.: Impact of pneumococcal conjugate vaccine and of reduction of antibiotic use on nasopharyngeal carriage of nonsusceptible pneumococci in children with acute otitis media. Pediatr Infect Dis J 2006, 25:1001–1007.PubMedCrossRefGoogle Scholar
  71. 71.
    Pelton SI, Loughlin AM, Marchant CD: Seven valent pneumococcal conjugate vaccine immunization in two Boston communities. Changes in serotypes and antimicrobial susceptibility among Streptococcus pneumoniae isolates. Pediatr Infect Dis J 2004, 23:1015–1022.PubMedCrossRefGoogle Scholar
  72. 72.
    Moore MR, Hyde TB, Hennessy TW, et al.: Impact of a conjugate vaccine on community-wide carriage of nonsusceptible Streptococcus pneumoniae in Alaska. J Infect Dis 2004, 190:2031–2038.PubMedCrossRefGoogle Scholar
  73. 73.
    Byington CL, Samore MH, Stoddard GJ, et al.: Temporal trends of invasive disease due to Streptococcus pneumoniae among children in the intermountain West: emergence of nonvaccine serogroups. Clin Infect Dis 2005, 41:21–29.PubMedCrossRefGoogle Scholar
  74. 74.
    Pai R, Moore MR, Pilishvili T, et al.: Postvaccine genetic structure of Streptococcus pneumoniae serotype 19A from children in the United States. J Infect Dis 2005, 192:1988–1995.PubMedCrossRefGoogle Scholar
  75. 75.
    Kyaw MH, Lynfield R, Schaffner W, et al.: Effect of introduction of the pneumococcal conjugate vaccine on drug-resistant Streptococcus pneumoniae. N Engl J Med 2006, 354:1455–1463.PubMedCrossRefGoogle Scholar
  76. 76.
    Farrell DJ, Klugman KP, Pichichero M: Increased antimicrobial resistance among nonvaccine serotypes of Streptococcus pneumoniae in the pediatric population after the introduction of 7-valent pneumococcal vaccine in the United States. Pediatr Infect Dis J 2007, 26:123–128.PubMedCrossRefGoogle Scholar
  77. 77.
    Messina AF, Katz-Gaynor K, Barton T, et al.: Impact of the pneumococcal conjugate vaccine on serotype distribution and antimicrobial resistance of invasive Streptococcus pneumoniae isolates in Dallas, TX, children from 1999 through 2005. Pediatr Infect Dis J 2007, 26:461–467.PubMedCrossRefGoogle Scholar
  78. 78.
    O’Brien KL, Dagan R: The potential indirect effect of conjugate pneumococcal vaccines. Vaccine 2003, 21:1815–1825.PubMedCrossRefGoogle Scholar
  79. 79.
    Porat N, Barkai G, Jacobs MR, et al.: Four antibiotic-resistant Streptococcus pneumoniae clones unrelated to the pneumococcal conjugate vaccine serotypes, including 2 new serotypes, causing acute otitis media in southern Israel. J Infect Dis 2004, 189:385–392.PubMedCrossRefGoogle Scholar
  80. 80.
    Porat N, Arguedas A, Spratt BG, et al.: Emergence of penicillin-nonsusceptible Streptococcus pneumoniae clones expressing serotypes not present in the antipneumococcal conjugate vaccine. J Infect Dis 2004, 190:2154–2161.PubMedCrossRefGoogle Scholar
  81. 81.
    Pelton SI, Huot H, Finkelstein JA, et al.: Emergence of 19A as virulent and multidrug resistant pneumococcus in Massachusetts following universal immunization of infants with pneumococcal conjugate vaccine. Pediatr Infect Dis J 2007, 26:468–472.PubMedCrossRefGoogle Scholar
  82. 82.
    Pichichero ME, Casey JR: Emergence of a multiresistant serotype 19A pneumococcal strain not included in the 7-valent conjugate vaccine as an otopathogen in children. JAMA 2007, 298:1772–1778.PubMedCrossRefGoogle Scholar
  83. 83.
    Klugman KP, McGee L: Resurgence of the multiresistant pneumococcus in the United States: a commentary. Pediatr Infect Dis J 2007, 26:473–474.PubMedCrossRefGoogle Scholar
  84. 84.
    Dagan R, Givon-Lavi N, Leibovitz E, Porat N: Increased importance of antibiotic-resistant Streptococcus pneumoniae serotype 19A in acute otitis media occurring before introduction of 7-valent pneumococcal conjugate vaccine in southern Israel [abstract G-1001]. Presented at 47th Interscience Conference on Antimicrobial Agents and Chemotherapy. Chicago, IL; September 17–20, 2007.Google Scholar

Copyright information

© Current Medicine Group LLC 2008

Authors and Affiliations

  1. 1.Pediatric Infectious Disease UnitSoroka University Medical CenterBeer-ShevaIsrael

Personalised recommendations