Pneumococcal Vaccines – How Many Serotypes are Enough?

Review Article

Abstract

Streptococcus pneumoniae causes meningitis, pneumonia, septicemia, arthritis, sinusitis and otitis media specially in children and over 65 y age groups. It contributes significantly to under-five mortality and morbidity worldwide as well as in India. Use of pneumococcal vaccine seems to be the most effective measure to decrease the disease burden and reduction of under-five mortality. Many countries have already included Pneumococcal Conjugate Vaccines (PCV) in their National Immunization Programmes (NIP). Government of India has announced recently to include PCV13 in NIP in a phased manner. Superiority of a vaccine over the other depends upon serotype coverage, vaccine efficacy, cost effectiveness and safety profile. These facts will be discussed for the vaccines available in India. Further research is warranted to know the disease burden and develop vaccines to have more serotype coverage.

Keywords

Invasive pneumococcal disease (IPD) Pneumococcal conjugate vaccine (PCV) National immunization programme (NIP) 

References

  1. 1.
    UNICEF/WHO. Pneumonia: The forgotten killer of children. Geneva: WHO; s Available at: www.who.int/child_adolescent_health/documents/9280640489/en/. Accessed 3 May 2017.S
  2. 2.
    Dowell SF, Butler JC, Giebink GS, et al. Acute otitis media: management and surveillance in an era of pneumococcal resistance—a report from the drug-resistant Streptococcus pneumonia therapeutic working group. Pediatr Infect Dis J. 1999;18:1–9.CrossRefPubMedGoogle Scholar
  3. 3.
    Centers for Disease Control and Prevention. Preventing pneumococcal disease among infants and young children: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR. 2000;49:1–35.Google Scholar
  4. 4.
    Immunization, vaccine and biological. Pneumococcal disease World Health Organization (WHO). Available at: www.who.int/immunization/topics/pneumococcal_disease/en/. Accessed 9 May 2017.
  5. 5.
    Thacker N. Integrated management of neonatal and childhood illnesses: a new hope for child survival. Indian Pediatr. 2007;44:169–71.PubMedGoogle Scholar
  6. 6.
    Progress in introduction of pneumococcal conjugate vaccine - worldwide, 2000–2012. MMWR Morb Mortal Wkly Rep. 2013;62:308–11.Google Scholar
  7. 7.
    Song JY, Nahm MH, Moseley MA. Clinical implications of pneumococcal serotypes: invasive disease potential, clinical presentations, and antibiotic resistance. J Korean Med Sci. 2013;28:4–15.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Hausdorff WP, Feikin DR, Klugman KP. Epidemiological differences among pneumococcal serotypes. Lancet Infect Dis. 2005;5:83–93.CrossRefPubMedGoogle Scholar
  9. 9.
    Balaji V, Jayaraman R, Verghese VP, Baliga PR, Kurien T. Pneumococcal serotypes associated with invasive disease in under five children in India & implications for vaccine policy. Indian J Med Res. 2015;142:286–92.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Shariff M, Choudhary J, Zahoor S, Deb M. Characterization of Streptococcus pneumoniae isolates from India with special reference to their sequence types. J Infect Dev Ctries. 2013;7:101–9.CrossRefPubMedGoogle Scholar
  11. 11.
    Kim SH, Song JH, Chung DR, et al. Changing trends in antimicrobial resistance and serotypes of Streptococcus pneumoniae isolates in Asian countries: an Asian network for surveillance of resistant pathogens (ANSORP) study. Antimicrob Agents Chemother. 2012;56:1418–26.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Prospective multicentre hospital surveillance of Streptococcus pneumoniae disease in India. Invasive Bacterial Infection Surveillance (IBIS) Group, International Clinical Epidemiology Network (INCLEN). Lancet. 1999;353:1216-21Google Scholar
  13. 13.
    Paediatric on call. Child Health Care. Conjugate pneumococcal vaccine 2011. Available at: http://www.pediatriconcall.com/fordoctor/diseasesandcondition/immunization_vaccination/pneumococcal_vaccine.asp. Accessed 7 May 2017.
  14. 14.
    Indian Academy of Pediatrics Committee on Immunization (IAPCOI). Consensus recommendations on immunization, 2008. Indian Pediatr. 2008;45:635–648.Google Scholar
  15. 15.
    Indian Academy of Pediatrics Committee on Immunization (IAPCOI). Consensus recommendations on immunization and IAP immunization timetable 2012. Indian Pediatr. 2012;49:549-64.Google Scholar
  16. 16.
    DeStefano F, Pfeifer D, Nohynek H. Safety profile of pneumococcal conjugate vaccines: systematic review of pre- and post-licensure data. Bull World Health Org. 2008;86:373–80.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Wise RP, Iskander J, Pratt RD, et al. Post licensure safety surveillance for 7-valent pneumococcal conjugate vaccine. JAMA. 2004;292:1702–10.CrossRefPubMedGoogle Scholar
  18. 18.
    Bermal N, Szenborn L, Chrobot A, et al. The 10-valent pneumococcal non- typeable Haemophilus influenza protein D conjugate vaccine (PCV10) coadministered with DTPw-HBV/Hib and poliovirus vaccines: assessment of immunogenicity. Pediatr Infect Dis J. 2009;28:S89–96.CrossRefPubMedGoogle Scholar
  19. 19.
    Chevallier B, Vesikari T, Brzostek J, et al. Safety and reactogenicity of the 10-valent pneumococcal nontypeable Haemophilus influenzae protein D conjugate vaccine (PHiD-CV) when coadministered with routine childhood vaccines. Pediatr Infect Dis J. 2009;28:S109–18.CrossRefPubMedGoogle Scholar
  20. 20.
    Ruiz-Palacios GM, Guerrero ML, Hernández-Delgado L, et al. Immunogenicity, reactogenicity and safety of the 10-valent pneumococcal nontypeable Haemophilus influenzae protein D conjugate vaccine (PHiD-CV) in Mexican infants. Hum Vaccin. 2011;7:1137–45.CrossRefPubMedGoogle Scholar
  21. 21.
    Grimprel E, Laudat F, Patterson S, et al. Immunogenicity and safety of a 13-valent pneumococcal conjugate vaccine (PCV13) when given as a toddler dose to children immunized with PCV7 as infants. Vaccine. 2011;29:9675–83.CrossRefPubMedGoogle Scholar
  22. 22.
    Nunes MC, Madhi SA. Review on the immunogenicity and safety of PCV-13 in infants and toddlers. Exp Rev Vaccin. 2011;10:951–80.CrossRefGoogle Scholar
  23. 23.
    Kieninger DM, Kueper K, Steul K, et al. Safety, tolerability, and immunologic non-inferiority of a 13-valent pneumococcal conjugate vaccine compared to a 7-valent pneumococcal conjugate vaccine given with routine pediatric vaccinations in Germany. Vaccine. 2010;28:4192–203.CrossRefPubMedGoogle Scholar
  24. 24.
    Amdekar YK, Lalwani SK, Bavdekar A, et al. Immunogenicity and safety of a 13-valent pneumococcal conjugate vaccine in healthy infants and toddlers given with routine vaccines in India. Pediatr Infect Dis J. 2013;32:509–16.CrossRefPubMedGoogle Scholar
  25. 25.
    Lalwani S, Chatterjee S, Chhatwal J, et al. Immunogenicity, safety, and reactogenicity of the 10-valent pneumococcal non-typeable Hemophilus influenza protein D conjugate vaccine (PHiD-CV) when co-administered with the DTPw-HBV/Hib vaccine in Indian infants: a single-blind, randomized, controlled study. Hum Vaccin Immunother. 2012;8:612–22.CrossRefPubMedGoogle Scholar
  26. 26.
    Lucero MG, Dulalia VE, Nillos LT, et al. Pneumococcal conjugate vaccines for preventing vaccine-type invasive pneumococcal disease and X-ray defined pneumonia in children less than two years of age. Cochrane Database Syst Rev. 2009;4:CD004977.Google Scholar
  27. 27.
    Skinner JM, Indrawati L, Canon J, et al. Pre-clinical evaluation of a 15-valent pneumococcal conjugate vaccine (PCV15-CRM197) in an infant rhesus monkey immunogenicity model. Vaccine. 2011;29:8870–6.CrossRefPubMedGoogle Scholar
  28. 28.
    Madhi SA, Klugman KP. World Health Organization definition of “radiologically-confirmed pneumonia” may under-estimate the true public health value of conjugate pneumococcal vaccines. Vaccine. 2007;25:2413–9.CrossRefPubMedGoogle Scholar
  29. 29.
    Madhi SA, Klugman KP. The Vaccine Trialist Group. A role of Streptococcus Pneumoniae in virus-associated pneumonia. Nat Med. 2004;10:811-3.Google Scholar
  30. 30.
    Fletcher MA, Fritzell B. Brief review of the clinical effectiveness of PREVENAR against otitis media. Vaccine. 2007;25:2507–12.CrossRefPubMedGoogle Scholar
  31. 31.
    McEllistrem MC, Adams JM, Patel K, et al. Acute otitis media due to penicillin nonsusceptible Streptococcus Pneumoniae before and after the introduction of the pneumococcal conjugate vaccine. Clin Infect Dis. 2005;40:1738–44.CrossRefPubMedGoogle Scholar
  32. 32.
    Block SL, Hedrick J, Harrison CJ, et al. Community-wide vaccination with the heptavalent pneumococcal conjugate significantly alters the microbiology of acute otitis media. Pediatr Infect Dis J. 2004;23:829–33.CrossRefPubMedGoogle Scholar
  33. 33.
    Roca A, Hill PC, Townend J, et al. Effects of community-wide vaccination with PCV-7 on pneumococcal nasopharyngeal carriage in the Gambia: a cluster-randomized trial. PLoSMed. 2011;8:e1001107.Google Scholar
  34. 34.
    Blaschke AJ, Heyrend C, Byington CL, et al. Molecular analysis improves pathogen identification and epidemiologic study of pediatric parapneumonic empyema. Pediatr Infect Dis J. 2011;30:289–94.CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    Klok RM, Lindkvist RM, Ekelund M, et al. Cost-effectiveness of a 10- versus 13-valent pneumococcal conjugate vaccine in Denmark and Sweden. Clin Ther. 2013;35:119–34.CrossRefPubMedGoogle Scholar
  36. 36.
    Earnshaw SR, McDade CL, Zanotti G, et al. Cost-effectiveness of 2 + 1 dosing of 13-valent and 10-valent pneumococcal conjugate vaccines in Canada. BMC Infect Dis. 2012;12:101.CrossRefPubMedPubMedCentralGoogle Scholar
  37. 37.
    Chaiyakunapruk N, Somkrua R, Hutubessy R, et al. Cost effectiveness of pediatric pneumococcal conjugate vaccines: a comparative assessment of decision-making tools. BMC Med. 2011;9:53.CrossRefPubMedPubMedCentralGoogle Scholar
  38. 38.
    Pneumococcal vaccine. WHO position paper. 2012. Available at: http://www.who.int/immunization/documents/positionpapers/en/. Accessed 5 May 2017.
  39. 39.
    Saha SK, Darmstadt GL, Baqui AH, et al. Identification of serotype in culture negative pneumococcal meningitis using sequential multiplex PCR: implication for surveillance and vaccine design. PLoS One. 2008;3:e3576.CrossRefPubMedPubMedCentralGoogle Scholar
  40. 40.
    Bravo LC; Asian Strategic Alliance for Pneumococcal Disease Prevention (ASAP) Working Group. Overview of the disease burden of invasive pneumococcal disease in Asia. Vaccine. 2009;27:7282-91.Google Scholar
  41. 41.
    Centers for Disease Control and Prevention (CDC). Direct and indirect effects of routine vaccination of children with 7-valent pneumococcal conjugate vaccine on incidence of invasive pneumococcal disease - United States, 1998–2003. MMWR Morb Mortal Wkly Rep. 2005;54:893–7.Google Scholar
  42. 42.
    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;41:21–9.CrossRefPubMedGoogle Scholar
  43. 43.
    Katoh S, Suzuki M, Ariyoshi K, Morimoto K. Serotype replacement in adult pneumococcal pneumonia after the introduction of seven-valent pneumococcal conjugate vaccines for children in Japan: a systematic literature review and pooled data analysis. Jpn J Infect Dis. 2017; doi:10.7883/yoken.JJID.2016.311.
  44. 44.
    Blaschke AJ, Heyrend C, Byington CL, et al. Molecular analysis improves pathogen identification and epidemiologic study of pediatric parapneumonic empyema. Pediatr Infect Dis J. 2011;30:289–94.CrossRefPubMedPubMedCentralGoogle Scholar
  45. 45.
    Martens P, Worm SW, Lundgren B, Konradsen HB, Benfield T. Serotype-specific mortality from invasive Streptococcus Pneumoniae disease serotypes in the 13-valent pneumococcal conjugate vaccine. Vaccine. 2011;29:9127–31.CrossRefGoogle Scholar
  46. 46.
    Gopi T, Ranjith J, Anandan S, Balaji V. Epidemiological characterisation of streptococcus pneumonia from India using multilocus sequence typing. Indian J Med Microbiol. 2016;34:17–21.CrossRefPubMedGoogle Scholar

Copyright information

© Dr. K C Chaudhuri Foundation 2017

Authors and Affiliations

  1. 1.Department of PediatricsUniversity College of Medical Sciences and Guru Tegh Bahadur HospitalNew DelhiIndia
  2. 2.Department of Pediatrics, School of Medical Sciences and ResearchSharda UniversityGreater NoidaIndia

Personalised recommendations