Immunity pneumococcal polysaccharide vaccine

PCV 7, 7-valent pneumococcal conjugated vaccine PPV 23, 23-valent pneumococcal polysaccharide vaccine. From Advisory Committee on Immunization Practices,18 Committee on Infectious Diseases,16 and Sickle Cell Disease Care Consortium.27... 

The 23-valent pneumococcal polysaccharide vaccine contains 23 serotypes that are responsible for causing more than 80% of invasive S. pneumoniae infections in adults. The vaccine includes those serotypes that are associated with drug resistance. Use of the vaccine will not prevent the development of antibiotic-resistant S. pneumoniae, but is likely to prevent infection from drug-resistant strains. The 23-valent pneumococcal polysaccharide vaccine has demonstrated good immunogenicity in adults, but an individual will not develop immunity to all 23 serotypes following vaccination.10... 

Pneumococcal Polysaccharide. Pneumococcal polysaccharide vaccine may be used for immunization of persons two years of age or older who are at increased risk of pneumococcal disease. 

The question of whether revaccination with 23-valent pneumococcal polysaccharide vaccine (PPV) at least 5 years after the first vaccination is associated with more frequent or more serious adverse events than those after the first vaccination has been studied in patients aged 50-74 years who had never been vaccinated with PPV (n = 901) or who had been vaccinated once at least 5 years before enrolment (n = 513) (8). After one dose of PPV, local injection site reactions and prevaccination concentrations of type-specific antibodies were measured. Those who were re-vaccinated were more likely than those who received their first vaccinations to report a local injection site reaction of at least 10.2 cm (4 in.) in diameter within 2 days of vaccination (55/513 versus 29/ 901, or 11 versus 3%). The reactions resolved by a median of 3 days after vaccination. The highest rate was among revaccinated patients who were immune competent and did not have chronic illnesses 15% (33/228) compared with 3% (10/337) among comparable patients receiving their first vaccinations. The risk of these local reactions correlated significantly with prevaccination geometric mean antibody concentrations. The authors concluded that physicians and patients should be aware that selflimited local injection site reactions occur more often after revaccination compared with a first vaccination however, this risk does not represent a contraindication to revaccination with PPV in recommended patients. 

Kazancioglu R, Sever MS, Yuksel-Onel D, Eraksoy H, Yildiz A, Cehk AV, Kayacan SM, Badur S. Immunization of renal transplant recipients with pneumococcal polysaccharide vaccine. Clin Transplant 2000 14(l) 61-5. 

In vivo assessment of B-lymphocyte function involves immunizing the patient with a protein (e.g., tetanus toxoid) and a polysaccharide (e.g., pneumococcal polysaccharide vaccine) antigen to elicit and... 

Two different pneumococcal vaccines are available. The 7-valent pneumococcal conjugate vaccine (PCV 7 Prevnar) induces good antibody responses in infants. Immunization with the PCV 7 is recommended for all children less than 24 months of age. Infants should receive the first dose between 6 weeks and 6 months. Two additional doses should be given at approximately 2-month intervals, followed by a fourth dose at age 12 to 15 months. The 23-valent pneumococcal polysaccharide vaccine (PPV 23 Pneumovax 23) was not recommended for use in children less than 2 years of age because... 

Pneumococcal polysaccharide vaccine (Pneumovax 23 and Pnu-Immune 23) is a mixture of highly purified capsular polysaccharides from 23 of the most prevalent or invasive types of S. pneumoniae seen in the Umted States. Serotypes included are 1,2, 3, 4, 5, 6B, 7F, 8, 9N, 9V lOA, 12F, 14, 15B, 17F, 18C, 19A, 20, 22F, 23F, and 33F. These 23 types represent 85% to 90% of all blood isolates and 85% of pneumococcal isolates from other generally sterile sites seen in the United States. The vaccine is administered intramuscularly or subcutaneously as a single 0.5-mL dose. Each 0.5-mL dose of vaccine contains 25 meg of each polysaccharide type dissolved in isotonic saline solution (for a total of 575 meg polysaccharide) and 0.25% phenol as preservative. Significant cross-reactivity with other pneumococcal capsular antigens not represented in the vaccine does not... 

A study of 190 rheumatoid arthritis patients found reduced immune responses to the 23-valent pneumococcal polysaccharide vaccine (PCV23) in those patients who were on combination tocilizumab and methotrexate [98 ]. 

CDC. Recommendations of the Immunization Practices Advisory Committee pneumococcal polysaccharide vaccine. MMWR 1989 38 64-68, 73-76. 

Adults with HIV infection should be vaccinated with the 23-valent pneumococcal polysaccharide and hepatitis B vaccines as early in the course of the disease as possible. Inactivated influenza vaccine should be given yearly. Children should continue to receive vaccinations on the standard childhood immunization schedule. The individual may experience a transient elevation in HIV viral load following vaccination.17... 

Prevenar is the pneumococcal polysaccharide-conjugate vaccine and contains polysaccharide, from seven capsular types of pneumococci, which is conjugated to diphtheria toxin (protein). Prevenar is recommended for individuals at increased risk of pneumococcal infection including those over 65 years, patients with chronic heart, renal, respiratory or liver disease, diabetics and immune deficiency. It is a component of the primary course of childhood immunisation. 

S. pneumoniae has more than 80 sero-types. The current polysaccharide vaccine consists of 23 serotypes and covers about 87% of all pneumococcal diseases in the United States. Current vaccine development is based on conjugate technology and concentrates on die most prevalent 7-9 serotypes. Three multivalent vaccine candidates are in clinical trials. All are based on conjugating the polysaccharide to a T-dependent protein carrier. The results of phase 1 and 11 trials in infants have demonstrated the safety and immnnogenicity of these vaccines. Phase. Ill trials to demonstrate efficacy are in progress and final approval of this vaccine for infant immunization will be by the year 2000. 

Capsular polysaccharides purified from bacteria are almost non-toxic and considerably less toxic than the whole-cell and elicited anti-polysaccharide antibodies at a single dose of 10-50 pg [17]. The antibodies provide type-specific immunity lasting for several years in healthy humans [18]. The simplicity of polysaccharides as vaccines and its low toxicity prompted development of the first polysaccharidic pneumococcal vaccine (tetravalent) marketed as early as 1946 [19]. Polysaccharide vaccines were only really introduced during the 1970s to counteract the emergence of bacterial resistance to antibiotics. 

The value of 100 was assigned in each case to the amount of radioactivity found using the serum obtained prior to immunization. The vaccine alone caused a minimum boost, but when given with poly(ICLC) there was a more pronounced boost. Polyadenylic polyuridylic acid complexed to carboxymethylcellulose and polylysine was not so effective as poly(ICLC). Poly(ICLC) is not a universal adjuvant. With albumin and pneumococcal polysaccharide antigen, there was inhibition of antibody production (Levy, unpublished observations). 

Pneumococcal vaccines Mixture of purified surface polysaccharide antigens obtained from differing serotypes of Streptococcus pneumoniae Active immunization against Streptococcus pneumoniae... 

Vaccines Pneumococcal vaccine, polyvalent, 23 types of S. pneumoniae PNU-Immune- 23 0.5 ml dose contains 26 pg polysaccharide antigen purified from 23 serotypes of S. pneumoniae IM,SC NA NA NA Single 0.5 ml dose NA NA... 

Pneumococcal vaccines produced by different manufacturers are currently available, for example Pneumovax 23 produced by Merck Sharp Dohme and Pnu-Imune 23 produced by Lederle Laboratories. Each vaccine dose (0.5 ml) contains 25 pg of each polysaccharide antigen. Immunization is recommended for people who are at increased risk of developing pneumococcal disease because of underlying chronic health conditions and for older people. About 50% of vaccinees develop mild adverse effects, such as erythema and pain at the injection site. Fever, myalgia, and severe local reactions have been reported in under 1% of vaccinees. Severe systemic reactions, such as anaphylaxis have been rarely reported. 

Much of this concern arises from extrapolation from published data on influenza immunization. However, there are some data on pneumococcal immunization alone. In 32 HIV-positive patients with a median CD4 cell count of 242 x 10 /1, who received Pneumovax and tetanus toxoid there was no change in plasma HIV-I RNA at 20-56 days after immunization (22). In contrast there were marked increases in plasma viral RNA (1.6-586 times) reported in 12 asymptomatic HIV-positive individuals (mean CD4 cell count 374 x 10 /1). More recently, a study of patients with more advanced disease found that HIV-l RNA and DNA were unaffected by either conjugate or polysaccharide pneumococcal vaccine up to 309 days after immunization (23). In summary, the authors of the review (21) recommended that HIV-infected individuals be immunized with pneumococcal vaccine and that immunization should be carried out as early as possible in the course of HIV infection. 

Prevnar is a glycoconjugate heptavalent pneumococcal vaccine for young children made from the polysaccharide capsule of the pneumococcus (20). Although older vaccines made from pneumococcus capsular polysaccharide are available for adults, young children cannot make antibodies to the capsule. By coupling the pneumococcal capsular polysaccharide with a protein carrier, a vaccine was created that will trigger an infant s immune system to produce antibodies. 

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