Pneumococcal disease, vaccines

Indications for Use. Pneumococcal polysaccharide vaccine maybe used for immuni2ation of persons two years of age or older who are at increased risk of pneumococcal disease. 

Composition and Methods of Manufacture. The vaccine consists of a mixture of purified capsular polysaccharides from 23 pneumococcal types that are responsible for over 90% of the serious pneumococcal disease in the world (47,48). Each of the polysaccharide types is produced separately and treated to remove impurities. The latter is commonly achieved by alcohol fractionation, centrifugation, treatment with cationic detergents, proteolytic en2ymes, nucleases or activated charcoal, diafiltration, and lyophili2ation (49,50). The vaccine contains 25 micrograms of each of the types of polysaccharide and a preservative such as phenol or thimerosal. 

Asthma patients should receive the influenza vaccine every year.1 Although the pneumococcal vaccine may decrease the risk of invasive pneumococcal disease in asthmatics, current guidelines do not include the routine administration of this vaccine to asthma patients.1,14... 

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... 

Centers for Disease Control and Prevention. 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. Morbidity and Mortality Weekly Report (MMWR) 2005 54(36) 893-897. 

Prevention of pneumococcal disease through the use of vaccination is a national goal. 

Prevention of pneumococcal disease by use of vaccination is a national goal Vaccination is used to prevent or minimize the severity of pneumonia caused by S. pneumoniae or the influenza virus. 

The 23-valent pneumococcal polysaccharide vaccine is recommended for use in all adults 65 years of age or older and adults less than 65 years who have medical comorbidities that increase the risk for serious complications from S. pneumoniae infection, such as chronic pulmonary disorders, cardiovascular disease, diabetes mellitus, chronic liver disease, chronic renal failure, functional or anatomic asplenia, and immunosuppressive disorders. Alaskan natives and certain Native American populations are also at increased risk. Children over the age of 2 years may be vaccinated with the 23-valent pneumococcal polysaccharide vaccine if they are at increased risk for invasive S. pneumoniae infections, such as children with sickle cell anemia or those receiving cochlear implants. 

Prevnar Pneumococcal 7-valent conjugate vaccine Lederle laboratories Immunization to prevent invasive pneumococcal disease... 

Pneumococcal Disease In October 2002, the FDA approved the use of Prevnar for immunization of infants and toddlers against otitis media— middle ear infection. Prevnar is a pneumococcal seven-valent conjugate vaccine. It is formulated with a sterile solution of saccharides conjugated to the antigen, Streptococcus pneumoniae. 

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. 

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. 

The immunogenicity of 7-valent pneumococcal-conjugate vaccine plus 23-valent pneumococcal vaccine in 11 children has been compared with the immunogenicity of 23-valent vaccine alone in 12 children up to 2 years of age with sickle cell disease (9). IgG pneumococcal antibody concentrations were higher with combined administration, with no increase in adverse effects after immunization with 23-valent vaccine. 

A comprehensive technical overview on the epidemiology and prevention of pneumococcal disease, including the use of polysaccharide and conjugate vaccines has been provided (11). 

In a study of the interaction between 23-valent pneumococcal polysaccharide vaccine and influenza vaccine, 152 adults with chronic respiratory disease were... 

Centers for Disease Control (CDC). Pneumococcal polysaccharide vaccine. MMWR Morb Mortal Wkly Rep 1989 38(5) 64-8, 73-6. 

Vernacchio L, Neufeld EJ, MacDonald K, Kurth S, Murakami S, Hohne C, King M, Molrine D. Combined schedule of 7-valent pneumococcal conjugate vaccine followed by 23-valent pneumococcal vaccine in children and young adults with sickle cell disease. J Pediatr 1998 133(2) 275-8. 

Fletcher TJ, Tunnicliffe WS, Hammond K, Roberts K, Ayres JG. Simultaneous immunisation with influenza vaccine and pneumococcal polysaccharide vaccine in patients with chronic respiratory disease. BMJ 1997 314(7095) 1663-5. 

Induction of active immunity against pneumococcal disease caused by the pneumococcal antigen types included in the vaccine (the vaccine protects against pneumococcal pneumonia. pneumococcal bacteremia, and other pncuiiiiK iK Cal infections)... 

The elderly suffer most in terms of increased morbidity and mortality when recommended vaccines are not administered. Pneumococcal diseases are the vaccine preventable diseases that cause, by far, the most mortality in the elderly.Unfortunately, the vaccine for pneumococcal-induced pneumonia has one of the lowest administration rates. Other vaccines that most elderly and longterm care residents should receive include the influenza and tetanus/diphtheria vaccines. Consultant pharmacists or pharmacists providing services to long-term care facilities are in excellent positions to identify those who need vaccines. 

Patients with SCD have impaired splenic function, which increases their susceptibility to infection by encapsulated organisms, particularly pneumococci. Prior to the routine use of penicillin prophylaxis and the development of pneumococcal vaccines, invasive pneumococcal disease was 20- to 100-fold more common in children with SCD than in healthy children. Even with these interventions, some groups of children with SCD continue to have a high rate of invasive pneumococcal infections. - ... 

Adamkiewicz TV, Samaik S, Buchanan GR, et al. Invasive pneumococcal infections in children with sickle cell disease in the era of penicillin prophylaxis antibiotic resistance and 23-valent pneumococcal polysaccharide vaccination. J Pediatr 2003 143 438-444. 

Committee on Infectious Diseases, American Academy of Pediatrics. Policy Statement Recommendations for the prevention of pneumococcal infections, including the use of pneumococcal conjugate vaccine (lYevnar), pneumococcal polysaccharide vaccine, and antibiotic prophylaxis. Pediatrics 2000 106 362-366. 

A conjugate pneumococcal vaccine that is indicated in infants and children has become available and provides a 6% reduction in the frequency of acute otitis media and a 20% reduction in the need for placement of a T-tube. Also, vaccine use has demonstrated an 8% decrease in office visits, as well as a 10% to 26% decrease in otitis media episodes in children who experienced 3 to 10 infections per year. Pneumococcal congugate vaccine is recommended for all children aged 2 to 23 months it is also recommended for those 24 to 59 months of age who are at high risk of invasive disease. Previously unvaccinated children older than age 1 who have had recurrent otitis media infections do not benefit from later vaccination. ... 

The pertussis and antil3miphoc3l e preparations are used in passive immunization. Both the mumps vaccine and BCG (used for tuberculosis) are used in active immunization, but they are live organisms. Pneumococcal vaccine is a polysaccharide recommended for individuals at high risk for pneumococcal disease. The Haemophilus and meningococcal vaccines (not listed) are also polysaccharides. The answer is (E). 

Children in the United States are vaccinated against a growing list of diseases pertussis (whooping cough), diphtheria, tetanus, measles, mumps, rubella, varicella (chicken pox), polio, hepatitis B, and pneumococcal disease. Annual influenza vaccination, depending on the prevalent viral strain, is recommended for most age groups. The HlNl influenza pandemic of 2009 saw the rapid development of an effective vaccine however, a vaccine for HIV remains ellusive. 

The era of more complex multivalent glycoconjugate vaccines having several CPS conjugated to a single protein carrier was inaugurated with the introduction of the 7-valent pneumococcal conjugate vaccine in 2000 in the USA. The vaccine led to a decrease in invasive pneumococcal disease by 75% in children younger than 5 years and by 94% for the pneumococcal serotypes contained in the vaccine. A tetravalent... 

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