ReviewCan the success of pneumococcal conjugate vaccines for the prevention of pneumococcal diseases in children be extrapolated to adults?
Section snippets
Streptococcus pneumoniae
The diseases and mortality associated with some Streptococcus pneumoniae serotypes are largely vaccine-preventable. It was estimated that S. pneumoniae was responsible for 500,000 cases of pneumonia, 50,000 cases of bacteremia and 3000 cases of meningitis per year in the United States in the whole population, prior to the introduction of conjugate pneumococcal vaccines [1]. The age-specific incidences of pneumococcal disease show a U-shaped distribution with the highest incidences in the
Pneumococcal nasopharyngeal carriage
There is convincing evidence that pneumococcal nasopharyngeal (NP) carriage is an immediate and essential precursor for pneumococcal disease and also the source of pneumococcal transmission between people [2], [3]. Pneumococcal NP carriage rate is age-dependent, starting early in the first year of life and peaking at about 55% around three years, with a steady continual decline into adulthood [4]. Although the prevalence of NP carriage in the elderly is low, frequent acquisition was reported in
Pneumococcal serotypes associated with IPD
Prior to PCV7 introduction, serotype 14 was the most frequently found serotype in IPD in all age groups in the US and Germany although its relative frequency differed with age [9], [10]. It was reported to be 33.5% in children <2 years, 25.2% in children <16 years, 16.7% in adults ≥16 years and 15.2% in adults ≥65 years. The second and third most frequent serotypes in children <2 years were 23F (7.3%) and 6B (7.7%) whereas in adults ≥16 years serotypes 3 (8.3%) and 4 (7.0%) were the second and
Clinical presentations following pneumococcal infections prior to the introduction of PCV7
Pneumococcal disease (PD) can be non-invasive such as otitis media, sinusitis, mastoiditis and non-bacteraemic pneumonia, or invasive (IPD) such as bacteraemia, meningitis, and bacteraemic pneumonia. IPD is defined by the isolation of S. pneumoniae from a normally sterile site (e.g. blood or cerebrospinal fluid, but not sputum).
In the US, the main clinical manifestation was occult bacteraemia in the younger age groups and bacteraemic pneumonia in the older age groups [10]. The case fatality
Pneumococcal serotypes, invasive power and disease severity
Not all of the more than 90 pneumococcal serotypes that have been identified based on their capsular polysaccharide antigens cause disease [12]. Among those that cause disease, not all have the same invasive potential. Serotypes that are more heavily encapsulated, with a lower invasive power and higher carriage prevalence have been reported to cause more severe disease. Serotypes 3, 6A, 6B, 9N and 19F have been repeatedly reported to be associated with an increased 30-day mortality risk in
Risk factors for IPD
The frequency of IPD in patients with comorbidities aged ≥50 years in the US increased significantly from 1998–1999 to 2002–2003; in patients with diabetes (from 15.3% to 21.8%), chronic obstructive pulmonary disease (from 21.7% to 25.0%), receiving recent immunosuppressive treatment (from 6.6% to 9.1%), ≥1 immunocompromising condition (from 19.5% to 23.0%) and those with other co-morbid conditions (from 53.9% to 62.6%) [17]. In the US the percentage of children <5 years with IPD with ≥1
Pneumococcal vaccination in children: Direct and indirect effects
Conjugation of certain capsule polysaccharides to protein carriers provides a vaccine that enables children aged <2 years to mount a protective immune response against vaccine serotypes early in life. Since the introduction of a seven-valent conjugate vaccine, PCV7, containing serotypes 4, 6B, 9V, 14, 18C, 19F and 23F, in North America, Australia and many European countries, substantial reductions in the incidences of PCV7-VT IPD, and healthcare visits (hospitalization, emergency room and
Pneumococcal vaccination in adults
In many countries the licensed 23-valent plain polysaccharide vaccine (PPV23) is recommended for all adults ≥65 years who are unvaccinated or were vaccinated ≥5 years previously and for adults aged 19–64 years with high risk of IPD due to underlying conditions; the exact conditions vary between countries but often include congenital or acquired immunosuppression, asthma, diabetes, and several other chronic disorders. PPV23 contains 12 of the serotypes in PCV13 (not 6A) and 11 other serotypes:
Clinical efficacy of conjugate pneumococcal vaccines in adults
Clinical efficacy data for PCVs in adults are sparse. In HIV-infected adults who had recovered from documented IPD, PCV7 has been reported to prevent recurrent pneumococcal infections due to PCV7-types and serotype 6A [55]. However, there is a wealth of immunological bridging data suggesting that since PCVs induce similar antibody levels in adults as those seen in children (although children need more doses), similar clinical efficacy can be expected, but direct evidence is now needed. The
Acknowledgements
The authors would like to thank Margaret Haugh (MediCom Consult) for writing and editorial assistance, funded by Pfizer International Operations, Paris, France, in the preparation of this manuscript. The authors received no financial support for the preparation of this manuscript.
References (56)
- et al.
Streptococcus pneumoniae colonisation: the key to pneumococcal disease
Lancet Infect Dis
(2004) - et al.
Invasive pneumococcal disease and the potential for prevention by vaccination in the United Kingdom
J Infect
(2007) - et al.
The influence of age and gender on the population-based incidence of community-acquired pneumonia caused by different microbial pathogens
J Infect
(2006) Impact of pneumococcal conjugate vaccine on infections caused by antibiotic-resistant Streptococcus pneumoniae
Clin Microbiol Infect
(2009)- et al.
Competition among Streptococcus pneumoniae for intranasal colonization in a mouse model
Vaccine
(2000) - et al.
Impact of the emergence of non-vaccine pneumococcal serotypes on the clinical presentation and outcome of adults with invasive pneumococcal pneumonia
Clin Microbiol Infect
(2013) - et al.
Incidence of invasive pneumococcal disease among elderly people in Southern Catalonia, Spain, 2002–2009: an increase in serotypes not contained in the heptavalent conjugate vaccine
J Infect
(2011) - et al.
Impact of conjugate 7-valent vaccination in Belgium: addressing methodological challenges
Vaccine
(2011) - et al.
The relationship between pneumococcal serotypes and antibiotic resistance
Vaccine
(2012) - et al.
Serotype specific invasive capacity and persistent reduction in invasive pneumococcal disease
Vaccine
(2010)
Effectiveness of the new serotypes in the 13-valent pneumococcal conjugate vaccine
Vaccine
Randomized trial of the quantitative and functional antibody responses to a 7-valent pneumococcal conjugate vaccine and/or 23-valent polysaccharide vaccine among HIV-infected adults
Vaccine
Pneumococcal conjugate vaccine is immunogenic in lung fluid of HIV-infected and immunocompetent adults
J Allergy Clin Immunol
Prevention of pneumococcal disease: recommendations of the Advisory Committee on Immunization Practices (ACIP)
MMWR Recomm Rep
The fundamental link between pneumococcal carriage and disease
Expert Rev Vaccines
Prevention of pneumococcal diseases in the post-seven valent vaccine era: a European perspective
BMC Infect Dis
Pneumococcal colonization in older persons in a nonoutbreak setting
J Am Geriatr Soc
Estimating the transmission parameters of pneumococcal carriage in households
Epidemiol Infect
Nasopharyngeal carriage of Streptococcus pneumoniae by adults and children in community and family settings
Clin Infect Dis
Antibody responses to nasopharyngeal carriage of Streptococcus pneumoniae in adults: a longitudinal household study
J Infect Dis
Association of serotypes of Streptococcus pneumoniae with age in invasive pneumococcal disease
J Clin Microbiol
Epidemiology of invasive Streptococcus pneumoniae infections in the United States, 1995–1998: opportunities for prevention in the conjugate vaccine era
JAMA
Invasive pneumococcal disease among adults: associations among serotypes, disease characteristics, and outcome
Clin Infect Dis
Site-specific disease potential of individual Streptococcus pneumoniae serotypes in pediatric invasive disease, acute otitis media and acute conjunctivitis
Pediatr Infect Dis J
Association of serotype with risk of death due to pneumococcal pneumonia: a meta-analysis
Clin Infect Dis
Pneumococcal serotypes and mortality following invasive pneumococcal disease: a population-based cohort study
PLoS Med
Clonal and capsular types decide whether pneumococci will act as a primary or opportunistic pathogen
Clin Infect Dis
Effect of serotype on focus and mortality of invasive pneumococcal disease: coverage of different vaccines and insight into non-vaccine serotypes
PLoS One
Cited by (21)
Serotype distribution of invasive Streptococcus pneumoniae in adults 65 years of age and over after the introduction of childhood 13-valent pneumococcal conjugate vaccination programs in Canada, 2010–2016
2018, VaccineCitation Excerpt :Adult vaccines for pneumococcal disease include the 23-valent pneumococcal polysaccharide vaccine (PPV23), which has been available since 1996 with efficacy in preventing invasive disease but has limited effectiveness with respiratory disease [7,20,21]. PPV23 is not licenced for routine use in young children and has little efficacy on carriage, an important reservoir for the transmission and spread of invasive disease [5,22–24]. PPV23 has also had little effect on IPD prevalence rates of constituent serotypes in adults, possibly due to low coverage, or due to the lower effectiveness of a non-conjugated polysaccharide vaccine [22,25–27].
Risk and outcomes of invasive pneumococcal disease in adults with underlying conditions in the post-PCV7 era, The Netherlands
2016, VaccineCitation Excerpt :Quantification of the risk of IPD and outcomes in persons with underlying conditions and elderly can be useful for policy makers to decide about preventive strategies. Since the European population is ageing [36] the burden of pneumococcal disease is likely to increase and vaccination of elderly or risk groups with a pneumococcal conjugate vaccine could be an effective strategy [11,13]. However, herd effects after PCV7 introduction in children already resulted in a substantial decrease in PCV7-type IPD and replacement disease with non-PCV7-type IPD in both elderly ≥65 years and other non-vaccinated adults (with and without underlying conditions) [1].
Review: Current and new generation pneumococcal vaccines
2014, Journal of InfectionStable Incidence of Invasive Pneumococcal Disease in Children in Northern France from 2014 Through 2018
2021, Pediatric Infectious Disease Journal
- 1
Tel.: +33 450 636 320.