Pneumococcal Disease and Pneumococcal Vaccines

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• Pneumococcal Disease and Pneumococcal Vaccines

Epidemiology and Prevention of Vaccine-Preventable
Diseases National Immunization Program Centers
for Disease Control and Prevention
Revised January 2007
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NOTICEContent and order of the slides in this
file may differ from those presented on the
broadcast and webcast
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Streptococcus pneumoniae

• Gram-positive bacteria
• 90 known serotypes
• Polysaccharide capsule important virulence factor
• Type-specific antibody is protective

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Pneumococcal DiseaseClinical Presentations

• Pneumococcal pneumonia
• estimated 100,000-135,000 cases requiring
  hospitalization per year
• Bacteremia
• 50,000 or more cases per year
• Meningitis
• 3,000 to 6,000 cases per year

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Pneumococcal Disease Epidemiology

• Reservoir Human carriers
• Transmission Respiratory
• Temporal pattern Winter and early spring
• Communicability Probably as long as
  organism in respiratory secretions

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• Invasive Pneumococcal Disease
• Incidence by Age Group1998

Rate per 100,000 population Source Active
Bacterial Core surveillance/EIP Network
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Risk Factors for Invasive Pneumococcal Disease

• Children 2 years of age and younger
• Persons 65 years and older
• Underlying medical conditions
• Recipients of a cochlear implant

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Risk Factors for Invasive Pneumococcal Disease

• Underlying medical conditions
• decreased immune function
• functional or anatomic asplenia
• chronic heart, pulmonary, liver, or renal disease
• CSF leak
• children who attend out of home child care
• children of certain racial and ethnic groups

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Pneumococcal Vaccines

• 1977 14-valent polysaccharide
• vaccine licensed
• 1983 23-valent polysaccharide vaccine
  licensed (PPV23)
• 2000 7-valent polysaccharide
• conjugate vaccine licensed (PCV7)

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Pneumococcal Polysaccharide Vaccine

• Purified capsular polysaccharide antigen from 23
  types of pneumococcus
• Account for 88 of bacteremic pneumococcal
  disease
• Cross-react with types causing additional 8 of
  disease

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Pneumococcal Polysaccharide Vaccine

• 60-70 against invasive disease (varies with
  underlying disease)
• Duration of immunity- at least 6 years
• Schedule- 1 dose with selective revaccination
• Not effective in children younger than 2 years
• Minimum age 2 years

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Pneumococcal Polysaccharide Vaccine
Recommendations

• Persons gt2 years with normal immune systems who
  have chronic illness
• cardiovascular
• pulmonary disease
• diabetes
• Alcoholism
• CSF leak
• cochlear implant
• Adults gt65 years of age

MMWR 199746(RR-8)1-24
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Pneumococcal Polysaccharide Vaccine
Recommendations

• Immunocompromised persons
• Hodgkins disease
• lymphoma
• multiple myeloma
• chronic renal failure
• nephrotic syndrome
• functional or anatomic asplenia
• HIV infection

MMWR 199746(RR-8)1-24
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Pneumococcal Polysaccharide Vaccine
Recommendations

• Children 2 years of age and older
• functional or anatomic asplenia
• sickle cell disease
• nephrotic syndrome
• CSF leak
• immunosuppression, including HIV infection
• cochlear implant

MMWR 199746(RR-8)1-24
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Pneumococcal Polysaccharide Vaccine Revaccination

• Routine revaccination of immunocompetent persons
  is not recommended
• Revaccination recommended for persons age gt2
  years at highest risk of serious pneumococcal
  infection
• Revaccination is a one-time event
• Single revaccination dose 5 years or longer after
  the first dose
• For children, a single revaccination dose should
  be given 3 years after the first dose if the
  child is 10 years of age or younger at the time
  of revaccination

MMWR 199746(RR-8)1-24
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Pneumococcal Polysaccharide VaccineCandidates
for Revaccination

• Persons gt2 years of age with
• functional or anatomic asplenia
• immunosuppression
• chronic renal failure
• nephrotic syndrome
• Persons vaccinated before 65 years of age

MMWR 199746(RR-8)1-24
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Pneumococcal VaccinesAdverse Reactions

• Local reactions
• polysaccharide 30-50
• conjugate 10-20
• Fever, myalgia
• polysaccharide lt1
• conjugate 15-24
• Severe adverse rarereactions

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Pneumococcal VaccinesContraindications and
Precautions

• Severe allergic reaction to vaccine component or
  following prior dose of vaccine
• Moderate or severe acute illness

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National Immunization ProgramContact Information

• Telephone 800.CDC.INFO
• Email nipinfo_at_cdc.gov
• Website www.cdc.gov/nip