Pneumococcal polysaccharide vaccine
|Target disease||23 serotypes of Streptococcus pneumoniae|
|(what is this?)|
Pneumococcal polysaccharide vaccine (PPSV)—the latest version is known as Pneumovax 23 (PPV-23)—is the first pneumococcal vaccine, the first vaccine derived from a capsular polysaccharide, and an important landmark in medical history. The polysaccharide antigens were used to induce type-specific antibodies that enhanced opsonization, phagocytosis, and killing of Streptococcus pneumoniae (pneumococcal) bacteria by phagocytic immune cells. The pneumococcal polysaccharide vaccine is widely used in high-risk adults. As a result, there have been important reductions in the incidence, morbidity, and mortality from invasive pneumococcal disease.
First used in 1945, the tetravalent vaccine was not widely distributed, since its deployment coincided with the discovery of penicillin. In the 1970s, Robert Austrian championed the manufacture and distribution of a 14-valent PPSV. This evolved in 1983 to a 23-valent formulation (PPSV23). A significant breakthrough impacting the burden of pneumococcal disease was the licensing of a protein conjugate heptavalent vaccine (PCV7) beginning in February 2000.
In the United States, PPSV is recommended for adults 65 years of age or older, adults with serious long-term health problems, smokers, children older than two years with serious long-term health problems, and even adults aged 55 years or younger, giving the protection of 5 years or more. The World Health Organization recommendations are similar. The WHO does not recommend use of PPV in routine childhood immunization programs. Pneumococcal vaccine is beneficial to control exacerbations of chronic obstructive pulmonary disease (COPD) and asthma.
In March 2011, The Joint Committee on Vaccination and Immunisation (JCVI) advised to stop using pneumococcal polysaccharide vaccine (PPV), for those aged 65 years and older. PPV should however still be offered to those in clinical risk groups.
PPSV is important for those with HIV/AIDS. In Canadian HIV patients, the vaccine has been reported to decrease the incidence of invasive pneumococcal disease from 768/100,000 person-years to 244/100,000 patient-years. Current WHO guidelines recommend immunization with PPV-23 for HIV patients in clinical stage 1, while the CDC recommends immunization in those with a CD4 cell count greater than 200/μL.
Adults and children over two years of age
The 23-valent vaccine (e.g., Pneumovax 23) is effective against 23 different pneumococcal capsular types (serotypes 1, 2, 3, 4, 5, 6B, 7F, 8, 9N, 9V, 10A, 11A, 12F, 14, 15B, 17F, 18C, 19F, 19A, 20, 22F, 23F and 33F) and so covers 90 percent of the types found in pneumococcal bacteremia.
Children under the age of two years fail to mount an adequate response to the 23-valent adult vaccine, and instead a 13-valent Pneumococcal Conjugated Vaccine (PCV) (e.g. Prevnar 13) must be used. Prevnar 13 is a new vaccine which has replaced Prevnar 7, adding six new serotypes to the vaccine. While this covers only thirteen strains out of more than ninety strains, these thirteen strains caused 80 percent to 90 percent of cases of severe pneumococcal disease in the US before introduction of the vaccine, and it is considered to be nearly 100 percent effective against these strains.
- Special risk-group
- Children at special risk (e.g. sickle cell disease and those without a functioning spleen) require additional protection using the 13-valent congugated vaccine, with the then more extensive 23-valent vaccine given after the second year of life:
|Age||2–6 months||7–11 months||12–23 months|
|Conjugated vaccine||3× monthly dose||2× monthly dose||2 doses, 2 months apart|
|Further dose in second year of life|
|23-valent vaccine||Then after 2nd birthday single dose of 23-valent|
- Siemieniuk, Reed A.C.; Gregson, Dan B.; Gill, M. John (November 2011). "The persisting burden of invasive pneumococcal disease in HIV patients: an observational cohort study". BMC Infectious Diseases 11: 314. doi:10.1186/1471-2334-11-314. PMC 3226630. PMID 22078162.
- Macleod CM, Hodges RG, Heidelberger M, Bernhard WG (1945). "Prevention of pneumococcal pneumonia by immunization with specific capsular polysaccharides". J Exp Med 82 (6): 445–65. doi:10.1084/jem.82.6.445. PMC 2135567. PMID 19871511.
- Austrian R; Douglas RM; Schiffman G et al. (1976). "Prevention of pneumococcal pneumonia by vaccination". Trans Assoc Am Physicians 89: 184–94. PMID 14433.
- Klein, JO, Plotkin, SA (2007). "Robert Austrian: 1917-2007". Clin Infect Dis 45: 2. doi:10.1086/520068.
- Kim NH; Lee J; Lee SJ; Lee H; Kim KH; Park SE et al. (2007). "Immunogenicity and safety of pneumococcal 7-valent conjugate vaccine (diphtheria CRM(197) protein conjugate; Prevenar ) in Korean infants: differences that are found in Asian children". Vaccine 25 (45): 7858–65. doi:10.1016/j.vaccine.2007.08.022. PMID 17931753.
- "Pneumococcal Disease In-Short". US Centers for Disease Control and Prevention (CDC).
- World Health Organization. Pneumococcal vaccines. http://www.who.int/vaccines/en/pneumococcus.shtml#position.[dead link]
- "JCVI issues preliminary advice on pneumococcal polysaccharide vaccination programme". National electronic Library for Medicines, NHS. 2011-03-17.
- Pneumococcal Polysaccharide Vaccine: What You Need to Know. US Centers for Disease Control and Prevention. 2009
- Pneumovax package insert Merck
- Childhood Pneumococcal Disease – information on the disease and the Prevnar vaccine, from the Victoria State (Australia) government. Includes possible side effects.
- "Chapter 25: Pneumococcal" (PDF). Immunisation against infectious disease — 'The Green Book' (PDF). Department of Health (UK). 2006.
- Moberley S, Holden J, Tatham DP, Andrews RM (2013). "Vaccines for preventing pneumococcal infection in adults". Cochrane Database Syst Rev 1: CD000422. doi:10.1002/14651858.CD000422.pub3. PMID 23440780.
- Pneumococcal Vaccines World Health Organization (WHO)
- Pneumovax 23 information Merck
- Pneumovax package insert Merck
- PATH's Vaccine Resource Library pneumococcus resources
- Centers for Disease Control and Prevention (2012). "Ch. 16: Pneumococcal Disease". In Atkinson W, Wolfe S, Hamborsky J. Epidemiology and Prevention of Vaccine-Preventable Diseases (12th ed.). Washington DC: Public Health Foundation. pp. 233–248.