New Vaccine Development Establishing Priorities: Volume II, Diseases of Importance in Developing Countries (1986) / Chapter Skim
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Appendix D-17: The Prospects for Immunizing Against Streptococcus pneumoniae
Appendix D-17: The Prospects for Immunizing Against Streptococcus pneumoniae
Pages 357-375
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From page 357... ...
The organism is a component of the normal bacterial flora of the human upper respiratory tract; it invades the lower respiratory tract or middle ear by direct extension from the nasopharynx when anatomic or physiologic defenses are compromised, most frequently by antecedent viral infection. Meningitis may occur either as a sequel to bacteremia secondary to pneumonia, or as a direct extension from an infected paranasal sinus or mastoid; or it may follow fracture of the skull.
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From page 358... ...
The chemical compositions of many of the polysaccharides in the U.S.-licensed vaccine are known. HOST IMMUNE RESPONSE In the normal human host, defense against invasion of internal bodily sites by pneumococci depends primarily on type-specific serum antibodies to pneumococcal capsular polysaccharides.
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From page 359... ...
Preliminary studies of type 6A pneumoccocal capsular polysaccharide coupled to tetanus toxoid suggest that responsiveness to the conjugated antigen occurs at a significantly earlier age and induces IgG as well as IgM antibodies. Limited data on the responsiveness of the elderly to parenteral administration of pneumococcal capsular polysaccharides suggest that, although they respond somewhat less vigorously than young adults, their responses are significant and result in protection against infection.
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From page 360... ...
Diagnosis of the cause of otitis media is made infrequently today because tympanocentesis to recover the infecting organism from the middle ear is practiced only in a few clinical settings. Despite these limitations, sufficient data are available to estimate the disease burdens resulting from these two pneumococcal infections in some areas.
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From page 361... ...
. TABLE D-17.2 Pneumococcal Pneumonia: Distribution of Morbidity Categories by Age Morbidity Category (percent distribution)
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From page 362... ...
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From page 363... ...
Disease burden estimates for pneumococcal bacteremia are shown in Table D-17.6. Pneumococcal otitis media is one of the most common illnesses seen in pediatric practices -- an estimated 20 percent of all children born in
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From page 364... ...
Disease burden estimates for pneumococcal otitis media are shown in Table D-17.7. Death is assumed to result in 1 percent of severe cases.
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From page 365... ...
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From page 366... ...
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From page 367... ...
Disease burden estimates for pneumococcal meningitis are shown in Table D-17.10. The total disease burden for S
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From page 368... ...
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From page 370... ...
reveals a considerable discrepancy, even when the disease burden shown in Table D-17.11 is assumed to be reduced by half from antibiotic use. While estimates shown in Table B.6 do not include pneumococcal meningitis and otitis media, calculations above suggest that these conditions would not proportionally add greatly to the pneumococcal pneumonia burden (i.e., probably less than 5 percent)
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From page 371... ...
of a fatal outcome. This category includes persons with chronic cardiac, pulmonary, hepatic, renal, endocrine, or malignant disease; case fatality rates of treated bacteremic pneumococcal infections in these patients range from 25 to 50 percent in the United States and Europe (Austrian, 1985~.
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From page 372... ...
The procedures in Chapter 7 facilitate easy incorporation of alternative estimates for the vaccine preventable disease burden calculations. SUITABILITY FOR VACCINE CONTROL Polyvalent vaccines of pneumococcal capsular polysaccharides have been demonstrated to be safe and antigenic, and it is known that serum anticapsular antibodies, whether acquired actively or passively, provide
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From page 373... ...
Several million persons have received vaccines of either whole pneumococci or of their capsular polysaccharides without permanent morbidity or a fatality. Transient local discomfort or pain, redness, induration, and swelling occur in 40 percent of adult recipients of the presently available vaccine, and up to 3 percent experience transient low-grade temperature elevations.
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From page 374... ...
, neither of which requires knowledge of the size of the vaccinated and unvaccinated populations at risk, are being used to refine efficacy assessments. Evaluation of the efficacy of conjugated Pneumococcal polysaccharide vaccines in preventing otitis media will require the routine use of tympanocentesis to establish causal diagnosis.
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From page 375... ...
Washington, D.C.: Population Reference Bureau. World Health Organization.
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