Impact of universal infant immunization with pneumococcal (Streptococcus pneumoniae) conjugate vaccines in the United States
- Elaine I Tuomanen, MD
Elaine I Tuomanen, MD
- Chair, Infectious Diseases
- St Jude Children's Research Hospital
Streptococcus pneumoniae (pneumococcus) is a leading cause of serious illness among children worldwide . Before universal infant immunization with pneumococcal conjugate vaccine in the United States, S. pneumoniae caused approximately 17,000 cases of invasive disease each year among children younger than five years of age, including 700 cases of meningitis and 200 deaths . It was the most frequent cause of bacteremia, bacterial pneumonia, bacterial meningitis, sinusitis, and acute otitis media .
The 7-valent pneumococcal conjugate vaccine (PCV7) was added to the schedule of recommended vaccines for children younger than two years of age in the United States in 2000 [1,2]. PCV7 contains serotypes 4, 6B, 9V, 14, 18C, 19F, and 23F conjugated to a mutant of diphtheria toxoid (table 1). The routine use of PCV7 resulted in a decreased incidence of invasive pneumococcal disease in children. However, there were increasing data to suggest that universal infant immunization with PCV7 changed the serotype patterns of invasive disease, nasopharyngeal (NP) colonization, and antibiotic resistance patterns. In 2010, a 13-valent pneumococcal conjugate vaccine replaced PCV7 in the routine childhood immunization schedule .
The impact of universal infant immunization with PCV7 and PCV13 on invasive serotypes, nasopharyngeal flora, and antibiotic resistance in children in the United States will be reviewed here. The impact in adults is discussed separately. (See "Invasive pneumococcal (Streptococcus pneumoniae) infections and bacteremia", section on 'Impact of childhood vaccination'.)
Pneumococcal conjugate and polysaccharide vaccines also are discussed separately. (See "Pneumococcal (Streptococcus pneumoniae) conjugate vaccines in children" and "Pneumococcal (Streptococcus pneumoniae) polysaccharide vaccines in children" and "Pneumococcal vaccination in adults".)
Surveillance after the introduction of the 7-valent pneumococcal conjugate vaccine (PCV7) to the standard childhood immunization schedule has shown that pneumococcal conjugate vaccines are effective in preventing invasive pneumococcal disease (IPD) and providing herd immunity (figure 1). In 2003, it was estimated that 29,599 cases of vaccine serotype IPD were prevented through routine immunization. Approximately two-thirds of these cases were prevented through herd immunity . The greatest decline has been noted in pneumococcal bacteremia without a focus.
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