Pneumococcal (Streptococcus pneumoniae) polysaccharide vaccines in children
- 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 (PCV) 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, pneumonia, meningitis, sinusitis, and acute otitis media.
The development of the pneumococcal vaccine, the first vaccine derived from a capsular polysaccharide, is an important landmark in medical history. The polysaccharide antigens were used to induce type-specific antibodies that enhanced opsonization, phagocytosis, and killing of pneumococci by phagocytic cells. The tetravalent vaccine was first used in 1945. However, it was not widely distributed because its deployment coincided with the discovery of penicillin . Vaccination programs were largely abandoned because pneumococcal disease was so easily controlled by antibiotics. The development and increasing prevalence of multiple-antibiotic-resistant strains has once again made prevention of pneumococcal disease a priority. (See "Resistance of Streptococcus pneumoniae to beta-lactam antibiotics".)
The use of pneumococcal polysaccharide vaccines in children will be reviewed here. The use of conjugate pneumococcal vaccines in children and pneumococcal vaccination of adults are discussed separately. (See "Pneumococcal (Streptococcus pneumoniae) conjugate vaccines in children" and "Pneumococcal vaccination in adults".)
The surface capsular polysaccharide of S. pneumoniae provokes a type-specific protective immune response and serves as the basis for serotyping of these organisms. More than 90 different pneumococcal serotypes have been identified. Serotypes 6, 14, 18, 19, and 23 are the most prevalent, accounting for between 60 and 80 percent of infections depending upon the area of the world. (See "Microbiology and pathogenesis of Streptococcus pneumoniae", section on 'Capsule'.)
It is not possible to include all of the serotypes in a polysaccharide vaccine. Vaccines representing subgroups of the most prevalent serotypes causing invasive disease have been formulated. A 14-valent polysaccharide vaccine (PPSV14) was developed in the 1970s . The current 23-valent polysaccharide vaccine (PPSV23) was developed in 1983. Polysaccharide vaccines generally are not considered to be immunogenic in children younger than two years [5,6], the age group with the highest incidence of invasive disease. The development of protein-polysaccharide conjugate vaccines was necessary to improve prevention of pneumococcal disease in these young children. Pneumococcal conjugate vaccines are discussed separately. (See "Pneumococcal (Streptococcus pneumoniae) conjugate vaccines in children".)
- Nuorti JP, Whitney CG, Centers for Disease Control and Prevention (CDC). Prevention of pneumococcal disease among infants and children - use of 13-valent pneumococcal conjugate vaccine and 23-valent pneumococcal polysaccharide vaccine - recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 2010; 59:1.
- Advisory Committee on Immunization Practices. Preventing pneumococcal disease among infants and young children. Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 2000; 49:1.
- Macleod CM, Hodges RG, Heidelberger M, Bernhard WG. PREVENTION OF PNEUMOCOCCAL PNEUMONIA BY IMMUNIZATION WITH SPECIFIC CAPSULAR POLYSACCHARIDES. J Exp Med 1945; 82:445.
- Austrian R, Douglas RM, Schiffman G, et al. Prevention of pneumococcal pneumonia by vaccination. Trans Assoc Am Physicians 1976; 89:184.
- Ghaffar F, Barton T, Lozano J, et al. Effect of the 7-valent pneumococcal conjugate vaccine on nasopharyngeal colonization by Streptococcus pneumoniae in the first 2 years of life. Clin Infect Dis 2004; 39:930.
- Douglas RM, Paton JC, Duncan SJ, Hansman DJ. Antibody response to pneumococcal vaccination in children younger than five years of age. J Infect Dis 1983; 148:131.
- Pneumovax 23 (pneumococcal vaccine polyvalent). US Food & Drug Administration approved product information. Revised October 2011. US Food & Drug Administration. http://www.fda.gov/BiologicsBloodVaccines/default.htm (Accessed on February 02, 2017).
- Centers for Disease Control and Prevention (CDC). Advisory Committee on Immunization Practices. Pneumococcal vaccination for cochlear implant candidates and recipients: updated recommendations of the Advisory Committee on Immunization Practices. MMWR Morb Mortal Wkly Rep 2003; 52:739.
- Yildirim I, Shea KM, Little BA, et al. Vaccination, underlying comorbidities, and risk of invasive pneumococcal disease. Pediatrics 2015; 135:495.
- Centers for Disease Control and Prevention (CDC), Advisory Committee on Immunization Practices. Updated recommendations for prevention of invasive pneumococcal disease among adults using the 23-valent pneumococcal polysaccharide vaccine (PPSV23). MMWR Morb Mortal Wkly Rep 2010; 59:1102.
- American Academy of Pediatrics. Pneumococcal infections. In: Red Book: 2015 Report of the Committee on Infectious Diseases, 30th ed, Kimberlin DW, Brady MT, Jackson MA, Long SS (Eds), American Academy of Pediatrics, Elk Grove Village, IL 2015. p.626.
- Rubin LG, Levin MJ, Ljungman P, et al. 2013 IDSA clinical practice guideline for vaccination of the immunocompromised host. Clin Infect Dis 2014; 58:e44.
- National Heart, Lung, and Blood Institute. Evidence-based management of sickle cell disease. Expert Panel Report, 2014. www.nhlbi.nih.gov/health-pro/guidelines/sickle-cell-disease-guidelines (Accessed on June 12, 2015).
- Fine MJ, Smith MA, Carson CA, et al. Efficacy of pneumococcal vaccination in adults. A meta-analysis of randomized controlled trials. Arch Intern Med 1994; 154:2666.
- Douglas RM, Miles HB. Vaccination against Streptococcus pneumoniae in childhood: lack of demonstrable benefit in young Australian children. J Infect Dis 1984; 149:861.
- Mufson MA, Krause HE, Schiffman G, Hughey DF. Pneumococcal antibody levels one decade after immunization of healthy adults. Am J Med Sci 1987; 293:279.
- Pomat WS, Lehmann D, Sanders RC, et al. Immunoglobulin G antibody responses to polyvalent pneumococcal vaccine in children in the highlands of Papua New Guinea. Infect Immun 1994; 62:1848.
- Peset Llopis MJ, Harms G, Hardonk MJ, Timens W. Human immune response to pneumococcal polysaccharides: complement-mediated localization preferentially on CD21-positive splenic marginal zone B cells and follicular dendritic cells. J Allergy Clin Immunol 1996; 97:1015.
- Sorensen RU, Leiva LE, Javier FC 3rd, et al. Influence of age on the response to Streptococcus pneumoniae vaccine in patients with recurrent infections and normal immunoglobulin concentrations. J Allergy Clin Immunol 1998; 102:215.
- Balloch A, Licciardi PV, Russell FM, et al. Infants aged 12 months can mount adequate serotype-specific IgG responses to pneumococcal polysaccharide vaccine. J Allergy Clin Immunol 2010; 126:395.
- Furth SL, Neu AM, Case B, et al. Pneumococcal polysaccharide vaccine in children with chronic renal disease: a prospective study of antibody response and duration. J Pediatr 1996; 128:99.
- Ammann AJ, Addiego J, Wara DW, et al. Polyvalent pneumococcal-polysaccharide immunization of patients with sickle-cell anemia and patients with splenectomy. N Engl J Med 1977; 297:897.
- Abzug MJ, Pelton SI, Song LY, et al. Immunogenicity, safety, and predictors of response after a pneumococcal conjugate and pneumococcal polysaccharide vaccine series in human immunodeficiency virus-infected children receiving highly active antiretroviral therapy. Pediatr Infect Dis J 2006; 25:920.
- Butler JC, Breiman RF, Campbell JF, et al. Pneumococcal polysaccharide vaccine efficacy. An evaluation of current recommendations. JAMA 1993; 270:1826.
- Fiore AE, Levine OS, Elliott JA, et al. Effectiveness of pneumococcal polysaccharide vaccine for preschool-age children with chronic disease. Emerg Infect Dis 1999; 5:828.