Pneumococcal Vaccine

Sayenna Uduman
Pneumococcal Vaccine -Summary
• PCV13 is ideal & recommended routinely for all children 2-71 months of age and should be the vaccine of choice in India.
• In healthy children, 6 through 18 years of age PCV13 is now recommended routinely. Children with high risk conditions are eligible for vaccination; and should get a single dose of PCV13.

Pneumococcal disease is caused by Streptococcus pneumoniae (pneumococcus). There are over 90 serotypes based on differences in the composition of the polysaccharide capsule that surrounds it. However, the majority of pneumococcal disease in infants is associated with a small number of these serotypes, which may vary by region. Globally, about 20 serotypes are associated with>80% of invasive pneumococcal disease (IPD) worldwide. Invasive pneumococcal infections include pneumonia, meningitis and febrile bacteremia. It can also lead to otitis media, sinusitis and bronchitis.
Based on recent estimates, more than 65,000 Indian children died from pneumococcal disease in 2012. Many more were hospitalized. India accounts for 20% of global pneumonia deaths under the age of five. Prior to use of vaccinations, the World Health Organization (WHO) estimates that 0.7 to 1 million global pneumococcal deaths and 14.5 million global pneumococcal cases per year occurred in children (uninfected with HIV) younger than 5 years.

Rationale for Vaccination
The rationale for childhood immunization is to protect children against life-threatening IPDs such as sepsis, meningitis and bacteremic pneumonia. Vaccination is the only available tool to prevent pneumococcal disease. The recent development of widespread microbial resistance to essential antibiotics underlines the urgent need for pneumococcal vaccines.

India has thus rolled out the conjugated pneumococcal vaccine (PCV13) as part of the government’s Universal Immunisation Programme (UIP) currently in few states of India.

The unconjugated pneumococcal vaccine (PPSV23) is poorly immunogenic, has short-lived immunity & is not protective for children younger than 24 months of age. Conjugated vaccines were thus developed for universal childhood immunization of infants and children as early 6 weeks of age and are now recommended for childhood immunization. The pneumococcal polysaccharide capsular antigens are individually conjugated to a diphtheria membrane carrier protein (CRM197).
The original seven valent conjugated pneumococcal vaccine (PCV7) was produced from the seven most prevalent strains of S. pneumoniae in the US. The bacterial capsule sugar was linked to CRM197, a nontoxic recombinant variant of diphtheria toxin. The original 7-valent formulation contained serotypes 4, 6B, 9V, 14, 18C, 19F, and 23F. While the proportion of serotypes in children potentially covered by PCV-7 varies markedly from region to region and even from country to country; in most places, at least 50% of invasive isolates from children aged <5 years were represented by PCV-7. It resulted in protection of 80% of the pneumococcal disease in infants in the US. In Western Europe, at least two-thirds of all isolates were covered by PCV-7. In addition, PCV-7 had a high level of cross-protection against serotype 6A.
The incidence of invasive pneumococcal disease due to vaccine serotypes decreased substantially after the introduction of PCV-7 in the US in vaccinated and unvaccinated children. The largest reductions in IPD incidence were observed in children aged less than 5 years. In addition to the substantial reductions in the incidence of IPD among vaccinated children, the introduction of PCV7 in 2000 also resulted in marked reductions in nasopharyngeal colonization with vaccine serotypes and subsequent reductions in IPD incidence among age groups that were not vaccinated. However, significant increases in the incidences of disease due to serotypes 3, 15, 19A, 22F, and 33F were observed among children during this period; serotype 19A has become the predominant cause of invasive disease in US children.
In 2010, 13 valent vaccine (PCV13) was introduced which contains six additional strains (i.e., 1, 3, 5, 6A, 19A and 7F), which protect against the majority of the remaining pneumococcal infections.

Pneumococcal Vaccine Pneumococcal Vaccine 11/10/2017
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