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The study attempts to evaluate the efficacy of a 7-valent pneumococcal conjugate vaccine in the treatment of streptococcus pneumoniae in HIV-infected adults. The results indicate that the vaccine was very beneficial in protecting HIV-infected individuals from contracting the pneumoniae.

A study examined the effects of the pediatric heptavalent pneumococcal conjugate vaccine (PCV7) on pneumococcal meningitis among children and adults over several years. Results showed a decrease in rates of pneumococcal meningitis among adults and children since the introduction of PCV7.

Abstract A 7-valent pneumococcal polysaccharide-protein conjugate vaccine (PCV7) was licensed in the United States of America in 2000, but no comprehensive postmarketing review of safety has been carried out. We conducted a systematic review of the safety of PCV7 and other pneumococcal conjugate vaccines. A total of 42 studies were included in the review. Reactogenicity data from some randomized trials suggest that PCV7 may result in more local reactions and fever than certain comparison vaccines. However, the reactions were mild and self-limited, and PCV7 did not carry an increased risk of severe injection-site reactions or high fever. Some, although not all, of the randomized trials in children found that mild local and systemic reactions associated with PCV7 may increase with the number of doses, at least over the three-dose primary series. In addition, PCV7 and other pneumococcal conjugate vaccines were found to have tolerable reactogenicity in Native American and African populations and in medically high-risk groups for which pneumococcal vaccination is recommended. Two of the largest studies of PCVs, one involving PCV7 and the other, PCV9, found a statistically significant increased risk of hospitalization for reactive airway disease, including asthma. Another large trial of PCV9, however, did not find an increased risk of asthma. In conclusion, this review of the evidence did not identify any major safety problems with PCV7 or any other pneumococcal conjugate vaccine, with the possible exception of reactive airway disease, which may bear further scrutiny as additional data become available. Le vaccin antipneumocccique conjugue proteine/polyoside heptavalent (PCV7) a ete autorise aux Etats-Unis d'Amerique en 2000, mais aucune etude d'innocuite postcommercialisation complete n'a ete effectuee. Nous avons mene une revue systematique concernant l'innocuite du PCV7 et d'autres vaccins antipneumococciques conjugues. Au total, 42 etudes ont ete incluses dans la revue. Les donnees de reactogenicite de certains essais randomises laissent a penser que le PCV7 peut entrainer davantage de reactions locales et de fievre que certains des vaccins auquel il est compare. Neanmoins, ces reactions sont benignes et spontanement resolutives et le PCV7 ne presente pas de risque accru de reaction grave au site d'injection ou de forte fievre. Certains des essais randomises menes chez l'enfant, mais pas tous, ont observe que les reactions locales ou systemiques benignes associees au PCV7 pouvaient augmenter avec le nombre de doses administrees, tout au moins sur la serie de trois doses primaires. En outre, il a ete constate que le PCV7 et d'autres vaccins antipneumococciques conjugues presentaient une reactogenicite tolerable pour les populations amerindiennes et africaines et pour les groupes a haut risque medical, chez lesquels la vaccination antipneumococcique est recommandee. Deux etudes de grande ampleur sur les PCV, l'une consacree au PCV7 et l'autre au PCV9, ont releve une augmentation statistiquement significative du risque d'hospitalisation pour maladie reactive des voies aeriennes, notamment pour une crise d'asthme. Un autre essai de grande ampleur sur le PCV9 n'a cependant pas constate d'augmentation du risque d'asthme. En conclusion, cette revue des donnees n'a identifie aucun probleme majeur de securite avec le PCV7, ni avec un autre vaccin antipneumococcique, a l'exception peut etre des maladies reactives des voies aeriennes, qui pourraient faire l'objet d'un examen plus approfondi lorsque des donnees supplementaires seront disponibles. En 2000 se autorizo en los Estados Unidos de America una vacuna antineumococica conjugada heptavalente de polisacaridos y proteinas (PCV7), pero no se ha Ilevado a cabo un analisis poscomercializacion exhaustivo de su seguridad. Realizamos una revision sistematica de la seguridad de la vacuna PCV7 y de otras vacunas antineumococicas conjugadas, que abarco en total 42 estudios. Los datos de reactogenicidad de algunos ensayos aleatorizados parecen indicar que la PCV7 puede provocar mas reacciones locales y fiebre que algunas de las vacunas de comparacion. Sin embargo, las reacciones fueron leves y de resolucion espontanea, y la PCV7 no se asocio a un mayor riesgo de fiebre alta o de reacciones graves en el punto de inyeccion. En algunos, aunque no todos, de los ensayos aleatorizados realizados con ninos se observo que las reacciones locales y sistemicas leves asociadas a la PCV7 tienden aparentemente a aumentar con el numero de dosis, al menos en la serie primaria de tres dosis. Se observo ademas que la PCV7 y otras vacunas antineumococicas conjugadas presentaban una reactogenicidad tolerable en las poblaciones africanas y de indios estadounidenses, asi como en grupos de alto riesgo medico a los que se recomienda la vacunacion antineumococica. En dos de los mayores estudios realizados sobre las PCV, uno sobre la PCV7 y otro sobre la PCV9, se obsero un aumento estadisticamente significativo del riesgo de hospitalizacion por enfermedades reactivas de las vias respiratorias, asma incluido. En otro importante ensayo sobre la PCV9, sin embargo, no se detecto un mayor riesgo de asma. En conclusion, en esta revision de la evidencia disponible no se detectaron problemas relevantes relacionados con la seguridad ni con la PCV7 ni con otras vacunas antineumococicas conjugadas, exceptuando quiza las enfermedades reactivas de las vias respiratorias, que pueden ser objeto de ulteriores investigaciones a medida que se obtengan nuevos datos., Background In February 2000, a 7-valent pneumococcal polysaccharide-protein conjugate vaccine (PCV7; Prevnar[R], Wyeth Lederle Vaccines) was licensed in the United States of America (USA). The vaccine is recommended for all [...]

Objectives. Influenza and pneumococcal vaccinations reduce morbidity, mortality, and health care costs, but their use lags behind goals set by public health experts. We evaluated the effect of a performance measurement program instituted by the Veterans Health Administration in 1995 to improve vaccination rates. Methods. We used cross-sectional chart-abstracted data to calculate influenza and pneumococcal vaccination rates among eligible patients, and administrative data to calculate pneumonia admission rates. We compared vaccination and hospitalization rates before and after the institution of the performance measurement program with rates outside the Veterans Health Administration. Results. Influenza and pneumococcal vaccination rates for eligible patients rose from 27% and 28% during 1994 to 1995 to 70% and 85%, respectively, by 2003 (Pfor trend < .001 ). Geographic and other variations were substantially reduced. During this time, pneumonia hospitalization rates decreased by 50% among elderly Veterans Health Administration enrollees but increased among Medicare enrollees by 15% (Pfor differences in trend Conclusions. The performance measurement program was associated with increases in vaccination rates, reduced variation, and reduced pneumonia admissions. Health systems instituting similarly effective programs may substantially improve the quality of their clinical health care.

Streptococcus pneumoniae is a major cause of serious bacterial infections in young children and is responsible for over one million deaths annually (The WHO Young Infants Study Group 1999). In [...]

Objective. We examined heptavalent pneumococcal conjugate vaccine (PCV7) uptake among children aged 19 to 35 months in the United States and determined how uptake rates differed by state vaccine financing policy. Methods. We analyzed data from the 2001-2003 National Immunization Survey. States that changed their vaccine financing policy between 2001 and 2003 (n=17) were excluded from analysis. Logistic regression was performed to identify the association between state vaccine financing policy and receipt of 3 or more doses of PCV7 after control for demographic characteristics. Results. The proportion of children receiving 3 or more doses increased from 6.7% in 2001 to 69.0% in 2003. After controlling for demographic characteristics, children residing in states that provided all vaccines except PCV7 to all children had lower odds of receiving 3 or more doses compared to children residing in states that provided PCV7 only to children eligible for the Vaccines for Children program (odds ratio = 0.58; 95% confidence interval = 0.51, 0.66). Conclusion. It is essential that we continue to monitor the effect that state vaccine financing policy has on the delivery of PCV7 and future vaccines, which are likely to be increasingly expensive.

The heptavalent pneumococcal conjugate vaccine (PCV7) has been shown to reduce the incidence of acute otitis media (AOM) caused by Streptococcus pneumoniae by 34% and reduces the overall incidence of AOM by 6% to 8%. More recent studies have shown increases in the proportion of Haemophilus influenzae and Moraxella catarrhalis in the middle-ear fluid of PCV7-immunized children. There has been no report on the effect of PCV7 on all 3 bacterial pathogens combined, either in the middle-ear fluid or nasopharynx of individual children with AOM. We investigated the impact of PCV7 on nasopharyngeal colonization with bacterial pathogens during AOM in the pre-PCV7 and post-PCV7 vaccination eras. Four hundred seventeen children (6 months to 4 years of age) were enrolled onto AOM studies between September 1995 and December 2004. Of these, 200 were enrolled before the vaccine use (historical controls), and 217 were enrolled after the initiation of PCV7 vaccination (101 were underimmunized, and 116 were immunized). Although the nasopharyngeal colonization rate for S pneumoniae was not different between the 3 groups, a significantly higher proportion of PCV7-immunized children with AOM were colonized with M catarrhalis. Overall, the mean number of pathogenic bacteria types isolated from immunized children (1.7) was significantly higher than in controls (1.4). The increase in bacterial colonization of the nasopharynx during AOM could be associated with an increase in AOM pathogens and theoretically can predispose PCV7-immunized children with AOM to a higher rate of antibiotic treatment failure or recurrent AOM., Key Words: acute otitis media, nasopharyngeal bacterial colonization, pneumococcal conjugate vaccine Abbreviations: AOM, acute otitis media; PCVT, heptavalent pneumococcal conjugate vaccine; MEF, middle-ear fluid; UTMB, University of Texas Medical Branch; [...]

Seven-valent pneumococcal conjugate vaccine (PCV7) was licensed in February 2000. In June 2000, the Advisory Committee on Immunization Practices and the American Academy of Pediatrics recommended the universal administration of pneumococcal conjugate vaccine for all children 23 months of age and younger and for children 24 to 59 months of age who are at high risk for serious pneumococcal disease. Since then, > 23 million doses have been administered in the United States. Postlicensure surveillance of invasive pneumococcal disease (IPD) in the United States from the Active Bacterial Core Surveillance program at the Centers for Disease Control and Prevention and the Northern California Kaiser Permanente Vaccine Study Center has reported a decline in IPD and in pneumococcal disease incidence as a result of vaccine serotypes, respectively. During this period, issues critical to the long-term success of PCV7 have become more relevant: Will PCV7 be as effective in groups of children who are at high risk for IPD as in healthy children? Will nonvaccine types replace vaccine serotypes in the nasopharynx and in disease? Why are the results of the clinical trials different for IPD and for acute otitis media? How many doses of PCV7 and what concentrations of antibody are necessary for protection? Will universal administration of PCV7 to children younger than 2 years reduce antimicrobial drug resistance and alter prescribing patterns of physicians for febrile infants? Have there been unanticipated adverse events or benefits observed? The purpose of this report is to review the current data available to address these questions and to identify gaps that will require additional knowledge to determine the ultimate value of pneumococcal conjugate vaccines in reducing the burden of pneumococcal disease in infants and children. Pediatrics 2002;110:805-814; pneumococcal disease, pneumococcal vaccine, conjugate vaccine, carriage, serotypes., ABBREVIATIONS. PCV, pneumococcal conjugate vaccine; IPD, invasive pneumococcal disease; NCKP, Northern California Kaiser Permanente; HIV, human immunodeficiency virus; NP, nasopharyngeal; PPV, pneumococcal polysaccharide vaccine; ELISA, enzyme-linked immunosorbent assay; OPA, opsonophagocytic [...]

The increase in drug resistance among strains of Streptococcus pneumoniae (pneumococcus) is making it more difficult to treat ear infections in children. For this reason, the pneumococcal vaccine is probably the best way to prevent ear infections. Streptococcus pneumoniae causes about half of all ear infections in children.

RICHARD BESSER ANNE SCHUCHAT Each year in the United States, Streptococcus pneumoniae is responsible for more than 125,000 hospitalizations for community-acquired pneumonia, 63,000 cases of bacteremia, and 2,500 cases of [...]

The article indicates the pneumococcal vaccination to be an important way of preventing pneumonia in Australian aborigines, and that the Australian National Health and Medical Research Council recommendations concerning this usage are appropriate. Studies show it reduces the pneumonia-associated morbidity and premature death experienced by this population, and the vaccination should be offered routinely to those considered to be at risk.

The pneumococcal polysaccharide vaccine may be more effective in certain patient populations than in others. The pneumococcal vaccine is given to at-risk individuals to prevent community-acquired pneumonia and meningitis. Researchers examined the the effectiveness of the vaccine in 2,837 patients over five years old with an infection of the blood or cerebrospinal fluid between May 1978 and Apr 1992. The vaccine was 57% effective in preventing infections caused by the serotypes of Streptococcus pneumoniae included in the vaccine. It was 84% effective for patients with diabetes mellitus, 73% for those with coronary vascular disease, 69% for those congestive heart failure and 65% for those with chronic pulmonary diseases. The time since vaccination did not affect efficacy of the vaccine significantly.

Among the 10 most common causes of hospitalization and death, pneumonia and influenza are the only disorders for which efficacious vaccines are available. Besides causing both lobar and bronchopneumonia, Streptococcus […]

The article discusses the updated recommendations prevention of invasive pneumococcal disease among adults by the Advisory Committee on Immunization Practices (ACIP) through the use of the 23-valent pneumococcal polysaccharide vaccine (PPSV23). The changes in the recommendations for the use of PPSV23 are highlighted.

To the Editor: Routine vaccination of children with the 7-valent pneumococcal conjugate vaccine (PCV-7; Wyeth Pharmaceuticals, Collegeville, PA, USA), initiated in the United States in 2000, was followed within 2 [...]

While pneumococcal pneumonia causes much illness and death among the elderly, vaccination against the disease is not widely practiced. This is true in spite of the known effectiveness of vaccination for high-risk and elderly patients, most of whom have additional medical problems. Since many people who are hospitalized due to pneumococcal bacteremia (a systemic infection with the pneumococcus organism) have been previously discharged from a hospital within the preceding three to five years, it is possible that immunization at the time of hospital discharge could reduce the incidence of subsequent pneumococcal pneumonia. This was examined in an epidemiological study of hospital discharges of Medicare patients in the Shenandoah, Virginia area. Results showed that 11.1 percent of the 1,633 people aged 65 or over discharged from Shenandoah hospitals with pneumonia had a diagnosis of pneumococcal pneumonia. Approximately 61 percent of the whole group had been discharged from a Shenandoah hospital at least once within the previous four years, most often within the previous two years. Eighty-seven percent of these patients had at least one high-risk condition. The probability of hospital admission with pneumonia for a cohort of patients discharged from Shenandoah hospitals without a diagnosis of pneumonia was between 6 and 9 percent (depending on patients' ages) over a five-year period. Calculations of the probable effect of immunization against pneumococcal pneumonia showed that 100 or fewer discharged patients would need to be vaccinated to prevent one pneumonia readmission. Pneumococcal vaccination of elderly people is inexpensive compared with the cost of hospitalization for pneumonia, and the results provide epidemiologic support for a program of hospital-based pneumococcal immunization. (Consumer Summary produced by Reliance Medical Information, Inc.)

The objective of this study was to evaluate the feasibility, acceptance, and utility of administering influenza and pneumococcal vaccines to active injection drug users at a syringe exchange program (SEP) in New York City. Influenza and pneumococcal vaccines were offered for 1 month. Data on demographics, health status, vaccine awareness, and prior vaccination status were collected using a staff-administered questionnaire. Of 199 participants interviewed 167 (86%) agreed to one or both vaccinations; 24% of study participants had a chronic condition for which vaccination was indicated and 53% had no regular source of medical care; 95% were aware of influenza vaccine while 25% were aware of pneumococcal vaccine (p < .0001). Of those offered the influenza vaccine, 86% accepted it and 70% of those offered pneumococcal vaccine accepted it (p < .001). Influenza and pneumococcal vaccinations were well-accepted by active drug users at a syringe exchange although there was both greater awareness of and acceptance of influenza. Many SEP participants with chronic medical conditions for which these vaccines are indicated did not have a regular source of health care. Syringe exchange programs may be valuable sites to administer respiratory vaccines and other public health interventions to drug injectors not engaged in medical care in other settings.

A report in the November 21, 1991 issue of The New England Journal of Medicine shows that the polyvalent pneumococcal polysaccharide vaccine (containing several strains of the organism the causes the disease) had an efficacy of 61 percent in subjects with competent immune systems. This and similar reports highlight the difficulty of evaluating vaccines, particularly those to prevent relatively rare diseases such as bacteremic pneumococcal pneumonia (in which the pneumococcus invades the bloodstream). High-risk populations are often studied, limiting the number of trials that can be performed. The best studies of the pneumococcal vaccine were carried out in young, healthy people at high risk (South African gold miners and military trainees); whether the results can be generalized to elderly Americans has not been ascertained. Several disadvantages of the randomized trials performed concerning this issue are cited. Vaccines should be subjected to evaluation in prospective, rigorous studies started shortly after the vaccine has been licensed. Such studies need not be randomized if acceptable methodologic approaches are used, such as the case-control method for determining efficacy. Factors such as patient age at the time of infection and the time since vaccination can be taken into account. These factors are important for the development of recommendations concerning vaccination. Although pneumococcal vaccine has been recommended for all persons older than 65, and for some younger persons, only one fifth of the control subjects in the Journal study had received it. Incentives to hospitals to immunize eligible patients could help improve this situation. It is possible that vaccination of all people housed in large, crowded settings should take place. The current vaccine has low efficacy in elderly and immunocompromised people, and better vaccines should be developed. However, the use of the present vaccine needs to become more widespread. (Consumer Summary produced by Reliance Medical Information, Inc.)

Objective. Although invasive pneumococcal disease is infrequent in cystic fibrosis (CF), it is recommended that all patients with CF receive pneumococcal immunization. As part of a comprehensive program to immunize our clinic population, we obtained preimmunization anti-pneumococcal antibody levels. We hypothesized that the percentage of CF patients without protective levels of anti-pneumococcal antibody levels would be high, as they are exposed to frequent antibiotic therapy that may eradicate organisms before generation of an antibody response. Methods. An observational study of 100 patients with CF, aged 1 to 39 years, was conducted in a regional CF center. Preimmunization anti-pneumococcal antibody levels against 6 serotypes were measured by enzyme-linked immunosorbent assay. Protective antibody levels were defined as [is greater than] 200 ng/mL. Results. A majority of CF patients--61% to 100%, depending on age and serotype--had protective levels of pneumococcal antibody. There was a significant positive correlation between antibody level and age for 5 of the 6 serotypes tested. Conclusions. In contradistinction to our hypothesis, the majority of CF patients have protective preimmunization anti-pneumococcal antibody levels. However, a significant proportion--between 17% and 39%, depending on the serotype--did not exhibit adequate levels. Therefore, we concur with current recommendations for pneumococcal immunization in CF. Pediatrics 2001;107(4). URL: http://www.pediatrics.org/cgi/content/ full/107/4/e62; cystic fibrosis, Streptococcus pneumoniae, immunization, ELISA.

Objectives. The optimal practice management of highly febrile 3- to 36-month-old children without a focal source has been controversial. The recent release of a conjugate pneumococcal vaccine may reduce the rate of occult bacteremia and alter the utility of empiric testing and treatment. The objective of this study was to determine the cost-effectiveness of 6 different management strategies of febrile 3- to 36-month-old children at current and declining rates of occult pneumococcal bacteremia. Methods. A cost-effectiveness (CE) analysis was performed to compare the strategies of "no work-up," "clinical judgment," "blood culture," "blood culture + treatment," "complete blood count (CBC) + selective blood culture and treatment," and "CBC and blood culture + selective treatment." A hypothetical cohort of 100 000 children who were 3 to 36 months of age and had a fever of [is greater than or equal to] 39 [degrees] C and no source of infection was modeled for each strategy. Our main outcome measures were cases of meningitis prevented, life-years saved compared with "no work-up," total cost (1999 dollars), and incremental CE ratios. Results. When compared with "no work-up," the strategy of "CBC + selective blood culture and treatment" using a white blood cell (WBC) cutoff of 15 x [10.sup.9]/L prevents 48 cases of meningitis, saves 86 life-years per 100 000 patients, and is less costly at the current rate of bacteremia (1.5%). Using the strategy of "CBC + selective blood culture and treatment" with a lower WBC cutoff of 10 x [10.sup.9]/L costs an additional $72 300 per life-year saved. If the rate of bacteremia declines to 0.5%, then the incremental CE ratio of "clinical judgment" compared with "no work-up" is $38 000 per life-year saved; however, strategies that include empiric testing or treatment result in CE ratios greater than $300 000 per life-year saved. Conclusions. "CBC + selective blood culture and treatment" using a WBC cutoff of 15 x [10.sup.9]/L is cost-effective at the current rate of pneumococcal bacteremia. If the rate of occult bacteremia falls below 0.5% with widespread use of the conjugate pneumococcal vaccine, then strategies that use empiric testing and treatment should be eliminated. Pediatrics 2001;108:835-844; fever, occult bacteremia, conjugate pneumococcal vaccine, cost-effectiveness analysis., ABBREVIATIONS. CBC, complete blood count; WBC, white blood count; CE, cost-effectiveness; YOS, Yale Observation Score. Physicians frequently evaluate and treat young, highly febrile children in the setting of the office [...]

ABBREVIATIONS. AAP, American Academy of Pediatrics; ACIP, Advisory Committee on Immunization Practices; CDC, Centers for Disease Control and Prevention; AAFP, American Academy of Family Physicians; PCV, pneumococcal conjugate vaccine; FDA, [...]

Pneumococcal infections are the most common invasive bacterial infections in children in the United States. The incidence of invasive pneumococcal infections peaks in children younger than 2 years, reaching rates of 228/100 000 in children 6 to 12 months old. Children with functional or anatomic asplenia (including sickle cell disease [SCD]) and children with human immunodeficiency virus infection have pneumococcal infection rates 20- to 100-fold higher than those of healthy children during the first 5 years of life. Others at high risk of pneumococcal infections include children with congenital immunodeficiency; chronic cardiopulmonary disease; children receiving immunosuppressive chemotherapy; children with immunosuppressive neoplastic diseases; children with chronic renal insufficiency, including nephrotic syndrome; children with diabetes; and children with cerebrospinal fluid leaks. Children of Native American (American Indian and Alaska Native) or African American descent also have higher rates of invasive pneumococcal disease. Outbreaks of pneumococcal infection have occurred with increased frequency in children attending out-of-home care. Among these children, nasopharyngeal colonization rates of 60% have been observed, along with pneumococci resistant to multiple antibiotics. The administration of antibiotics to children involved in outbreaks of pneumococcal disease has had an inconsistent effect on nasopharyngeal carriage. In contrast, continuous penicillin prophylaxis in children younger than 5 years with SCD has been successful in reducing rates of pneumococcal disease by 84%. Pneumococcal polysaccharide vaccines have been recommended since 1985 for children older than 2 years who are at high risk of invasive disease, but these vaccines were not recommended for younger children and infants because of poor antibody response before 2 years of age. In contrast, pneumococcal conjugate vaccines (Prevnar) induce proposed protective antibody responses ([is greater than] .15 [micro]g/ mL) in [is greater than] 90% of infants after 3 doses given at 2, 4, and 6 months of age. After priming doses, significant booster responses (ie, immunologic memory) are apparent when additional doses are given at 12 to 15 months of age. In efficacy trials, infant immunization with Prevnar decreased invasive infections by [is greater than] 93% and consolidative pneumonia by 73%, and it was associated with a 7% decrease in otitis media and a 20% decrease in tympanostomy tube placement. Adverse events after the administration of Prevnar have been limited to areas of local swelling or erythema of 1 to 2 cm and some increase in the incidence of postimmunization fever when it is given with other childhood vaccines. Based on data in phase 3 efficacy and safety trials, the US Food and Drug Administration has provided an indication for the use of Prevnar in children younger than 24 months., ABBREVIATIONS. AOM, acute otitis media; SCD, sickle cell disease; HIV, human immunodeficiency virus; OR, odds ratio; CI, confidence interval; NP, nasopharyngeal; PCV7, heptavalent pneumococcal [CRM.sub.197] conjugate vaccine; DTaP, diphtheria and [...]

Heptavalent pneumococcal conjugate vaccine (PCV7) is recommended for universal use in children 23 months and younger, to be given concurrently with other recommended childhood vaccines at 2, 4, 6, and 12 to 15 months of age. For children 7 to 23 months old who have not received previous doses of PCV7, administration of a reduced number of doses is recommended. Two doses of PCV7 are recommended for children 24 to 59 months old at high risk of invasive pneumococcal infection--including children with functional, anatomic, or congenital asplenia; infection with human immunodeficiency virus; and other predisposing conditions--who have not been immunized previously with PCV7. Recommendations have been made for use of 23-valent pneumococcal polysaccharide (23PS) vaccine in high-risk children to expand serotype coverage. High-risk children should be given vaccines at the earliest possible opportunity. Use of antibiotic prophylaxis in children younger than 5 years with functional or anatomic asplenia, including children with sickle cell disease, continues to be recommended. Children who have not experienced invasive pneumococcal infection and have received recommended pneumococcal immunizations may discontinue prophylaxis after 5 years of age. The safety and efficacy of PCV7 and 23PS in children 24 months or older at moderate or lower risk of invasive pneumococcal infection remain under investigation. Current US Food and Drug Administration indications are for administration of PCV7 only to children younger than 24 months. Data are insufficient to recommend routine administration of PCV7 for children at moderate risk of pneumococcal invasive infection, including all children 24 to 35 months old, children 36 to 59 months old who attend out-of-home care, and children 36 to 59 months old who are of Native American (American Indian and Alaska Native) or African American descent. However, all children 24 to 59 months old, regardless of whether they are at low or moderate risk, may benefit from the administration of pneumococcal immunizations. Therefore, a single dose of PCV7 or 23PS vaccine may be given to children 24 months or older. The 23PS is an acceptable alternative to PCV7, although an enhanced immune response and probable reduction of nasopharyngeal carriage favor the use of PCV7 whenever possible., ABBREVIATIONS. PCV7, heptavalent pneumococcal conjugate vaccine; 23PS, 23-valent pneumococcal polysaccharide; SCD, sickle cell disease; DTaP, diphtheria and tetanus toxoids and acellular pertussis; HbOC, Haemophilus influenzae type b conjugate vaccine; HIV, [...]

An educational handout written at the fifth grade level or lower may be effective in encouraging elderly patients to get vaccinated against Streptococcus pneumoniae. The pneumococcal vaccine can protect against pneumonia caused by this bacterium. Researchers randomly gave 433 elderly poor patients an educational handout about pneumococcal vaccine or nutrition. Those who received the educational handout were four times more likely to discuss the vaccine with their doctor and five times more likely to receive it compared to those who received nutritional information.

Advisers to the U.S. Centers for Disease Control and Prevention (CDC) have recommended that all smokers should receive the pneumococcal vaccine. No safety problems with the vaccine have been identified but safety monitoring of the vaccine will continue.

Objectives. Pneumococcal conjugate vaccine (PCV) was first licensed for routine administration to young children in February 2000. The objective of this study was to assess physician perspectives about the use of PCV, to ascertain which children were being given the vaccine soon after licensure, and to determine how the addition of PCV to the schedule of recommended childhood vaccines may affect the timing of other vaccinations. Methods. A 30-item survey containing questions about the use of PCV was sent to all pediatricians and family physicians who provide primary care to young children in Monroe County (Rochester, NY) and Davidson County (Nashville, TN) in October 2000. As many as 3 subsequent mailings were sent to nonresponders. Descriptive and [chi square] statistical analyses and logistic regression were used to evaluate the responses. Results. Response rates were 82% in Rochester and 78% in Nashville. Eighty-two percent of responding physicians, including 92% of pediatricians and 55% of family physicians, indicated that they were giving PCV to their patients at the time of the survey. Sixty percent noted that an initial lack of insurance reimbursement for the cost of the vaccine caused them to delay introducing PCV. Fifty-one percent delayed initially offering the vaccine to any of their patients because the Vaccines for Children (VFC) program did not begin to offer PCV until several months later. The vast majority routinely vaccinated healthy children who are younger than 2 years as well as older children who had defined chronic medical conditions that put them at high risk of invasive pneumococcal disease. Fewer than 15% were recalling patients for PCV, with most recall efforts focused on patients who had chronic medical conditions. When discussing PCV with parents, 78% of physicians primarily emphasized the vaccine&apos;s potential to decrease the risk of sepsis and/or meningitis, whereas smaller percentages primarily emphasized the vaccine&apos;s potential to decrease the risk of pneumonia or ear infections. Approximately 20% of physicians who gave PCV delayed other vaccinations (primarily varicella vaccine, hepatitis B vaccine, or polio vaccine) because of concern about administering 4 or more vaccines simultaneously. Similarly, 40% of physicians indicated that they considered PCV to be more important than varicella vaccine or hepatitis B vaccine, whereas 26% percent considered PCV to be more important than polio vaccine. Conclusions. PCV has been widely accepted by physicians in both Rochester and Nashville. However, many physicians delayed introducing the vaccine for reasons that were ultimately related to financial considerations. For privately insured patients, delays were related to when coverage for PCV was added to benefit packages. For patients who receive publicly purchased vaccine via the VFC program, delays were related to availability of the vaccine through the VFC program. In addition, after the introduction of PCV, some physicians began delaying the administration of other vaccines because of the need to give multiple vaccinations simultaneously. Although lack of insurance or VFC coverage and concerns about multiple simultaneous injections may somewhat delay the initial use of newly recommended vaccines, physicians rapidly begin to provide new vaccines that they believe to be beneficial once those vaccines are incorporated into existing payment mechanisms. Pediatrics 2002;110(6). URL: http://www.pediatrics.org/ cgi/content/full/110/6/e68; Pneumococcus, vaccine, vaccination, immunization.

Doctors should begin vaccinating high-risk people against pneumococcal infections. Pneumococcal infections are caused by the bacterium Streptococcus pneumoniae. There is a pneumococcal vaccine available that can lower the risk of pneumococcal infection by two-thirds. Young children and the elderly are most at risk. A 1999 report revealed an outbreak of pneumococcal pneumonia among nursing home residents. Only 4% had received the pneumococcal vaccine. Since Streptococcus pneumoniae is now resistant to many antibiotics, it is even more critical to vaccinate susceptible groups.

The number of elderly Americans who are vaccinated against influenza and pneumococcal infections is the highest ever recorded. In 1995, a survey of 22,639 adults 65 years or older found that 36% had received the pneumococcal vaccine and 58% had received the influenza vaccine during the past 12 months. This represents a 7 percentage point increase in the use of both vaccines since a similar 1993 survey. In twenty-three states, influenza vaccination rates equalled 60% or more, up from 5 states in 1993. Non-Hispanic whites were more likely to be vaccinated than blacks or Hispanics.

An analysis of 1995 Medicare billing data reveals that physicians are missing many opportunities to vaccinate elderly hospital patients against influenza and pneumococcal infections. Among 4,548 elderly patients hospitalized in 12 Western states that year, only 20% had received the pneumococcal vaccine at some time in the previous five years. About two-thirds of those not vaccinated had risk factors for pneumococcal infection. In a survey of 1,242 patients admitted to a hospital in last quarter of 1994, only 35% had received the influenza vaccine.

All nursing home residents 65 years or older should receive pneumococcal vaccine to prevent infection with Streptococcus pneumoniae. This bacterium is a common cause of pneumonia in elderly nursing home residents. In Oct, 1995, 10 people in a Massachusetts nursing home developed pneumococcal pneumonia and 2 died. In Feb, 1996, 12 people at a Oklahoma facility contracted this infection and 3 died. In May-Jun, 1996, 14 people in a Maryland facility developed pneumococcal pneumonia and 4 died. Less than 5% of the residents at these facilities had been vaccinated.

A concerted public awareness campaign can increase rates of vaccination against Streptococcus pneumoniae in the elderly. This bacterium, often called pneumococcus, is responsible for many cases of bacterial pneumonia and kills approximately 40,000 people each year in the US. The 1993 National Health Interview Survey found that fewer than 30% of high-risk people had received the pneumococcal vaccine. A Texas health care alliance found it could substantially increase the number of elderly who were vaccinated by providing its member organizations with media kits and access to lists of member hospitals offering the vaccine. Barriers to vaccination include inadequate supplies of vaccine, missed opportunities to vaccinate during physician visits and substandard vaccine delivery systems in non-health care settings such as workplaces. One of the goals of Healthy People 2000 is to increase the percentage of vaccinated elderly to 60%.

Even though a vaccine against Streptococcus pneumoniae (the organism responsible for most cases of pneumonia that require hospitalization) is available, only 10 percent of the elderly and other high-risk groups actually get immunized. Pneumococcal vaccine is utilized less than vaccines against other diseases, such as influenza, but similar factors cause the overall low utilization of adult vaccines. These factors include a lack of emphasis on preventive care in the medical community, uncertainty regarding which patients are high-risk and should be vaccinated, and fear of side effects. Why is pneumococcal vaccine particularly underutilized? The disease is difficult to diagnose; in fact, the causative organism in one-third of all cases of pneumonia is never determined. Since only one-third of pneumonias are pneumococcal, even a vaccine with good effectiveness (60 to 70 percent) will appear to 'work' for only 20 percent of the patients who undergo immunization (the remainder will not have this type of pneumonia). Attempts to convince physicians of the value of pneumococcal vaccination have not been particularly successful, nor has patient education. Another approach is described in an article in the September 5, 1990, issue of The Journal of the American Medical Association. The authors propose the immunization of high-risk people at the time they are discharged from the hospital after treatment for other disorders. Although it is impossible to calculate the benefits of such a hospital-based immunization policy directly, an estimated one-half to three-quarters of discharged, eligible patients can be immunized in this fashion. The article presents a convincing cost-benefit analysis of the savings that accrue by preventing pneumococcal pneumonia; however, such arguments are not likely to be as compelling for hospitals (needing admissions) as for health maintenance organizations (needing to keep patients out of the hospital). Financial incentives could be provided to hospitals to encourage them to immunize discharged patients. It is time for medical practice to reflect the recommendations of public health policy regarding pneumococcal pneumonia vaccination. (Consumer Summary produced by Reliance Medical Information, Inc.)