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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.)