Pneumococcal vaccine
Vaccine description | |
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Target | Streptococcus pneumoniae |
Vaccine type | Conjugate |
Clinical data | |
AHFS/Drugs.com | Monograph |
ATC code | |
Legal status | |
Legal status |
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Identifiers | |
ChemSpider |
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Pneumococcal vaccines are
The World Health Organization (WHO) recommends the use of the conjugate vaccine in the routine immunizations given to children.[1] This includes those with HIV/AIDS.[1] The recommended three or four doses are between 71 and 93% effective at preventing severe pneumococcal disease.[1] The polysaccharide vaccines, while effective in healthy adults, are not effective in children less than two years old or those with poor immune function.[1]
These vaccines are generally safe.[1] With the conjugate vaccine about 10% of babies develop redness at the site of injection, fever, or change in sleep.[1] Severe allergies are very rare.[1]
Whole cell vaccinations were developed alongside characterisation of the subtypes of pneumococcus from the early 1900s.[2]
The first pneumococcal vaccine was developed in the 1980s.[1] It is on the World Health Organization's List of Essential Medicines.[3][4]
Recommendations
Worldwide
A pilot
The Humanitarian Mechanism makes the pneumococcal vaccine available to humanitarian actors (but not governments) at a lower than normal price during humanitarian emergencies.[10]
Belgium
The national vaccination program started vaccinating newborns in 2004 with the 7-valent pneumococcal conjugate vaccine (PCV 7). This was changed into the 13-valent conjugate (PCV 13) in 2011. The switch to the 10-valent conjugate (PCV 10) was made in July 2015 in Flanders and May 2016 in Wallonia.[11] In late 2020 a start was made with the vaccination of care home residents with the 23-valant pneumococcal polysaccharide vaccine (PPV 23).[12]
Canada
Health Canada's general recommendations are 13-valent pneumococcal conjugate vaccine (PCV 13) vaccine for children aged 2 months to 18 years and 23-valent pneumococcal polysaccharide vaccine (PPV 23) vaccine for adults.[13]
India
In May 2017, the Government of India decided to include pneumococcal conjugate vaccine in its
The Netherlands
The national vaccination program started including the pneumococcal vaccine for newborns in April 2006.[15]
The Health Council advised in 2018 that those who are over the age of 60 should also be vaccinated on a 5-year recurring schedule. The resulting program from this, NPPV, started at the end of 2020.[16]
Health authorities reported in December 2020 that former COVID-19 patients also have an indication for this vaccine because of the damage their lungs incurred. Vaccinating this group is not part of the NPPV program.[17]
South Africa
The 7- and 13-valent pneumococcal conjugate vaccines (PCV7 and PCV13) were introduced into the national Expanded Program on Immunization (EPI) in South Africa in 2009 and 2011, respectively. South Africa became the first African country – and the first nation in the world with a high HIV prevalence – to introduce PCV7 into its routine immunization program.[18] Rates of invasive pneumococcal disease (IPD) – including cases caused by antibiotic-resistant bacteria – have fallen substantially in South Africa following the introduction of PCV7. Among children under two years of age, the overall incidence of IPD declined nearly 70% after PCV introduction, and rates of IPD caused by bacteria specifically targeted by the vaccine decreased nearly 90%.[19] Due to the indirect protection conferred by herd immunity, a significant decline in IPD in children and in unvaccinated adults has also been shown.[19]
Pneumovax 23 is used for all ages and, according to the enclosed patient information leaflet, has a reported 76% to 92% protective efficacy (pneumococcal types 1, 2, 3, 4, 5, 6B**, 7F, 8, 9N, 9V**, 10A, 11A, 12F, 14**, 15B, 17F, 18C, 19A**, 19F**, 20, 22F, 23F** and 33F** are included, where ** indicates drug-resistant pneumococcal infections; these are the 23 most prevalent or invasive pneumococcal types of Streptococcus pneumoniae).[medical citation needed]
United Kingdom
It was announced in February 2006, that the UK government would introduce vaccination with the conjugate vaccine in children aged 2, 4 and 13 months.[20][21] This included changes to the immunisation programme in general.[22] In 2009, the European Medicines Agency approved the use of a 10 valent pneumococcal conjugate vaccine for use in Europe.[23] The 13-valent pneumococcal vaccine was introduced in the routine immunization schedule of the UK in April 2010.[citation needed]
United States
In the United States, a heptavalent pneumococcal conjugate vaccine (PCV 7) (e.g. Prevnar, called Prevenar in some countries[25]) was recommended for all children aged 2–23 months and for at-risk children aged 24–59 months in 2000. The normal four-dose series is given at 2, 4, 6 and 12–14 months of age. In February 2010, a pneumococcal conjugate vaccine which protects against an additional six serotypes was introduced (PCV 13/brand name: Prevnar 13) and can be given instead of the original Prevnar.[26][27] On 10 June 2021, a pneumococcal conjugate vaccine which protects against 20 serotypes was approved with the brand name Prevnar 20.[28] In April 2023, the FDA approved the use of Prevnar 20 vaccine to prevent pneumococcal disease in children aged six weeks to 17 years.[29][30][31]
Mechanism
Polysaccharide vaccine
The pneumococcal polysaccharide vaccine most commonly used today [citation needed] consists of purified polysaccharides from 23 serotypes (1, 2, 3, 4, 5, 6b, 7F, 8, 9N, 9V, 10A, 11A, 12F, 14, 15B, 17F, 18C, 19A, 19F, 20, 22F, 23F, and 33F).[32] Immunity is induced primarily through stimulation of B-cells which release IgM[32] without the assistance of T cells.[33]
This immune response is less robust than the response provoked by conjugated vaccines, which has several consequences. The vaccine is ineffective in children less than 2 years old, presumably due to their less mature immune systems.[32] Non-response is also common amongst older adults.[32] Immunity is not lifelong, so individuals must be re-vaccinated at age 65 if their initial vaccination was given at age 60 or younger.[32] Since no mucosal immunity is provoked, the vaccine does not affect carrier rates, promote herd immunity, or protect against upper or lower respiratory tract infections.[32] Finally, provoking immune responses using unconjugated polysaccharides from the capsules of other bacteria, such as H. influenzae, has proven significantly more difficult.[32]
Conjugated vaccine
The pneumococcal conjugate vaccine consists of capsular polysaccharides covalently bound to the diphtheria toxoid CRM197, which is highly immunogenic but non-toxic.[32] This combination provokes a significantly more robust immune response by recruiting CRM197-specific type 2 helper T cells, which allow for immunoglobulin type switching (to produce non-IgM immunoglobulin) and production of memory B cells.[32] Among other things, this results in mucosal immunity and the eventual establishment of lifelong immunity after several exposures.[32] The main drawbacks to conjugated vaccines are that they only provide protection against a subset of the serotypes covered by the polysaccharide vaccines.[medical citation needed] depitte, J.; Gove, Sandy; Breiman, Robert F.
Research
Due to the geographic distribution of pneumococcal serotypes, additional research is needed to find the most efficacious vaccine for developing-world populations. In a previous study, the most common pneumococcal serotypes or groups from developed countries were found to be, in descending order, 14, 6, 19, 18, 9, 23, 7, 4, 1 and 15. In developing countries, the order was 6, 14, 8, 5, 1, 19, 9, 23, 18, 15 and 7.[34] In order to further pneumococcal vaccine research and reduce childhood mortality, five countries and the Bill & Melinda Gates Foundation established a pilot Advance Market Commitment for pneumococcal vaccines worth US$1.5 billion. Advance Market Commitments are a new approach to public health funding designed to stimulate the development and manufacture of vaccines for developing countries.[35]
There is research into producing vaccines than can be given into the nose rather than by injection.[36][37] It is believed that this improves vaccine efficacy and also avoids the need for injection.[medical citation needed]
The development of serotype-specific anticapsular monoclonal antibodies has also been researched in recent years. These antibodies have been shown to prolong survival in a mouse model of pneumococcal infection characterized by a reduction in bacterial loads and a suppression of the host inflammatory response.[38][39] Additional pneumococcal vaccine research is taking place to find a vaccine that offers broad protection against pneumococcal disease.[40]
As of 2017[update], pneumonia vaccines target up to 23 forms of the bacterium that cause pneumonia with a new version under development covering 72 strains of the bacterium.[41][needs update]
References
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- ^ "Vaccine Fund". PneumoADIP. Global Alliance for Vaccines and Immunization (GAVI); Johns Hopkins Bloomberg School of Public Health. Archived from the original on 8 February 2011.
- ^ "Pneumococcal Advance Market Commitment (AMC)". GAVI. Archived from the original on 7 June 2013.
- ^ Photography by Apostolia S (3 December 2019). "Gavi must stop giving millions in subsidies to Pfizer and GSK for pneumococcal vaccine". Doctors Without Borders. Archived from the original on 2 August 2022.
- PMID 31384748.)
{{cite journal}}
: CS1 maint: overridden setting (link - ^ Photography by De Cock B (23 February 2011). "Pneumococcal Vaccine is Launched in Africa, But Are Donors Getting a Fair Deal from Companies?". Doctors Without Borders. Archived from the original on 14 September 2022.
- ^ Photograph by Ekholm K (2015). "Vaccination". Doctors Without Borders. Archived from the original on 27 June 2022.
- ^ "Pneumokokken - Nieuw advies Hoge Gezondheidsraad vaccinatie zuigelingen" [Pneumococcal: New advice from High Health Council concerning the vaccination of newborns]. vaxinfopro.be (in Dutch). 15 April 2019. Archived from the original on 1 February 2022. Retrieved 5 September 2020.
- ^ "Gratis pneumokokkenvaccin voor bewoners van woonzorgcentra" [Free pneumococcal vaccination for the residents of care homes]. laatjevaccineren.be (in Dutch). 9 November 2020. Archived from the original on 28 October 2021. Retrieved 5 September 2021.
- ^ "Pneumococcal vaccine: Canadian Immunization Guide". Government of Canada. 16 February 2020. Archived from the original on 1 September 2022.
- ISSN 0971-751X. Archived from the originalon 18 August 2022. Retrieved 18 September 2017.
- ^ "Prik tegen pneumokokken; Alle baby's vanaf april volgend jaar tegen bacterie ingeënt" [Jab against pneumacoccal; All babies vaccinated against bacteria from April of next year]. Algemeen Dagblad (in Dutch). 3 December 2005. Retrieved 4 September 2021 – via Delpher.
- ^ van Twillert M (17 December 2020). "Gezondheidsraad: 'Doorgaan met pneumokokkenvaccinatie van ouderen'" [Health council: 'continue pneumococcal vaccination of elderly']. Medisch Contact (in Dutch). Archived from the original on 15 May 2021. Retrieved 4 September 2021.
- ^ "COVID-19 en vaccinatie tegen pneumokokken (2)" [COVID-19 and vaccination against pneumococcal (2)]. Health Council of the Netherlands (Gezondheidsraad) (in Dutch). 17 December 2020. Archived from the original on 19 September 2021. Retrieved 19 August 2021.
- ^ "Critical decline in pneumococcal disease and antibiotic resistance in South Africa". NICD. Archived from the original on 23 July 2015. Retrieved 20 July 2015.
- ^ PMID 25386897.)
{{cite journal}}
: CS1 maint: overridden setting (link - ^ "Children to be given new vaccine". BBC News. 8 February 2006. Archived from the original on 30 May 2006.
- ^ "Pneumococcal vaccine added to the childhood immunisation programme" (Press release). Department of Health and Social Care. 8 February 2006. Archived from the original on 23 October 2006.
- ^ "Changes to the immunisation programme in the UK". Meningitis Research Foundation. Archived from the original on 13 July 2007. Retrieved 6 May 2017.
- ^ "Synflorix, GlaxoSmithKline's pneumococcal vaccine receives European authorisation" (Press release). GlaxoSmithKline. 31 March 2009. Archived from the original on 4 August 2009.
- ^ "Pneumococcal Vaccination: Information for Health Care Providers". Centers for Disease Control and Prevention (CDC). 11 July 2016. Archived from the original on 23 July 2016. Retrieved 26 July 2016.
- ^ "Prevenar — Annex I: Summary of Product Characteristics" (PDF). European Medicines Agency. Archived from the original (PDF) on 17 December 2008.
- ^ Wilson D (24 February 2010). "Vaccine Approved for Child Infections". The New York Times. Archived from the original on 4 November 2015.
- ^ "Prevnar 13". U.S. Food and Drug Administration (FDA). 12 January 2012. STN: 125324. Archived from the original on 18 August 2011.
- ^ "Prevnar 20". Food and Drug Administration. 10 June 2021. Archived from the original on 6 September 2022. Retrieved 20 June 2021.
- ^ "FDA Greenlights Pfizer's Pneumococcal Vaccine in Infants and Children". BioSpace. Archived from the original on 3 May 2023. Retrieved 3 May 2023.
- ^ Hazarika I (28 April 2023). "FDA clears Pfizer's Prevnar 20 vaccine for IPD prevention". Pharmaceutical Technology. Archived from the original on 3 May 2023. Retrieved 3 May 2023.
- ^ "Supplemental Approval: 20-valent Pneumococcal Conjugate Vaccine (PREVNAR 20)". Food and Drug Administration. 27 April 2023. Archived from the original on 1 May 2023. Retrieved 12 May 2023.
- ^ S2CID 10514479.
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{{cite journal}}
: CS1 maint: overridden setting (link - ^ "Saving Lives with New Vaccines: Advance Market Commitments". Advance Market Commitments for Vaccines (vaccineAMC). GAVI. November 2012. Archived from the original (PDF) on 6 March 2016.
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- ^ "Acute Respiratory Infections (Update September 2009): Streptococcus pneumoniae". Initiative for Vaccine Research (IVR). World Health Organization (WHO). Archived from the original on 23 May 2012.
- PMID 29057325.; Lay summary in: "The end of pneumonia? New vaccine offers hope: Vaccine under development provides the 'most comprehensive coverage' to date and alleviates antimicrobial concerns, new study finds". ScienceDaily. 20 October 2017. Archived from the originalon 8 August 2022. Retrieved 12 July 2018.
Further reading
- Kakade R. "Global Pneumonia Vaccine Market Analysis 2016-2020 and Forecast 2021-2026". Industry Research Place.[permanent dead link]
- Moberley S, Holden J, Tatham DP, Andrews RM (January 2013). "Vaccines for preventing pneumococcal infection in adults". The Cochrane Database of Systematic Reviews. 1 (1): CD000422. PMID 23440780.
- Käyhty H, Nurkka A, Soininen A, Väkeväinen M (September 2009). The immunological basis for immunization series: module 12: pneumococcal vaccines (PDF). ISBN 9789241598217. Archived from the original(PDF) on 14 September 2022.
- Salisbury D, Ramsay M, Noakes K, eds. (November 2006). "Chapter 25: Pneumococcal". Immunisation against infectious disease (PDF). Public Health England. Archived from the original (PDF) on 11 March 2022.
- Gierke R, Wodi AP, Kobayashi M (2021). "Chapter 17: Pneumococcal Disease". In Hall E, Wodi AP, Hamborsky J, Morelli V, Schillie S (eds.). Epidemiology and Prevention of Vaccine-Preventable Diseases (14th ed.). Washington D.C.: U.S. Centers for Disease Control and Prevention (CDC). Archived from the original on 30 December 2016. Retrieved 12 November 2019.
External links
- "Pneumococcal Conjugate Vaccine Information Statement". U.S. Centers for Disease Control and Prevention (CDC).
- "Pneumococcal Polysaccharide Vaccine Information Statement". U.S. Centers for Disease Control and Prevention (CDC).
- Pneumococcal Vaccines at the U.S. National Library of Medicine Medical Subject Headings (MeSH)