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Published on: February 23, 2014
Recent advances in the epidemiology and prevention of Streptococcus pneumoniae infections
Charles Feldman1, Ronald Anderson2
1Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, 7 York Road, Parktown, Johannesburg, 2193, South Africa.
Insights
Pneumococcal conjugate vaccines (PCVs) have reduced infant deaths from invasive pneumococcal disease (IPD). However, global IPD burden remains high due to access issues, new strains, and waning herd protection in aging populations.
Area of Science:
- * Infectious Disease Epidemiology
- * Vaccinology
- * Public Health Policy
Background:
- * Pneumococcal conjugate vaccines (PCVs) 7 and 13 significantly reduced infant invasive pneumococcal disease (IPD) and mortality in the US.
- * Childhood PCV immunization provides herd protection for unvaccinated adults, especially the elderly.
- * Global IPD burden persists due to limited PCV access in developing nations, emergence of non-vaccine serotypes, and aging populations.
Purpose of the Study:
- * To review the impact of PCVs on IPD reduction and herd protection.
- * To examine challenges in global pneumococcal disease control.
- * To discuss strategies for improving PCV efficacy and access in vulnerable populations.
Main Methods:
- * Literature review of studies on PCV impact, IPD epidemiology, and immunization strategies.
- * Analysis of factors contributing to persistent pneumococcal disease burden.
- * Examination of current and future PCV technologies and access initiatives.
Main Results:
- * PCVs have been highly effective in reducing IPD in vaccinated infants and providing herd protection to adults.
- * Herd protection from current PCVs is plateauing in aging populations.
- * Non-vaccine serotypes and limited global access hinder complete disease eradication.
Conclusions:
- * While successful, current PCVs face challenges including serotype replacement and access inequity.
- * Optimizing immunization strategies for the elderly is crucial given population aging.
- * Future strategies must focus on broader serotype coverage and improved global vaccine access to reduce the overall burden of pneumococcal disease.
Abstract:
The introduction of pneumococcal conjugate vaccines (PCVs) 7 and 13 into national childhood immunization programs in the US in 2000 and 2010, respectively, proved to be remarkably successful in reducing infant mortality due to invasive pneumococcal disease (IPD), resulting in widespread uptake of these vaccines. Secondary herd protection of non-vaccinated adults against IPD has proven to be an additional public health benefit of childhood immunization with PCVs, particularly in the case of the vulnerable elderly who are at increased risk due to immunosenescence and underlying comorbidity. Despite these advances in pneumococcal immunization, the global burden of pneumococcal disease, albeit of unequal geographic distribution, remains high. Reasons for this include restricted access of children living in many developing countries to PCVs, the emergence of infection due to non-vaccine serotypes of the pneumococcus, and non-encapsulated strains of the pathogen. Emerging concerns affecting the elderly include the realization that herd protection conferred by the current generation of PCVs (PCV7, PCV10, and PCV13) has reached a ceiling in many countries at a time of global population aging, compounded by uncertainty surrounding those immunization strategies that induce optimum immunogenicity and protection against IPD in the elderly. All of the aforementioned issues, together with a consideration of pipeline and pending strategies to improve access to, and serotype coverage of, PCVs, are the focus areas of this review.
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