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Published on: February 23, 2014
Pneumococcal Disease Prevention: Are We on the Right Track?
Nicola Principi1, Susanna Esposito2
1Università Degli Studi di Milano, 20122 Milan, Italy.
Insights
Pneumococcal conjugate vaccines (PCVs) reduced disease but led to serotype replacement. New vaccines are needed to combat emerging strains, though current PCVs remain crucial for preventing pneumococcal infections.
Area of Science:
- Microbiology
- Immunology
- Vaccinology
Background:
- * *Streptococcus pneumoniae* diseases significantly impacted public health globally.
- * The introduction of pneumococcal conjugate vaccines (PCVs) marked a turning point in managing these infections.
Purpose of the Study:
- * To review the historical impact of PCVs on invasive pneumococcal diseases (IPDs) and non-invasive pneumococcal diseases (nIPDs).
- * To analyze the phenomenon of serotype replacement following PCV introduction.
- * To discuss the need for next-generation pneumococcal vaccines.
Main Methods:
- * Retrospective analysis of disease incidence data.
- * Review of vaccine efficacy studies.
- * Examination of serotype distribution trends.
Main Results:
- * PCV7 significantly reduced IPDs and nIPDs caused by vaccine serotypes (STs).
- * Serotype replacement was observed, with an increase in IPDs/nIPDs caused by non-vaccine STs.
- * PCV10 and PCV13 also faced challenges with emerging STs and limited effectiveness against specific serotypes like ST3 and non-encapsulated strains.
Conclusions:
- * While current PCVs offer substantial benefits, they have not eliminated pneumococcal diseases due to serotype replacement.
- * Development of next-generation *S. pneumoniae* vaccines targeting conserved antigens is crucial for broad protection.
- * Continued use of existing PCVs is recommended due to their proven efficacy in reducing overall disease burden.
Abstract:
The history of Streptococcus pneumoniae diseases dramatically changed with the introduction into the immunization schedule of infants and children of the first pneumococcal conjugate vaccine, the one containing 7 (PCV7) of the most common pneumococcal serotypes (STs) causing invasive pneumococcal diseases (IPDs). Where PCV7 was largely used, incidence of both IPDs and non-invasive pneumococcal diseases (nIPDs) in vaccinated children and in unvaccinated subjects of any age, mainly the elderly, significantly decreased. Unfortunately, the impact of PCV7 administration was slightly lower than expected, as the reduction in infections due to vaccine serotypes (STs) was accompanied by a significant increase in the number of IPDs and nIPDs due to STs not included in the vaccine. To overcome this problem, two PCVs containing 10 (PCV10) and 13 (PCV13) STs, chosen among those emerging, were developed and licensed. However, ST replacement occurred again. Moreover, the new PCVs showed little effectiveness in the prevention of infection due to non-encapsulated STs and to ST3. Next-generation S. pneumoniae vaccines able to prevent pneumococcal infections regardless of infecting ST are urgently needed. For the moment, the use of available PCVs remains fundamental because their benefits far outweigh any concerns for emerging STs.
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