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Published on: February 23, 2014
Epidemiology of pneumococcal serotypes and conjugate vaccine formulations
1Childhood and Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
Insights
Seven key Streptococcus pneumoniae serotypes cause most infections in young children. A conjugate vaccine targeting these serotypes could prevent over 80% of invasive pneumococcal disease cases.
Area of Science:
- Pediatric Infectious Diseases
- Vaccinology
- Bacteriology
Background:
- Streptococcus pneumoniae infections, including bacteremia and meningitis, disproportionately affect children under 5.
- Traditional polysaccharide vaccines have shown limited efficacy in young children.
- Conjugate vaccines, linking polysaccharides to proteins, enhance immune responses in this age group.
Purpose of the Study:
- To identify the most prevalent Streptococcus pneumoniae serotypes causing infections in children under 6 years old.
- To inform the development of a more effective pneumococcal conjugate vaccine for pediatric populations.
- To assess the potential impact of a multivalent conjugate vaccine on invasive pneumococcal disease and otitis media.
Main Methods:
- National surveillance data from the CDC was analyzed for pneumococcal isolates from children under 6 years old (1978-1994).
- Isolates were categorized by infection type: bacteremia, meningitis, and otitis media.
- Serotyping was performed to determine the prevalence of different Streptococcus pneumoniae serotypes.
Main Results:
- Seven serotypes (14, 6B, 19F, 18C, 23F, 4, and 9V) accounted for 78% of all analyzed isolates.
- A vaccine targeting these seven serotypes could potentially prevent 86% of bacteremia, 83% of meningitis, and 65% of otitis media cases.
- The prevalence of these key serotypes increased from 78% to 87% between 1978 and 1994, and 80% of penicillin-nonsusceptible isolates belonged to these serotypes.
Conclusions:
- A targeted conjugate pneumococcal vaccine against the identified seven serotypes holds significant potential for reducing invasive pneumococcal disease and otitis media in young children.
- The increasing prevalence of these serotypes underscores the need for vaccine strategies addressing them.
- The high proportion of penicillin-nonsusceptible and resistant isolates within these serotypes highlights their clinical importance and the potential benefit of a conjugate vaccine in managing antibiotic resistance.
Abstract:
The incidence of bacteremia and meningitis due to Streptococcus pneumoniae is highest among preschool-age children, particularly those < 2 years of age. Clinical trials of capsular polysaccharide vaccines among young children have been disappointing. Conjugation of bacterial polysaccharides to proteins can increase antibody responses following vaccination of young children. Most conjugate vaccines proposed to date have been seven-valent. To identify serotypes most commonly associated with infection in young children, we serotyped pneumococcal isolates submitted to the CDC through national surveillance from 3884 children < 6 years old with pneumococcal bacteremia (n = 3169), meningitis (n = 401), or otitis media (n = 314) from 1978 to 1994. Seven serotypes (14, 6B, 19F, 18C, 23F, 4, and 9V) accounted for 3045 (78%) isolates. A conjugate pneumococcal vaccine protecting against these seven serotypes and serologically cross-reactive serotypes could potentially prevent 86% of bacteremia, 83% of meningitis, and 65% of otitis media cases. The proportion of isolates covered by such a vaccine increased from 78% to 87% from 1978 to 1994. Of 70 isolates submitted during 1992-1994 which were nonsusceptible to penicillin (minimal inhibitory concentration [MIC] > 0.1 microgram/mL, 56 (80%) were among the seven most prevalent serotypes. All 21 isolates resistant to penicillin (MIC > or = 2.0 micrograms/mL) were among these seven serotypes.
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