# Presentation: 397175

## Pneumococcal Disease and Pneumococcal  Vaccines

**Epidemiology and Prevention of Vaccine-Preventable Diseases**
**National Immunization Program**
**Centers for Disease Control and Prevention**

**Revised January 2007**

## NOTICEContent and order of the slides in this file may differ from those presented on the  broadcast and webcast

## Streptococcus pneumoniae

**Gram-positive bacteria**
**90 known serotypes**
**Polysaccharide capsule important virulence factor**
**Type-specific antibody is protective**

## Pneumococcal DiseaseClinical Presentations

**Pneumococcal pneumonia**
**estimated 100,000-135,000 cases requiring hospitalization per year**
**Bacteremia**
**50,000 or more cases per year**
**Meningitis**
**3,000 to 6,000 cases per year**

## Pneumococcal Disease Epidemiology

**Reservoir****	****	****  ****	****Human carriers**** **
**Transmission****	**** ****	****Respiratory ****	****	****	****	****	****	****	**
**Temporal pattern   ****	****Winter and early spring**** **
**Communicability****	****  ****	****Probably as long as ****	****	****	****	****  ****	****organism in respiratory ****	****	****	****	****  ****	****secretions****	**

## Invasive Pneumococcal Disease
Incidence by Age Group—1998

**Incidence by Age Group—1998**

***Rate per 100,000 population**
** ****Source:  Active Bacterial Core surveillance/EIP Network**

## Risk Factors for Invasive Pneumococcal Disease

**Children 2 years of age and younger**
**Persons 65 years and older**
**Underlying medical conditions**
**Recipients of a cochlear implant **

## Risk Factors for Invasive Pneumococcal Disease

**Underlying medical conditions**
**decreased immune function**
**functional or anatomic asplenia**
**chronic heart, pulmonary, liver, or renal disease**
**CSF leak**
**children who attend out of home child care**
**children of certain racial and ethnic groups **

## Pneumococcal Vaccines

**1977****	****   14-valent polysaccharide**
**	****	****    ****vaccine licensed**
**1983****	****   23-valent polysaccharide****	****   vaccine licensed (PPV23)**
**2000****	****   7-valent polysaccharide**
**	****	****   ****conjugate vaccine licensed (PCV7)**

## Pneumococcal Polysaccharide Vaccine

**Purified capsular polysaccharide antigen from 23 types of pneumococcus**
**Account for 88% of bacteremic  pneumococcal disease**
**Cross-react with types causing additional 8% of disease**

## Pneumococcal Polysaccharide Vaccine

**60%-70% against invasive disease (varies with underlying disease)**
**Duration of immunity- at least 6 years**
**Schedule- 1 dose with selective revaccination **
**Not effective in children younger than 2 years**
**Minimum age 2 years****	****	****	****	**

## Pneumococcal Polysaccharide Vaccine Recommendations

**Persons **_**>**_**2 years with normal immune systems who have chronic illness**
**cardiovascular**
**pulmonary disease**
**diabetes**
**Alcoholism**
**CSF leak**
**cochlear implant**
**Adults **_**>**_**65 years of age**

***MMWR***** 1997;46(RR-8):1-24**

## Pneumococcal Polysaccharide Vaccine Recommendations

**Immunocompromised persons**
**Hodgkins disease**
**lymphoma**
**multiple myeloma**
**chronic renal failure**
**nephrotic syndrome **
**functional or anatomic asplenia**
**HIV infection**

***MMWR***** 1997;46(RR-8):1-24**

## Pneumococcal Polysaccharide Vaccine Recommendations

**Children 2 years of age and older**
**functional or anatomic asplenia**
**sickle cell disease**
**nephrotic syndrome**
**CSF leak**
**immunosuppression, including HIV infection**
**cochlear implant **

***MMWR***** 1997;46(RR-8):1-24**

## Pneumococcal Polysaccharide Vaccine Revaccination

**Routine revaccination of immunocompetent persons is not recommended**
**Revaccination recommended for persons age **_**>**_**2 years at highest risk of serious pneumococcal infection**
**Revaccination is a one-time event**
**Single revaccination dose 5 years or longer after the first dose**
**For children, a single revaccination dose should be given 3 years after the first dose if the child is 10 years of age or younger at the time of revaccination **

***MMWR***** 1997;46(RR-8):1-24**

## Pneumococcal Polysaccharide VaccineCandidates for Revaccination

**Persons **_**>**_**2 years of age with:**
**functional or anatomic asplenia**
**immunosuppression**
**chronic renal failure**
**nephrotic syndrome**
**Persons vaccinated before 65 years of age**

***MMWR***** 1997;46(RR-8):1-24**

## Pneumococcal VaccinesAdverse Reactions

**Local reactions**
**polysaccharide****	****	****   30%-50%**
**conjugate****	****	****	****	****   10%-20%**
**Fever, myalgia**
**polysaccharide****	****	****	****   <1%**
**conjugate****	****	****	****	****   15%-24%**
**Severe adverse ****	****	****	****   ****rare****reactions**

## Pneumococcal VaccinesContraindications and Precautions

**Severe allergic reaction to vaccine component or following prior dose of vaccine**
**Moderate or severe acute illness**

## National Immunization ProgramContact Information

**Telephone****	****	****800.CDC.INFO**** **
**Email****	****	****	****nipinfo@cdc.gov**** **
**Website****	****	****www.cdc.gov/nip**