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Pneumococcal
Conjugate VaccineBy
Dr Dinesh Agarwal
Associate Consultant
Department of Paediatrics
Pushpanjali Crosslay Hospital
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Invasive and Noninvasive
Infections
Invasive pneumococcal disease1
Bacteremia/sepsis
Meningitis
Bacteremic pneumonia
Noninvasive pneumococcal disease1
Non-bacteremic pneumonia
Acute otitis media
Sinusitis
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S. pneumoniae Disease Burden in ChildrenS. pneumoniae Disease Burden in Children
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The polysaccharide capsule of
S. pneumoniae Gram-positive, encapsulated
diplococci
The capsule is a major virulence
factor, hindering opsonization byphagocytes
Antibodies to the capsular
polysaccharide (CPS) are
protective
Capsular polysaccharide defines
a serotype
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Streptococcus pneumoniae :
Seroepidemiology Subtle differences exist in the chemical structure of the
polysaccharide coat, creating distinct serotypes of S.pneumoniae.
Approximately 45 serogroups (denoted by numbers 1, 2,3, etc.)comprised of 90 serotypes(denoted by alphabets/letters A, C, F etc.)
Prevalence of individual serotypes varies geographically,between different age-groups and over time
Small subset of serogroup accounts for vast majority ofthe invasive disease in almost every region of the worldand these most often display antibiotic resistance(serotypes 4, 6, 9, 14, 18, 19 and 23)
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Epidemiology
Reservoir Human carriers
Transmission Respiratory
auto-innoculation
(droplet)
Route ofTransmission Lymphatics
- Blood stream
(Bacteremia)
- Direct Extension fromlocal site (sinuses)
Temporal pattern Winter and early
spring
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Important risk factors for invasive
pneumococcal diseaseCo-morbiditiesSickle cell disease (SCD)
Certain chronic diseases
HIV infection
Primary immune deficienciesImmunosuppressive therapy
Immunologic factorsYoung age
Limited breast feeding
Other predisposingconditionsCSF leak
Cochlear implant
Passive smoking
Antecedent antibiotic use
Recent/frequent otitis media
Pre-maturity or low birth weight
Social factors
Poverty
Crowding
Day care attendance
Race / ethnicity
Demographic factorsBeing a boy
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In India, data on prevelance of pneumococcal
disease is scanty.
Most prevelant serotypes:6,1,9,4,5,45,12,7,23
Serotypes 1 and 5 are responsible for 30% IPD
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Prevenar
(Pneumococcal Conjugate Vaccine)
Heptavalent (seven valent) vaccine
Conjugation with CRM 197 Protein
Aluminum as aluminum phosphate adjuvent
Serotype 3,6B,9V,14,18C,19F and 23
First introduced in July 2000 in Universal Immunisation in the
USA
Presently licensed in 19 Countries
Indicated below 2 years of age
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Recommended for Use
For EPI:IPD burden greatest among underprivileged children
Public Health Importance
Ideally available to all children
Limitation: High Cost
Limited Coverage of prevalent serotypes in India
High Risk: Both PPV 23/PCV
Provide expanded Provide robust immune
serotype coverage response and immune memory Healthy Children: 1:1 discussion with parents below 2 years of
age
Cover 55% pneumococcal serotypes prevelant
in India
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Doses and Administration
Dose - 0.5 ml
Route of Administration - Intramuscular
Sites - Anterolateral aspect of thigh in
infant
- Deltoid muscle of the upper arm inolder children
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Vaccination Schedule
Primary Immun
ization
3 doses at 6,10,11 weeks and 1 booster at 15-18 months of age.
Catch up Vaccination
Age at First Dose Total Number of 0.5 ml doses
7-11 months of age 3*
12-23 months of age 2**
>24 months through 9 years
of age
1
*2 dose atleast 4 weeks apart; third dose after the one year birthday, separated
from the second dose by at least 2 months.
**2 doses at atleast 2 months apart
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Children at high risk
Congenital immunodeficiency
HIV
Immunosuppressive therapy
Organ transplant recipients
Sickle cell disease, asplenia/hyposplenia Chronic cardiac disease
Chronic pulmonary disease excluding asthma unless on high
dose oral steroids
Chronic liver disease Chronic renal failure, nephrotic syndrome
Diabetes mellitus
Cerebrospinal fistula, cochlear implants
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High Risk
If affordable, PCV-1ST 2 years, PPV 23 also
PCV PPV 23
2 month
PPV 23, PCV after 2 months
2nd dose of PPV 23: 3-5 years later10 years
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Adverse Reaction
Very Common Injection site erythema, induration/swelling, pain/tenderness
Diarrhea, vomiting
Fever
Decreased appetite
Drowsiness; restless sleep
Irritability
Crying
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Rare/Very Rare
Seizure (including febrile seizure)
Hypotonic-hyporesponsive-episode
Injection site: urticaria
dermatitis
pruritus
Lymphadenopathy
Hypersensitivity reactions including face edema
Dyspnea
Bronchospasm
Anaphylactic/anaphylactoid reaction including shock
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Efficacy: 95%
with herd effect resulting from decrease from nasopharyngeal
carriage
Recent Vaccines
10 valent from GSK including serotype 1,5,7 in addition to 7
valent prevnar with Protein D-carrier.
13 valent from Wyeth including serotypes 1,3,5,6A,7F,19A in
addition to 7 valent prevnar with CRM 19 carrier protein.
*Both the vaccines are licensed in some countries.
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Unconjugated Polysaccharide
Vaccine
23 valent
Serotypes 1,2,3,4,5,6B,7F,8,9N,10A,11A,12F,14,15B,17F,18C,
19F,19A,20,22F,23F,33F
T-cell independent Vaccine
Poorly immunogenic
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70% efficacy in high risk but no protection against non bacteric
pneumonia and OM
Dose: 0.5 ml
Route: S/C or I/M
Safe occasional local side effects
Maximum two doses
More doses causes immunologic hypo responsiveness
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