Pneumococcal vaccine - past, present, and future

Article Abstract:

A report in the November 21, 1991 issue of The New England Journal of Medicine shows that the polyvalent pneumococcal polysaccharide vaccine (containing several strains of the organism the causes the disease) had an efficacy of 61 percent in subjects with competent immune systems. This and similar reports highlight the difficulty of evaluating vaccines, particularly those to prevent relatively rare diseases such as bacteremic pneumococcal pneumonia (in which the pneumococcus invades the bloodstream). High-risk populations are often studied, limiting the number of trials that can be performed. The best studies of the pneumococcal vaccine were carried out in young, healthy people at high risk (South African gold miners and military trainees); whether the results can be generalized to elderly Americans has not been ascertained. Several disadvantages of the randomized trials performed concerning this issue are cited. Vaccines should be subjected to evaluation in prospective, rigorous studies started shortly after the vaccine has been licensed. Such studies need not be randomized if acceptable methodologic approaches are used, such as the case-control method for determining efficacy. Factors such as patient age at the time of infection and the time since vaccination can be taken into account. These factors are important for the development of recommendations concerning vaccination. Although pneumococcal vaccine has been recommended for all persons older than 65, and for some younger persons, only one fifth of the control subjects in the Journal study had received it. Incentives to hospitals to immunize eligible patients could help improve this situation. It is possible that vaccination of all people housed in large, crowded settings should take place. The current vaccine has low efficacy in elderly and immunocompromised people, and better vaccines should be developed. However, the use of the present vaccine needs to become more widespread. (Consumer Summary produced by Reliance Medical Information, Inc.)

Editorial, Testing

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The prevention of pneumococcal disease in children

Article Abstract:

The increase in drug resistance among strains of Streptococcus pneumoniae (pneumococcus) is making it more difficult to treat ear infections in children. For this reason, the pneumococcal vaccine is probably the best way to prevent ear infections. Streptococcus pneumoniae causes about half of all ear infections in children.

Prevention, Otitis media

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Pneumococcal research transformed

Article Abstract:

The genes of Streptococcus pneumoniae serotype 4 have been sequenced, and vaccines can be targeted to specific proteins expressed on the surface of the bacterium. Hopefully, the remaining strains of Streptococcus pneumoniae will be sequenced, along with other bacteria that cause serious infections.

Research, Streptococcus pneumoniae

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