EBO with EWSs seems to be a reasonable and manageable treatment option for patients with prolonged pulmonary air leaks, including those with severe respiratory failure requiring mechanical ventilation.

Serotype-specific protective immunity of pediatric patients with invasive pneumococcal disease (IPD) has not been fully investigated. To determine the protective immunity to the infecting serotype, the serotype-specific immunoglobulin G (IgG) levels and opsonophagocytic assay (OPA) titers were examined in twenty-four pediatric patients whose serum was collected within one month of IPD episode in between May 2008 and June 2011 in Japan. The median age (range) of IPD patients was 17 (10–108) months and 63% were boys. The levels of serotype-specific IgG to the infecting serotype were higher than 0.2 μg/ml in all of 17 patients tested. By contrast, the OPA titers were < 8 to the infecting serotype in all of 17 patients tested. The avidities of 19F or 6B-specific IgG level higher than 5.0 μg/ml, but undetectable OPA titers, were confirmed to be lower than those with high OPA titers. Our data demonstrated that although the levels of serotype-specific IgG to the infecting serotype were higher than 0.2 μg/ml in sera of pediatric patients with IPD, the OPA titers were low during one month after the IPD episode. Impaired opsonic activities in these patients may be, in part, explained by the low avidities of serotype-specific IgG. Impaired serum opsonic activity in children immediately after the episode of IPD suggests their susceptibility to the infecting serotype of pneumococci.

No abstract

Streptococcus pneumoniae is a major worldwide cause of morbidity and mortality. Pneumococcal carriage is considered to be an important source of horizontal spread of this pathogen within the community. Pneumococcal conjugate vaccine (PCV) is capable of inducing serotype-specific antibodies in sera of infants, and has been suggested to reduce nasopharyngeal carriage of vaccine-type pneumococci in children. PCV is generally immunogenic for pediatric patients with invasive pneumococcal disease, with an exception for the infecting serotypes. Based on evidences from the clinical trials of PCV, the health impact of childhood pneumococcal pneumonia appears to be high in developing countries where most of global childhood pneumonia deaths occur. PCV vaccination may prevent hundreds of deaths per 100,000 children vaccinated in developing countries, while PCV vaccination is expected to prevent less than 10 deaths per 100,000 children vaccinated in the developed countries. Therefore, the WHO has proposed a strategy to reduce the incidence of severe pneumonia by 75% in child less than 5 years of age compared to 2010 levels by 2025.