Prevention of Antibiotic-Nonsusceptible Streptococcus pneumoniae With Conjugate Vaccines

Abstract

Antibiotic-nonsusceptible IPD rates remain below pre-PCV7 rates for children <5 and adults ≥65 years old. PCV13 vaccines hold promise for further nonsusceptibility reductions.

The role of vaccines in fighting antimicrobial resistance (AMR)

“…27 Importantly at this time, resistance to penicillin and other classes of antibiotics also spread in Str pneumoniae in the US, with invasive pneumococci becoming resistant to 3 or more drug classes. 28 , 29 Similar to Hib vaccines, pneumococcal polysaccharide conjugate vaccines were highly effective with >90% efficacy against invasive pneumococcal disease (IPD) observed in the primary target populations of children <5 years of age. Not only was disease prevented, but significant reductions in bacterial colonization in US children was observed contributing to herd immunity in individuals initially not targeted for routine immunization, in particular adults.…”

“…Not only was disease prevented, but significant reductions in bacterial colonization in US children was observed contributing to herd immunity in individuals initially not targeted for routine immunization, in particular adults. 30 In 2000, 7 years after the introduction of PCV7, ∼211,000 cases of IPD caused by the 7 serotypes covered by PCV7 (including antibiotic-resistant strains) were prevented not only in children but in individuals of all ages 29 , 30 Second generation pneumococcal conjugate vaccines with extended serotype coverage such as PCV10 (10-valent) and PCV13 (13-valent) have increased direct protection and herd immunity to the pneumococcal serotypes covered by these vaccines with similar efficacy. 31 , 32 Very importantly, just as observed after introduction of PCV7, PCV13 also reduced antibiotic use and in parallel the prevalence of antibiotic non-susceptible strains also decreased (Figure 2).…”

“…31 , 32 Very importantly, just as observed after introduction of PCV7, PCV13 also reduced antibiotic use and in parallel the prevalence of antibiotic non-susceptible strains also decreased (Figure 2). 28 , 29 , 31

10.1080/21645515.2018.1476814-F0002Figure 2.Rates of antibiotic non-susceptible invasive pneumococcal disease (<5 years) 2005–2013. 28 .

…”

Racial and Regional Differences in Rates of Invasive Pneumococcal Disease

“…1,2 After introduction of the heptavalent pneumococcal conjugate vaccine (PCV7) in 2000, the incidence of pneumococcal diseases declined significantly. [1][2][3][4] While overall invasive pneumococcal disease (IPD) rates declined after the introduction of PCV7, [5][6][7] rates of residual IPD caused by non-PCV7 serotypes (particularly 19A) increased. 3 ,8 In February 2010, a 13-valent pneumococcal conjugate vaccine (PCV13) replaced PCV7 in the US routine infant vaccination schedule.…”

Narrow Vs Broad-spectrum Antimicrobial Therapy for Children Hospitalized With Pneumonia

“…1 Reasons for this recommendation include the recognition of Streptococcus pneumoniae as the leading bacterial pneumonia pathogen among children, [2][3][4] reductions in pneumococcal disease caused by penicillin-resistant strains after introduction of pneumococcal conjugate vaccines, [5][6][7][8] and demonstrated effectiveness of higher-dosed penicillin-based therapies for relatively resistant pneumococcal infections outside of the central nervous system. 9,10 Implicit in these recommendations is also the desire to increase awareness about the epidemic of antimicrobial resistance, due in part to overprescribing of broad-spectrum antibiotics for upper and lower respiratory tract infections.…”