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5. Also called « pneumococc

6.  Streptococcus pneumoniae, also called pneumococcus are
lancet-shaped, gram-positive diplococci.
 The pneumococcal cell wall surface is covered by a
polysaccharide capsule .
 The polysaccharide capsule is an essential virulence factor
and means of evading the immune system by resisting
phagocyte killing.
 Type-specific antibody to capsular polysaccharide is
protective.
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9.  Colonization:
o S. Pneumoniae is common inhabitant of the
respiratory tract and may be isolated from the
nasopharynx.
o Humans may carry the bacteria without being infected
(asymptomatic carriers) , but may still pass on the
bacteria to others .
 Transmission:
Person-to-person via respiratory droplets/secretions
OR Autoinoculation in asymptomatic carriers .
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S. Pneumoniae: Transmission &
colonization

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13. Clinical Syndromes of pneumococcal
disease

15. Pneumonia
1 in 20
deaths
Bacteremia
1 in 5
deaths
Meningitis
3 in 10
deaths
Clinical Syndromes –case fatality Rates

17. Everybody Is at Risk

18. The Very Young ≥65 Adults

19. Underlying Conditions
Long-Term Health
Problems
Weakened Immune System
Heart or lung disease, sickle cell,
diabetes, alcoholism, cirrhosis, leaks of
cerebrospinal fluid, cochlear implant
Hodgkin’s lymphoma, leukemia, kidney
failure, multiple myeloma, nephrotic
syndrome, HIV or AIDS, damaged or no
spleen, organ transplant

20. Smokers
Asthma Sufferers

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24. Pneumococcal Vaccines
Vaccine Trade Name
Pneumococcal Polysaccharide Vaccine
(PPSV23)
Pneumovax
Pneumococcal Conjugate Vaccine
(PCV7)
Prevnar 7
Pneumococcal Conjugate Vaccine
(PCV13)
Prevnar 13

26. Serotype coverage
Conjugate vs. polysaccharide vaccines
PCV13 4 6B 9V 14 18C 19F 23F 1 5 7F 3 19A 6A
PPSV23 4 6B 9V 14 18C 19F 23F 1 5 7F 3 19A
2 8 9N 10A 11A 12F 15B 17F 20 22F 33F

27. + =
Conjugate vaccine
The conjugation of a polysaccharide to a carrier protein leads to the
interaction with T cells resulting in the release of functional
antibodies and production of memory B cells
Polysaccharide
antigens
Immunogenic
carrier protein
B cell
Plasma
cell
T-independent
Presentatio
n
T cell B cell
Memory B
cell T-dependent
Plasma
cell

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33. Road Map

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37. Indications for PPSV23 Alone
Adults aged 19 through 64 years with :
 Chronic heart disease including congestive heart
failure and cardiomyopathies (excluding
hypertension)
 Chronic lung disease including chronic
obstructive lung disease, emphysema, and
asthma
 Diabetes mellitus
 Chronic liver disease including cirrhosis
 Alcoholism
 Who smoke cigarettes.
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38. Adults aged 19 through 64 years with
 Chronic heart disease including congestive heart
failure and cardiomyopathies (excluding
hypertension)
 Chronic lung disease including chronic obstructive
lung disease, emphysema, and asthma
 Diabetes mellitus
 Chronic liver disease including cirrhosis
 Alcoholism; or who smoke cigarettes should receive
PPSV23.

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At age 65 years or older, they should receive
PCV13 & another dose of PPSV23 at least 1 year
after PCV13 & at least 5 years after the most
recent dose of PPSV23.

39. Adults aged 19 through 64 years with
:
 Immunocompromising conditions or
 Anatomical or functional asplenia
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40. Adults aged 19 through 64 years with
:
 Immunocompromising conditions or
 Anatomical or functional asplenia
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Should receive PCV13 and a dose of PPSV23 at least 8
weeks after PCV13, followed by a second dose of
PPSV23 at least 5 years after the first dose of PPSV23.

If the most recent dose of PPSV23 was administered
before age 65 years, at age 65 years or older,
administer another dose of PPSV23 at least 8 weeks
after PCV13 and at least 5 years after the most
recent dose of PPSV23.

41. Adults aged 19 through 64 years with
:
 with cerebrospinal fluid leak or cochlear
implant
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Should receive PCV13 and a dose of PPSV23 at least 8
weeks after PCV13. A PPSV23 booster is not
necessary

If the most recent dose of PPSV23 was administered
before age 65 years, at age 65 years or older,
administer another dose of PPSV23 at least 8 weeks
after PCV13 and at least 5 years after the most
recent dose of PPSV23.

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49. Pneumococcal Immunization in Person ≥65
Years of Age
Source: ACIP. Recommended Adult Immunization Schedule. 2016.
PCV13
≥ 1
Year
PPSV2
3
Pneumococcal Vaccine-Naïve
Age 65

50. Pneumococcal Immunization in Person ≥65
Years of Age
Source: ACIP. Recommended Adult Immunization Schedule. 2016.
PCV13
≥ 1
Year
PPSV2
3
Pneumococcal Vaccine-Naïve
PCV13
PPSV2
3
Has Already Received PPSV After Age 65
Age 65
≥ 1
Year
Received

51. PCV13
≥ 1
Year
PPSV2
3
Pneumococcal Vaccine-Naïve
PCV13
PPSV2
3
Has Already Received PPSV After Age 65
Age 65
≥ 1
Year
Has Received Pneumococcal Polyasaccharide Vaccine
Before Age 65
≥ 1
Year
PCV13
Received
Received
≥ 5 years
≥ 1
Year
PPSV2
3
PPSV2
3
Pneumococcal Immunization in Person ≥65
Years of Age
Source: ACIP. Recommended Adult Immunization Schedule. 2016.

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57. “ Immunizations are one of the world's biggest public health
success stories. But not all communities have the same
access to vaccines .”
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