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Microbial Diseases of the
                              Upper Respiratory System

Laryngitis: S. pneumoniae, S.
pyogenes, ...
History
0 In 1881, the organism,
 discovered by Leo Escolar,
 then known as the
 pneumococcus for its role
 as an etiologi...
Pneumococcal disease:
          a major health threat
0 Streptococcus pneumoniae is the leading bacterial
  cause of infec...
S. pneumoniae
0 leading cause of pneumonia
 0 particularly young and old
 0 after damage to upper respiratory tract
   *e....
DISEASES CAUSED BY STREPTOCOCCUS
           PNEUMONIAE


                     PNEUMOCOCCAL INFECTION




Non-invasive dise...
Streptococcus pneumoniae

0 Most common cause of both pneumonia overall and fatal
    pneumonia.
0   Antibiotic resistance...
Streptococcus pneumoniae
0 Streptococcus
 pneumoniae cells are
 Gram-positive, lancet-
 shaped cocci (elongated
 cocci wit...
Streptococcus pneumoniae
                  0 Individual cells are
                     between 0.5 and 1.25
              ...
Streptococcus pneumoniae
                                           • leading cause pneumonia
                            ...
PNEUMOCOCCUS:
Nasopharyngeal carriage may occur in up to 60% of healthy pre-school
children and upTRANSMISSION AND COLONIS...
PNEUMOCOCCUS:
 PATHOGENESIS




     Dr.T.V.Rao MD                                          12
                     Salyer...
Pneumococcal cell surface




         Dr.T.V.Rao MD      13
Genome of S. pneumoniae
0 The genome of S. pneumoniae is a closed, circular DNA
 structure that contains between 2.0 and 2...
S. pneumoniae TIGR4
       genome




  R6
  D39




    Comparative
genome hybridizations   Dr.T.V.Rao MD             15
...
The capsule
# Composition: polysaccharide
# Virulence factor: avoiding phagocytosis
# Induce type-specific immune response...
Serotyping
0 The quelling reaction
 (swelling reaction) forms the
 basis of serotyping and relies
 on the swelling of the ...
Summary Figure (Identification Scheme)
                                                                                   ...
S. pneumoniae
0   hemolytic
0 pneumolysin
    0 degrades red blood
     cells under aerobic
     conditions
  grows well o...
Hemolysis
      Streptococcus pneumoniae are Alphahemylotic
  alpha




  beta




gamma

                        Dr.T.V.R...
Bile solubility test




    Streptex antiserum
                                          optochin sensitive    Not optoch...
Optochin Test

0 The minimum criteria for
 identification and
 distinction of pneumococci
 from other streptococci are
 bi...
Not optochin sensitive




                optochin sensitive




Dr.T.V.Rao MD                            23
PNEUMOCOCCAL CARRIER STATE

0 Disease occurs in persons who are already asymptomatic
  carriers
0 Carrier rates
   38%-60%...
Pathogenesis: the route to
                   infection
                  Colonisation of the respiratory tract
Innate and...
Pneumococcus:
                  colonisation and transmission
0   Exclusively a human pathogen, part of the normal microbi...
Dr.T.V.Rao MD   27
Streptococcus pneumoniae: Symptoms and
                  Signs

0 Classic description
  0 sudden onset of chills and pleur...
Types of infection
 non-invasive                       invasive
otitis (25-50%)                    pneumonia
sinusitis    ...
PNEUMOCOCCAL DISEASE: MENINGITIS

0Meningitis
   0   Inflammation of the meninges (membranes surrounding the brain)
   0  ...
PNEUMOCOCCAL DISEASE: PNEUMONIA a major
               Complication


0 Bacteraemia in 15−30% of patients with pneumonia
 ...
Asplenic patients at risk with
   Pneumococcal Infections
0 Asplenic patients and those
  with impaired splenic
  function...
HIV infection and
Pneumococcal Infection
                 0 Adults infected with HIV have
                   high rates of...
PNEUMOCOCCAL PNEUMONIA MORTALITY


                  8%-10%
   Overall healthy young adults (non bacteriemic) < 1%


     ...
Treatment
0 Treatment is usually with Beta-lactam antibiotics.
  In the 1960s, nearly all strains of S. pneumoniae
  were ...
ORAL ANTIBIOTICS

0 Amoxicillin: first choice in < 5 years
0 Alternatives: co-amoxiclav, azithromycin,
  cefaclor, erythro...
IV antibiotics
0Indications of Intravenous antibiotics
 0 Unable to take oral antibiotics (for
   example, because of vomi...
Vancomycin is helpful in resistant
            strains
 0 Most remain susceptible to
  vancomycin, which is a less
  desir...
PNEUMOCOCCAL POLYSACCHARIDE
            VACCINEs
0 14-valent pneumococcal vaccine licensed in 1977
0 23-valent preparation...
Pneumococcal vaccines
   Protective immunity is conferred by anti-capsular
                type-specific antibodies
Antibo...
23-valent Pneumococcal Polysaccharide Vaccine
                          PPV23

25 µg of purified capsular polysaccharide a...
PPV23
                Negative aspects


0   immune response mediocre in children <2 years
    and in immunocompromised in...
PPV23 Recommendations
0 For healthy adults ≥ 65 years of age, particularly those
 living in institutions
- Based on data f...
7-valent Pneumococcal Conjugated Vaccine
                               PCV7

• Seven S. pneumoniae capsular polysaccharid...
PCV7. Characteristics
0 higher antibody levels and a more efficient immune
  response in infants

0 significant immunologi...
PCV7. Effectiveness
        (Wyeth Lab. Prevnar®,USA or Prevenar®, Europe)
                           ®                ®

...
PPV7. Efficacy in invasive disease
                        Pre-licensed study
 Northern Carolina Kaiser Permanent Trial

 ...
PCV7. Safety and schedule

02, 4, 6 months, booster 12-14
 months
0Possible interference with other
 conjugate vaccines (m...
CDC RECOMMENDATIONS
0 Immunocompromised persons >2 years with:
   Functional or anatomic asplenia
   HIV, AIDS
   Leukemia...
CDC RECOMMENDATIONS


0 Persons >2 years living in special environments or social
 settings, such as:
   Nursing homes
   ...
PNEUMOCOCCAL DISEASE: CONCLUSIONS

0Pneumococcal disease
   0   Major cause of morbidity and mortality worldwide

   0   D...
0 Programme created by Dr.T.V.Rao MD for
  e-learning resources for Medical and
   Paramedical Students in Developing
    ...
Streptococcus pneumonia
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Streptococcus pneumonia Slide 1 Streptococcus pneumonia Slide 2 Streptococcus pneumonia Slide 3 Streptococcus pneumonia Slide 4 Streptococcus pneumonia Slide 5 Streptococcus pneumonia Slide 6 Streptococcus pneumonia Slide 7 Streptococcus pneumonia Slide 8 Streptococcus pneumonia Slide 9 Streptococcus pneumonia Slide 10 Streptococcus pneumonia Slide 11 Streptococcus pneumonia Slide 12 Streptococcus pneumonia Slide 13 Streptococcus pneumonia Slide 14 Streptococcus pneumonia Slide 15 Streptococcus pneumonia Slide 16 Streptococcus pneumonia Slide 17 Streptococcus pneumonia Slide 18 Streptococcus pneumonia Slide 19 Streptococcus pneumonia Slide 20 Streptococcus pneumonia Slide 21 Streptococcus pneumonia Slide 22 Streptococcus pneumonia Slide 23 Streptococcus pneumonia Slide 24 Streptococcus pneumonia Slide 25 Streptococcus pneumonia Slide 26 Streptococcus pneumonia Slide 27 Streptococcus pneumonia Slide 28 Streptococcus pneumonia Slide 29 Streptococcus pneumonia Slide 30 Streptococcus pneumonia Slide 31 Streptococcus pneumonia Slide 32 Streptococcus pneumonia Slide 33 Streptococcus pneumonia Slide 34 Streptococcus pneumonia Slide 35 Streptococcus pneumonia Slide 36 Streptococcus pneumonia Slide 37 Streptococcus pneumonia Slide 38 Streptococcus pneumonia Slide 39 Streptococcus pneumonia Slide 40 Streptococcus pneumonia Slide 41 Streptococcus pneumonia Slide 42 Streptococcus pneumonia Slide 43 Streptococcus pneumonia Slide 44 Streptococcus pneumonia Slide 45 Streptococcus pneumonia Slide 46 Streptococcus pneumonia Slide 47 Streptococcus pneumonia Slide 48 Streptococcus pneumonia Slide 49 Streptococcus pneumonia Slide 50 Streptococcus pneumonia Slide 51 Streptococcus pneumonia Slide 52
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Streptococcus pneumonia

  1. 1. Microbial Diseases of the Upper Respiratory System Laryngitis: S. pneumoniae, S. pyogenes, viruses Tonsillitis: S. pneumoniae, S. pyogenes, viruses Sinusitis: Bacteria Epiglottitis: H. influenzae Dr.T.V.Rao MD 2
  2. 2. History 0 In 1881, the organism, discovered by Leo Escolar, then known as the pneumococcus for its role as an etiologic agent of pneumonia, was first isolated simultaneously and independently by the U.S Army physician George Sternberg and the French chemist Louis Pasteur. Dr.T.V.Rao MD 3
  3. 3. Pneumococcal disease: a major health threat 0 Streptococcus pneumoniae is the leading bacterial cause of infection worldwide: - asymptomatic colonisation - common infections (otitis media, ) - life-threating infections (sepsis, meningitis, ) 0 Despite the introduction of antimicrobial drugs over the past few decades it remains a significant threat to health Dr.T.V.Rao MD 4
  4. 4. S. pneumoniae 0 leading cause of pneumonia 0 particularly young and old 0 after damage to upper respiratory tract *e.g.following viral infection 0 bacteremia 0 meningitis 0 middle ear infections (otitis media) Dr.T.V.Rao MD 5
  5. 5. DISEASES CAUSED BY STREPTOCOCCUS PNEUMONIAE PNEUMOCOCCAL INFECTION Non-invasive disease Invasive disease • Sinusitis (sinuses) • Bacteraemia (blood) • Otitis media (middle ear) • Pneumonia (lungs) • Meningitis (CNS) • Endocarditis (heart) • Peritonitis (body cavity) • Septic arthritis (bones and joints) • Others (appendicitis, salpingitis, soft-tissue infections) Dr.T.V.Rao MD 6 Musher, in Principles and Practice of Infectious Diseases, 1995
  6. 6. Streptococcus pneumoniae 0 Most common cause of both pneumonia overall and fatal pneumonia. 0 Antibiotic resistance has developed worldwide and is most frequent in pneumococcal serotypes that are most prevalent in children (types/groups 6, 14, 19, and 23). 0 The incidence of pneumococcal disease is the highest in children < 2 years of age and in adults > 65 years of age. 0 Penicillin (penicillin G/amoxicillin) remains the drug of choice for strains that are fully sensitive 0 Cefotaxime and ceftriaxone are the first-line alternatives in cases with higher levels of resistance. Dr.T.V.Rao MD 7
  7. 7. Streptococcus pneumoniae 0 Streptococcus pneumoniae cells are Gram-positive, lancet- shaped cocci (elongated cocci with a slightly pointed outer curvature). Usually, they are seen as pairs of cocci (diplococci), but they may also occur singly and in short chains. When cultured on blood agar, they Dr.T.V.Rao MD 8 are alpha hemolytic
  8. 8. Streptococcus pneumoniae 0 Individual cells are between 0.5 and 1.25 micrometers in diameter. They do not form spores, and they are nonmotile. Like other streptococci, they lack catalase and ferment glucose to lactic acid Dr.T.V.Rao MD 9
  9. 9. Streptococcus pneumoniae • leading cause pneumonia – particularly young and old – after damage to upper respiratory tract *e.g. following viral infection • bacteremia S. pneumoniae - diplococci • meningitis • middle ear infections (otitis media) 0 capsule: 0 pneumolysin: 0 Surface protein adhesinand secretory IgA protease. 0 Teichoic acid and the Peptidoglycan fragment, phosphorylchorine . Dr.T.V.Rao MD 10
  10. 10. PNEUMOCOCCUS: Nasopharyngeal carriage may occur in up to 60% of healthy pre-school children and upTRANSMISSION AND COLONISATION to 30% of healthy older children and adults Nasal cavity Asymptomatic carrier Nasopharynx: site of colonisation Aerosol Inhalation Trachea Patient with pneumococcal disease Dr.T.V.Rao MD Fedson, Musher, in Vaccines, 1994 11 2.4 Dissemination Musher, in Principles and Practice of Infectious Diseases, 1995
  11. 11. PNEUMOCOCCUS: PATHOGENESIS Dr.T.V.Rao MD 12 Salyers, Whitt, in Bacterial Pathogenesis, 1994
  12. 12. Pneumococcal cell surface Dr.T.V.Rao MD 13
  13. 13. Genome of S. pneumoniae 0 The genome of S. pneumoniae is a closed, circular DNA structure that contains between 2.0 and 2.1 million base pairs, depending on the strain. It has a core set of 1553 genes, plus 154 genes in its virulome, which contribute to virulence, and 176 genes that maintain a noninvasive phenotype. Genetic information can vary up to 10% between strains.[5] Dr.T.V.Rao MD 14
  14. 14. S. pneumoniae TIGR4 genome R6 D39 Comparative genome hybridizations Dr.T.V.Rao MD 15 Science 2001
  15. 15. The capsule # Composition: polysaccharide # Virulence factor: avoiding phagocytosis # Induce type-specific immune response # More than 90 different serotypes Dr.T.V.Rao MD 16
  16. 16. Serotyping 0 The quelling reaction (swelling reaction) forms the basis of serotyping and relies on the swelling of the capsule upon binding of homologous antibody. The test consists of mixing a loopful of colony with equal quantity of specific antiserum and then examining microscopically at 1000X for capsular swelling Dr.T.V.Rao MD 17
  17. 17. Summary Figure (Identification Scheme) Note: Strep. viridans GRAM POSITIVE COCCI are alpha hemolytic and negat ive for all t he tests below Catalase + Staphylococcus (Clusters) - (pairs & chains) Streptococcus Coagulase Hemolysis + S. aureus - S. epidermidis • BETA: Bacitracin + S .pyogenes (group A) hemolytic nonhem olytic (usua lly) CAMP/Hippurate + S. agalactiae (group B) mannitol mannitol (2) ALPHA: Optochin/Bile Solubility + S. pneumoniae yellow white • GAMMA: Bile Es culin + 6.5% NaCl + Group D* Enterococcus Bile Esc ulin + 6.5% NaCl - Group D* Non-Enterococcus (*can also be beta or alpha hemolytic) Dr.T.V.Rao MD 18
  18. 18. S. pneumoniae 0 hemolytic 0 pneumolysin 0 degrades red blood cells under aerobic conditions grows well on sheep blood agar 0 No group antigen Dr.T.V.Rao MD 19
  19. 19. Hemolysis Streptococcus pneumoniae are Alphahemylotic alpha beta gamma Dr.T.V.Rao MD 20
  20. 20. Bile solubility test Streptex antiserum optochin sensitive Not optochin sensitive Quellung reaction • using antisera • capsule "fixed" Dr.T.V.Rao MD 21 • visible microscopically Latex agglutination - streptococci
  21. 21. Optochin Test 0 The minimum criteria for identification and distinction of pneumococci from other streptococci are bile or optochin sensitivity, Gram-positive staining, and hemolytic activity. Dr.T.V.Rao MD 22
  22. 22. Not optochin sensitive optochin sensitive Dr.T.V.Rao MD 23
  23. 23. PNEUMOCOCCAL CARRIER STATE 0 Disease occurs in persons who are already asymptomatic carriers 0 Carrier rates 38%-60% in preschool children 29%-35% in grammar school children 9%-25% in junior high school students 18%-29% in adults with children at home 6% in adults with no children at home Virtually all children <2 of age become carriers Dr.T.V.Rao MD 24
  24. 24. Pathogenesis: the route to infection Colonisation of the respiratory tract Innate and adaptive immune system Replication in the nasopharynx Viral infections, malnutrition Spread to adjacent sites mucosal damage pneumonia middle-ear otitis sinusitis Dr.T.V.Rao MD 25 blood meningitis
  25. 25. Pneumococcus: colonisation and transmission 0 Exclusively a human pathogen, part of the normal microbial flora of the upper respiratory tract 0 Transmission: by droplet secretions 0 Temporal pattern: winter-early spring 0 Communicability: Unknown. Probably as long as organism in respiratory secretions Dr.T.V.Rao MD 26
  26. 26. Dr.T.V.Rao MD 27
  27. 27. Streptococcus pneumoniae: Symptoms and Signs 0 Classic description 0 sudden onset of chills and pleuritic chest pain 0 followed by fever and then cough productive of rusty sputum. 0 Varies greatly. 0 Respiratory tract symptoms may be absent, especially among patients with bacteremic disease. 0 Lack of fever is not uncommon and indicates a poor prognosis. 0 Gastrointestinal symptoms such as nausea, vomiting, or diarrhea are present in 15 to 20% Dr.T.V.Rao MD 28
  28. 28. Types of infection non-invasive invasive otitis (25-50%) pneumonia sinusitis sepsis recurrent bronchitis meningitis Dr.T.V.Rao MD 29
  29. 29. PNEUMOCOCCAL DISEASE: MENINGITIS 0Meningitis 0 Inflammation of the meninges (membranes surrounding the brain) 0 Can be caused by a range of microorganisms, as well as be a manifestation of some non-infectious diseases 0Pneumococcal meningitis 0 Invasive pneumococcal disease 0 Generally, pneumococci invade the CNS from the blood stream 0Signs and symptoms1 0 Early stages: fever, irritability, neck stiffness, drowsiness 0 Later stages: headache, seizures, coma 0The signs and symptoms are not specific to pneumococcal disease Dr.T.V.Rao MD 30 1 Salyers, Whitt, in Bacterial Pathogenesis, 1994
  30. 30. PNEUMOCOCCAL DISEASE: PNEUMONIA a major Complication 0 Bacteraemia in 15−30% of patients with pneumonia − 0 high mortality despite appropriate antibiotic therapy 0 overall case fatality rate 15−20% for pneumococcal − bacteraemia 0 higher case fatality rates (30−40%) for elderly persons and − other vulnerable groups 0 Spread of pneumococci in the blood to other normally sterile sites can cause other invasive pneumococcal diseases (e.g. meningitis) 0 Empyema (pus in the pleural cavity) in about 2% of cases 1 Salyers, Whitt, in Bacterial Pathogenesis, 1994 Dr.T.V.Rao MD 2 Fedson, Musher, in Vaccines, 1994 31 3 Musher, Clin Infect Dis, 1992
  31. 31. Asplenic patients at risk with Pneumococcal Infections 0 Asplenic patients and those with impaired splenic function are at risk for a fulminant sepsis syndrome usually due to Streptococcus pneumoniae 0 The combined use of pneumococcal polysaccharide immunization and early administration of oral empiric antibiotic therapy for fever offers a high level of protection against postsplenectomy sepsis Dr.T.V.Rao MD 32
  32. 32. HIV infection and Pneumococcal Infection 0 Adults infected with HIV have high rates of invasive pneumococcal disease. 0 Persons infected with HIV are particularly susceptible to invasive pneumococcal disease, with a 50- to 100- fold higher incidence than the general U.S. population Dr.T.V.Rao MD 33
  33. 33. PNEUMOCOCCAL PNEUMONIA MORTALITY 8%-10% Overall healthy young adults (non bacteriemic) < 1% Bacteriemic pneumonia: 15%-20% High-risk groups: 50% Elderly > 70 years: 30%-40% Young adults (<45 years): <8% Dr.T.V.Rao MD 34
  34. 34. Treatment 0 Treatment is usually with Beta-lactam antibiotics. In the 1960s, nearly all strains of S. pneumoniae were susceptible to penicillin, but since that time, there has been an increasing prevalence of resistance, especially in areas of high antibiotic use. A varying proportion of penicillin-resistant strains may also be resistant to erythromycin, macrolides, and clindamycin and the quinolones. Dr.T.V.Rao MD 35
  35. 35. ORAL ANTIBIOTICS 0 Amoxicillin: first choice in < 5 years 0 Alternatives: co-amoxiclav, azithromycin, cefaclor, erythromycin, clarithromycin 0 > 5 years. 0 Macrolide antibiotics should be used if either mycoplasma or chlamydia pneumonia is suspected 0 Amoxicillin should be used as first line treatment at any age if S pneumoniae is thought to be the likely pathogen. Dr.T.V.Rao MD 36
  36. 36. IV antibiotics 0Indications of Intravenous antibiotics 0 Unable to take oral antibiotics (for example, because of vomiting) 0 presents with severe signs and symptoms. 0Antibiotics: 0 co-amoxiclav, cefuroxime, and cefotaxime. Dr.T.V.Rao MD 37
  37. 37. Vancomycin is helpful in resistant strains 0 Most remain susceptible to vancomycin, which is a less desirable antibiotic because of dosing and tissue penetration issues. Susceptibility testing is routine, with empiric antibiotic treatment, guided by resistance patterns in the community in which the organism was acquired, pending the results. Dr.T.V.Rao MD 38
  38. 38. PNEUMOCOCCAL POLYSACCHARIDE VACCINEs 0 14-valent pneumococcal vaccine licensed in 1977 0 23-valent preparation licensed in 1983 0 23-valent vaccines cover 85%-90% of serotypes that cause invasive pneumococcal infections 0 23-valent vaccines contain serotypes 1, 2, 3, 4, 5, 6B, 7F, 8, 9N, 9V, 10A, 11A, 12F, 14, 15B, 17F, 18C, 19A, 19F, 20, 22F, 23F, and 33F 0 6 serotypes most frequently associated with drug- resistant infection: 6B, 9V, 14, 19A, and 23F Dr.T.V.Rao MD 39
  39. 39. Pneumococcal vaccines Protective immunity is conferred by anti-capsular type-specific antibodies Antibodies against pneumococcal surface proteins confer protection in animal models. In humans this role is to be determined Currently licensed in Europe: 2 types of pneumococcal vaccines Old 23-valent Pneumococcal Polysaccharide Vaccine (PPV23) New 7-valent Pneumococcal Conjugated Vaccine (PCV7) Dr.T.V.Rao MD 40
  40. 40. 23-valent Pneumococcal Polysaccharide Vaccine PPV23 25 µg of purified capsular polysaccharide antigen serotypes: 1, 2, 3, 4, 5, 6B, 7F, 8, 9N, 10A, 11A, 12F, 14, 15B, 17F, 18C, 19A, 19F, 20, 22F, 23F, 33F Covers 85-90% of invasive pneumococcal disease Relatively good antibody responses (60–70%) following a single intramuscular/subcutaneous immunization in most healthy adults Dr.T.V.Rao MD 41
  41. 41. PPV23 Negative aspects 0 immune response mediocre in children <2 years and in immunocompromised individuals (HIV/AIDS) 0 does not induce immunological memory which is required for subsequent booster responses Dr.T.V.Rao MD 42
  42. 42. PPV23 Recommendations 0 For healthy adults ≥ 65 years of age, particularly those living in institutions - Based on data from observational studies: significant protective effect against IPD, but not pneumonia - Based on data from randomised controlled trials: failed to show a beneficial effect of the vaccine 0 Persons ≥ 2 years at higher risk of PID (asplenic, immunocompromised, …) Dr.T.V.Rao MD 43
  43. 43. 7-valent Pneumococcal Conjugated Vaccine PCV7 • Seven S. pneumoniae capsular polysaccharide antigens, conjugated to nontoxic diphtheria toxin (cross-reactive material, CRM(197) • CRM(197): inert but immunogenic variant of diphtheria toxoid also used as a carrier molecule in one H.influenzae type b conjugate vaccine Dr.T.V.Rao MD 44
  44. 44. PCV7. Characteristics 0 higher antibody levels and a more efficient immune response in infants 0 significant immunological memory 0 >90% effective against invasive disease 0 less effective against other forms of the disease (non-invasive pneumonia, otitis media, …) Dr.T.V.Rao MD 45
  45. 45. PCV7. Effectiveness (Wyeth Lab. Prevnar®,USA or Prevenar®, Europe) ® ® 0 serotypes 4, 6B, 9V, 14, 18C, 19F, 23F 0 serotypes included: most prevalent in invasive diseases and antibiotic resistance potential coverage of serotypes causing PID: 85% for the USA 70-75% for Europe ≈ 65% for Latin America ≈ 50% for Asia Dr.T.V.Rao MD 46
  46. 46. PPV7. Efficacy in invasive disease Pre-licensed study Northern Carolina Kaiser Permanent Trial - 37,816 children enrolled & 4 doses of vaccine or control - efficacy against vaccine serotype disease: 97.4% (19F) - efficacy against all serotypes IPD: 89.1% Black S, et al. Efficacy, safety and immunogenicity of the heptavalent pneumococcal conjugate vaccine in children. Pediatric Infect Dis J. 2000;19:187-195 r.T.V.Rao MD D 47
  47. 47. PCV7. Safety and schedule 02, 4, 6 months, booster 12-14 months 0Possible interference with other conjugate vaccines (meningococcal) when administered together 0 Safe 0 Adverse reactions: fever Dr.T.V.Rao MD 48
  48. 48. CDC RECOMMENDATIONS 0 Immunocompromised persons >2 years with: Functional or anatomic asplenia HIV, AIDS Leukemia, lymphoma, Hodgkin’s disease, multiple myeloma Generalized malignancy Chronic renal failure, nephrotic syndrome Receiving immunosuppressive chemotherapy, radiation Organ and bone marrow transplant patients Dr.T.V.Rao MD 49
  49. 49. CDC RECOMMENDATIONS 0 Persons >2 years living in special environments or social settings, such as: Nursing homes Chronic-care facilities Alaskan Natives Certain Native American populations Dr.T.V.Rao MD 50
  50. 50. PNEUMOCOCCAL DISEASE: CONCLUSIONS 0Pneumococcal disease 0 Major cause of morbidity and mortality worldwide 0 Diagnosis not always made and difficult to establish 0 Treatment may be complicated by antibiotic resistance 0 Management can be costly 0Prevention by vaccination is a priority in populations who are at risk: 0 The elderly 0 Patients with chronic cardiovascular, pulmonary, renal, hepatic and metabolic disorders 0 Patients who are immunocompromised 0 Patients with asplenia Dr.T.V.Rao MD 51
  51. 51. 0 Programme created by Dr.T.V.Rao MD for e-learning resources for Medical and Paramedical Students in Developing world 0 Email 0 doctortvrao@gmail.com Dr.T.V.Rao MD 52
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Streptococcus pneumonia

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