Pneumococcal polysaccharide vaccination in rheumatoid arthritis patients receiving tacrolimus.

INTRODUCTION: In rheumatoid arthritis (RA) patients receiving immunosuppressive treatments, vaccination against Streptococcus pneumoniae is recommended. The objective of the study was to evaluate the effects of tacrolimus (TAC) on immune response following administration of a 23-valent pneumococcal polysaccharide vaccine (PPSV23) in patients with established RA. METHODS: Patients with RA (n = 133) were vaccinated with PPSV23. Patients were classified into TAC (n = 29), methotrexate (MTX) (n = 55), control (n = 35), and TAC/MTX (n = 14) treatment groups. We measured the concentrations of pneumococcal serotypes 6B and 23F by using an enzyme-linked immunosorbent assay and determined antibody functionality by using a multiplexed opsonophagocytic killing assay, reported as the opsonization index (OI), before and 4 to 6 weeks after vaccination. A positive antibody response was defined as at least a twofold increase in the IgG concentration or as at least a 10-fold increase in the OI. RESULTS: IgG concentrations and OIs were significantly increased in all treatment groups after PPSV23 vaccination. The TAC treatment group appears to respond in a manner similar to that of the RA control group in terms of 6B and 23F serotype concentration and function. In contrast, the MTX group had the lowest immune response. Patients who received a combination of TAC and MTX (TAC/MTX) also had a diminished immune response compared with those who received TAC alone. CONCLUSIONS: TAC monotherapy does not appear to impair PPSV23 immunogenicity in patients with RA, whereas antibody production and function may be reduced when TAC is used with MTX. Thus, PPSV23 administration during ongoing TAC treatment should be encouraged for infection-prone TAC-treated patients with rheumatic diseases. TRIAL REGISTRATION: University Hospital Medical Information Network Clinical Trials Registry: UMIN000009566. Registered 12 December 2012.

Bacterial spectrum of spontaneously ruptured otitis media in the era of pneumococcal conjugate vaccination in Germany.

UNLABELLED: Otitis media is a common pediatric disease and the main reason for antibiotic prescription in children. Before implementation of routine childhood pneumococcal vaccination in Germany, serotypes contained in the seven-valent pneumococcal conjugate vaccine (PCV) were among the most frequent pneumococcal serotypes responsible for acute otitis media (AOM). This report describes the first 3 years of a prospective, multicenter, epidemiological cross-sectional study examining the bacteriology of middle ear fluids (MEF) and nasopharyngeal swabs (NPS) of children 2 months to 5 years of age with spontaneously perforated AOM in the era of routine pneumococcal vaccination. MEF was obtained from 963 subjects; NPS from 877. Reported case numbers steeply decreased over the three study years even though the recruiting base remained the same. Among subjects with relevant bacterial growth in their MEF swabs, 113 (11.7%) had Streptococcus pyogenes, 97 (10.1%) Staphylococcus aureus, 88 (9.1%) Streptococcus pneumoniae, 63 (6.5%) Haemophilus influenzae, and 8 (0.8%) Moraxella catarrhalis. S. pneumoniae isolates decreased from 41 (9.3%) in year 1 to 12 (5.7%) in year 3 (p = 0.128). PCV7 serotypes accounted for only 7.9% (n = 7) of isolated pneumococci. Of the 877 subjects with NPS cultures, 465 (53.0%) carried S. pneumoniae, 314 (35.8%) H. influenzae, 292 (33.3%) M. catarrhalis, and 110 (12.5%) S. pyogenes; 79.4% (n = 765) of the children were vaccinated with at least one dose of PCV. Carriage of pneumococci was slightly lower in vaccinated (47.8%) than in unvaccinated (52.7%) children (p = 0.254). PCV7 serotypes were carried by 9.6% of unvaccinated children but by only 4.2% of vaccinated children, resulting in a 56.3% vaccine effectiveness. CONCLUSIONS: Following universal PCV7 immunization, a clear epidemiological impact of pneumococcal conjugate vaccination was observed as PCV7 serotypes have almost disappeared among AOM.

Radical serotype rearrangement of carried pneumococci in the first 3 years after intensive vaccination started in Hungary.

UNLABELLED: Streptococcus pneumoniae is responsible for a significant amount of morbidity and mortality worldwide. Healthy carriers, mainly young children, are the most important sources of infections. In the current study, we aimed to determine the changes that have occurred since the introduction of PCV-7 in Hungary. Nasal specimens were collected from 1,022 healthy children aged 3-6 years attending day-care centres. After thorough identification, pneumococcal isolates were serotyped, and their antibiotic sensitivity was determined. The carriage rate was found to be 34.9%. A huge serotype rearrangement was detected compared to earlier results, with the previously leading serotype 14 having completely disappeared. Serotypes 11A, 35F, 19A, 6B, 15B, 3 and 38 were most prevalent, and 29 different types were identified in total. The PCV-7 types were responsible for 16.5% of all serotypes, and 36.0% are not covered by any pneumococcal vaccines. The isolates were sensitive to most tested antibiotics, except erythromycin (resistance was 21.6%). Only one penicillin-resistant strain was found. The newly and rapidly emerging non-vaccine serotypes are much more sensitive, except serotype 19A. CONCLUSION: Due to PCV vaccination, a complete serotype arrangement occurred also in Hungary. The old "paediatric" serotypes were replaced by serotypes 11A, 35F, 19A, 6B, 15B, 3 and 38.

Efeito da vacina pneumocócica 10-valente em eventos de colonização nasofaríngea em crianças na cidade de Salvador-Bahia / Effect of pneumococcal 10-valent in nasopharyngeal colonization events in children in the city of Salvador, Bahia

Streptococcus pneumoniae é uma bactéria patogênica que afeta crianças e idosos em todo o mundo, sendo responsável por elevada morbidade e mortalidade, especialmente nos países em desenvolvimento onde o acesso às vacinas pneumocócicas conjugadas (PCVs) é limitado. A colonização da nasofaringe precede o desenvolvimento de infecções e as crianças são o principal reservatório deste patógeno na comunidade. As vacinas pneumocócicas conjugadas reduzem a taxa de colonização e de doenças causadas por sorotipos vacinais, entretanto, pouco se sabe sobre seu efeito em eventos na substituição de sorotipos. Os objetivos deste estudo foram determinar o efeito da vacina pneumocócica conjugada 10-valente (PCV10) na colonização nasofaríngea por pneumococos em crianças menores que um ano, saudáveis e que apresentaram doença crônica ou desordem imunológica nos períodos pré- e pós esquema vacinal primário entre maio de 2011 a janeiro de 2014 e determinar a influência desta vacina na distribuição de sorotipos, da susceptibilidade antimicrobiana e do perfil genotípico dos pneumococos. Foram investigadas 168 crianças, sendo 63 do grupo de portadores de doenças clínicas (Grupo I) e 105 do grupo de crianças sadias (Grupo II). O isolamento, a identificação e a avaliação da resistência antimicrobiana do pneumococo foram realizados através de técnicas microbiológicas convencionais. A determinação dos sorotipos capsulares foi realizada através das técnicas de reação de polimerase em cadeia multiplex e reação de Quellung. A taxa de colonização pneumocócica total foi de 24%, sendo 17% (11/63) e 28% (29/105) para os grupos I e II, respectivamente...

Streptococcus pneumoniae is a pathogenic bacterium that affects children and elderly throughout the world, accounting for high morbidity and mortality, especially in developing countries where acess to pneumococcal conjugate vaccines (PCVs) is limited. Nasopharyngeal colonization precedes the development of infections and children are the main reservoir of this pathogen in the community. The pneumococcal conjugate vaccine has been effective in reducing colonization and disease by vaccine serotypes, however, little is known about its effect on the overall rate of colonization due to serotypes replacement events. The study aims to evaluate the effect of pneumococcal conjugate vaccine on nasopharyngeal carriage in children younger than one years old, healthy, suffering from crhonic diseases or immune disorders during vaccine primary immunization with PCV-10 between may 2011 and jaanuary 2014 and the influence of this vaccine in the distribution of serotypes, antimicrobial susceptibility and genotypic profile of pneumococcus. A total of 168 children were enrolled, 63 with chronic diseases (Group I) and 105 of the group of healthy children (Group II). The isolation, identification and evaluation of antimicrobial resistance of pneumococci were made using conventional microbiological techniques. The determination of capsular serotypes was performed using the multiplex-PCR and/or Quellung reaction. Overal, the pneumococcal colonization rate was 24%, being 17% (11/63) and 28% (29/105) to group I and II, respectively...

Inhalative vaccination with pneumococcal polysaccharide in patients with chronic obstructive pulmonary disease.

In order to determine the feasibility of inhalative vaccination with polysaccharide antigen in patients with chronic obstructive pulmonary disease (COPD), we used controlled inhalation of a defined dose of Pneumovax in a randomized 3-arm study. The vaccine was either deposited in the alveoli (alveolar vaccination) or in the large airways (bronchial vaccination) and these were compared to standard intramuscular vaccination. Adverse effects were minor and never exceeded WHO grade 2. There was frequent cough, headache and shivering in the bronchial vaccination group, frequent fatigue only in the alveolar vaccination group and no frequent adverse effects in the intramuscular vaccination group. Specific serum IgG antibody was measured before and at 4 and 12 weeks after vaccination. At 12 weeks there was a greater than twofold rise in 7 out of 10 individuals in every vaccination group. Mean antibody levels of responders at 12 weeks were 278 mg/l for alveolar vaccination, 238 mg/l for bronchial vaccination and 737 mg/l for standard intramuscular vaccination. The data show that polysaccharide vaccine can be safely administered by controlled inhalation in COPD patients and that it can induce a rapid serum antibody response.

Immunogenicity of sequential pneumococcal vaccination in subjects splenectomised for hereditary spherocytosis.

Splenectomy predisposes for invasive pneumococcal disease. We investigated the immune response of splenectomised hereditary spherocytosis (HS) patients upon sequential pneumococcal vaccination. Thirty-nine HS-patients (2- to 18-year-old) had undergone near-total or total splenectomy. All received one dose of 7-valent pneumococcal conjugate vaccine (PCV-7) and 23-valent-pneumococcal-polysaccharide vaccine (PPV-23) 2 months apart. Pneumococcal antibodies against serotypes 5/6B/7/14/18C/19F/23F and immunoglobulin serum concentrations were determined before PCV-7 and 4 weeks after PPV-23. Significant rises in antibody geometric mean concentrations were observed after PCV-7 except for serotypes 5 and 7, which increased after PPV-23. We found no impact of the mode of splenectomy.

Pneumococcal conjugate vaccines: proceedings from an interactive symposium at the 41st Interscience Conference on Antimicrobial Agents and Chemotherapy.

Globally, Streptococcus pneumoniae is a leading cause of invasive and noninvasive disease in infants and young children. The emergence of antibiotic-resistant strains has increased interest in prevention through immunization. Currently, the only available conjugate pneumococcal vaccine is a seven-valent formulation, PNCRM7. This paper presents excerpts from a symposium that provided an update of ongoing surveillance data and clinical trials evaluating pneumococcal conjugate vaccines. The topics addressed included: (1) PNCRM7 postmarketing safety data; (2) the impact of PNCRM7 in premature infants; (3) the direct and indirect effect of pneumococcal conjugate vaccines on colonization; (4) the effect of pneumococcal conjugate vaccines on replacement disease and the rate of resistance among replacement serotypes; (5) the current recommendations for the use of PNCRM7; and (6) the potential impact of conjugate vaccines in Europe and the Asia-Pacific region.