Characterization of Pili Protein 67 kDa Streptococcus pneumoniae: New Candidate for Virulence Factor-Based Pneumococcal Antigen Vaccine.

INTRODUCTION: Streptococcus pneumoniae is a Gram-positive diplococci bacteria that causes infectious diseases such as otitis, meningitis, and pneumonia. Streptococcus pneumoniae has various virulence factors, one of which is pilus. In addition to being immunogenic, pilus S. pneumoniae also plays a role in bacterial adhesion to host cells and biofilm formation. The S. pneumoniae pilus found in this study consisted of several proteins with various molecular weights, one of which was a 67 kDa protein. OBJECTIVE: This study aimed to determine the characteristics of the 67 kDa pilus protein, including its capacity as hemagglutinin and adhesin and its amino acid sequence (AA). METHODS: The LCMS/MS method is used to determine the AA sequence of the 67 kDa pilus protein. The AA structure was analyzed through BLASTP by matching it with the sequence of the protein data bank of S. pneumoniae (taxid: 1313). The ProtParam tool from ExPASY was used to calculate various physical and chemical parameters of the protein, while for evaluating its immunogenicity, the VaxiJen V2.0 online server was used. RESULTS: The results of this study indicate that the 67 kD a pilus protein, is an anti-hemagglutinin protein and has a role as an adhesin protein. Adhesion tests show the action between protein concentration and the number of bacteria attached to enterocyte cells. LCMS/MS test results obtained by BLASTP showed that the 67 kDa pilus protein had three AA sequences (ITYMSPDFAAPTLAGLDDATK, AEFVEVTK, and LVVSTQTALA), which had similarities with the A backbone chain of S. pneumoniae pilus. The physicochemical test showed that the protein is hydrophilic and nonpolar, while the antigenicity test showed that the protein is antigenic. CONCLUSION: Based on these characteristics, it can be concluded that the 67 kDa S. pneumoniae pilus protein can be used as a vaccine candidate for pneumococcus.

Serotype distribution of Streptococcus pneumoniae among healthy carriers and clinical patients: a systematic review from Iran.

Streptococcus pneumoniae is associated with high morbidity and mortality in the world. Commercially licensed and available pneumococcal conjugate vaccines (PCVs) contain 10 (PCV10) and 13 (PCV13) pneumococcal serotypes. The most common serotypes of S. pneumoniae causing clinical diseases and carriers of S. pneumoniae in Iran are not yet known. Reviewing and reporting trends in the distribution of pneumococcal serotypes in Iran will be useful for policy-making as PCV is being introduced into Iran's routine immunization program. Here, we report a systematic literature review of studies regarding S. pneumoniae serotype distribution in clinical and carrier patients in Iran. MEDLINE (via PubMed), Scopus, Embase, Ovid, Google Scholar, Web of Science, and the Iranian Database were used to identify relevant papers published from 1 January 2000 to 21 August 2019. The search returned 8 relevant articles. Among serotypes causing invasive pneumococcal diseases (IPD), serotype 23F (16.4%) was the most circulating serotype followed by 19F (15.2%), 19A (11.3%), 6A/B (9.2%), 9 V (5.8%), and 11A (5.14%). In carrier patients, the most common serotypes were, in rank order, 6A/B (10%), 19F (9%), 14(6.2%), 17F (4.8%), and 20(4.5%). Vaccine coverage among IPD patients would be 67.1% for PCV10-TT and 73.8% for PCV13. The present review demonstrates that the serotypes which were most responsible for disease in Iran are included in PCV10-TT and PCV13. However, sentinel surveillance must be continued in representative parts of the country to assess changing trends in the distribution of pneumococcal serotypes and their implications for vaccine selection and rollout in Iran.

Serotype distribution of disease-causing Streptococcus pneumoniae in Thailand: A systematic review.

BACKGROUND: Streptococcus pneumoniae infection is associated with a high morbidity and mortality worldwide. There are currently >98 known serotypes; the most burdensome are covered by current pneumococcal conjugate vaccines (PCVs) such as PCV10 (Synflorix®) and (Prevnar 13®) PCV13. However, at present no PCV is available on the National Expanded Programme of Immunization (EPI) in Thailand. METHODS: Here we report a systematic review of studies regarding pneumococci associated with invasive pneumococcal disease (IPD) and non-IPD in Thailand. The NCBI PubMed database and Google Scholar were used to identify relevant papers published from 1st January 1990 to 21st August 2017. The quantitative analysis was reported as the distribution of serotypes across two age groups, ≤5 and >5 years old, as these were the most commonly reported. Where age was not stated, or data was combined, data were categorised as all ages. RESULTS: The search returned 15 relevant articles. From these the five most common disease-causing serotypes, in rank order, were 6B, 23F, 14, 19A and 19F. Vaccine coverage would be 55.3% for PCV10 and 69.7% for PCV13. There was insufficient data to draw conclusions regarding non-invasive disease-causing pneumococcal serotypes. CONCLUSION: This review demonstrates that the serotypes which were most responsible for disease in Thailand are included in PCV10 and PCV13. Better surveillance data of IPD and non-IPD are required for monitoring vaccine effectiveness if PCV is implemented nationally.

Measuring quantity and function of pneumococcal antibodies in immunoglobulin products.

BACKGROUND: Immunoglobulin replacement therapy is a cornerstone of the treatment of primary immunodeficiencies. Preparations used for replacement therapy are processed by purifying immunoglobulins from large pools of plasma, which were obtained from healthy donors. The constituent antibodies in these products depend on the immune history of the donor pool as well as manufacturing processes that differ among manufacturers. For these reasons various methods have been proposed to examine the levels and function of antibodies to organisms such as Streptococcus pneumoniae, which frequently causes infections in patients with immunodeficiencies. Pneumococcal antibody levels or antibody function can be measured with enzyme-linked immunosorbent assay (ELISA) or multiplexed opsonophagocytosis assay (MOPA). Although these assays were developed initially to assess the immunogenicity of pneumococcal vaccines, the techniques have been adapted to evaluate immunoglobulin products as well. STUDY DESIGN AND METHODS: This article provides a concise review of the analytic techniques for measuring pneumococcal antibodies and prior studies of immunoglobulin products utilizing these methods. RESULTS: Studies utilizing these assays have demonstrated that antibody levels of immunoglobulin products can vary with time, location, and manufacturer. CONCLUSIONS: We highlight current issues and future considerations concerning measurement of pneumococcal antibodies in immunoglobulin products, and the assays used for this purpose.

Antigenuria positiva a neumococo y vacunación / Positive urine pneumococcal antigen test and vaccination

Introducción y objetivo: La detección del antígeno neumocócico en orina es una prueba útil pero puede presentar falsos positivos, entre ellos, la vacunación neumocócica. Material y métodos: Detección de las antigenurias positivas a neumococo en el Hospital de Denia (enero-febrero/2015). Se determinaron variables epidemiológicas, radiológicas, microbiológicas y antecedente de vacunación neumocócica (neumo-23 y/o neumo-13). Resultados: La antigenuria a neumococo mostró un resultado positivo en el 12,4% de 385 determinaciones. Solo en el 33,3% de los casos con antigenuria positiva se documentó infiltrado radiológico en la radiografía de tórax. En el 35,4% de los pacientes existía antecedente de vacunación neumocócica previa. En la mayor parte de los casos (87,5%) un antígeno neumocócico positivo supuso la prescripción de un tratamiento antibiótico. Conclusiones: La vacunación neumocócica puede generar falsos positivos a la antigenuria por neumococo en la práctica clínica, con la consiguiente prescripción innecesaria de antibióticos en gran número de casos (AU)

Introduction and objective: Although urine pneumococcal antigen is an useful test, it has false positives such as pneumococcal vaccination. Material and methods: Positive urine pneumococcal antigen in Hospital de Denia (January-February/2015). We studied epidemiological, radiological and microbiological variables as well as previous pneumococcal vaccination (neumo-23 and/or neumo-13). Results: Urine pneumococcal antigen test was positive in 12.4% of 385 cases. Only 33.3% of positive cases had pneumonia in chest X-ray, and 35.4% of patients had previous pneumococcal vaccination. In most cases (87.5%), an antibiotic was prescribed. Conclusions: Pneumococcal vaccination can produce a false positive result in the urine pneumococcal antigen test in clinical practice, leading to an unnecessary prescription of antibiotics (AU)

Efecto del uso de la vacuna antineumocócica 13-valente en los niños (y adultos) americanos / The effect of using 13-valent pneumococcal vaccine in American children (and adults)

Fundamento. En el año 2000 la vacuna antineumocócica de polisacáridos conjugados heptavalente (PCV-7) fue introducida en los Estados Unidos (EE. UU.), lo que produjo una reducción rápida de la enfermedad invasiva por neumococo (EIN) e incrementos moderados de la EIN por neumococos no incluidos en la vacuna PCV-7. En 2010 la vacuna antineumocócica de polisacáridos conjugados 13-valente (PCV-13) sustituyó a la PCV-7 en el calendario de inmunización de aquel país. Este estudio intenta evaluar el efecto de la utilización de la PCV-13 sobre la incidencia de la EIN en los niños y adultos de EE. UU. Método. Se utilizaron bases de datos analíticas, datos poblacionales sobre la incidencia de EIN de la encuesta Active Bacterial Core (enmarcado dentro el Centers for Disease Control and Prevention's Emerging Infections Program) y un modelo de series temporales que comparara las tasas de EIN antes y después de la introducción de la PCV-13. Los casos de EIN detectados entre julio de 2004 y junio de 2013 fueron clasificados según los serotipos de la PCV-13 en contra de los cuales la vacuna PCV-7 no tendría ningún efecto (o sea, serotipos de la PCV-13 menos los de la PCV-7). Según un modelo de series temporales se introdujeron los resultados esperados para comparar la incidencia por EIN que se esperaría si la PCV-13 no hubiera reemplazado a la PCV-7. Resultados. Evaluando la incidencia esperada de EIN entre los niños menores de 5 años frente a la vacunación mediante la PCV-7 si se hubiera mantenido, la incidencia tras la vacunación mediante PCV-13 globalmente disminuyó un 64% (IC 95% 59-68); el porcentaje de serotipos de la PCV-13 menos los de la PCV-7 disminuyeron un 93% entre julio de 2012 y junio de 2013. Entre los adultos, la incidencia de EIN global también disminuyó entre un 12-32%, y los serotipos de la PCV-13 menos los de la PCV-7 se redujeron entre un 58-72%, dependiendo de la edad. Según esto, estiman que alrededor de 30.000 casos de EIN y 3.000 muertes se evitaron en los primeros 3 años de la introducción de la PCV-13. Conclusión. Concluyen que la PCV13 reduce la incidencia de la EIN en todos los grupos de edad cuando se utiliza rutinariamente en los niños de EE. UU. Esta vacuna genera una protección parecida a la anterior PCV7, y el hecho de que se introduzcan nuevos serotipos aumenta la protección de la población ya vacunada (AU)

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Cobertura de vacunación antineumocócica en niños con condiciones de riesgo en Cataluña / Pneumococcal vaccination coverage in at-risk children in Catalonia

INTRODUCCIÓN: En Cataluña, el sistema público de sanidad solo financia la vacunación antineumocócica en pediatría a niños con condiciones de riesgo. El objetivo del estudio fue determinar la cobertura de dicha vacunación y su asociación con la edad, factores sociodemográficos y otras variables. MATERIAL Y MÉTODO: Estudio descriptivo transversal de los niños de 2 meses a 15 años de edad, asignados a los centros de atención primaria de Cataluña, y con enfermedades para las que el programa oficial de vacunas indica la vacunación antineumocócica. La información sobre el estado vacunal y las variables en estudio se recogió a partir de los datos registrados en la historia clínica electrónica de los equipos de atención primaria. Se analizó la asociación de la vacunación antineumocócica con variables demográficas y médicas mediante un análisis bivariado y un modelo de regresión logística múltiple, utilizando como medida de asociación la odds ratio ajustada (ORa), con su intervalo de confianza al 95%. RESULTADOS: La cobertura vacunal fue del 47,7%. Las variables asociadas a la vacunación fueron: edad (ORa: 9,2 [7,9-10,7] en niños de 2 meses a 2 años; ORa: 8,1 [7,0-9,3] en ni˜nos de 3-5 a˜nos; ORa: 4,6 [4,0-5,2] en niños de 6-11 años), nacionalidad española (ORa: 3,9 [3,5-4,3]), inmunización correcta según el calendario de vacunación sistemática (ORa: 2,5 [2,1-3,0]), y número de condiciones de riesgo (ORa: 3,2 [2,5-4,1] en niños con 2 o más condiciones). CONCLUSIONES: La cobertura vacunal frente a neumococo en niños con condiciones de riesgo es baja en Cataluña. Es necesario implementar estrategias para aumentar la cobertura

INTRODUCTION: The public health system in Catalonia only funds pneumococcal vaccination in paediatrics for children at-risk. The aim of this study was to determine pneumococcal vaccination coverage and its association with age, sociodemographic factors and other variables. MATERIAL AND METHOD: Descriptive cross-sectional study of children aged between 2 months and 15 years old assigned to primary care centres in Catalonia and with diseases that are included for pneumococcal vaccine in the official vaccination program. The information on vaccination status and study variables were obtained from data registered in the electronic medical records in the primary care centres. An analysis was made of the association between pneumococcal vaccination and demographic and medical variables using bivariate analysis and a multiple logistic regression model. The adjusted odds ratio (aOR), with a confidence interval of 95%, was used to measure the relationships. RESULTS: Pneumococcal vaccination coverage was 47.7%. Variables which predicted pneumococcal vaccination were: age (aOR: 9.2 [7.9-10.7] in children 2 months-2 years old; aOR 8.1 [7.0-9.3] in children 3-5 years; aOR: 4.6 [4.0-5.2] in children 6-10 years), Spanish nationality (aOR: 3.9 [3.5-4.3]), correct immunisation according to systematic immunisation schedule (aOR: 2.5 [2.1-3.0]), and number of risk conditions (aOR: 3.2 [2.5-4.1] in children with 2 or more conditions). CONCLUSIONS: Pneumococcal vaccination coverage in children with risk conditions is low in Catalonia. Strategies need to be implemented to increase coverage

Vacunas antineumocócicas. Nuevas vacunas conjugadas para el adulto / Pneumococcal vaccines. New conjugate vaccines for adults

Las infecciones neumocócicas son una importante causa de morbimortalidad y constituyen una de las 10 principales causas de muerte en el mundo. Los niños menores de 2 años son los que tienen una tasa de incidencia más elevada, seguidos de los adultos mayores de 64 años. El principal grupo de riesgo son los individuos con inmunodeficiencias de cualquier tipo y aquellos con asplenia anatómica o funcional, aunque también afecta a personas inmunocompetentes con ciertas enfermedades crónicas. En la última década se ha realizado un importante progreso en la prevención de estas infecciones. Hasta hace pocos años solo se disponía de la vacuna antineumocócica no conjugada 23-valente, con resultados controvertidos en cuanto a su eficacia y efectividad, y con limitaciones importantes por el tipo de respuesta inmune inducida. La posibilidad actual de utilizar la vacuna conjugada 13-valente en el adulto abre expectativas importantes en la mejora de la prevención de la enfermedad neumocócica en estos grupos de edad

Pneumococcal infections are a significant cause of morbidity and mortality, and are one of the 10 leading causes of death worldwide. Children under 2 years have a higher incidence rate, followed by adults over 64 years. The main risk group are individuals with immunodeficiency, and those with anatomical or functional asplenia, but can also affect immunocompetent persons with certain chronic diseases. Significant progress has been made in the last 10 years in the prevention of these infections. Until a few years ago, only the 23-valent non-conjugate pneumococcal vaccine was available. Its results were controversial in terms of efficacy and effectiveness, and with serious limitations on the type of immune response induced. The current possibility of using the 13-valent conjugate vaccine in adults has led to greater expectations in improving the prevention of pneumococcal disease in these age group

Vacunas antimeningocócicas. Situación epidemiológica mundial y estrategias de prevención mediante la vacunación / Meningococcal vaccines. Global epidemiological situation and strategies for prevention by vaccination

N. meningitidis es una de las principales bacteriascausantes de meningitis y de sepsis y supone un problema importante de salud pública. La enfermedad, que puede tener un curso fulminante, tiene una elevada mortalidad y puede dejar secuelas graves, incluso en los casos de tratamiento médico aparentemente óptimo. La quimioprofilaxis puede evitar casos secundarios entre quienes están en estrecho contacto con los enfermos, pero dado que los casos secundarios representan sólo el 1-2% del conjunto de enfermedades meningocócicas, la quimioprofilaxis tiene poco interés en la lucha contra la mayor parte de las formas endémicas y epidémicas. Teniendo en cuenta que al menos el 5-15% de los niños y adultos jóvenes son portadores, la lucha contra las enfermedades meningocócicas basada en la eliminación quimioterapéutica de la colonización nasofaríngea es prácticamente imposible. Por consiguiente, la inmunización es el único medio racional de combatir esta enfermedad

N. meningitidis is a major cause of meningitis and septicemia and a major public health problem in many countries. The disease, that can be fulminant, has a high mortality and may cause serious sequelae, even in cases of apparently optimal medical treatment. Chemoprophylaxis may prevent secondary cases among those in close contact with the ill, but, since secondary cases represent only 1%-2% of all meningococcal disease, chemoprophylaxis has a small impact when fighting most of endemic and epidemic forms. Given that al least 5% -15% of children and young adults are carriers, the fight against meningococcal disease based on chemotherapeutic elimination of nasopharyngeal colonization is virtually impossible. Therefore, immunization is the only rational way to combat this disease

A cost-effectiveness analysis of a 10-valent pneumococcal conjugate vaccine in children in six Latin American countries

BACKGROUND: A recently developed 10-valent pneumococcal non-typeable H influenzae protein D-conjugate vaccine (PHiD-CV) is expected to afford protection against more than two thirds of isolates causing IPD in children in Latin America, and also against acute otitis media caused by both Spn and NTHi. The objective of this study is to assess the cost-effectiveness of PHiD-CV in comparison to non-vaccination in children under 10 years of age in Argentina, Brazil, Chile, Colombia, Mexico and Peru. METHODS: We used a static, deterministic, compartmental simulation model. The dosing regimen considered included three vaccine doses (at 2 months, 4 months and 6 months) and a booster dose (at 13 months) (3 + 1 schedule). Model outcomes included number of cases prevented, deaths averted, quality-adjusted life-years (QALYs) gained and costs. Discount for costs and benefits of long term sequelae was done at 3.5%, and currency reported in 2008-2009 U$S varying between countries. RESULTS: The largest effect in case prevention was observed in pneumococcal meningitis (from 27% in Peru to 47% in Colombia), neurologic sequelae after meningitis (from 38% in Peru to 65% in Brazil) and bacteremia (from 42% in Argentina to 49% in Colombia). The proportion of predicted deaths averted annually ranged from 18% in Peru to 33% in Brazil. Overall, the health benefits achieved with PHiD-CV vaccination resulted in a lower QALY loss (from 15% lower in Peru to 26% in Brazil). At a cost of USD 20 per vaccine dose, vaccination was cost-effective in all countries, from being cost saving in Chile to a maximum Incremental Cost-effectiveness Ratio of 7,088 US$ Dollars per QALY gained. Results were robust in the sensitivity analysis, and scenarios with indirect costs affected results more than those with herd immunity. CONCLUSIONS: The incorporation of the 10-valent pneumococcal conjugate vaccine into routine infant immunization programs in Latin American countries could be a cost-effective strategy to improve infant population health in the region.(AU)

Bacteriemia neumocócica durante el año 2009 en un hospital pediátrico de nivel 2: características clínicas y microbiológicas / Bacteremia pneumococcal throughout 2009 in a level 2 children's hospital: clinical and microbiological characteristics

Objetivo: Estudiar las características clínicas y microbiológicas de los pacientes con hemocultivo positivo a Streptococcus pneumoniae durante el año 2009 en un hospital pediátrico de nivel 2. Material y métodos: Estudio observacional descriptivo de los pacientes pediátricos con hemocultivo positivo a neumococo desde el 1 de enero hasta el 31 de diciembre de 2009. Se analizaron las siguientes variables: edad, vacunación antineumocócica conjugada heptavalente, antibioterapia previa, diagnóstico clínico, serotipo y sensibilidad antibiótica, así como la necesidad de ingreso hospitalario. Resultados: Se detectaron 15 pacientes con hemocultivo positivo a S. pneumoniae. El 60% de los aislamientos se obtuvo en niños entre 3 y 36 meses de edad. El diagnóstico clínico más frecuente fue neumonía, con o sin derrame pleural (67%). El serotipo aislado más frecuentemente fue el 1 (40%). Todos los pacientes infectados por el serotipo 1 presentaban como manifestaciónclínica la neumonía. Todas las cepas aisladas fueronsensibles a penicilina y cefotaxima según los nuevos criterios del Clinical Laboratory Standards Institute (2008). El 80%de los serotipos aislados están incluidos en la vacuna antineumocócica conjugada 13-valente, el 67% en la 10-valente y ninguno en la 7-valente.Conclusión: Los serotipos más frecuentemente aislados productores de enfermedad neumocócica invasiva durante el año2009 en nuestro centro son serotipos no incluidos en la vacuna antineumocócica conjugada heptavalente. Todos los serotipos aislados fueron sensibles a penicilina y cefotaxima(AU)

Objective: To study the clinical and microbiological characteristics of patients with positive blood culture for Streptococcus pneumoniae in 2009 in a pediatric level 2 hospital. Material and methods: Retrospective observational study of pediatric patients with positive blood culture for Streptococcus pneumoniae from January 1st to December 31st 2009. We analyzed the following variables: age, heptavalent pneumococcal conjugate vaccine (PCV7), previous antibiotic therapy, clinical diagnosis, serotype and antibiotic sensitivity and need for hospitalization. Results: We identified 15 patients with positive blood culture for S. pneumoniae (60%) and were obtained in children aged between 3 and 36 months of age. The most common clinical diagnosis was pneumonia with or without pleural effusion(67%). Serotype 1 was the most frequently isolated serotype(40%). All serotype 1-infected patients had pneumonia as a clinical manifestation. All isolates were susceptible to penicillin and cefotaxime under the new criteria of the Clinical Laboratory Standards Institute (2008). 80% of the isolated serotypes are included in pneumococcal conjugate vaccine13-valent, 67% in 10-valent and none in 7-valent.Conclusion: The most frequently isolated invasive pneumococcal disease producing serotypes in our center in 2009 were serotypes not included in PCV7 and were sensitive to penicillin and cefotaxime(AU)

Serotipos de neumococo en nasofaringe de niños preescolares sanos tras la vacunación antineumocócica conjugada heptavalente / Nasopharyngeal carriage of pneumococcal serotypes in healthy pre-school aged children after 7-valent pneumococcal vaccine

Fundamento y objetivo: Tras la introducción de la vacuna neumocócica conjugada heptavalente (VNC-7v) se plantea investigar en nuestro medio las características que influyen en la colonización por serotipos de neumococo en niños preescolares sanos, la distribución de serotipos y su sensibilidad a antimicrobianos.Sujetos y método: Entre febrero de 2008 y enero de 2009 se recogieron muestras nasofaríngeas a niños de entre 2 meses y 5 años de edad que acudían a revisiones del niño sano en 4 centros de atención primaria de la provincia de Zaragoza (España) para cultivo y serotipado. Mediante regresión logística se estudiaron diferentes variables relacionadas con el estado de portador y las resistencias.Resultados: De los 371 niños estudiados, un 30,7% portaban neumococo en la nasofaringe. Con una cobertura de VNC-7v del 66%, factores relacionados con el hecho de ser portador fueron el número de hermanos (odds ratio [OR] 1,44; intervalo de confianza del 95% [IC 95%] 1,05 a 1,97 por cada hermano), estar escolarizado o asistir a guardería (OR 3,99; IC 95% 2,00 a 7,96), y padecer afección leve de vías respiratorias altas en el momento de la toma (OR 1,72; IC 95% 1,02 a 2,90). Solamente correspondían a serotipos incluidos en la vacuna (STV) un 8,7%. Los serotipos no vacunales más frecuentemente aislados fueron 19A, 6A, 15B, 11 y 15A. Se detectaron significativamente más resistencias a antibióticos entre los STV. Conclusiones: Los niños menores de 6 años de nuestro medio portan neumococos más frecuentemente cuando tienen hermanos, están escolarizados o padecen afecciones leves de vías respiratorias altas. Tras la introducción de la vacuna VNC-7v, los STV son casi anecdóticos (8,7%) y los serotipos emergentes presentan mejor sensibilidad a antibióticos (AU)

Background and objective: To determine the characteristics influencing pneumococcal serotype colonization in healthy pre-school aged children, the distribution of serotypes and their antimicrobial susceptibility, after the introduction of pneumococcal 7-valent conjugate vaccine (VNC-7v). Sujetos and methods: Nasopharyngeal samples were collected from children under 6years of age attending well-child examinations in the province of Zaragoza (Spain). Logistic regression was used to study different variables related to the status of the carriers. Results:Of the 371 children studied 30.7% were found to be carriers. With a vaccine coverage rate of 66%, factors related with presence of pneumococcal carriage were found to be the number of siblings (OR 1.44; CI 95% 1.05-1.97 for each sibling), attending a school or child day care centre (OR 3.99; CI 95% 2.00-7.96) and suffering from a minor upper respiratory tract infection (URTI) (OR 1.72; CI 95% 1.02-2.90). Only 8.7% corresponded to VNC-7v serotypes. The most common non VNC-7v serotypes isolated were 19A, 6A, 15B, 11, and 15A. Significantly greater resistance was detected among VNC-7v serotypes. Conclusion: Children in the setting of this study carried pneumococci more commonly when they have siblings, attend school or day care, or suffer from minor URTI. In the VNC-7v vaccine era, VNC-7v serotypes have become rare occurrences (8.7%) and emerging serotypes present better susceptibility to antibiotics (AU)

Vacunación antineumocócica. Más allá de la infancia / Pneumococcal vaccination. Beyond childhood

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Neumonía neumocócica en la era de la vacuna conjugada heptavalente / Pneumococcal pneumonia in the era of heptavalent pneumococcal conjugate

Introducción: Describir las características clínicas, las complicaciones, los serotipos y las resistencias antibióticas en la neumonía neumocócica en nuestro medio tras la generalización de la vacuna conjugada heptavalente (VNC-7) en pediatría. Material y métodos: Estudio prospectivo de los episodios de neumonía neumocócica, con cultivos positivos, en pacientes atendidos en urgencias desde enero de 2006 hasta febrero de 2010.Resultados: Se estudiaron 346 episodios en 320 pacientes; 335 correspondían a 309 pacientes adultos,221 (71,5%) varones, mediana de edad 68 años (rango: 16-94) y 11 episodios a pacientes < 15 años. Fueron de adquisición comunitaria 237 episodios (68,5%). Presentaron bacteriemia 130 (37,6%) casos, evidenciando una tendencia al aumento de riesgo en los pacientes < 65 años (OR = 1,56; IC del 95%, 0,96-2,56;p = 0,07). Desarrollaron empiema 13 (3,8%) y shock séptico 33 (9,5%). La media de edad de los pacientes con empiema fue menor (p = 0,03). En el análisis multivariante se relacionaron con la presencia de bacteriemia: antecedente de patología respiratoria = (..) (AU)

Introduction: To describe clinical features, complications, serotypes and antibiotic resistance in pneumococcal pneumonia in our environment after the generalization of the heptavalent conjugate vaccine(PCV-7) in paediatrics. Material and methods: Prospective study of episodes of pneumococcal pneumonia, with positive cultures in patients treated in the emergency department from January 2006 to February 2010.Results: We studied 346 episodes in 320 patients, 335 belonged to 309 adult patients, 221 (71.5%) males, median age 68 years (range 16-94), and 11 episodes to patients < 15 years. Two-hundred and thirty-seven (68.5%) episodes were community acquired. Bacteraemia was present in 130 (37.6%) cases, with a tendency towards an increased risk in patients < 65 years (OR = 1.56, 95% CI 0.96- 2.56, P = .07). Thirteen (3.8%) patients developed empyema and 33 (9.5%) septic shock. The mean age of patients with empyema was lower (P = .03). In the multivariate analysis were related to the presence of bacteraemia: a history of chronic respiratory disease (OR = 0.45, 95% CI 0.25-0.81, P = .008), positive urinary antigen (OR 2.02,95% CI 1 13-3.62, P = .01) and pleural effusion (OR = 3.86, 95% CI 1.79-8.35, P = .001). Shock was associated with Fine IV-V stage (OR = 23.6, 95% CI 4.96-112.82, P < .001), age < 65 years (OR = 4.47, 95% CI 1.75-11.39,P = .002) and pleural effusion (OR = 4.15, 95% CI 1.65 to 10.41, P = .002).Increased mortality risk was associated with presence of any complication (OR = 6.6, 95% CI 1.5-27.2,P = .009) and specifically septic shock (OR = 3.3, 95% CI 1.06-10.3, P = .04). Most serotypes obtained were not included in the VNC-7.Conclusions: Pneumococcal pneumonia after generalisation of PCV-7 is mainly related to non-vaccine serotypes. Younger patients without respiratory disease are at increased risk of bacteraemia, empyema, and septic shock, the latter being associated with a higher mortality (AU)

Evolución de los serotipos de neumococo a lo largo de tres décadas / Evaluation of the pneumococcal serotypes over three decades

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Vacunación antineumocócica polisacárida 23-Valente / No disponible

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Fallo de la vacuna antineumocócica conjugada en un niño VIH positivo. A propósito de un caso / Pneumococcal conjugate vaccine failure in HIV-infected child

La infección neumocócica sigue asociada con una importante mortalidad, especialmente en grupos de riesgo (esplenectomizados, déficit de la inmunidad humoral, etc.) a pesar de vacunas y antibióticos adecuados. Presentamos a un niño de 13 años VIH positivo por transmisión vertical tratado con triple terapia (amprenavir, lamivudina y zidovudina). Fue vacunado con vacuna 23-valente a los 6 años y conjugada heptavalente a los 10 años de edad. El recuento de células CD4 y su carga viral a los 6 años eran de 2.063/μl y 13.461 copias/ml, respectivamente. A los 10 años el recuento de CD4 y su carga viral eran de 1.315/μl y 32.400 copias/ml, respectivamente. El último recuento de CD4 (1.000/μl) y la carga viral (3.800 copias/ml) confirmaban un buen control de la enfermedad 15 días antes del ingreso. Acude a urgencias por fiebre, dolor abdominal y vómitos. Hay un progresivo deterioro del nivel de conciencia y signos meníngeos. En el hemocultivo y en el cultivo de LCR crece Streptococcus pneumoniae serotipo 18C, y es tratado con cefotaxima y vancomicina, así como medidas antiedema cerebral, pero evoluciona a muerte cerebral en 24 h (AU)

Despite appropriate antimicrobial therapy and vaccination, invasive pneumococcal infections remain associated with significant mortality, especially in selected high-risk groups (asplenic, humoral immunity deficient patients, etc.). We present a 13-year-old caucasian boy with HIV infection (vertical transmission). He received treatment with highly-active antiretroviral therapy (amprenavir, lamivudine and zidovudine) and vaccination with 23-valent vaccine (6 years old) and 7-valent pneumococcal conjugate vaccine (10 years old). His CD4 count and his viral load at these times were 2,063/μl and 13461 cop/ml, when he was 6 years old and 1,315/μl and 32400 cop/ml when he was 10 years old, respectively. The latest CD4 count (1,000/μl) and his viral load (3800 cop/ml) confirmed satisfactory control of the disease. He was referred to our emergency department presenting with fever, head and stomach-ache and vomiting. In the following hours his condition continued to deteriorate and depressed level of consciousness and meningismus were observed. Streptococcus pneumoniae, serotype 18 C, was detected in blood and cerebrospinal fluid cultures. Despite appropriate treatment with antibiotics (cefotaxime and vancomycin) and anti-oedema medications, brain-death was confirmed 24 hours after his admittance (AU)

Vacunas antimeningocócicas / Vaccines against Neisseria meningitidisg

Se revisa la situación actual de las vacunasantimeningocócicas. Por una parte, las vacunaspolisacáridas simples frente a los serogrupos A, C, Y y W-135 y, por otra, las polisacáridas conjugadas a distintos transportadores proteicos, monovalentes o multivalentes.Respecto a las vacunas frente a Neisseria meningitidisserogrupo B, se analizan las experiencias basadas en lasproteínas de membrana externa y su uso en el control debrotes epidémicos, y las expectativas de una vacunauniversal que se podrían alcanzar con las técnicas devacunología inversa

The present article reviews the state of the art on vaccines against Neisseria meningitidis, from plain polysaccharide to mono- and multivalent protein-polysaccharide conjugate vaccines targeting A, C, Y and W-135 serogroups. We also review immunization againstserogroup B Neisseria meningitidis using protein-basedvaccines composed of outer membrane vesicles and theiruse in the control of epidemic outbreaks, as well asexpectations of a universal vaccine, which could beachieved with reverse vaccinology techniques (AU)

Vacunas neumocócicas conjugadas: presente y futuro / Conjugate pneumococcal vaccines: present and future

La introducción de la vacuna neumocócica conjugadaheptavalente en algunos países ha dado lugar a cambiossubstanciales en la epidemiología de las infeccionesproducidas por esta bacteria. La mayor repercusión ha sido una disminución global de la enfermedad invasora, sobre todo por un descenso de las infecciones producidas por los serotipos vacunales. La vacuna ha generado una inmunidad de grupo muy efectiva, extendiendo su efecto protector a las personas no vacunadas de todas las edades, entre ellas los mayores de 65 años, una población en la que la infección conlleva una morbimortalidad elevada.La inmunidad de grupo se debe, en parte, a la inducción de respuestas inmunitarias en las mucosas respiratorias. El resultado es una disminución de la colonizaciónnasofaríngea por los serotipos vacunales, que, sin embargo, son reemplazados por otros serotipos no contenidos en la vacuna. Como quiera que la colonización nasofaríngea es un hecho crucial en la epidemiología de las infecciones neumocócicas, no es de extrañar que los cambios en la misma den lugar a algunas consecuencias conocidas y otras que se empiezan a conocer. Más del 80% de las resistencias de neumococo van ligadas a 5 de los serotipos vacunales, cuya desaparición de la nasofaringe se ha acompañado de una disminución marcada de infecciones causadas por cepas resistentes. Un hecho preocupante ha sido la emergencia de serotipos no contenidos en la vacuna, como 19A, 3, 15, 33 y 6A, que podría, en un futuro, dar lugar a una disminución de la efectividad de la vacuna o a cambios en la epidemiología de la enfermedad

The introduction of the heptavalent pneumococcalconjugate vaccine in some countries has substantiallychanged the epidemiology of pneumococcal infections.The greatest effect has been an overall reduction ofinvasive disease, especially due to a decrease in infectionsproduced by vaccine serotypes. This vaccine has generatedhighly effective group immunity, extending its protectiveeffect to non-vaccinated individuals of all ages, includingthose older than 65 years, a population in which infection carries high morbidity and mortality. Group immunity is partly due to induction of immune responses in the respiratory mucosa. The result is a decrease innasopharyngeal colonization by vaccine serotypes which,however, can be replaced by other serotypes notcontained in the vaccine. Since nasopharyngealcolonization is a crucial factor in the epidemiology ofpneumococcal infections, changes in colonization lead tosome known consequences and others that are beginningto be known. More than 80% of pneumococcal-resistantstrains are linked to five vaccine serotypes; thedisappearance of these vaccine serotypes from thenasopharynx has been accompanied by a marked decreasein infections caused by resistant strains. A worrying recent finding has been the emergence of serotypes notcontained in the vaccine such as 19A, 3, 15, 33 and 6A,which could in future decrease the effectiveness of thevaccine or lead to changes in the epidemiology of pneumococcal disease (AU)