dr.dinesh agarwal

8/9/2019 Dr.Dinesh Agarwal

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Pneumococcal

Conjugate VaccineBy

Dr Dinesh Agarwal

Associate Consultant

Department of Paediatrics

Pushpanjali Crosslay Hospital


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Invasive and Noninvasive

Infections

Invasive pneumococcal disease1

Bacteremia/sepsis

Meningitis

Bacteremic pneumonia

Noninvasive pneumococcal disease1

Non-bacteremic pneumonia

Acute otitis media

Sinusitis


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S. pneumoniae Disease Burden in ChildrenS. pneumoniae Disease Burden in Children


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The polysaccharide capsule of

S. pneumoniae Gram-positive, encapsulated

diplococci

The capsule is a major virulence

factor, hindering opsonization byphagocytes

Antibodies to the capsular

polysaccharide (CPS) are

protective

Capsular polysaccharide defines

a serotype


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Streptococcus pneumoniae :

Seroepidemiology Subtle differences exist in the chemical structure of the

polysaccharide coat, creating distinct serotypes of S.pneumoniae.

Approximately 45 serogroups (denoted by numbers 1, 2,3, etc.)comprised of 90 serotypes(denoted by alphabets/letters A, C, F etc.)

Prevalence of individual serotypes varies geographically,between different age-groups and over time

Small subset of serogroup accounts for vast majority ofthe invasive disease in almost every region of the worldand these most often display antibiotic resistance(serotypes 4, 6, 9, 14, 18, 19 and 23)


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Epidemiology

Reservoir Human carriers

Transmission Respiratory

auto-innoculation

(droplet)

Route ofTransmission Lymphatics

- Blood stream

(Bacteremia)

- Direct Extension fromlocal site (sinuses)

Temporal pattern Winter and early

spring


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Important risk factors for invasive

pneumococcal diseaseCo-morbiditiesSickle cell disease (SCD)

Certain chronic diseases

HIV infection

Primary immune deficienciesImmunosuppressive therapy

Immunologic factorsYoung age

Limited breast feeding

Other predisposingconditionsCSF leak

Cochlear implant

Passive smoking

Antecedent antibiotic use

Recent/frequent otitis media

Pre-maturity or low birth weight

Social factors

Poverty

Crowding

Day care attendance

Race / ethnicity

Demographic factorsBeing a boy


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In India, data on prevelance of pneumococcal

disease is scanty.

Most prevelant serotypes:6,1,9,4,5,45,12,7,23

Serotypes 1 and 5 are responsible for 30% IPD


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Prevenar

(Pneumococcal Conjugate Vaccine)

Heptavalent (seven valent) vaccine

Conjugation with CRM 197 Protein

Aluminum as aluminum phosphate adjuvent

Serotype 3,6B,9V,14,18C,19F and 23

First introduced in July 2000 in Universal Immunisation in the

USA

Presently licensed in 19 Countries

Indicated below 2 years of age


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Recommended for Use

For EPI:IPD burden greatest among underprivileged children

Public Health Importance

Ideally available to all children

Limitation: High Cost

Limited Coverage of prevalent serotypes in India

High Risk: Both PPV 23/PCV

Provide expanded Provide robust immune

serotype coverage response and immune memory Healthy Children: 1:1 discussion with parents below 2 years of

age

Cover 55% pneumococcal serotypes prevelant

in India


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Doses and Administration

Dose - 0.5 ml

Route of Administration - Intramuscular

Sites - Anterolateral aspect of thigh in

infant

- Deltoid muscle of the upper arm inolder children


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Vaccination Schedule

Primary Immun

ization

3 doses at 6,10,11 weeks and 1 booster at 15-18 months of age.

Catch up Vaccination

Age at First Dose Total Number of 0.5 ml doses

7-11 months of age 3*

12-23 months of age 2**

>24 months through 9 years

of age

1

*2 dose atleast 4 weeks apart; third dose after the one year birthday, separated

from the second dose by at least 2 months.

**2 doses at atleast 2 months apart


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Children at high risk

Congenital immunodeficiency

HIV

Immunosuppressive therapy

Organ transplant recipients

Sickle cell disease, asplenia/hyposplenia Chronic cardiac disease

Chronic pulmonary disease excluding asthma unless on high

dose oral steroids

Chronic liver disease Chronic renal failure, nephrotic syndrome

Diabetes mellitus

Cerebrospinal fistula, cochlear implants


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High Risk

If affordable, PCV-1ST 2 years, PPV 23 also

PCV PPV 23

2 month

PPV 23, PCV after 2 months

2nd dose of PPV 23: 3-5 years later10 years


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Adverse Reaction

Very Common Injection site erythema, induration/swelling, pain/tenderness

Diarrhea, vomiting

Fever

Decreased appetite

Drowsiness; restless sleep

Irritability

Crying


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Rare/Very Rare

Seizure (including febrile seizure)

Hypotonic-hyporesponsive-episode

Injection site: urticaria

dermatitis

pruritus

Lymphadenopathy

Hypersensitivity reactions including face edema

Dyspnea

Bronchospasm

Anaphylactic/anaphylactoid reaction including shock


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Efficacy: 95%

with herd effect resulting from decrease from nasopharyngeal

carriage

Recent Vaccines

10 valent from GSK including serotype 1,5,7 in addition to 7

valent prevnar with Protein D-carrier.

13 valent from Wyeth including serotypes 1,3,5,6A,7F,19A in

addition to 7 valent prevnar with CRM 19 carrier protein.

*Both the vaccines are licensed in some countries.


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Unconjugated Polysaccharide

Vaccine

23 valent

Serotypes 1,2,3,4,5,6B,7F,8,9N,10A,11A,12F,14,15B,17F,18C,

19F,19A,20,22F,23F,33F

T-cell independent Vaccine

Poorly immunogenic


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70% efficacy in high risk but no protection against non bacteric

pneumonia and OM

Dose: 0.5 ml

Route: S/C or I/M

Safe occasional local side effects

Maximum two doses

More doses causes immunologic hypo responsiveness


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dr.dinesh agarwal

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