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Pneumo Coccus

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PNEUMOCOCCUS Introduction Streptococcus pneumoniae (pneumococcus) is a leading cause of illness in young children and causes illness and deaths among the elderly and persons who have certain underlying medical conditions. Pneumococcal diseases include pneumonia, bacteremia, meningitis, otitis media and sinusitis There are more than 90 serotypes identified, based on the antigenicity and chemical composition of pneumococcal capsular polysaccharide. The capsular polysaccharide also acts as the virulence factor, inhibiting phagocytosis and interfering with intracellular killing of phagocytosed bacteria. Vaccines available
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  PNEUMOCOCCUS Introduction Streptococcus pneumoniae (pneumococcus) is a leading cause of illness in young children and causes illness and deaths among the elderly and persons who have certain underlying medical conditions. Pneumococcal diseases include pneumonia, bacteremia, meningitis, otitis media and sinusitis There are more than 90 serotypes identified, based on the antigenicity and chemical composition of pneumococcal capsular polysaccharide. The capsular polysaccharide also acts as the virulence factor, inhibiting phagocytosis and interfering with intracellular killing of phagocytosed bacteria. Vaccines available Pneumococcal polysaccharide vaccine The 14-valent pneumococcal vaccine was first licensed in 1977 which was later replaced by th TMNet.lnk e 23-valent vaccine in 1983. The composition of the pneumococcal vaccine was determined by the observed frequency of individual serotypes that caused invasive diseases. The 23-valent vaccine represents at least 85-90% of the serotypes that cause invasive pneumococcal infections. Drug-resistant pneumococcal serotypes causing invasive infection are also represented in the 23-valent vaccine. One dose (0.5 ml) of the 23-valent vaccine contains 25  g of each capsular polysaccharide antigen (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) Pneumococcal conjugate vaccine Pneumococcal polysaccharide antigens are covalently coupled to carrier proteins to induce immunological response in children under 2 years of age. Current conjugate vaccine development has focused on the serotypes most commonly causing infections in childhood. The 7- component conjugate pneumococcal vaccine efficacy study is ongoing. Mode of administration and dosing regimen One dose of 0.5 ml 23-valent vaccine is administered by intramuscular or subcutaneous route. Routine revaccination of immunocompetent persons previously vaccinated is not recommended. However, a single revaccination is recommended for persons aged _2 years who are at highest risk for serious pneumococcal infection and those who are likely to have a rapid decline in pneumococcal antibody levels, provided 5 years have elapsed since receipt of the first dose of pneumococcal vaccine. 42 Contraindications and adverse reactions Children under 2 years of age do not respond satisfactorily to the 23- valent polysaccharide vaccine. In these children the pneumococcal conjugate vaccine is a promising vaccine candidate. Immunization should be deferred during pregnancy.  Local reactions include pain, redness and induration which usually last less than 48 hours. Systemic reactions such as fever, rash, myalgia, headache are uncommon. Severe reactions such as serum sickness and anaphylaxis are extremely rare. Vaccination is not recommended for subjects who have been vaccinated within the previous 3 years unless indicated otherwise. Vaccines available in Malaysia 1. Pneumovax 23 2. Pneumo 23  At present, the conjugate pneumococcal vaccine is not yet available. Target groups Pneumococcal vaccine is recommended for the following 1 : 1. Persons aged _65 years. A second dose of vaccine is recommended if patient received vaccine _5 years previously and were aged <65 years at the time of primary vaccination. 2. Persons aged 2-64 years with chronic cardiovascular disease, chronic pulmonary disease(COPD or emphysema, but not asthma), or diabetes mellitus, alcoholism, chronic liver disease, or cerebrospinal fluid leaks. 3. Persons aged 2-64 years with functional or anatomical splenia. Revaccination is recommended if _5 years have elapsed after previous dose in patients aged >10 years. If patient is aged _10 years, consider revaccination 3 years after previous dose. 4. Persons aged 2-64 years living in special environment or social settings 5. Immunocompromised persons aged _2 years, including those with HIV infection, leukemia, lymphoma, Hodgkins disease, multiple myeloma, generalized malignancy, chronic renal failure or nephrotic syndrome; those receiving immunosuppressive chemotherapy (including corticosteroids); and those who have received an organ or bone marrow transplant. Single revaccination is indicated if _5 years have elapsed since receipt of first dose. If patient is aged _10 years, 43 consider revaccination 3 years after previous dose. Evidence of effectiveness  A meta-analysis by Cornus et al 2 based on 14 randomised trials confirms unambiguously the high efficacy of pneumococcal polysaccharide vaccine  in reducing definite (bacteremic) pneumococcal pneumonia by 71% and presumptive pneumococcal pneumonia by 40% with a possible 32% reduction in mortality due to pneumonia. ( Level 1 ) References 1. Prevention of pneumococcal disease. Recommendation of ACIP. MMRW.1997;46:RR-8. 2. Cornu C,Yzebe D, Leophonte P, Gaillat J, Boissel JP, Cucherat M. Efficacy of pneumococcal polysacharride vaccine in immunocompetent adults: a meta-  
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