2Pneumococcal disease: Is one of leading causes of death in the world.As WHO estimation , more than 1.6 million people including more than 800,000 children under 5 years die every year from pneumococcal infection.Up to 60% of children carry pneumococcal bacteria.There are more than 90 subtypes of SP.
3Streptococcus pneumonia: Gram-positive bacteria.90 known serotypes.Polysaccharide capsule important virulence factor.Type-specific antibody is protective.
4Pneumococcal Disease Burden: Pneumococcal infections are estimated to cause >700,000 deaths annually among children under 5 worldwide; most deaths occur in developing countries.Important clinical syndromes include pneumonia, bloodstream infections, meningitis, and acute otitis media.Emerging antibiotic resistance increases the cost of treatment of pneumococcal infections and can result in treatment failures
5Pneumococcal Disease in Children: Bacteremia without known site of infection most common clinical presentation.S. pneumoniae leading cause of bacterial meningitis among children younger than 5 years of age.Highest rate of meningitis among children younger than 1 year of age.Common cause of acute otitis media.
6Diagnosing Pneumococcal Disease: The diagnosis of pneumococcal disease is difficult and microbiological proof of infection may not be possible.There are various ways of finding out whether a patient has a pneumococcal infection.
7Which tests are used will depend on the patient’s signs and symptoms. As other types of bacteria can also cause infections with similar symptoms, testing specifically for the presence of S. pneumoniae is important.
11Pneumococcal acute otitis media - signs and symptoms: Earache.An elevated body temperature (fever).Vomiting.Diarrhea.Temporary hearing loss.Ear discharge.
122- Invasive pneumococcal diseases (IPD): These tend to be more serious and occur inside a major organ, or in the blood. Examples of IPDs include:Bacteremia (sepsis) - bacterial infection of the blood.Bacteremia refers to the presence of live bacteria in the blood, while sepsis means a blood infection which is associated with capillary leak, shock and an increased risk of mortality.
13Pneumococcal bacteremia - signs and symptoms may include: An elevated body temperature (fever).Headache.Muscular aches and pains.Rapid heart rate.Rapid breathing.
14Pneumococcal Meningitis: Estimated 3, ,000 cases per year in the United States.Case-fatality rate ~30%, up to 80% in the elderly.Neurologic sequelae common among survivors.
15Pneumococcal meningitis - signs and symptoms may include: An elevated body temperature (fever).Headache.Nausea.Vomiting.Sleepiness.Irritability.Stiff neck.Seizures.Sometimes coma.
16Treatment: in case the S. pneumoniae has developed resistance. The emergence of resistant pneumococcal strains over the last few years is making treatment more difficult, extending the period of many hospitalizations, as well as increasing the likelihood of more expensive alternative therapy.
17Treatment Options for Pneumococcal Disease: Despite early and adequate treatment, there can still be serious and potentially life threatening complications arising from pneumococcal infection.Otitis media.May need to be treated with antibiotics.Bacterial pneumonia.Needs to be treated with antibiotics.
18Invasive pneumococcal infections treatment: antibiotics for invasive pneumococcal infections. If the infection is mild the patient will take oral antibiotics.Serious infections will require intravenous administration a solution containing antibiotics will be administered directly into the venous circulation via a syringe or intravenous catheter.
19Pneumococcal Disease Transmition: S. pneumoniae, the bacterium, is most commonly found in the throat and nose (nasopharynx) of infants and young children.They may also exist in the nasopharynx of adults, but this is less likely.
20The bacterium spreads from person to person via respiratory droplets if the infected person coughs or sneezes in close proximity to other people, the other people may become infected.
21DISEASES CAUSED BY STREPTOCOCCUS PNEUMONIAE: PNEUMOCOCCAL INFECTIONNon-invasive diseaseSinusitis (sinuses)Otitis media (middle ear)Pneumonia (lungs)Invasive diseaseBacteraemia (blood)Meningitis (CNS)Endocarditis (heart)Peritonitis (body cavity)Septic arthritis (bones and joints)Others (appendicitis, salpingitis, soft- tissue infections)26
22Pneumococcal bacteria cause disease when they spread beyond the nasopharynx LarynxNasopharynxEustachiantubeNasal cavityTracheaPrimarybronchiLungsS. pneumoniaeColonisationMeningitisUpperrespiratorytractinfectionsSinusitisOtitis mediaInvasivediseasePneumococcal disease is caused by Streptococcus pneumoniae.1,2,3These bacteria are benign when carried in the nasopharynx, but when they go beyond the nasopharynx they cause more severe pneumococcal disease such as pneumonia and invasive pneumococcal diseases such as septicaemia(blood poisoning), and meningitis.1,2,3Bacterial spread within the respiratory tract causes non-invasive pneumonias, ear infections (otitis media), and sinusitis.1,2,3Pneumococcal disease is most common in infants (<2 years) and the elderly (>65 years).1,2,31Ministry of Health. Chapter 16: Pneumococcal Disease. In: Immunisation Handbook. Wellington: New Zealand Government; Available at: Accessed 10 January 2011.2US Centers for Disease Control and Prevention. Chapter 15: Pneumococcal Disease. The Pink Book - Epidemiology and prevention of vaccine preventable diseases. 11th ed. Atlanta: CDC; 2009: 217–230. Available at: Accessed 10 January 2011.3European Centre for Disease Prevention and Control. Factsheet for healthcare professionals. Available at: e=1&PDF=true Accessed 10 January 2011.LowerrespiratorytractinfectionsPneumoniaBacteraemia/septicaemiaParapneumonicempyema
23Pneumococcal Vaccine: There are two kinds of pneumococcal vaccine:1- Pneumococcal polysaccharide vaccine (PPV).2- Pneumococcal conjugate vaccine (PCV)
25Pneumococcal polysaccharide vaccine (PPV): The first PPV was approved in the USA in 1977 containing purified protein from 14 types of pneumococcal bacteria.In 1983 a PPV vaccine with the purified protein from 23 pneumococcal bacteria was approved (known as PPSV23).The PPSV23 is approved for use in adults and patients with specific risk factors who are at least 2 years of age.
26Pneumococcal conjugate vaccine (PCV): The first PCV was approved in the USA in 2000 for use in infants and young children aged six weeks to 5 years for the prevention of pneumococcal disease.This vaccine is commonly known as PCV7.
27Pneumococcal Conjugate Vaccine: A conjugate vaccine is created by covalently attaching a poor (polysaccharide organism) antigen to a carrier protein, thereby conferring the immunological attributes of the carrier on the attached antigen. This technique for the creation of an effective immunogen is most often applied to bacterial polysaccharides for the prevention of invasive bacterial disease.
28Polysaccharide vaccines: Made from polysaccharide from the capsule surrounding the bacteria.Works in adults:Two major problems:Not immunogenic in babies.No immune memory.
29Pnemoumoccal Conjugate Vaccine pcv for infant and children: The first PCV was approved in the USA in known as PCV7.(PCV7): vaccine protects against 7 serotypes, (PCV10): vaccine protects against 10 serotypes(PCV13): vaccine protects against serotypes. This type will be used in Palestin.
30Conjugate vaccine Polysaccharide And lipid (LPS) Pneumococcal bacteriumLipidCRM197 Protein CarrierChemicalReactionPurificationprocessPolysaccharide-proteinconjugateTo overcome this problem the polysaccharides are coupled with an immunogenic protein. In this example ( Prevenar and Prevenar 13 vaccine) this protein is derived from the diphtheria toxin. It is called CRM197 (Cross Reactive Protein 197). Many other conjugates have also been designed
31DOSES OF VACCINE: First dose: 2 month. Second dose: 4 month. Third dose: 6 month.
32Symptoms of an allergic reaction may include: • Shortness of breath. • Wheezing or difficulty breathing. • Swelling of the face, lips, tongue or other parts of the body. • Rash, itching or hives on the skin.
33Vaccine administration: Vaccine administration: * PPSV23 - given as an injection either in the muscle or the fatty tissue of the arm or leg. * PCV7 - as an injection into the muscle of the antero-lateral thigh or deltoid. * PCV10 - given as an injection into the muscle of the antero-lateral thigh or deltoid.
35Administration of prefilled syringe: Holding the syringe barrel (not the plunger) in one hand, unscrew the syringe cap by twisting anticlockwise.To attach the needle to the syringe, twist the needle clockwise into the syringe until you feel it lock.Synflorix should also be administered in the same way as PCV7: by intramuscular injection.1,4The preferred sites are the vastus lateralis of the thigh in children younger than 1 year or the deltoid muscle of the upper arm in children older than 1 year.1Each prefilled syringe contains one dose (0.5mL).1,4There is no need to expel air from the syringe prior to use1. GlaxoSmithKline. Synflorix® Data Sheet. GSK New Zealand; Available at: Accessed 3 January 2011.2. Wyeth. Prevenar® Data Sheet. Wyeth New Zealand; Available at: Accessed 3 January 2011.Remove the needle protector and administer the vaccine.
36Side effects of PCV7: Vaccine is safe. Between 10% and 20% of children develop redness.Tenderness.Swelling at the injection site.Approximately 11% get a mild fever.
37How effective is PCV7?A large clinical study showed that PCV7 is 97% effective in preventing invasive disease caused by the pneumococci contained in the vaccine.Children with chronic diseases, such as HIV infection and sickle cell disease appear to respond well to PCV7.
38Contraindications of Vaccine: Anaphylactic shock due to previous dose of vaccine.Moderate or sever illness (temporary).Pregnancy.