Prophylaxis of Community-Acquired Pneumonia Outbreaks with Pneumococcal Polysaccharide Vaccine. Prospects Analysis for Russian Military Community
Abstract
Pneumococcal pneumonia and other diseases caused by pneumococci still remain the main factors of high morbidity and mortality rates throughout the world. Pneumococci as the leading pathogens of community-acquired pneumonia (CAP), acute otitis media and sinusitis also cause a number of other serious systemic disorders including invasive infections with high mortality in spite of the antimicrobial resistance status and adequate antimicrobials choice. Pneumococcal infections are responsible for 5-35% or more of community-acquired pneumonias. The burden of pneumonia (up to 100-200%) is recorded among military recruits in training centers. Since the specific environment of the soldiers could be carrected, their health protection requires medical surveillance. For these reasons, polysaccharide and more immunogenic conjugated pneumococcal vaccines were developed. There is now an urgent need to understand whether such vaccines are effective in military conscripts. Controversy about the effectiveness and value of the polysaccharide (PPV-23) vaccine as a CAP morbidity restriction measure still persists. There were implemented plenty of metaanalyses of pneumococcal vaccines in adults. Some of them showed that the vaccine was effective against bacteremic pneumococcal pneumonia in 'low risk' healthy adults and elders. There have been a number of poor quality observational studies in Russia where 'all pneumonia cases' were considered as an endpoint. It remains controversial whether these observational studies provide adequate evidence to justify the use of the polysaccharide vaccine in the groups of healthy young men for whom it is being advocated. In our analysis we found weak evidence supporting pneumococcal vaccination with PPV-23 for this group. Nevertheless, favorable tendency was found to immunize. It is the reason for a trail to find pharmacoepidemiological support for vaccination by novel conjugated vaccines with better immunogenicity.
About the Authors
I. A. Guchev
Alliance of Clinical Pharmacologists and Microbiologists
Russian Federation
Russian Federation
O. I. Klochkov
Voronov Hospital
Russian Federation
Russian Federation
A. I. Sinopalnikov
Russian Medical Academy for Postgraduate Education
Russian Federation
Russian Federation
References
1. Jain S., Self W.H., Wunderink R.G. et al. Community-acquired pneumonia requiring hospitalization among U.S. Adults. New England J Med 2015.
2. Колосов В.П., Курганова О.П., Тезиков Н.Л. и др. Эпидемиологические особенности внебольничных пневмоний в Амурской области, проблемы и пути решения. Бюлл физиол патол дыхан 2014; 53: 8-17
3. Torné A., Dias J., Quinten C. et al. ECDC country experts for pneumococcal disease. European enhanced surveillance of invasive pneumococcal disease in 2010: data from 26 European countries in the post-heptavalent conjugate vaccine era. Vaccine 2014; 32: 3644-3650.
4. Сидоренко В.А., Фесюн А.Д., Гуревич К.Г. и др. Оценка заболеваемости органов дыхания среди военнослужащих внутренних войск МВД России. Мед Вест МВД 2013; 63: 2: 62-65
5. Guchev I.A., Yu V.L., Sinopalnikov A., Klochkov O.I., Kozlov R.S., Stratchounski L.S. Management of nonsevere pneumonia in military trainees with the urinary antigen test for Streptococcus pneumoniae: an innovative approach to targeted therapy. Clin Infect Dis 2005; 40: 11: 1608-1616.
6. Guchev I.A., Gray G.C., Klochkov O.I. Two regimens of azithromycin prophylaxis against community-acquired respiratory and skin/soft-tissue infections among military trainees. Clin Infect Dis 2004; 38: 8: 1095-1101.
7. Austrian R. The pneumococcus at the millennium: not down, not out. J Infect Dis 1999; 179: Suppl 2: S338-3341.
8. Russell K.L., Baker C.I., Hansen C. et al. Lack of effectiveness of the 23-valent polysaccharide pneumococcal vaccine in reducing all-cause pneumonias among healthy young military recruits: A randomized, double-blind, placebo-controlled trial. Vaccine 2015; 33: 9: 1182-1187.
9. Schiffner-Rohe J., Witt A., Hemmerling J., von Eiff C., Leverkus F.W. Efficacy of PPV23 in preventing pneumococcal pneumonia in adults at increased risk - a systematic review and meta-analysis. PLoS ONE 2016; 11: 1: e0146338.
10. Moberley S., Holden J., Tatham D.P., Andrews R.M. Vaccines for preventing pneumococcal infection in adults. Cochrane Database Systematic Rev (Online) 2013; 1: CD000422.
11. Cadeddu C., De Waure C., Gualano M.R., Di Nardo F., Ricciardi W. 23-Valent pneumococcal polysaccharide vaccine (PPV23) for the prevention of invasive pneumococcal diseases (IPDs) in the elderly: is it really effective? J Prev Med Hyg 2012; 53: 2: 101-103.
12. Diao W.Q., Shen N., Yu P.X., Liu B.B., He B. Efficacy of 23-valent pneumococcal polysaccharide vaccine in preventing community-acquired pneumonia among immunocompetent adults: a systematic review and meta-analysis of randomized trials. Vaccine 2016.
13. Gadsby N.J., Russell C.D., McHugh M.P. et al. Comprehensive molecular testing for respiratory pathogens in community-acquired pneumonia. Clin Infect Dis 2016.
14. Holter J.C., Muller F., Bjorang O. et al. Etiology of community-acquired pneumonia and diagnostic yields of microbiological methods: a 3-year prospective study in Norway. BMC Infect Dis 2015; 15: 64.
15. Johansson N., Kalin M., Tiveljung-Lindell A., Giske C.G., Hedlund J. Etiology of community-acquired pneumonia: increased microbiological yield with new diagnostic methods. Clin Infect Dis 2010; 50: 2: 202-209.
16. Said M.A., Johnson H.L, Nonyane B.A. et al. Estimating the burden of pneumococcal pneumonia among adults: a systematic review and metaanalysis of diagnostic techniques. PLoS ONE 2013; 8: 4: e60273.
17. Herrero F.S, Cardona C.G., Palop N.T. et al. The potential role of 13-valent pneumococcal conjugate vaccine in preventing respiratory complications in bacteraemic pneumococcal community-acquired pneumonia. Vaccine 2016.
18. Lynch J.P., Zhanel G.G. Streptococcus pneumoniae: epidemiology, risk factors, and strategies for prevention. Seminars in Respirator Critical Care Med2009; 30: 2: 189-209.
19. Огарков П.И., Жоголев С.Д. Материалы научной конференции 200-летия Военно-медицинской академии, Санкт-Петербург. 1999; 223-227. / Ogarkov P.I., Zhogolev S.D. Materialy nauchnoj konferencii 200-letija Voenno-medicinskoj akademii, Sankt Peterburg. 1999; 223-227. [in Russian]
20. Mayanskiy N., Alyabieva N., Ponomarenko O. et al. Bacterial etiology of acute otitis media and characterization of pneumococcal serotypes and genotypes among children in Moscow, Russia. Pediat Infect Dis J 2015; 34: 3: 255-260.
21. Mayanskiy N., Alyabieva N., Ponomarenko O. et al. Serotypes and antibiotic resistance of non-invasive Streptococcus pneumoniae circulating in pediatric hospitals in Moscow, Russia. Int J Infect Dis 2014; 20: 58-62.
22. Tatochenko V., Sidorenko S., Namazova-Baranova L. et al. Streptococcus pneumoniae serotype distribution in children in the Russian Federation before the introduction of pneumococcal conjugate vaccines into the National Immunization Program. Expert Rev Vaccines 2014; 13: 2: 257-2564.
23. Лобзин Ю., Сидоренко С., Харит С. et al. Серотипы Streptococcus pneumoniae, вызывающие ведущие ологичнеские формы певмококковых инфекций. Журнал инфектологии 2013; 5: 4: 35-41
24. Холодок Г.Н., Евсеева Г.П., Ивахнишина H.M., Гарбуз Ю.А., Морозова Н.В., Козлов В.К. Актуальность вакцинопрофилактики пневмококковой инфекции в г. Хабаровске. Инфек бол иммунол иммунотер 2014; 3: 29-33
25. Белошицкий Г.В., Королева И.С. Серотиповая характеристика штаммов S.pneumoniae в Москве. Эпидемиол вакцинопрофилакт 2014; 74: 1: 90-97
26. Мартынова А.В., Балабанова Л.А., Чулакова О.А. Мультилокусное сиквенстипирование штаммов Streptococcus pneumoniae, выделенных у пациентов пожилого возраста с внебольничными пневмониями. Бюлл Сибир Мед 2014; 13: 3: 40-45
27. Jackson L.A., Gurtman A., van Cleeff M. et al. Immunogenicity and safety of a 13-valent pneumococcal conjugate vaccine compared to a 23-valent pneumococcal polysaccharide vaccine in pneumococcal vaccinenaive adults. Vaccine 2013; 31: 35: 3577-3584.
28. Shiramoto M. Hanada R., Juergens C. et al. Immunogenicity and safety of the 13-valent pneumococcal conjugate vaccine compared to the 23-valent pneumococcal polysaccharide vaccine in elderly Japanese adults. Hum Vaccin Immunother 2015; 11: 9: 2198-21106.
29. Austrian R., Douglas R.M., Schiffman G. et al. Prevention of pneumococcal pneumonia by vaccination. Trans Assoc Am Physicians 1976; 89: 184-194.
30. McLeod C.M., Hodges R.G., Heidelberger M., Bernhard W.G. Prevention of pneumococcal pneumonia by immunization with specific capsular polysaccharides. J Exper Med 1945; 82: 445.
31. Kaufman P. Pneumonia in old age: active immunization against pneumonia with pneumococcus polysaccharide, results of a 6-year study. Arch Internal Med 1947; 79: 518-531.
32. Kaufman P. Studies in old age pneumonia. II. Prophylactic effect of pneumococcus polysaccharide against pneumonia. Arch Internal Med 1941; 67: 304-319.
33. Concepcion N.F., Frasch C.E. Pneumococcal type 22f polysaccharide absorption improves the specificity of a pneumococcal-polysaccharide enzyme-linked immunosorbent assay. Clin Diagn Lab Immunol 2001; 8: 2: 266-272.
34. Heidelberger M., Dilapi M.M., Siegel M., Walter A.W. Persistence of antibodies in human subjects injected with pneumococcal polysaccharides. J Immunol 1950; 65: 5: 535-541.
35. Hedlund J., Ortqvist A., Konradsen H.B., Kalin M. Recurrence of pneumonia in relation to the antibody response after pneumococcal vaccination in middle-aged and elderly adults. Scandinav J Infect Dis 2000; 32: 3: 281-286.
36. Hausdorff W.P., Bryant J., Paradiso P.R., Siber G.R. Which pneumococcal serogroups cause the most invasive disease: implications for conjugate vaccine formulation and use, part I. Clin Infect Dis 2000; 30: 1: 100-121.
37. Marston B.J., Plouffe J.F., File T.M., Jr. et al. Incidence of community-acquired pneumonia requiring hospitalization. Results of a population-based active surveillance Study in Ohio. The Community-Based Pneumonia Incidence Study Group. Arch Internal Med 1997; 157: 15: 1709-1718.
38. Smit P., Oberholzer D., Hayden-Smith S., Koornhof H.J., Hilleman M.R. Protective efficacy of pneumococcal polysaccharide vaccines. JAMA 1977; 238: 24: 2613-2616.
39. Kerneis S., Launay O., Turbelin C., Batteux F., Hanslik T., Boelle P.Y. Longterm immune responses to vaccination in HIV-infected patients: a systematic review and meta-analysis. Clin Infect Dis 2014; 58: 8: 1130-1139.
40. Broome C.V., Facklam R.R., Fraser D.W. Pneumococcal disease after pneumococcal vaccination: an alternative method to estimate the efficacy of pneumococcal vaccine. New England J Med 1980; 303: 10: 549-552.
41. Dominguez A., Salleras L., Fedson D.S. et al. Effectiveness of pneumococcal vaccination for elderly people in Catalonia, Spain: a case-control study. Clin Infect Dis 2005; 40: 9: 1250-1257.
42. Shapiro E.D., Berg A.T., Austrian R. et al. The protective efficacy of polyvalent pneumococcal polysaccharide vaccine. New England J Med 1991; 325: 21: 1453-1460.
43. Shapiro E.D., Clemens J.D. A controlled evaluation of the protective efficacy of pneumococcal vaccine for patients at high risk of serious pneumococcal infections. Ann Internal Med 1984; 101: 3: 325-330.
44. Sims R.V., Steinmann W.C., McConville J.H., King L.R., Zwick W.C., Schwartz J.S. The clinical effectiveness of pneumococcal vaccine in the elderly. Ann Internal Med 1988; 108: 5: 653-657.
45. Leventer-Roberts M., Feldman B.S., Brufman I., Cohen-Stavi C.J., Hoshen M., Balicer R.D. Effectiveness of 23-valent pneumococcal polysaccharide vaccine against invasive disease and hospital-treated pneumonia among people aged >65 years: a retrospective case-control study. Clin Infect Dis 2015; 60: 10: 1472-1480.
46. Ochoa-Gondar O., Vila-Corcoles A., Rodriguez-Blanco T. et al. Effectiveness of the 23-valent pneumococcal polysaccharide vaccine against community-acquired pneumonia in the general population aged >60 years: 3 years of follow-up in the CAPAMIS study. Clin Infect Dis 2014; 58: 7: 909-917.
47. Jackson L.A., Neuzil K.M., Yu O. et al. Effectiveness of pneumococcal polysaccharide vaccine in older adults. New England J Med 2003; 348: 18: 1747-1755.
48. Vila-Corcoles A., Ochoa-Gondar O., Hospital I. et al. Protective effects of the 23-valent pneumococcal polysaccharide vaccine in the elderly population: the EVAN-65 study. Clin Infect Dis 2006; 43: 7: 860-868.
49. Huss A., Scott P., Stuck A.E., Trotter C., Egger M. Efficacy ofpneumococcal vaccination in adults: a meta-analysis. CMAJ 2009; 180: 1: 48-58.
50. Butler J.C., Breiman R.F., Campbell J.F., Lipman H.B., Broome C.V., Facklam R.R. Pneumococcal polysaccharide vaccine efficacy. An evaluation of current recommendations. JAMA 1993; 270: 15: 1826-1831.
51. Cornu C., Yzebe D., Leophonte P., Gaillat J., Boissel J.P., Cucherat M. Efficacy of pneumococcal polysaccharide vaccine in immunocompetent adults: a meta-analysis of randomized trials. Vaccine 2001; 19: 32: 4780-4790.
52. Moore R.A., Wiffen P.J., Lipsky B.A. Are the pneumococcal polysaccharide vaccines effective? Meta-analysis of the prospective trials. BMC Family Practice 2000; 1: 1.
53. Fine M.J., Smith M.A., Carson C.A. et al. Efficacy of pneumococcal vaccination in adults. A meta-analysis of randomized controlled trials. Arch Internal Med 1994; 154: 23: 2666-2677.
54. Melegaro A., Edmunds W.J. The 23-valent pneumococcal polysaccharide vaccine. Part II. A cost-effectiveness analysis for invasive disease in the elderly in England and Wales. European J Epidemiol 2004; 19: 4: 365-375.
55. Melegaro A., Edmunds W.J. The 23-valent pneumococcal polysaccharide vaccine. Part I. Efficacy of PPV in the elderly: a comparison of metaanalyses. Eur J Epidemiol 2004; 19: 4: 353-363.
56. Watson L., Wilson B.J., Waugh N. Pneumococcal polysaccharide vaccine: a systematic review of clinical effectiveness in adults. Vaccine 2002; 20: 17-18: 2166-2173.
57. Dear K., Holden J., Andrews R, Tatham D. Vaccines for preventing pneumococcal infection in adults. Cochrane Database Systematic Rev (Online) 2003; 4: CD000422.
58. Kobayashi M., Bennett N.M., Gierke R. et al. Intervals between PCV13 and PPSV23 vaccines: recommendations of the Advisory Committee on Immunization Practices (ACIP). Mmwr 2015; 64: 34: 944-947.
59. Pilishvili T., Bennett N.M. Pneumococcal disease prevention among adults: strategies for the use of pneumococcal vaccines. American J Preventiv Med 2015; 49: 6: Suppl 4: S383-390.
60. Fedson D.S., Liss C. Precise answers to the wrong question: prospective clinical trials and the meta-analyses of pneumococcal vaccine in elderly and high-risk adults. Vaccine 2004; 22: 8: 927-946.
61. Austrian R. A reassessment of pneumococcal vaccine. New England J Med 1984; 310: 10: 651-653.
62. Clemens J.D., Shapiro E.D. Resolving the pneumococcal vaccine controversy: are there alternatives to randomized clinical trials? Rev Infect Dis 1984; 6: 5: 589-600.
63. Fedson D.S., Scott J.A. The burden of pneumococcal disease among adults in developed and developing countries: what is and is not known. Vaccine 1999; 17: Suppl 1: S11-18.
64. Рыбаченко B.B., Мануйлов B.M., Кузнецов M.C., Мазур Г.И. Результаты применения вакцины «ПНЕВМО-23» на Северном Флоте. Экология человека 2007; 9: 18-19. / Rybachenko V.V., Manuilov V.M., Kuznecov M.S., Mazur G.I. Rezul'taty primenenija vakciny «PNEVMO-23» na Severnom Flote. Jekologija cheloveka 2007; 9: 18-19. [in Russian]
65. Ан Р., Шевчук П.А., Рахчеев C.B., Емельянов В.П., Обласова Т.М. Опыт профилактики внебольничной пневмонии в воинских коллективах вакциной Пневмо-23. Военно-мед журн 2005; 327: 10: 401
66. Калиногорская О.С., Беланов С.С., Волкова М.О., Гостев B.B., Сидоренко С.В. Антибиотикорезистентность и серотиповый состав Streptococcus pneumoniae, выделенных у детей в Санкт-Петербурге в 2010-2013 гг. Антибиотики и химотер 2015; 60: 1-2: 10-18
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For citations:
Guchev I.A., Klochkov O.I., Sinopalnikov A.I. Prophylaxis of Community-Acquired Pneumonia Outbreaks with Pneumococcal Polysaccharide Vaccine. Prospects Analysis for Russian Military Community. Antibiot Khimioter = Antibiotics and Chemotherapy. 2016;61(1-2):43-52. (In Russ.)
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