Potential interventions for the prevention of childhood pneumonia

Authors:
  • DSDavid H. Sniadack
    David H. Sniadack
  • BSBenjamin Schwartz
    Benjamin Schwartz
  • HLHarvey Lipman
    Harvey Lipman
  • JBJ. Bogaerts
    J. Bogaerts
  • JBJay C. Butler
    Jay C. Butler
  • RDRon Dagan
    Ron Dagan
  • NLNellie Lloyd-Evans
    Nellie Lloyd-Evans
  • AFA. Fenoll
    A. Fenoll
  • NGNabil I. Girgis
    Nabil I. Girgis
  • JHJorgen Henrichsen
    Jorgen Henrichsen
  • KKKeith Klugman
    Keith Klugman
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Abstract
Streptococcus pneumoniae is a leading cause of fatal bacterial pneumonia in young children. Pneumococcal polysaccharide vaccines have not been promoted for use in young children because many constituent serotypes are not immunogenic in children <2 years old. Conjugating pneumococcal polysaccharide epitopes to a protein carrier would likely increase vaccine immunogenicity in children. We reviewed published and unpublished pneumococcal serotype and serogroup data from 16 countries on 6 continents to determine geographic and temporal differences in serotype and serogroup distribution of sterile site pneumococcal isolates among children and to estimate coverage of proposed and potential pneumococcal conjugate vaccine formulas. The most common pneumococcal serotypes or groups from developed countries were, in descending order, 14, 6, 19, 18, 9, 23, 7, 4, 1 and 15. In developing countries the order was 6, 14, 8, 5, 1, 19, 9, 23, 18, 15 and 7. Development of customized heptavalent vaccine formulas, one for use in all developed countries and one for use in all developing countries, would not provide substantially better coverage against invasive pneumococcal disease than two currently proposed heptavalent formulas. An optimal nanovalent vaccine for global use would include serotypes 1, 5, 6B, 7F, 9V, 14, 18C, 19F and 23F. Geographic and temporal variation in pneumococcal serotypes demonstrates the need for a species-wide pneumococcal vaccine.