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Pneumococcus Pneumonia Disease & Prevention
Pneumovax 23(Pneumococcal Vaccine Polyvalent)
2
Contents
Pneumococcus Pneumonia Disease
Prevention and Vaccine
Penumococcus Pneumonia Disease
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(Pneumonia) 1001
138,957 611.34 100.00 133,679 590.28 100.00 3.57 21.07
1 37,222 163.76 26.79 1 36,357 160.54 27.20 2.01 3.22
2 13,139 57.81 9.46 3 12,339 54.48 9.23 6.10 3.32
3 12,970 57.06 9.33 2 12,861 56.79 9.62 0.48 0.27
4 10,501 46.20 7.56 4 9,191 40.58 6.88 13.84 5.62
5 8,365 36.80 6.02 5 8,453 37.33 6.32 -1.40 -0.52
6 5687 25.02 4.09 6 5536 24 4 2.35 0.58 7 5,621 24.73 4.05 7 5,351 23.63 4.00 4.66 1.10
8 4,822 21.21 3.47 8 4,680 20.67 3.50 2.66 0.55
9 4,282 18.84 3.08 9 3,468 15.31 2.59 23.02 3.53
10 1,891 8.32 1.36 10 1,806 7.97 1.35 4.32 0.34
%
%
%
6589% (5,034)
()
http://www.doh.gov.tw/statistic/data//94/94.htm
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Pneumonia
(Pneumonitis)
(+/-)
65
6
(pathophysiology)
:COPD
7
1); 2): X
Adapated from the Merck Manuals online medical library home edition for patients and caregivers. Pneumonia http://www.merck.com/mmhe/sec04/ch042/ch042a.html
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Pneumococcal vaccine vs Flu vaccine:
(CAP)(21.8%)(Influenza A virus) 6.7%
(NHRI TAIWAN, 2003)
Ref: (NHRI TAIWAN), 2003Materials:
9
(CAP)25~30%
(community-acquired pneumonia; CAP)25~30% (30%) CAP20~22%
20%5CAP20%5CAP20%
10
3)
Gram Stain(bronchoscopy)
ELISA, RIA, PCR
CBC with differential counts:
Streptococcus Pneumoniae Staphylococcus aureus
Hemophilus Influenza Klebsiella pneumoniae
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Community Acquired Pneumonia (CAP):X-ray
14
Hospital Acquired Pneumonia (HAP)48
Healthcare Associated Pneumonia(HCAP)90;
;30IV;
Ventilator Associated Pneumonia(VAP) 48-72
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Streptococcus pneumoniae: Microbiology
: overview
Micrococcus Pasteuri (1881)
, Pneumococcus
,
1974
(Streptococcus pneumoniae)
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Streptococcus pneumoniae: Microbiology
: overview (contd) 90
(Polysaccharidecapsule)
Cell wall
Cytoplasmicmembrane
Musher, in Principles and Practice of Infectious Diseases, 1995
2.2
14
: overview
2040510
Nasopharynx: site of colonisation
TracheaInhalation
Patient withpneumococcaldisease
Asymptomaticcarrier
Aerosol
Nasal cavity
Musher, D.M.: Streptococcus pneumoniae, in Mandell, Douglas, and Bennetts Principles and Practice of Infectious Diseases (5th ed.), eds. G.L. Mandell, J.E. Bennett, and R. Dolin, Philadelphia,
Churchill Livingstone, 2000, pp. 2128-2147. 2.4
Dissemination
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Breachof blood-brainbarrier
Bacteraemia
SinusitisCSF leakage
Meningitis
Otitis media
Nasopharynxcolonisation
Pneumoniae
Breachof phagocyticdefences
Breach of mucociliarydefences
Salyers, Whitt, in Bacterial Pathogenesis, 1994
PeritonitisArthritis arc
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Musher, in Principles and Practice of InfectiousDiseases, 1995
Non-invasive disease-Sinusitis (sinuses)-Otitis media (middle ear)-Pneumonia (lungs)
Invasive disease / IPD- Bacteraemia (blood)
- Meningitis (CNS)- Endocarditis (heart)- Peritonitis (body cavity)- Septic arthritis (bones and joints)- Others (appendicitis, salpingitis,
soft-tissue infections)
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Epidemiology
(disease burden)
4S. pneumoniae 1
60,20%,
30-40
80%,30%
1. Centers for Disease Control and Prevention: in Epidemiology and Prevention of Vaccine-Preventable Diseases (6th ed.), eds. W. Atkinson, et al, Department of Health & Human Services, Public Health Service, January 2000, pp. 249263.
2. 2. Centers for Disease Control and Prevention: MMWR 46(RR-8):124, April 4, 1997.
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Flu & Pneumonia shot campaign DM Patients
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Epidemiology
(disease burden)
6542.%1
65NT106,291 2
1. Epidemiology of Invasive Pneumococcal Infection in Taiwan: Antibiotic Resistance, Serogroup Distribution,and Ribotypes Analyses, MICROBIAL DRUG RESISTANCE, Volume 8, Number 3 2002
2. AJIC Chen et al, Nov 2006 597 Vol. 34 No.9
20
.
: The effect of Influenza vaccine coverage on chronic bronchitis, pulmonary emphysema, asthma and pneumonia deaths among the elderly of Taiwan
Ref: (NHRI TAIWAN), 2003Materials:
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( Streptococcus pneumonia ) 1970
PNSSP (penicillin non-susceptible S. pneumonia)
Streptococcus pneumoniapenicillin 60~80% 60% of PNSSP: also resistant to extended-spectrum cephalosporins &
carbapenems
Most PNSSP serotypes: 23F, 19F, 6B &14 (all included in Pneumovax 23)
PNEUMOVAX 23 (Pneumococcal Vaccine Polyvalent)
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Pneumococcal vaccine vs Flu vaccine:
(ACIP)
Hospitalization Deaths(% reduction) (%
reduction)
Influenza vaccine alone 52% 70%
Pneumococcal vaccine alone 27% 34%
Influenza + pneumococcal vaccine 63% 81%
Nichol KL. The additive benefits of influenza and pneumococcal vaccinations during influenza seasons among elderly persons with chronic lung disease. Vaccine. 1999. 17:S91-S93.
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2 2
3 3
6565
22
,,,,),,,,)
()()
Prevention and Vaccine
Pneumovax 23(Pneumococcal Vaccine Polyvalent)
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Pneumovax 23 23 (capsular polysaccharides)
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Pneumovax 23 :80~85%
23
80%2
1999~200080COPD
Ref.: C.C. Lai, et al, J Formos Med Assoc, 2007. Vol 106. No3
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Pneumovax 23 : 80~85%
Pneumovax 23 23 :
5 3, 4, 6, 9, 14,15,19, 23 6B, 14 , 19F & 23F
*
1, 2, 3, 4, 5, 6B*, 7F, 8, 9N, 9V, 10A, 11A, 12F, 14*, 15B, 17F, 18C, 19F*, 19A, 20, 22F, 23F*, 33F
Pneumococcal capsular type included in Pneumovax 23
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(COPD)
Asplenia
> 65 years
CLINICAL EFFICACY
INDIRECT COHORT ANALYSIS : 1978-1992
US Centers for Disease Control study in 2837 patients (5 years old)
75 %75 % 84 %84 % 73 %73 %
65 %65 % 77 %77 % 69 %69 %
J.C. Butler et al. J.C. Butler et al. -- JAMA 1993;270 (15):1826JAMA 1993;270 (15):1826--3131
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Pneumovax 23 :
50(ACIP65
)
,
, ,,
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Australia Recommendations All individuals 65 years of age Selected high-risk individuals >2 years of age including:
Germany All individuals >60 years of age Children, adolescents, and adults with increased health risk
Canada All individuals 65 years of age All individuals >2 years of age with increased health risk
USAThe Advisory Committee on Immunization Practices (ACIP), and theCenters for Disease Control and Prevention (CDC) All individuals 65 years of age Individuals 2 64 years of age with chronic illness
National Health and Medical Research Council: Pneumococcal infectins, in The Australian Immunisation Handbook, (7th ed), 2000, pp 183187.
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WHO Individuals >2 years of age with increased risk of pneumococcal disease,
(such as healthy elderly >65 years of age, particularly those living in institutions, and patients suffering from chronic organ failures, diabetes, or certain immunodeficiencies
World Health Organization: Weekly Epidemiological Record, June 11, 1999.
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Dosage & Use
PNEUMOVAX 23
0.5 ml/vial,25mcg (0.25% Phenol)
(intramuscular/ IM)
(intradermal)
2-8C 510
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Side Effect
( 38.8 C / 102 F )
Reminding:
34
(active infection) ()
(C)
()
T(T-cell-independent)
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Summary of Key Messages
(IPD)42.5%
65NT106,291
()
(63%81%)
Streptococcus pneumoniapenicillin
60~80%
5-10
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