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Pneumococcus Pneumonia Disease & Prevention

Pneumovax 23(Pneumococcal Vaccine Polyvalent)

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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

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.

: 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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Thank you very much!Thank you very much!