Pneumococcal vaccines Review

Yıl 2007, Cilt: 42 Sayı: 11, 43 - 50, 01.05.2007

Zafer Kurugöl

Öz

Diseases caused by Streptococcus pneumoniae pneumococcus are major public health problems worldwide Serious diseases that are often caused by pneumococci include pneumonia meningitis and bacteraemia; otitis media and sinusitis are more common but less serious manifestations of infection 23 valent pneumococcal polysaccharide vaccine PPV23 is not effective in children younger than 2 years of age in whom 80 of childhood invasive pneumococcal diseases occur The 7 valent pneumococcal conjugate vaccine PCV7 contains 4 6B 9V 14 18C 19F and 23F serotypes Serotypes included in PCV7 and potentially cross reactive serotypes 6A 9A 9L 18B and 18F accounted for 86 of bacteremia 83 of meningitis and 65 of AOM among children aged lt;6 years PCV7 is administered intramusculary at ages of 2 4 6 and 12 15 months After three doses of PCV7 a preventing level of type specific antibody against the vaccine serotypes is achieved in approximately 90 of children Clinical studies suggest that PCV7 is safe and highly effective in preventing invasive pneumococcal disease in healthy children aged lt;2 years and has nbsp; a significant impact on pneumonia and acute otitis media Therefore it is recommended that all children aged lt;2 years should be vaccinated with PCV7 Heptavalent conjugate vaccine has advantages over PPV23 which include induction of immune system memory possibly resulting in longer duration of protection reduction in carriage probable higher efficacy against serotypes causing most invasive disease and probable effectiveness against noninvasive syndromes pneumonia and acute otitis media A 7 valent pneumococcal conjugate vaccine has been licensed since 2000 in USA The introduction of PCV7 in the US has resulted in substantial decline in IPD in the target population despite supply shortages including high risk children A herd effect in unvaccinated children and adults especially in the elderly has been observed A decline in antibiotic resistance has been observed since introduction of PCV7 Serotype replacement has been observed for carriage isolates of SP and for IPD nbsp; Serotypes 19A 15 22F 33F 35 are increasing in frequency in both children and in those agedabove 65 Today PCV7 is licensed in more than 70 countries and is used routinely in several developed countries Vaccines with 10 and 13 serotypes might be licensed between 2008 and 2010 Turk Arch Ped 2007; 42 Suppl: 43 50 Key words: nbsp; İnvazive pneumococcal disease pneumococcal conjugate vaccıne

Anahtar Kelimeler

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Pnömokok aşıları Derleme

Öz

Streptococcus pneumoniae pnömokok tüm dünyada önemli bir halk sağlığı sorunudur Pnömokoklar menenjit pnömoni ve bakteriyemi gibi invazif hastalıklara neden olduğu gibi otitis mediya ve sinüzit gibi sık görülen mukozal enfeksiyonlara da neden olur Pnömokokların neden olduğu hastalıklar her yaşta görülmekle birlikte invazif pnömokok hastalığı IPH küçük çocuklarda özellikle iki yaş altı çocuklarda sık görülür Hastalığın sık görülmesinin yanı sıra etkeni olduğu invazif enfeksiyonlar ölüme de neden olmaktadır Dünya genelinde aşı ile korunabilir hastalıklar arasında pnömokok hastalığı yılda 1 609 000 ölümle birinci sırayı almaktadır Pnömokok enfeksiyonlarında kaynak genellikle bulgu vermeyen taşıyıcılardır Pnömokokların penisilin direnci son yıllarda tüm dünyada artmıştır Bazı ülkelerde orta veya yüksek düzeyde penisilin direnci 50’lere ulaşmıştır Tüm bu nedenlerle pnömokok enfeksiyonlarından korunmak gereklidir Korunma 23 valanlı pnömokok polisakkarid aşısı PPV23 ve 7 valanlı konjüge pnömokok aşısı PCV7 ile sağlanır PPV23 1977’den beri uygulanmaktadır Ancak PPV23 kısa süreli immünite oluşturması antijenle tekrar karşılaşılınca “anemnestik” yanıt oluşmaması ve iki yaşından küçüklerde yeterli antikor yanıtı koruyuculuk oluşturmaması nedeniyle normal aşılamada kullanılamaz Sadece iki yaş üstü risk grubu çocuklara uygulanabilir PCV7 ilk kez 1999 yılında ABD’de ruhsat almış ve aşı şemasına dahil edilmiştir ABD’de gerek ruhsat öncesi yapılan “Kaiser Permanente” çalışması gerekse normal uygulamadan sonra yapılan gözlem çalışmaları PCV7’nin IPH ve mukozal enfeksiyona karşı etkili olduğunu dolaylı olarak immünite sağladığını taşıyıcılığı penisilin direncini ve antibiyotik kullanımını azalttığını göstermiştir Aşı serotipleri olan enfeksiyon ve taşıyıcılıkta azalma olmasına karşın aşı içeriğinde yer almayan pnömokok serotiplerinde 19A 15 22F 33F ve 35 gibi artış vardır Ancak aşı ile korunulamayan serotiplerdeki bu artış şimdilik IPH’ye neden olmamaktadır Üretimin de artması ile son yıllarda PCV7 ülkemizin de içinde olduğu 70’den fazla ülkede ruhsat almış ve birçok gelişmiş ülkede aşı şemasına dahil edilmiştir 10 ve 13 valanlı aşıların da 2008 2010 yılları arasında ruhsat almaları beklenmektedir Ayrıca 20’den fazla aday pmönokok aşısı protein aşılar dahil ile ilgili çalışmalar umut vericidir Türk Ped Arş 2007; 42 Özel Sayı: 43 50 Anahtar kelimeler: Konjüge pnömokok aşısı invazif pnömokok hastalığı

Anahtar Kelimeler

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Kaynakça

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