ABSTRACT
Streptococcus pneumoniae is the most common cause of community-acquired pneumonia, meningitis, and bacteremia
in children and adults. Invasive pneumococcal disease (IPD) primarily affects young
children, older adults (> 65 years of age), and individuals with comorbidities or
impaired immune systems. Case fatality rates range from 10 to 30% in adults with IPD
but are much lower (< 3%) in children. In this article, we describe the epidemiology
of IPD, risk factors, and the influence of host- and organism-specific factors on
outcomes. Most cases of IPD are caused by a limited number of serotypes that vary
in infectivity and virulence. Vaccinating adults and high-risk patients with the pneumococcal
polysaccharide vaccine reduces the incidence of IPD in populations at risk but does
not affect nasopharyngeal colonization and has had limited benefit in the population
at large. Use of the heptavalent pneumococcal conjugate vaccine (PCV7) in children
in the United States since 2000 has resulted in a substantial decline of IPD in both
children and adults (by herd immunity), but has facilitated the emergence of serotypes
not encompassed in the PCV7 vaccine. Recent reports of “replacement” serotypes that
have heightened virulence are worrisome. In this chapter, we discuss the role of vaccines
(both polysaccharide and conjugate) and other preventive strategies to limit this
important and potentially lethal disease.
KEYWORDS
Streptococcus pneumoniae
- pneumococcus - invasive pneumococcal disease - pneumococcal vaccine - pneumococcal
conjugate vaccine - serotypes
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Joseph P Lynch IIIM.D.
Division of Pulmonary, Critical Care Medicine, Allergy, and Clinical Immunology, The
David Geffen School of Medicine at UCLA
10833 Le Conte Ave., Rm. 37-131 CHS, Los Angeles, CA 90095
eMail: jplynch@mednet.ucla.edu