Civilizations have always been at the mercy of diseases. Over 50 million people died because of the influenza outbreak during 1918 and the bubonic plague cut down populations to half where it found refuge.
Though not as deadly as the pandemics that have sent humans to the backfoot but Pneumoniae has made its fair share of trouble. It has been living with us since forever, to quote Hippocrates it’s the “disease named by the ancient”. One can imagine how ancient something can be if a 4th century BC Greek Physician calls it ancient. During the 19th century pneumonia had taken down tuberculosis as the leading cause of death worldwide and hence folks of that time started to refer it as “the captain of men of death”. What a rad title, I must say.
Today, although pneumonia still affects over 500 million individuals worldwide but the destruction has largely been taken care by vaccines, such as those for Streptococcus pneumonia.
The cause of Pneumococcal Pneumonia is the notorious Streptococcus pneumonia. Because of its devastating effects. scientists have targeted this bacterial strain for most of the on-going vaccine programs.
In the United States of America, this clinical criminal hospitalizes almost 800,000 individuals under the charge of suffering from Pneumococcal Pneumonia. And at times at penetrates a step further and kills on average 40,000 patients in the Unites States. The insanity of this strain doesn’t stop here as it most commonly infects children, exposing their immunogenic fragility to many diseases.
In the severe cases of Pneumonia, if the infection is allowed to spread unchecked it can then cause severe conditions such as:
- Bacteraemia (Spread of infection in the blood stream)
- Septicaemia (Spread of infection throughout the body)
In the case of Pneumococcal Pneumonia, the numbers of cases which progress to bacteremia are almost 20% which is an indication of the infectious potential of this disease. The mortality rate of Pneumococcal Pneumonia is also higher (to as much as five folds) as compared to the mortality rates of Pneumonia occurring from non-bacterial causes such as viral pneumonia.
A healthy person gets infected with pneumococcal infections when he gets in touch with the secretions of the respiratory system of an ill person e.g. saliva, mucus, or both containing the infection microorganisms.
One of the most asked questions from general physicians, ‘is pneumonia contagious?’ can be better understood if we are aware of the process in which pneumonia spreads. The infected people act as reservoirs for the time period when they are symptomatic and many days after that. A symptomatic patient with any pneumococcal disease carries the viable microorganisms in their nasal and oral cavity which can be easily transferred to the atmosphere in the form of aerosol droplets.
Streptococcus Pneumoniae And Associated Infections
It is a known fact that infections arising from Pneumococcal causative agents are quite common including viral pneumonia, hence their unfathomable prevalence. As soon as the infection is diagnosed the patient undergoes a prompt course of antimicrobial therapy. But even these actions have proven ineffective to alleviate the mortality rate of Pneumococcal Pneumonia. This could be attributed to two explanations:
- The emergence of new strains and variants of the bacterium.
- Development of antibiotic resistance in the bacterium.
Usually, the infections caused by Streptococcus pneumoniae are not limited to Pneumococcal Pneumonia, a plethora of other infections are also caused by the same agent which are:
- Otitis media (OM).
Another important factor that has allowed these pathogens to have an upper hand over the antibiotics, mainly penicillin, is the evolution of resistance in them. This intelligent microbial process has made scientists and vaccine manufacturer go to the drawing board again to find an “evolving” solution for this problem.
The first indication of penicillin resistance was reported in 1967 D. Hansman and M.M. Bullen, published in The Lancet, according to which the pneumococcal strains had started to show desensitization towards penicillin in the form of lower susceptibility when antibiotics were administered.
Since then, a lot of pneumococcal strains have emerged which not only show varying degree of resistance towards penicillin but also towards multiple antibiotic classes, hence being labeled as an emerging concern for the health care personnel all over the world. Today, the spread of penicillin resistance streptococcal strains is rapid, with emerging cases being reported from Europe, Africa, and the United States.
Apart from penicillin, the resistant strains show assorted degrees of resistance amongst many other antibiotics which are:
- Chloramphenicol etc.
The dynamic nature of the pneumococcal strains has been the main reason behind the development of drug resistance in this organism. The strains promote the resistant clones in which the genes associated with resistance are either taken up or given up leading to spread of resistance genes to other strains of the organism.
Prevalence Of Resistant Strains
Though the first complete penicillin-resistant strain was identified in an adult but children are more susceptible to it, as well as multi-drug resistant strain.
Following serogroups of Streptococcus pneumoniae have so far retained the resistant traits to themselves which are both penicillin and multidrug resistance:
- Serogroup 14.
- Serogroup 9.
- Serogroup 19.
- Serogroup 6.
- Serogroup 23.
Surprisingly, all of these serotypes are majorly involved with the transfer and spread of various pneumococcal diseases in the children.
Following is a brief insight into various types of pneumococcal shots against pneumococcal pneumonia in terms of their plan of action and how they lack the qualities of being a broad spectrum vaccine solution to the Pneumococcal pneumonia.
- Polysaccharide vaccines.
- Polysaccharide proteins conjugate vaccines.
- Purified protein vaccines.
- Combination protein vaccines.
- Strategic vaccines target towards the mucosal
All of the above-mentioned vaccines lacked the broad spectrum control of different strains of Pneumonia which are almost 23. Some of the vaccines have shown promising results in the lab but clinical studies are lacking in terms of their efficacy and long-term prevention of pneumococcal diseases to occur in the vaccinee.
Ideal Recipients For Pneumococcal Vaccine
Though pneumoniae doesn’t discriminate between whom it has to infect but like us it shows a slight biasedness towards certain groups. According to pneumonia shot guidelines issued by National Health Service (NHS) UK, infants, elder people above the age of 65 years must be vaccinated, since they are highly susceptible. Apart from them, a person (whether a child or an adult) who has been suffering from a long-term disease, especially concerning the heart or the kidneys, should be administered with Pneumococcal vaccine in order to reduce the risk of impending pneumococcal infections in them.
Centers for Disease Control and Prevention (CDC) U.S. has recommended mandatory vaccination of the children who are less than the age of 2 years as they are more susceptible to acquire a pneumococcal infection. It is also suggested that the health care practitioner which is consulted by the family should be taken into confidence in order to get the best possible medical advice in the case of a particular individual who has acquired a pneumococcal infection or is at the risk of acquiring it.
Types Of Pneumonia Vaccine
Although pneumonia vaccine has undergone tremendous research over the period of time but at the moment only two vaccine preparations are considered safe to be used for intervention in order to vaccinate people against the possible pneumococcal infection. According to the data presented by NHS and CDC, following vaccines are recommended to be used for vaccination:
Pneumococcal Polysaccharide Vaccine
Pneumococcal polysaccharide vaccine, also known as PPSV23 or pneumonia vaccine 23, uses dead microorganisms in order to train the immunity of the vaccinee against the pathogen. At the moment this vaccine is being marketed with the tag of “Pneumovax.”
PPSV23 makes the vaccinee immune against developing meningitis or bacteraemia from the strains of S. pneumoniae for which the person has been vaccinated apart from the obvious pneumonia immunization
Since this vaccine constitutes of the dead microorganisms which are unlike the older concept of vaccination when a vaccine used to contain weakened or live microorganisms, so, there are least chances of a person getting infected as a result of inoculation let alone get sick.
Pneumococcal Conjugate Vaccine
The pneumococcal conjugate vaccine, also known as PCV vaccine or pneumonia shot 13, has been engineered to provide immunity in the vaccinee against 13 different strains of Streptococcus pneumonia. Traditionally, this vaccine was designed to be inoculated in the infants and children under the age of two in order to train their immune system to prevent any future infection of Streptococcus pneumonia. According to CDC and NHS, the ideal pneumonia vaccine age for immunization of a child is after two months since by that time the immune system is fully developed to respond towards a vaccine.
Pneumonia shot 13 (PCV vaccine) makes the vaccinee immune against developing meningitis or bacteraemia from the strains of S. pneumoniae. PCV vaccine primary function, however, is to provide Pneumonia immunization. In 2011, the Food and Drug Administration (FDA) of U.S. gave the approval of the use of this particular vaccine in order to inoculate people who were more than 50 years of age. At the moment, this vaccine is available in the market with the brand name “Prevnar.” Prevnar pneumonia shot is currently a part of the vaccination program initiated by NHS known as “Childhood Vaccination Program” according to which the vaccine is administered to the children who are less than two years old in order to prevent pneumonia in children.
Way Things Work
It has been established earlier that pneumococcal conjugate vaccine provides immunity against 13 strains of Streptococcus pneumonia while pneumococcal polysaccharide vaccine helps the body to develop immunity against 23 strains of the same organism. But one question arises; “How these vaccines actually work once a vaccinee is inoculated with one or both of them?”
Both PCV vaccine and PPV contain the causative organism of Pneumococcal infections i.e. S. pneumonia in an inactivated or killed state. The point of introducing the actual organism as a whole or in parts is to strengthen the immune system of vaccinee so that it produces the necessary antibodies against S. pneumonia ahead of time.
Antibodies are the defensive proteins produced by the immune system of the body in order to combat disease-causing organisms and agents by disintegrating them or making them incapable of causing disease in an individual. If a microorganism infects a person who has the antibodies against that microorganism in their body prior to the infection then it greatly reduces the risk of that person getting sick as a result of an established disease.
To date, only 10 strains of pneumococcal bacteria have been highlighted out of a total of almost 90 strains to be behind the most serious infections. NHS pneumococcal vaccine recommendations suggest that the vaccines against pneumococcal bacterium show their efficacy in approximately 60% of the cases. The scenario in which vaccine itself is responsible for causing the disease is ruled out owing to the fact that the vaccines include dead, killed or inactivated microorganisms and their parts.
Recommended Vaccination Schedule
A schedule of vaccination inoculation is a chart depicting the timeline of vaccination shots which are either recommended or made mandatory by a doctor. The pneumococcal vaccine frequency varies according to different vaccines available and the region in which they are being administered. Following is an inoculation and a follow up plan of NHS for the vaccination of babies who are two years or less of age. In this plan, chalked out according to the pneumococcal vaccine recommendations, the primary dose of pneumonia shot 13 is followed up by subsequent pneumonia booster dose.
|Age||Vaccine||Number of Shots|
|8 weeks||PCV vaccine (PCV13)||1|
|16 weeks||PCV vaccine (PCV13)||1|
|1 year||PCV vaccine (PCV13)||1|
Unlike babies, the vaccination schedule for the pneumococcal vaccine for adults is comparatively simpler which comprises of a single shot sufficient to impart lifelong immunity to the adults who are 65 years of age or older. Pneumonia shots for seniors do not require a subsequent pneumonia booster dose. In the case of the adults who are suffering from a medical condition which makes their immune system prone to getting weak, a five yearly vaccination regimen is advised which is sufficient to renew their capacity to tackle pneumococcal microorganisms in order to keep them at bay.
Success Rate Of Pneumonia Vaccines
It has been a matter of great debate amongst researchers that how many times does a vaccine work and how many times it doesn’t. According to the facts and figures shared by CDC at their website, the vaccines against pneumococcal diseases work perfectly well if the overall statistics are considered but in the case of individual patients, they fail to prevent all the cases, unfortunately.
According to the studies carried out on the dosage of pneumococcal conjugate vaccine (PCV13) a single dose of the vaccine is sufficient to prevent pneumococcal diseases to become symptomatic in 8 babies out of every 10 babies who were inoculated. An analysis of 100 patients above the age of 65 who were inoculated with a single shot of pneumococcal conjugate vaccine (PCV13), 75% develop protection against all kinds of pneumococcal diseases while 5% are protected from getting pneumococcal pneumonia infection.
The studies concerning the pneumococcal polysaccharide vaccine, also known as PPSV23, show that for every 100 adults who were inoculated with a single dose of pneumococcal polysaccharide vaccine, protection from pneumococcal disease was observable in 50% to 85% of the group.
Contraindications Regarding Pneumococcal Vaccines
Despite the indication of CDC and NHS to initiate the vaccine inoculation in certain people who are at a greater risk to develop pneumococcal infections, there are some contraindications mentioned by both the bodies in which it is preferable to delay the vaccine inoculation or to stop it altogether. These contraindications are explained below:
Pregnancy And Beyond
Generally, it is not considered harmful for the health of the baby or the mother to get vaccinated with pneumonia vaccine during the gestation period or during the phase of breastfeeding. It has been a general practice to avoid the inoculation of an expecting mother or when she is lactating as a way to avoid an unnecessary reaction which may harm the mother or the child equally.
The physicians generally ask the mothers to wait till their pregnancy is over in order to get vaccinated. In certain cases, even during the pregnancy, a physician may recommend inoculation of a pneumonia vaccine; given the circumstances when the benefit of getting vaccinated outweigh the risks of getting a reaction.
It is a common practice to observe the health of any person who signs up to get vaccinated (including children and adults). In the cases when the patients exhibit the signs and symptoms of a mild illness, the doctors generally allow them to be inoculated with the vaccine.
In some particular cases when the diseases have attained a serious stage where fever overcomes the body, the doctors refrain from inoculating the vaccine. In such conditions, it is advised to let the fever subside before the vaccine is inoculated.
Allergic reactions are a serious concern when it comes to the health of the vaccinee right after they are inoculated. Doctors advise the parents to disclose any reactions which the child may have experienced in the past when they were inoculated with other vaccines so that they may be able to determine whether the pneumonia vaccine is going to cause a reaction or not.
In the cases when the patients were subject to an anaphylactic reaction (severe allergic reaction) right after being inoculated with pneumonia vaccine or any other vaccine, the doctors suggest avoiding getting vaccinated at all since a worse anaphylactic reaction may lead to a fatality if the case is not properly handled.
If after getting inoculated a mild inflammation occurs at the point of injection or a mild rash at any other portion of the skin then it is safe and the patient should be considered out of danger since this is normal with the administration of the pneumococcal vaccine.
Can We Count On Free Vaccines To Tackle Pneumonia In Underdeveloped Countries?
In late 2016, a global coalition known as “Doctors Without Borders” rejected the offer of Pfizer to provide free pneumonia vaccine to tackle pneumonia in the developing countries. In the developing countries, the current situation of pneumococcal diseases is worse. Globally a total of almost one million child deaths occur in these countries because of pneumonia. This ball figure puts pneumococcal diseases as the deadliest diseases of the children.
Vaccines are available in the market to vaccinate children against pneumococcal diseases, manufactured by GlaxoSmithKline and Pfizer but the price of these vaccines is very high which renders it unaffordable to all the inhabitants of the developing countries.
When the representatives of Doctors Without Borders tried to negotiate the prices of these vaccines with the manufacturing companies, one of them offered free vaccines as donations instead. Upon this offer, the Chief Operating Officer of Doctors Without Borders rejected this offer saying that “By giving the pneumonia vaccine away for free, pharmaceutical corporations can use this as justification for why prices remain high for others, including other humanitarian organizations and developing countries that also can’t afford the vaccine.”
Jason Cone, the Executive Director of the coalition says that the offer of free vaccination is not only a short-term solution to the looming problem of high occurrence rate of pneumococcal disease against the sky-rocketing prices of the vaccine but also slows down the efforts carried out by coalitions like Doctors Without Borders in terms of getting the government to initiate an affordable vaccination program for all the inhabitants of a country who are at a high risk. It is the stance of the Doctors Without Borders that pharmaceutical giants such as Pfizer should reduce the cost of their latest pneumonia vaccination to as low as $5 so that it becomes affordable to vaccinate every child on the planet who needs to get vaccinated.
Anti-Vax Columnist Retracts His Recent Views
Dr. Daniel Neides is the Chief Operating Officer as well as the Medical Director at Cleveland Clinic Wellness Institute. On January 6th, he published a column on the official blog of Cleveland Clinic Wellness Institute suggesting that vaccines are causing more harm than good. He claimed that the preservatives and adjuvants which are a part of vaccine composition are causing neurologic disorders in the offspring such as autism. A review of a column which Dr. Neides published a few years earlier has a totally different tale to tell. In the review, he praises the flu shots which he received earlier that allowed him to survive the flu wave which became an epidemic in 2009.
A spokesperson on behalf of the Cleveland Clinic Wellness Institute commented on the situation saying that the column is the thinking and remarks of a guest columnist and the logo of the Clinic appears on all the columns which are published by the guest columnist on the official website. The comment came as a result of the backlash from the scientific and health care community all around the globe who were in the favor evidence-based reporting in the case of allegations which linked autism to thimerosal.
Centers for Disease Control and Prevention (CDC) acknowledges the presence of thimerosal, monosodium glutamate, formaldehyde, egg protein, antibiotics and aluminum salts in the vaccines that are allowed in the U.S. but the presence of all these additives and preservatives is justified with one or more functions which contribute towards the stability and efficacy of the vaccine.
An earlier study carried out by Paul A. Offit and Rita K. Jew was published in the 112th volume of Pediatrics. In the elaborative study, both the authors analyzed the amounts of additives in the vaccines, the functions of additives and the toxic amount of the additives which needs to be present in order to assess the detrimental (negative) effects in the vaccinee. The amount of otherwise toxic metals and their salts, as well as other components, needs to be increased to as much as 1000 folds than the amount present in vaccines, only then it starts to get toxic for the human beings to internalize.
At the end of the day, it should be kept in mind that all the animal and human trials which are conducted on the vaccines so far have rendered them harmless. The pneumonia vaccine side effects observed commonly are of mild nature and do not pose a threat to the health of the person undergoing pneumonia immunization.
The adverse reactions which have been observed in some cases are in the form of anaphylactic reactions which are probably due to the presence of gelatin and egg proteins in the vaccines. Hypersensitivity to any other component of the vaccine has not been documented so far.