Influenza and Pneumococcal vaccination in patients with diabetes
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Data for uptake of the recommended influenza and pneumococcal vaccination in patients with diabetes from developing countries are scarce. The aim of the study was to assess the uptake of influenza and pneumococcal vaccination in patients with diabetes. One thousand and five hundred patients with diabetes were approached; 1100 (685 female, age 5-90 years, median 50 years) consented for participation. Information regarding knowledge, beliefs and practices regarding vaccination was recorded by administering a predefined questionnaire. Only 99 (9%) and 97 (8.8%) of the 1100 patients had received influenza and pneumococcal vaccination respectively in the past 1-5 years. Vaccination rates were higher in males (15.9% versus 4.8% for influenza, p = 0.000 and 16.1% versus 4.5% ; p = 0.000 for Pneumococcus); and in those aged > 65 years (13.1% versus 7.96% , p = 0.017 for influenza; and 13.6% versus 7.6% , p = 0.012 for Pneumococcus). Reasons cited for non-participation included misperceptions about personal risk, vaccine efficacy and safety. Only 4 of the 28 physicians caring for the patients prescribed the vaccines regularly and the vaccination rates in their patients were significantly higher (p = 0.000). Poor vaccination rates in Northern Indian patients with diabetes call for intensive efforts to improve uptake.Keywords:
Pneumococcal vaccine
Pneumococcal infections
A survey of the coverage, distribution and the factors associated with use of influenza and pneumococcal vaccines among general practitioners (GPs) in primary care and in hospital settings was carried out in 53 general practices in Scotland taking part in the 'Continuous Morbidity Recording' (CMR) programme. The annual vaccine distribution increased substantially among 53 general practices from 1993 to 1999 and in Scotland as a whole from 1984 to 1999. From the questionnaire, overall coverage was 43% (95% CI 38-48) for influenza vaccine in the 2000-1 season and 13% (95% CI 9-16) for pneumococcal vaccine in the last 5 year period, in high-risk patients recommended for these vaccines by the Department of Health (DoH). Influenza vaccine coverage was highest in the elderly (65 years of age and above) at 62% (95% CI 59-74). Although pneumococcal vaccination is not currently recommended for all elderly, coverage of this vaccine was also higher in this group (22%, 95% CI 16-29). In the majority of patients (influenza vaccine, 98% and pneumococcal vaccine, 94%), vaccination was carried out in general practice. Only 2% of patients had received pneumococcal vaccination in a hospital setting. The level of influenza and pneumococcal vaccination varied with the level of deprivation. Most GPs considered that the responsibility for influenza and pneumococcal vaccination lay with them. Forty-five percent of GPs reported having a written policy with set target for influenza vaccination and 11% for pneumococcal vaccination.
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Streptococcus pneumoniae remains a leading cause of morbidity and mortality, especially among younger children and the elders. Streptococcus pneumococcus vaccines on the market have major disadvantages because of the limitation of serotypes. Therefore, it is an urgent need to develop an economic and broadly protective vaccines based on the bacterial proteins. The virulence factors and antigens expressed on the surface as potential candidates make a big progress. This review summarizes the components of protein-based pneumococcal vaccines in clinical trials, and the characteristics of the proteins, the protection in the infected animals and clinical trials. It will help readers to understand current status of protein-based pneumococcal vaccines.
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Streptococcus pneumoniae; Vaccine; Protein
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Streptococcus pneumoniae cell wall and cytoplasmic proteins contribute directly to pathogenesis of pneumococcal infection. Protective effect of pneumococcal proteins such as pneumolysin (Ply), muramylamidase (LytA) and pneumococcal surface protein A (PspA). There is discussion in the literature about development of conjugared pneumococcal vaccines, which should include polysaccharides of invasive serotypes of pneumococci as well as protein antigens of this pathogen, for prevention of infections caused by S. pneumoniae. Researches suggest that such hybrid vaccines will be effective, first of all, for children 65 years old because immune response to polysaccharide vaccines either do not form at all or insufficient for prevention of pneumococcal infection.
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Current vaccination against Streptococcus pneumoniae uses vaccines based on capsular polysaccharides from selected serotypes and has led to nonvaccine serotype replacement disease. We have investigated an alternative serotype-independent approach, using multiple-antigen vaccines (MAV) prepared from S. pneumoniae TIGR4 lysates enriched for surface proteins by a chromatography step after culture under conditions that induce expression of heat shock proteins (Hsp; thought to be immune adjuvants).
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ABSTRACT The role of pneumococcal surface protein C (PspC; also called SpsA, CbpA, and Hic) in sepsis by Streptococcus pneumoniae was investigated in a murine infection model. The pspC gene was deleted in strains D39 (type 2) and A66 (type 3), and the mutants were tested by being injected intravenously into mice. The animals infected with the mutant strains showed a significant increase in survival, with the 50% lethal dose up to 250-fold higher than that for the wild type. Our findings indicate that PspC affords a decisive contribution to sepsis development.
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Knowledge about the type distribution of Streptococcus pneumoniae is fundamental to ensure an effective formulation of pneumococcal vaccine, especially with the possibility of producing a polysaccharide-protein-conjugated vaccine for the prevention of invasive disease in children. During the 6-year period 1982–1987, we received and typed 10,298 isolates from patients with invasive pneumococcal disease: 7,812 (76%) from blood and 2,486 (24%) from CSF. Of all isolates, 81% were recovered from individuals in Europe and 23% were from children. In order of frequency, S. pneumoniae types 6A + 6B, 14, 18C, 19F, 1, 7F, 23F, 19A, 4, and 5 were most commonly isolated from children, and types 3, 1, 14, 7F, 4, 6A + 6B, 8, 23F, 9V, and 19F, from adults. The pneumococcal types in the currently available 23-valent vaccine represented 87% of all isolates in this study, but the proportion of vaccine types varied somewhat with age and source. In all pneumococcal groups included in the vaccine, the vaccine types represented >80% of the isolates, except in groups 6, 15, and 18.
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To investigate the frequency with which influenza and pneumococcal vaccines are administered alone and together.Retrospective review.Marshall University internal medicine practice, Huntington, West Virginia.All patients aged 65 and older seen in the practice from 1999 through 2005 who received pneumococcal or influenza vaccine.Billing records were reviewed for administration of pneumococcal and influenza vaccines to Medicare beneficiaries, and rates of administration of these vaccines given alone and together were calculated.Nine hundred sixty-nine doses of pneumococcal vaccine were administered. Of these, 796 (82%) were administered during the fall and winter. Three hundred fifty-six (45%) pneumococcal vaccinees received it together with influenza vaccine. During 2001 and 2005, when influenza vaccine supply was limited, the rate of pneumococcal vaccine administered together with influenza vaccine declined sharply. Nonetheless, the rate of pneumococcal vaccination remained relatively stable because of an increase in the rate of vaccine administered alone.Four-fifths of pneumococcal vaccine was administered in the fall and winter, and approximately half was given together with influenza vaccine. When influenza vaccine was in limited supply, physicians continued to vaccinate with pneumococcal vaccine alone. These findings suggest that the imminent influenza season provides the trigger for physicians to prescribe pneumococcal vaccine. Physicians should be reminded that pneumococcal vaccine can be administered any time of year.
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Isolates of Streptococcus pneumoniae in cultures of blood from 258 adults seen in 10 Franklin County, Ohio, hospitals from 1991 and 1992 were serotyped. Most strains (230 [89.2%]) belonged to serotypes that are included in the current pneumococcal vaccine. An additional 16 isolates (6.2%) were immunologically related to strains with serotypes that are included in the vaccine. Only 12 isolates (4.6%) were not covered by the vaccine. The rate of mortality from pneumococcal bacteremia in adults remains high (20%). While recent studies have documented the efficacy of the pneumococcal vaccine for preventing pneumococcal bacteremia (56 to 70%), use of the pneumococcal vaccine in susceptible patients by physicians remains low (19% in Franklin County). Additional efforts need to be expended to increase the use of the pneumococcal vaccine.
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Streptococcus pneumoniae is a major cause of severe disease worldwide, particularly in the risk population. Two pneumococcal vaccines are currently available for specific prevention of pneumococcal infections among adults in Russia: a 23-valent pneumococcal polysaccharide vaccine (PPSV23) and a 13-valent pneumococcal conjugate vaccine (PCV13). The article describes modern views on the effectiveness and safety of two pneumococcal vaccines in adults with underlying medical conditions and adults aged ≥65 years and provides current recommendations for routine use of PPSV23 and PCV13 among persons included in the risk group.
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