Pneumococcal Infections

Sherman J. Alter

doi:10.1542/pir.30-5-155

This article has a correction. Please see:

Clarification - September 01, 2009

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Sherman J. Alter, MD*

^*Associate Professor of Pediatrics, Boonshoft School of Medicine, Wright State University, Division of Infectious Disease, The Children's Medical Center of Dayton, Dayton, Ohio

Objectives

After completing this article, readers should be able to:

Identify risk factors for acquisition of pneumococcal infections in the pediatric population.
Discuss the common clinical presentations of infections caused by Streptococcus pneumoniae.
Describe antibiotic resistance patterns of S pneumoniae.
Outline effective antibiotic regimens used to treat specific pneumococcal infections.
Recognize the major differences between the pneumococcal conjugate vaccine and the capsular polysaccharide vaccine and the indications for their administration.
Know the impact of pneumococcal conjugate vaccine on infections caused by S pneumoniae in the United States.

Introduction

S pneumoniae is a major cause of human disease, ranging from upper respiratory tract infections to severe invasive diseases such as bacteremia, pneumonia, and meningitis. In 2005, the pneumococcus was estimated to be responsible for approximately 1 million deaths worldwide in children younger than 5 years of age. Most of these deaths occurred in developing countries. Following widespread use of the Haemophilus influenzae type b (Hib) conjugate vaccine in infants, S pneumoniae emerged as the leading cause of bacterial meningitis in children younger than 2 years of age. In 2000, a 7-valent pneumococcal conjugate vaccine (PCV7) for routine use in infants and children was licensed in the United States. PCV7 targeted the serotypes responsible for more than 80% of invasive pneumococcal disease (IPD) as well as the serotypes most likely to be resistant to antimicrobial agents.

Despite reductions in invasive disease among the target population and others, infections with S pneumoniae continue to pose challenges for clinicians. Antimicrobial resistance among pneumococcal isolates presents difficulties in treatment. Furthermore, both upper respiratory tract and invasive infections caused by pneumococcal serotypes not represented in the current conjugate vaccine have been observed with increasing frequency.

Epidemiology

The epidemiology of infections caused by S pneumoniae has been affected significantly through the introduction of PCV7 into the routine childhood immunization …