Pneumococcal disease

Many medications that are essential for the health of children were first developed to treat adults and only later tested on children. Adults tend to have more illnesses than children, which may provide more testing opportunities. Many researchers feel that it is ethically preferable to try new medicines for children only when they already have a record of safety in adults. For vaccinations, the process is often reversed because adults are not prone to acquiring certain infections (e.g., Haemophilus influenzae type b [Hib]) or because vaccinating children is likely to have benefits both in childhood and later in adulthood (e.g., the varicella vaccine protects children from varicella disease, which in turn protects them from varicella zoster, or shingles, as adults). The history of pneumococcal vaccine is different and points out some of the different challenges of preventing disease in adults versus children. A well-tolerated and safe polysaccharide vaccine [PPSV] for adults has been around for three decades. This vaccine was not useful in very young children because they have inadequate production of antibodies to polysaccharide antigens and hence are unprotected when given PPSV. (See this video of vaccine developer John Robbins, MD, discussing why this is so.) However once the success of protein-conjugated polysaccharide vaccines was appreciated, a number of them were developed for young children. There are three successful conjugate vaccines for children: Hib, meningococcal, and pneumococcal. Hib vaccine is not needed for adults because of the negligible risk of this infection in adults. Conjugate meningococcal vaccine is standard for children and can also be used for adults who are at unusually high risk of meningococcal disease because of medical condition or travel to a part of world where meningococcal disease occurs in epidemics. Now, as of December 2011, a 13-valent pneumococcal conjugate vaccine [PCV-13] has been approved for use in adults. More

It’s National Influenza Vaccination Week, and we’re taking a look back to 1918, the time of the “Spanish” influenza pandemic. When the illness emerged, several useful vaccines had already been developed: smallpox, typhoid fever, and rabies, for example. Scientists and physicians tried many different approaches to develop influenza vaccines during the pandemic even though the cause of influenza was not clear. We look at several of them below.

No other epidemic has claimed as many lives as the Spanish influenza epidemic in 1918-1919. Worldwide, at least 40 million people died as this virulent illness swept through city after city (some estimates put total deaths closer to 70 million). Newspaper reports described people dying within hours of first feeling ill. The mortality rate was highest among adults under age 50, who were, for unknown reasons, particularly vulnerable to serious disease resulting from this strain of influenza.

The first reported cases of an unusual influenza appeared in U.S. Army camps in Kansas in early spring 1918. Later that spring, officials reported large numbers of cases from Europe, though this flu did not seem particularly dangerous. However, influenza became more deadly in late summer. Soon waves of infection moved through towns, nations, and continents, overwhelming hospitals and medical personnel. Because of wartime censorship, reports of influenza were not widely distributed, but news from Spain continued to flow. The name Spanish influenza came from the devastating effects of the flu in Spain in autumn 1918. More

New this week on The History of Vaccines are interviews with two vaccine pioneers, Baruch Blumberg, MD, PhD, and Robert Austrian, MD.

The History of Vaccines interviewed Dr. Blumberg here at The College of Physicians of Philadelphia in November 2010. Dr. Blumberg discussed the fieldwork that led to his discovery of the Australia antigen, the challenges of investigating the nature of the Australia antigen, the discovery of its relationship to the hepatitis B virus, and his work on the serum-based hepatitis B vaccine. He also discussed being awarded the Nobel Prize in 1976 (only after prompting from us!), his subsequent travels in China at a time when very few Westerners had been there, and results of studies of reduction of HBV prevalence associated with the vaccine.

Infectious disease physican and Chief Medical Officer of the Penn Health System P.J. Brennan, MD, interviewed Dr. Austrian (1916-2007) in 2000. Dr. Austrian discussed his initial investigations into the prevalence of pneumococcal pneumonia, the assumptions he worked against that antimicrobials had "solved" the problem of pneumococcal pneumonia, and his pneumococcal vaccine trial among gold miners in South Africa. More

Globally, pneumonia remains the most deadly disease for children younger than five. Yet with a combination of vaccination efforts and treatment with antibiotics, the Global Alliance for Vaccines and Immunisation (GAVI) calls pneumonia "one of the most solvable problems in global health."

As a reminder of the disease's impact and the importance of global efforts to stop preventable deaths from pneumonia, GAVI and a host of other organizations have announced that Friday, November 12, will be the second annual World Pneumonia Day. As part of this effort to raise awareness, the organizing groups have offered several ways for people to get involved, including wearing blue jeans on Friday to raise awareness about pneumonia's impact worldwide (as the organizers put it, "We tried to come up with a painless (and free!) way to communicate that we must pay attention to these preventable deaths. What we came up with is a world-wide blue jean day. The reason is simple: Children who are dying of pneumonia turn blue because they can't breathe") and sending "Pneumonia Grams" to public officials, asking them to consider pneumonia as a priority issue. (See http://worldpneumoniaday.org/act/pneumonia-gram/). More