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Pneumococcal infectious disease — Clinical Guidelines

Overview

Streptococcus pneumoniae causes a range of infections including pneumonia, meningitis, and invasive disease, particularly affecting elderly individuals and those with underlying health conditions 1 5.

Diagnosis

Clinical Presentation: Symptoms vary by site of infection (respiratory, urinary tract, soft tissue).

Laboratory Tests: Culture of blood, cerebrospinal fluid, or other sterile sites; sensitivity testing for antibiotic resistance 9.

Serotyping: Important for understanding vaccine coverage and resistance patterns 3.

Management

Vaccination:

- Adults ≥65 years: Recommended to receive either 21-valent pneumococcal conjugate vaccine (PCV21) or 20-valent PCV (PCV20) 1. - Adults 19-64 with risk conditions: PCV21 if not previously vaccinated or history unknown 1. - Pediatric and High-Risk Populations: 13-valent PCV (PCV13) and 23-valent pneumococcal polysaccharide vaccine (PPSV23) as per guidelines 4 5.

Antibiotics: Selection based on local resistance patterns; penicillin resistance testing crucial 9.

Special Populations

Elderly: High burden of disease; emphasis on PCV13 and PPV23 for additional serotype coverage 5.

Pediatric Rheumatology Patients: Increased risk due to immunosuppression; interventions to improve vaccination rates recommended 4.

Pregnancy: Not specifically addressed in provided abstracts.

Comorbidities: Immunosuppressed individuals require tailored vaccination strategies 4.

Key Recommendations

Vaccination for Adults ≥65 Years: Administer PCV21 or PCV20 for optimal protection against pneumococcal disease (Evidence: Strong 1).

High-Risk Adults (19-64): Vaccinate with PCV21 if not previously vaccinated or history unknown (Evidence: Strong 1).

Pediatric High-Risk Groups: Implement strategies to enhance pneumococcal vaccination rates, including provider education and reminders (Evidence: Moderate 4).

Monitoring Antibiotic Resistance: Regularly assess local resistance patterns to guide antibiotic selection (Evidence: Moderate 9).

National Funding for Vaccination: Advocate for nationally funded pneumococcal vaccination programs to improve coverage (Evidence: Expert opinion 6).

References

1 Kobayashi M, Leidner AJ, Gierke R, Farrar JL, Morgan RL, Campos-Outcalt D et al.. Use of 21-Valent Pneumococcal Conjugate Vaccine Among U.S. Adults: Recommendations of the Advisory Committee on Immunization Practices - United States, 2024. MMWR. Morbidity and mortality weekly report 2024. link 2 Miao C, Cui Y, Li Y, Qi Q, Shang W, Chen H et al.. Immunoinformatics Prediction and Protective Efficacy of Vaccine Candidate PiuA-PlyD4 Against Streptococcus Pneumoniae. Drug design, development and therapy 2023. link 3 Men W, Dong Q, Shi W, Yao K. Serotype distribution and antimicrobial resistance patterns of invasive pneumococcal disease isolates from children in mainland China-a systematic review. Brazilian journal of microbiology : [publication of the Brazilian Society for Microbiology] 2020. link 4 Harris JG, Maletta KI, Ren B, Olson JC. Improving Pneumococcal Vaccination in Pediatric Rheumatology Patients. Pediatrics 2015. link 5 Vila-Corcoles A, Ochoa-Gondar O. Preventing pneumococcal disease in the elderly: recent advances in vaccines and implications for clinical practice. Drugs & aging 2013. link 6 Andrews RM, Lester RA. Improving pneumococcal vaccination coverage among older people in Victoria. The Medical journal of Australia 2000. link 7 Nichol KL, MacDonald R, Hauge M. Side effects associated with pneumococcal vaccination. American journal of infection control 1997. link90008-0) 8 Hakenbeck R, Ellerbrok H, Briese T, Handwerger S, Tomasz A. Penicillin-binding proteins of penicillin-susceptible and -resistant pneumococci: immunological relatedness of altered proteins and changes in peptides carrying the beta-lactam binding site. Antimicrobial agents and chemotherapy 1986. link 9 Jones RN, Edson DC. The ability of participant laboratories to detect penicillin-resistant Pneumococci. A report from the microbiology portion of the College of American Pathologists (CAP) surveys. American journal of clinical pathology 1982. link 10 Green RF, Selinger DS. Urinary tract infection and soft tissue abscess caused by Streptococcus pneumoniae. Southern medical journal 1980. link

Pneumococcal infectious disease