Do pneumococcal conjugate vaccines provide any cross-protection against serotype 19A.docVIP

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Do pneumococcal conjugate vaccines provide any cross-protection against serotype 19A.doc

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Do pneumococcal conjugate vaccines provide any cross-protection against serotype 19A

Hausdorffetal.BMCPediatrics2010,10:4 /1471-2431/10/4 DEBATE OpenAccess Dopneumococcalconjugatevaccinesprovide anycross-protectionagainstserotype19A? WilliamPHausdorff*,BernardHoet,LodeSchuerman Abstract Background:Introductionofthe7-valentpneumococcalconjugatevaccine(7vCRM)inseveralcountrieshasledto arapid,significantdropinvaccine-typeinvasivepneumococcaldisease(IPD)inimmunizedchildren.IntheUnited Statesandsomeothercountrieswithhighantibioticuse,asubsequentriseinserotype19AIPDhasbeentakento indicatethatthe19Fconjugateinthevaccineprovidesnocross-protectionagainsttheimmunologicallyrelated 19A. Discussion:Wesystematicallyassessedtheclinicalefficacyandeffectivenessof19F-containingvaccinesagainst 19AdiseaseornasopharyngealcarriagebysearchingEnglish-languagearticlesintheelectronicdatabasesPubMed, Currentcontents,Scopus,andEmbasefrom1985to2008.Thevaccineefficacyandeffectivenesspointestimates wereconsistentlypositiveformodestprotectionagainst19AIPDandacuteotitismedia(AOM).However,statistical significancewasnotreachedinanyindividualstudy.Noconsistentimpactof7vCRMon19Anasopharyngeal colonizationcouldbedetected.Thesefindingsarediscussedincontextofimmunogenicityanalysesindicatingthat 7vCRMinducesfunctionallyactiveanti-19Aantibodiesaftertheboosterdose,andthatother19F-containing vaccineformulationsmayelicithigherlevelsofsuchantibodiesafterbothprimaryandboosterdoses. Summary:Takentogether,theseresultssuggestthat19F-conjugatescanprovidesomeprotectionagainst19A disease.Themagnitudeofthisprotectioninagivensettingwilllikelydependonseveralfactors.Theseincludethe anti-19Aimmunogenicityofthespecificvaccineformulation,thenumberofdosesofthatformulationneededto elicittheresponse,andtheburdenof19Adiseasethatoccursafterthosedoses.Itispossiblethatamodest protectiveeffectmaybeobscuredbythepresenceofcountervailingselectionpressures(suchashighantibiotic use)thatfavoranincreaseincolonizationwithantibiotic-non-susceptiblestrainsof19A. Background conjugated to a non-toxic variant of diphtheria tox