pneumococcus and flu vaccine

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Influenza and Pneumococcus vaccines – An update : 

Influenza and Pneumococcus vaccines – An update ?????

Slide 2: 

Influenza virus

Flu vaccine composition 2008-9 : 

Flu vaccine composition 2008-9 Recommended by WHO which maps flu viruses as they continuously move around the world. These are the strains most likely to cause flu in northern hemisphere in coming winter.

Slide 13: 

Some vaccines incorporate inactivated virus particles; others use the purified hemagglutinin. Both types incorporate antigens from the three major strains in circulation, currently: an A strain of the H1N1 subtype an A strain of the H3N2 subtype and a B strain.

????????? : 

????????? 2007-2008 A/Solomon Islands/3/2006 H1N1? A/Wisconsin/67/2005 H3N2 B/malaysia/2506/2004 ? 2008-2009 A/Brisbane ???? /59/2007 H1N1 ? A/Brisbane???? /10/2007 H3N2 ? B/Florida ????/4/2006

Clinical Risk Groups : 

Clinical Risk Groups All aged over 6 months in the following risk groups : Chronic Respiratory Disease including asthma COPD Chronic Bronchitis & emphysema Bronchiectasis Cystic Fibrosis Interstitial lung fibrosis Bronchopulmonary dysplasia Pneumonconiosis Asthma requiring continuous or repeated use of inhaled or systemic steroids with previous exacerbations requiring hospital admission Children who have been admitted to hospital for LRTI

Clinical Risk Groups : 

Clinical Risk Groups Individuals requiring regular medication &/or follow up for: Ischaemic Heart Disease Congenital Heart Disease Hypertension with cardiac complications Chronic Heart Failure Chronic neurological disease Stroke TIA Multiple sclerosis and related conditions Hereditary and degenerative disease of the central nervous system

Clinical Risk Group : 

Clinical Risk Group Type 1 Diabetes Type 2 Diabetes requiring insulin or hypoglycaemic drugs Diet controlled diabetes

Clinical Risk group : 

Clinical Risk group Immunosuppression due to disease or treatment chemotherapy leading to immunosuppression asplenia or splenic dysfunction HIV at all stages those on systemic steroids equivalent to 20mg prednisolone daily for more than one month children under 20kg a dose of more than 1mg or more per kg per day * Some immunocompromised patients may have a suboptimal response to vaccine

Clinical Risk group : 

Clinical Risk group Chronic Renal Disease Nephrotic syndrome Chronic Renal Failure Renal Transplants Chronic liver disease Cirrhosis Biliary Atresia Chronic Hepatitis

Clinical Risk Group : 

Clinical Risk Group All NHS staff directly involved in patient care Nursing and care home staff ( social care staff ) that look after elderly people Other examples are: Clinicians, midwives & nurses, paramedics, ambulance drivers GPs, PNs, DNs, HVs OTs, physios and radiographers Giving the influenza vaccination to staff who are directly involved in patient care is an adjunct to good infection control procedures** Students and trainees, and volunteers who are working with patients should also be included.

FluMist®Influenza Virus Vaccine Live, Intranasal : 

FluMist®Influenza Virus Vaccine Live, Intranasal MedImmune Gaithersburg, Maryland Edward Connor, M.D. Executive VP, Clinical Development Chief Medical Officer

Slide 22: 

Live, cold-adapted, temperature-sensitive, attenuated influenza virus vaccine Trivalent (A/H1N1, A/H3N2, B) 107 FFU of each strain per dose Dose: 0.2 mL intranasal spray (0.1 mL per nostril) Storage: 2-8ºC (refrigerator) Contains no preservatives (e.g., no thimerosal) FluMist® Product Characteristics

INDICATIONS AND USAGE : 

INDICATIONS AND USAGE FluMist is a vaccine indicated for the active immunization of individuals 2-49 years of age against influenza disease caused by influenza virus subtypes A and type B contained in the vaccine

CONTRAINDICATIONS : 

CONTRAINDICATIONS • Hypersensitivity to eggs, egg proteins, gentamicin, gelatin or arginine or life threatening reactions to previous influenza vaccination. Concomitant aspirin therapy in children and adolescents.

WARNINGS AND PRECAUTIONS : 

WARNINGS AND PRECAUTIONS Do not administer FluMist to children <24 months of age because of increased risk of hospitalization and wheezing observed in clinical trials. FluMist should not be administered to any individuals with asthma or children < 5 years of age with recurrent wheezing because of the potential for increased risk of wheezing post vaccination.

WARNINGS AND PRECAUTIONS : 

WARNINGS AND PRECAUTIONS If Guillain-Barré syndrome has occurred with any prior influenza vaccination, the decision to give FluMist should be based on careful consideration of the potential benefits and risks. Administration of FluMist, a live virus vaccine, to immunocompromised persons should be based on careful consideration of potential benefits and risks. Safety has not been established in individuals with underlying medical conditions predisposing them to wild-type influenza infection complications.

ADVERSE REACTIONS : 

ADVERSE REACTIONS Most common adverse reactions (= 10% in FluMist and at least 5% greater than in control) are runny nose or nasal congestion in all ages, fever >100°F in children 2-6 years of age, and sore throat in adults.

Slide 28: 

??????????,?????????? ????,????????????,??H?N?? ?????????,???????M2(??????????? ??) ???A???????M2??,?????????? ?????????M2??(??) ,????????????? ???,????????????????????? ????????,????????????????? ???? ????????

Universal Influenza Vaccine Tested Successfully In Humans : 

Universal Influenza Vaccine Tested Successfully In Humans British-American biotech company Acambis reports the successful conclusion of Phase I trials of the universal flu vaccine in humans. This vaccine is intended to provide protection against all ‘A’ strains of the virus that causes human influenza, including pandemic strains. Therefore, this vaccine will not need to be renewed annually. ScienceDaily (Jan. 25, 2008)

Slide 31: 

Sublingual vaccination with influenza virus protects mice against lethal viral infection PNAS FEBRUARY 5, 2008 VOL. 105 NO. 5 1644-1649 ???????,?formalin-inactivated??????? [A/PR/8 virus (H1N1)]????,??????,???? ??,?????????????,?????????, ???????????????

Pneumococcus vaccines : 

Pneumococcus vaccines

Leading infectious killers : 

Leading infectious killers Deaths (millions) > 5 years old 0 0.5 1.0 1.5 2.0 2.5 3.0 3.5 Source: WHO S. pneumoniae: ~1.6 million deaths, including ~800,000 child deaths

???????(CAP)?????,???????25~30% : 

???????(CAP)?????,???????25~30% ??????????,???????(community-acquired pneumonia; CAP)?????,???????25~30%?? (???30%): ????:??????????CAP?,???????????20~22%? ??:???????????????????????????,?????????????20%????5????????CAP???20%????????,??5?????????CAP?????20% ?

??(Pneumonia) ????????? “ ??? ”???100????1????? : 

??(Pneumonia) ????????? “ ??? ”???100????1????? ??????????? (??????) ????: http://www.doh.gov.tw/statistic/data/??????2/96/?????/index.htm 65?????????? (??????5,895?;??????????)

Streptococcus pneumoniae: Microbiology?????: overview : 

Streptococcus pneumoniae: Microbiology?????: overview ????? Micrococcus Pasteuri (1881) ?????, ???? Pneumococcus ??????;????? ????????, ?????,??????? 1974?????????: ????? (Streptococcus pneumoniae)

Streptococcus pneumoniae: Microbiology?????: overview (cont’d) : 

Streptococcus pneumoniae: Microbiology?????: overview (cont’d) ???????90????,???????????;???????????????????? ????????? (Polysaccharide capsule) Cell wall Cytoplasmic membrane Musher, in Principles and Practice of Infectious Diseases, 1995 2.2

???????: overview : 

???????: overview 20??40???????5??10???????,?????????????????? ????????????????,????????????????,????????????????,????????????? Musher, D.M.: Streptococcus pneumoniae, in Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases (5th ed.), eds. G.L. Mandell, J.E. Bennett, and R. Dolin, Philadelphia, Churchill Livingstone, 2000, pp. 2128-2147. 2.4 Dissemination

????????? : 

????????? ?. ??????????????,????????????????????,?????? ?,??????????????,???? ??????????????????? ?. ????-???????????????,? ??????????,?????????? ??????????????? ?. ?????????? -???????????????? -???????? -??????????????

Nasopharyngeal carriage of Pneumococcus : 

Nasopharyngeal carriage of Pneumococcus 1 Presentation by Mark A. Fletcher, M.D., on Epidemiology of Streptococcus pneumoniae: “Pneumococcus”

?????????????? : 

?????????????? 1. Available at: http://www.cdc.gov/nip/publications/pink/pneumo.pdf. Accessed Sept 9, 2002. 2. MMWR. 1997;46:1-24.

Young Children – High Risk : 

Young Children – High Risk Risk factors for IPD are: Children < 2 years of age Underlying disease Children who attend daycare in previous 3 months Risk factors for penicillin-resistant IPD Children exposed to > 1 course of antibiotics Children with history of > 1 recent ear infection in previous 3 months OS Levine, M Farley, et. al. Risk factors for Invasive Pneumococcal Diseases in Children: A Population-Based Case-Control Study in North America. Pediatrics 103; 3: 1999

???????????????????????????????:??????? : 

???????????????????????????????:??????? Breach of blood-brain barrier Bacteraemia Sinusitis CSF leakage Meningitis Otitis media Nasopharynx colonisation Pneumoniae Breach of phagocytic defences Breach of mucociliary defences Salyers, Whitt, in Bacterial Pathogenesis, 1994 Peritonitis Arthritis arc

???????????????????????????????:??????? : 

???????????????????????????????:??????? Musher, in Principles and Practice of Infectious Diseases, 1995 Non-invasive disease Sinusitis (sinuses) Otitis media (middle ear) ??Pneumonia (lungs) ? ? ? ? ? ? ? ? ? ????????? Invasive disease / IPD ???Bacteraemia (blood) ???Meningitis (CNS) ????Endocarditis (heart) ???Peritonitis (body cavity) ??????Septic arthritis (bones and joints) Others (appendicitis, salpingitis,soft-tissue infections) ??

??:????????????(disease burden)??? : 

??:????????????(disease burden)??? ????4?????S. pneumoniae????? 1 ?? 60???????????????,??????20%, ???????????? ??? ??????????30-40? ???????????? ??? ????????????????????80%,???????30% ???????????? Centers for Disease Control and Prevention: in Epidemiology and Prevention of Vaccine-Preventable Diseases (6th ed.), eds. W. Atkinson, et al, Department of Health & Human Services, Public Health Service, January 2000, pp. 249–263. 2. Centers for Disease Control and Prevention: MMWR 46(RR-8):1–24, April 4, 1997.

??:????????????(disease burden)??? : 

??:????????????(disease burden)??? 65??????????????????,??????42.%1 65?????????????????,??????????NT106,291 2 Epidemiology of Invasive Pneumococcal Infection in Taiwan: Antibiotic Resistance, Serogroup Distribution,and Ribotypes Analyses, MICROBIAL DRUG RESISTANCE, Volume 8, Number 3 2002 AJIC Chen et al, Nov 2006 597 Vol. 34 No.9

The burden of pneumococcal disease : 

The burden of pneumococcal disease 2?????????????,80%?????????? WHO report: Total: 1.6 million death/yr(2005) <5 Y: 0.7-1 million death/esp in developing countries Aging population: immunodeficient “PCV should be a priority for inclusion in national childhood immunization programs” Immunization should be initiated <6 mo, and may start as early as 6wk, to maximize the benefits of PCV. Weekly epidemiological record 2007 Mar, WHO

Pneumococcal vaccine vs Flu vaccine:??????????(CAP)???????????(21.8%),????(Influenza A virus) ???6.7% : 

Pneumococcal vaccine vs Flu vaccine:??????????(CAP)???????????(21.8%),????(Influenza A virus) ???6.7% ????????????? (NHRI TAIWAN?????????, 2003) Ref: ???????(NHRI TAIWAN), 2003Materials: ?????????????

PROTEKT 2001, penicillin-resistant S. pneumoniae : 

PROTEKT 2001, penicillin-resistant S. pneumoniae Mexico 30.0% 16.25% USA12.6% 33.3% Hong Kong10.3% 60.3% Japan23.9% 30.9% Eastern Europe15.5% 15.5% South Korea 15.5% 60.9% Canada 9.5% 8.6% Australia 8.5% 6.8% Brazil 23.7% 6.0% Argentina 17.2% 10.3% Western Europe9.0% 14.0% Africa-Middle East: Pen-intermediate: 1.6? 40% Pen-resistant: 0.0 ? 50% www.protekt.org

Middle East and Africa: penicillin-resistant S. pneumoniae : 

Middle East and Africa: penicillin-resistant S. pneumoniae Egypt 29.1% 0.0% South Africa 20.9% 51.0% Kenya 41.2% 1.8% Nigeria 36.0% Ghana 17.0% 0.0% Lebanon 38.0% 18.0% Kuwait 1.6% 45.6% Tunisia 24.0% 11.0% Algeria 11.4% 5.7% Turkey 26.8% 18.3% Data from various sources and various years Israel 16.9% 29.7% Saudi Arabia 39.8% 21.7%

Multi-drug resistant S. pneumoniae : 

Multi-drug resistant S. pneumoniae eryR + tetR + TMP-SMXR Brazil Russia South Africa Israel Taiwan Saudi Arabia Hong Kong South Korea 55.5% 32.6% 56.1% 58.1% 2.9% 5.9% 10.6% 8.8% Felmingham D. Chemotherapy 2004;50 (Suppl 1):3–10. Japan 7.2% 13.3% Mexico 13.9% USA 10.6%

Invasive Pneumococcal Disease Incidence by Age Group England and Wales 2000 (pre-PCV7) : 

Invasive Pneumococcal Disease Incidence by Age Group England and Wales 2000 (pre-PCV7) Health Protection Agency Communicable Disease Surveillance Centre. CDR Weekly 2003; 12(21) Germany: 8.9 per 100,000 children; Switzerland: 7.6 per 100,000 children England and Wales: 14.5 per 100,000 children

???????????? : 

???????????? 1881: Pasteur and Sternberg -???? Pneumococcus 1891: Klemperers – ???????? 1911: Wright – ?????????? 1930: Francis – ??????????? 1935: ???????????? 1938-46: ???????(????) 1977: 14????????????? 1983: 23??????????? 2000: ??????????(7?)

Vaccine : 

Vaccine Pneumococcal Polysaccharide vaccine (Pneumovax) Directed against 23 capsular serotypes Overall protective efficacy of 60-70%

Pneumovax 23 ?????????: ??????????80~85%?? : 

Pneumovax 23 ?????????: ??????????80~85%?? Pneumovax 23 ???23?????? : ???????, 5?????????????????? 3, 4, 6, 9, 14,15,19, 23?????????????? 6B, 14 , 19F & 23F

???????????????? : 

???????????????? ??????????????????????? ?????,?????????????? 3, 6, 14, 19, 23?, 5????????????????,? 3, 4, 6, 9, 14,15,19, 23? 1.???????News Letter. 2. Siu LK et al. Microb Drug Resist. 2002;8:201-8

Problems with polysaccharide vaccine in children : 

Problems with polysaccharide vaccine in children Not effective in children less than 2 years No effect on nasal carriage No herd effect Absence of immunologic memory Antibody level to several serotypes decline to pre-vaccination values within 3-7 years corresponding to a decline of clinical protection

Dosage & Use ??????? : 

Dosage & Use ??????? PNEUMOVAX 23?????????? 0.5 ml/vial,???????????25mcg (??0.25% Phenol?????);????????????? ???? (intramuscular/ IM) ??????????????? ?????????(intradermal) ???????????????? 2-8?C ????,???????5–10?

Side Effect ?????? : 

Side Effect ?????? ?????????: ?????????????? ?????????????????????? ?? ( ? 38.8 ºC / 102 ºF ) Reminding: ???????????????????

???? : 

???? ??????????????????(active infection)?,??????? (???????????????????????????) ???????? (??????C;??????????????????,??????????) ??????????? (?????????????????) ????????????? ????????????,??????T?????????(T-cell-independent)?????????????????????,????????????????????????????????

Conjugate Vaccine : 

Conjugate Vaccine induce a T-cell dependent immune response. These vaccines are protective even in children under two years of age, and may reduce pneumococcal transmission through a herd effect

Prevenar (PCV7) : 

Prevenar (PCV7) Serotypes contained in the vaccine (4, 6B, 9V, 14, 18C, 19F, 23F) The serotypes included responsible for 85% of pneumococcal diseases and 70% of IPD in the States These saccharides are coupled to a nontoxic mutant of diphtheria toxin and the protein CRM197.

Antimicrobial resistance of S. pneumoniae in Taiwan : 

Antimicrobial resistance of S. pneumoniae in Taiwan ??????5????:23F,19F, 6B, 14, 6A Tsai-Ling Lauderdale, et al Diagnostic Microbiology and Infectious Disease 2006;56;421-426

???????????????? : 

???????????????? * 0~5 Years of Age ** ? 3% Siu L K et al. Microb Drug Resist. 2002; 8:201-8

Efficacious in Preventing IPD : 

Efficacious in Preventing IPD 97.4% efficacy fully immunized children 93.9% efficacy in intention to treat analysis 89.1% effective in reducing overall IPD regardless of serotype No increased in non-vaccine serotype IPD Black S, Shinefield H, Fireman B, et al.  Efficacy, safety and immunogenicity of heptavalent pneumococcal conjugate vaccine in children.  Pediatric Infectious Disease Journal 2000; 19:187-195

Evidence of Herd Immunity reducing disease among children : 

Evidence of Herd Immunity reducing disease among children Drop in vaccine type disease in children outside vaccinated age group ? 50% reduction in infants < 2 months and children 5-17 yrs Poehling K. Invasive Pneumococcal Disease Among Infants Before and After Introduction of Pneumococcal Conjugate Vaccine JAMA 2006; 295:1668-1674 Not the specific target

Kaiser Permanente Vaccine Study – Postlicensure surveillance study : 

Kaiser Permanente Vaccine Study – Postlicensure surveillance study Compare year 1998-1999 to 2001-2002 Penicillin: 28.9% to 19.5% Erythromycin: 29.5% to 15.0% Tetracycline: 39.3% to 13.9% p value all<0.001 Black S, Shinefield H, Baxter R, et al. Postlicensure surveillance for pneumococcal invasive disease after use of heptavalent pneumococcal conjugate vaccine in Northern California Kaiser Permanente. Pediatr Infect Dis J. 2004;23:485-489

Penicillin resistance : 

Penicillin resistance PCV7 licensed

Impact of Conjugate Vaccine on Pneumococcal Epidemiologysummary : 

Impact of Conjugate Vaccine on Pneumococcal Epidemiologysummary Large decline in invasive disease rates in young children Reduction in Nasal Carriage Herd benefit in unvaccinated children and adults Indirect benefit in older children and adults Fewer antibiotic resistant infections

Pneumococcal vaccine vs Flu vaccine:?????????????????????? : 

Pneumococcal vaccine vs Flu vaccine:?????????????????????? ???????????(ACIP)??,????????????????????????,??????????????????? Hospitalization Deaths (% reduction) (% reduction) Influenza vaccine alone 52% 70% Pneumococcal vaccine alone 27% 34% Influenza + pneumococcal vaccine 63% 81% Nichol KL. The additive benefits of influenza and pneumococcal vaccinations during influenza seasons among elderly persons with chronic lung disease. Vaccine. 1999. 17:S91-S93.

Slide 74: 

Vaccine effectiveness according to serotype Effective against all 7 vaccine serotypes individually, the poorest response is to 19F Effective against vaccine-related 6A; Not effective against vaccine-related serotype 19A PCV-7 4, 6B, 9V, 14, 18C, 19F, 23F

Pneumococcal Conjugate Vaccine Effectiveness Study : 

Pneumococcal Conjugate Vaccine Effectiveness Study USA Centers for Disease Control and Prevention Active Bacterial Core surveillance Matched Case-control study Whitney CG. Effectiveness of seven-valent pneumococcal conjugate vaccine against invasive pneumococcal disease: a matched case-control study. The Lancet 2006; 368:1495-151502

Slide 76: 

The 7-valent conjugate vaccine was introduced into the childhood immunization schedule on the 4th September 2006, which corresponds with week 36 above http://www.hpa.org.uk/infections/topics_az/pneumococcal/default.htm Cumulative Weekly Number of Reports of Invasive Pneumococcal Disease Due To One of the Seven Serotypes Present in Prevenar™ for Children Aged 0-2 Years in England and Wales by Epidemiological Year: July-June (2003 to Date)

Slide 77: 

Cumulative Weekly Number of Reports of Invasive Pneumococcal Disease Due To One of the Serotypes Not Present in Prevenar™ for Children Aged 0-2 Years in England and Wales by Epidemiological Year: July - June (2003 to Date) The 7-valent conjugate vaccine was introduced into the childhood immunization schedule on the 4th September 2006, which corresponds with week 36 above http://www.hpa.org.uk/infections/topics_az/pneumococcal/default.htm

Efficacy Against Otitis Media in Finland : 

Efficacy Against Otitis Media in Finland 1662 infants Overall reduction of acute OM 6% (CI –4 to 16%) Reduction in cultured confirmed pneumo OM 34% Reduction in OM from vaccine serotypes: 57% 6B, 14, 23F, (good), 19F (poor) 6A (X-react good), 19A (poor) Increase in non-vaccine serotype pneumo OM 33% Eskola, etal. Efficacy of a Pneumococcal Conjugate Vaccine against Otitis Media. NEJM 2001; 344:403-409 Not sig. 84% 25%

Advisory Committee on Immunization (ACIP) : 

Advisory Committee on Immunization (ACIP) Recommend use of PCV7 for: Universal vaccination of all infants ? 23 months of age Vaccination of all children, 24-59 months of age, with the following conditions: Sickle cell anaemia Splenic dysfunction HIV / AIDS Chronic disease Immunocompromising condition MMWR 2000; 49(No.RR-9):1-38

PCV7??????????? : 

PCV7??????????? DTP/Hib DTaP Hib IPV Hepatitis B MMR Varicella Prevnar® Product Information. Wyeth. February 2000.

?????? : 

?????? ????????? ????????

CHARACTERISTICS OF IMMUNE RESPONSES TO T-CELL INDEPENDENT VS. T-CELL DEPENDENT ANTIGENS : 

CHARACTERISTICS OF IMMUNE RESPONSES TO T-CELL INDEPENDENT VS. T-CELL DEPENDENT ANTIGENS Polysaccharide antigen T cell independent Production dysproportionate IgM Lack of immunological memory Short-lived immune response Failure to produce high affinity antibody Protein-Polysachharide conjugate antigen T cell dependent Stimulate T-helper cell response Strong booster response upon re-exposure iii. High affinity antibody

Slide 83: 

?????? (Lancet 2006; 368: 1495–502)?782 ??????????? (5 ???) ? 2512 ????????????,???? ???????????,????????????,?????? (??)???, ??????????,? 73% ?????;????????,? 94% ????????????,????????,?????????????????? ????,????????????

Slide 84: 

??????????????????????????? ???????????????????,??????? ??????????????????,???????? ?:????????????????????????? ????????????????,?????????? ????????,???????:?????????? ???????????????????????????, ???????????????????????????? ???????,?????????

Slide 85: 

Increase of cfrtriaxone resistance among penicillin resistant S.pneumoniae in Taiwan Globally serotypes 1,3,5,7F are non vaccine serotypes that are important Serotypes related to the PCV7(6A, 19A) are not responding appropriately in view of the potential for antibiotic resistance

Immunogenicity and serotype-specific efficacy of a 9-valent pneumococcal conjugate vaccine (PCV-9) determined during an efficacy trial in The Gambia Vaccine 26 (2008) 3719–3726 : 

Immunogenicity and serotype-specific efficacy of a 9-valent pneumococcal conjugate vaccine (PCV-9) determined during an efficacy trial in The Gambia Vaccine 26 (2008) 3719–3726

Safety & Immunogenicity Study of 10-Valent Pneumococcal Conjugate Vaccine When Administered as a 2-Dose Schedule (PHRASE III GSK)Anti-pneumococcal serotypes 1, 4, 5, 6B, 7F, 9V, 14, 18C, 19F and 23F : 

Safety & Immunogenicity Study of 10-Valent Pneumococcal Conjugate Vaccine When Administered as a 2-Dose Schedule (PHRASE III GSK)Anti-pneumococcal serotypes 1, 4, 5, 6B, 7F, 9V, 14, 18C, 19F and 23F CLINICAL TRIAL

Study Evaluating a 13-valent Pneumococcal Conjugate Vaccine Administered to Infants in Taiwan (Wyeth) phrase III : 

Study Evaluating a 13-valent Pneumococcal Conjugate Vaccine Administered to Infants in Taiwan (Wyeth) phrase III The purpose of this study is to assess the safety, tolerability and immunogenicity of a 13-valent pneumococcal conjugate vaccine (13vPnC), relative to a 7-valent pneumococcal conjugate vaccine (7vPnC) when given concomitantly with routine vaccines in Taiwan. 4, 6B, 9V, 14, 18C, 19F, 23F, 1, 3, 5, 6A, 7F and 19A

Kamalapur Vaccine Serotype Coverage : 

Kamalapur Vaccine Serotype Coverage Incidence Total IPD = 400/100,000 child-years 7-valent serotypes = 170/100,000 child-years 10-valent serotypes = 240/100,000 child-years 13-valent serotypes = 250/100,000 child-years Ref: Brooks WA, personal communication *Includes cross-protection with 6A

Pneumococcal vaccine supply : 

Pneumococcal vaccine supply Multinationals Wyeth: 7-valent Prevnar/Prevenar® licensed in >70 countries. Wyeth: 13-valent expected licensure in late 2009/early 2010 GSK: 10-valent expected licensure in Q4 2008 Supply adequate to meet GAVI demand through 2011 GAVI:Global Alliance for Vaccines and Immunization

Proportion of pediatric pneumococcal disease prevented by vaccination : 

Proportion of pediatric pneumococcal disease prevented by vaccination 7-valent 10-valent 13-valent

Pneumococcal vaccine pipeline : 

Pneumococcal vaccine pipeline

Potential vaccine supply timeline : 

Potential vaccine supply timeline Licensure (FDA, EMEA) Avail for emerging markets (developing countries) 7-valent: 4, 6B, 9V, 14, 18C, 19F, 23F 10-valent: 7-valent + 1, 5, 7F 13-valent: 10-valent + 3, 6A, 19A Vaccine serotypes:

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