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Prevention of invasive pneumococcal disease with emphasis on conjugated pneumococcal vaccines
Sieghart Dittmann
Member of the German Advisory Committee on Immunization
Former chief, Communicable and Immunization Programmes, WHO Regional Office for Europe

Meningitis, pneumonia, and bacteraemia are the most common manifestations of invasive disease due to Streptococcus pneumoniae, whereas otitis media, sinusitis and others occur as result of direct spread of the organism from nasopharynx. Globally, and particularly in developing countries, pneumococcal infection causes over 1 million deaths in children below 5 years annually and contributes largely to the estimated 2.6 million deaths due to acute respiratory infections. Additionally, many ten-thousands of children die due to pneumococcal meningitis and acute otitis media, and a high percentage of survivors develop CNS sequelae and deafness.
In industrially developed countries of Europe, North America, and other parts of the world, pneumococcal pneumonia affects approximately 100 per 100 000 adults per year. The corresponding figures for meningitis and bacteraemia are 1-2 and 15-19 per 100 000, respectively. In preschool children below 5 years of age, the incidence of invasive pneumococcal disease ranges from 10 to 72 per 100 000 and the incidence of pneumococcal meningitis ranges from 2 to 10 per 100 000.
Twenty-three serotypes of Streptococcus pneumoniae account for 90% of pneumococcal disease in adults in industrialized countries, whereas the majority of pneumococcal disease in infants and young children is associated with 11 most common serotypes. 
Twenty-three-valent pneumococcal polysaccharide vaccines are increasingly used in the US and western European countries to prevent invasive disease in elderly and chronically ill persons. However, polysaccharide vaccines induce only insufficient protection in children below 2 years of age considered to be at high risk for invasive pneumococcal disease. The development of conjugated pneumococcal vaccines provides safe and immunogenic tools for disease prevention in very young children. In 2000, the first 7-valent vaccine has been licensed in the U.S. , recently in all EU Member States and also in Argentina, Australia, Curacao, Malta, Mexico, Peru, Switzerland, Trinidad/Tobago. Seven-valent pneumococcal vaccines could prevent more than 80% of invasive disease in U.S. children and about 70% in European children below 2 years of age. Development and implementation of 9- and 11-valent conjugate pneumococcal vaccines will further extend the serotype coverage.
In Germany, a laboratory-based clinical surveillance system called ESPED (involving more than 90% of clinical paediatric institutions in Germany) has been used to collect data on invasive pneumococcal disease in children in order to decide on the disease impact and the possible effective-ness of the newly developed conjugated pneumococcal vaccine. Details of the results of the ESPED study and the decision of the German Advisory Committee on Immunization (STIKO) regarding the implementation of conjugated pneumococcal vaccines will be provided during the presentation.