BACKGROUND: Streptococcus pneumoniae is the primary causative agent of pneumonia in older adults. Vaccination is the only tool to protect against pneumococcal infection; however, vaccination rates remain far below the Healthy People 2010 objective of 90% coverage. The number one reason for such low rates is attributed to controversy over the protective efficacy of the vaccine in preventing nonbacteremic pneumonia (eg, community-acquired pneumonia [CAP]). OBJECTIVES: The primary objectives of this study were to assess the incidence of pneumonia, pneumonia requiring hospitalization, and pneumonia hospitalization costs. METHODS: In this retrospective cohort study of Medicare beneficiaries aged 65 years in 2003, subjects were selected based on exposure status. Exposure was defined as receipt of the 23-valent pneumococcal polysaccharide vaccine (PPV23). Vaccinated persons were then matched 1:1 on gender and the presence of any comorbidity to unvaccinated persons. Subjects were followed up for 1 year (January 1, 2004 through December 31, 2004). The primary outcomes were pneumonia, pneumonia requiring hospitalization, and hospitalization costs. Mantel-Haenszel chi-square or logit was used to estimate the relative risk (RR) associated with vaccination and each outcome and Proc Ttest was used to test the difference between mean hospital costs of the vaccinated and non-vaccinated. RESULTS: During the follow-up period, 443 patients were diagnosed with pneumonia; 266 had previously been vaccinated and 177 had no documented receipt of prior vaccination. Results of the Chi-square analysis revealed a significant association between vaccination and the risk of pneumonia, as the vaccinated were 50% more likely to develop pneumonia than were the non-vaccinated (Adjusted RR: 1.50; 95% CI: 1.25, 1.81). Approximately 67% of patients diagnosed with pneumonia required hospitalization; of which, 183 were previously vaccinated and 115 had no documented receipt of prior vaccination. There was no association between vaccination and risk of pneumonia requiring hospitalization (P value 0.4001). However, the vaccine was associated with a significant reduction in hospital costs (P value 0.004). CONCLUSIONS: The results of this study suggest that use of the vaccine may be associated with cost savings due to a reduction in hospitalization.

published_or_final_version / Medical Sciences / Master / Master of Medical Sciences

Streptococcus pneumonine viršutiniuose kvėpavimo takuose sutinkamos gram-teigiamos bakterijos, galinčios sukelti pneumoniją, meningitą, vidurinės ausies uždegimą, sinusitus ir kitus susirgimus. Neatspariausi šiems susirgimams yra vaikai. Vienas šio darbo tikslų buvo ištirti streptokokų paplitimą ikimokyklinio amžiaus grupės sveikų vaikų populiacijoje. Buvo ištirtas 601 nosiaryklės tepinėlis, paimtas iš 2-7 metų amžiaus vaikų, lankančių ikimokyklines ugdymo įstaigas Vilniaus mieste. Streptococcus pneumoniae išaugo 280 vaikų tepinėlių pasėliuose (47 proc.). Viso rasti 22 skirtingi serotipai; nustatyti dažniausiai šioje populiacijoje sutinkami serotipai 19F,23F, 6B, 6A, 3, 18C. Labai dažnai pneumokokai susitelkia nosiaryklės gleivinės epitelyje nesukeldami jokių ligos simptomų. Šiuo atveju ypatingą reikšmę įgauna žmogaus imuninė sistema, todėl buvo tiriamas atskirų klasių imunoglobulinų (IgG, IgA, IgM) kiekis infekuotų vaikų seilių pavyzdžiuose. Šiems tyrimams buvo panaudoti monokloniniai antikūnai, gauti hibridominės technologijos pagalba. Imunofermentiniu metodu seilių mėginiuose buvo nustatytas IgA, sIgA, IgG, IgM klasių antikūnų kiekis, o taip pat specifinių S. pneumonine antikūnų kiekis; nustatyta, kad koreliacija tarp duomenų grupių (bendras konkrečios klasės imunoglobulinų skaičius, specifinių antikūnų skaičius) yra vidutinė arba silpna. Tačiau gleivinių imuniteto vertinimas imunofermentiniu metodu yra pakankamai informatyvus ir perspektyvus, ypač dėl tos priežasties, kad... [toliau žr. visą tekstą] / Streptococcus pneumonine is a gram-positive bacterial organism that colonizes the upper respiratory tract and causes diseases such as pneumonia, meningitis, otitis media, sinusitis and others. Disease rates are particularly high in young children. One of the aims of this study was to assess the prevalence rates of streptococcal infection among the population of healthy children of preschool age. 601 nasopharyngeal samples were tested from 2-7 years age kindergardeners in Vilnius. Streptococcus pneumonine were grown from 280 samples (47 % of collected samples). 22 different serotypes were identified; the most frequent serotypes were determined 19F, 23F, 6B, 6A, 3, and 18C. Frequently S.pneumonine colonizes mucosal epithelium at nasopharynx without causing any symptoms. In that case the immunity of an organism is of great significance. The second aim of this study is to evaluate the immune response to pneumococcal infection. The amount of separate immunoglobuline classes (IgG, IgA, and IgM) were assessed in saliva samples of infected children. Monoclonal antibodies developed by hybridoma technology were applied. The amounts of classes IgA, sIgA, IgG, IgM antibodies were determined parallel to amount of specific antibodies to S.pneumonine. Correlation between data groups (total amount of actual immunoglobulin class, concentration of specific antibodies) was weak or moderate. Generally, evaluation of mucosal immunity by enzyme immunoassay is informative and perspective especially... [to full text]

A retrospective study of invasive pneumococcal disease in patients from Greater Göteborg in 1964- 1980 identified 125 cases of meningitis, 305 of pneumonia, 61 of septicemia with unknown focus, and 17 with other manifestations, all verified by cultures from normally sterile body fluids. The incidence was several times higher in infants and in the elderly than in any other age-group. A wide variety of underlying conditions were present in 23% of the infants, 34% of the children, and 81% of the adults. In adults alcoholism was known in one third of the cases. The case fatality rate was 24% among patients with underlying conditions and 9% among previously healthy individuals. The case fatality rate was 50% in patients with hospital-acquired infection. Twohundred-fifteen pneumococcal strains, isolated from blood or CSF from 1971 to 1983 at the laboratories of clinical bacteriology of Göteborg, Malmö, and Umeå were serotyped by coagglutination (COA). Of all isolates, 89% belonged to serotypes represented in the 23-valent vaccine. In a separate study COA was compared with counterimmunoelectrophoresis (CIE). COA was found to have several advantages; rapidity, lower cost, and ability to disclose serotypes with neutral charge, which constituted 19% of all strains. In a prospective study the etiology was determined in 196 hospitalized patients with pneumonia, most of them community-acquired. Culture of specimens from blood, transtracheal aspirate (TTA), sputum, and nasopharynx, assays of antigen in sputum, urine, and TTA, and assays of pneumococcal antibodies to capsular polysaccharide, C-polysaccharide, and pneumolysin in paired sera were performed. The etiology was established in 64% of the patients. Streptococcus pneumoniae was the most common agent (32%). In a serological study of patients with pneumococcal infection, diagnosed by culture of CSF, TTA, or blood, IgG antibodies against C-polysaccharide and pneumolysin were determined by ELISA. The diagnostic sensitivity was only 51% and 60%, respectively. In conclusion, invasive pneumococcal disease is strongly overrepresented at tender and high age and in patients with concomitant conditions, notably alcoholism. S. pneumoniae remains a predominant causative agent of community-acquired pneumonia in adults needing hospitalization. Due to the low sensitivity and/or specificity of individual microbiological techniques, a combined use of several techniques is necessary when trying to assess the relative importance of pneumococci and other agents in pneumonia. Extended use of the currently available pneumococcal vaccine and development of improved pneumococcal vaccines seem highly warranted. / <p>Diss. (sammanfattning) Umeå : Umeå universitet, 1993, härtill 5 uppsatser.</p> / digitalisering@umu.se

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2007. / Härtill 4 uppsatser.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2007. / Härtill 4 uppsatser.

Diss. (sammanfattning) Stockholm : Karol. inst., 2005. / Härtill 5 uppsatser.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2006. / Härtill 5 uppsatser.

Thesis (Ph. D.)--University of Alabama at Birmingham, 2008. / Title from first page of PDF file (viewed Feb. 19, 2009). Includes bibliographical references.

Thesis (Ph. D.)--University of Alabama at Birmingham, 2007. / Title from first page of PDF file (viewed Feb. 18, 2009). Includes bibliographical references.