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BOSTON, MA -- May 15, 2000 -- Vaccination with an experimental pneumococcal vaccine in children who attend daycare reduces illness as well as antibiotic use, according to a study presented at the Pediatric Academic Society/American Academy of Pediatrics meeting by Ron Dagan, M.D., pediatrician and lead investigator.
"The results of this study are very important," said Dr. Dagan, "because pneumococcal disease is a major cause of illness in young children, especially those in daycare. For the first time, it was demonstrated that vaccinating children in daycare against pneumococcal disease can reduce their bouts of illness and the reliance on the antibiotics that treat these illnesses."
Pneumococcal disease ranges from the very serious invasive infections, such as blood poisoning and meningitis to pneumonia and otitis media, the common ear infection. Meningitis, an infection in the lining of the brain and/or spinal cord, can be fatal. For those who survive it, many are left with permanent neurological deficits including deafness, impaired vision, seizures or mental retardation.
In the U.S., pneumococcal disease accounts for an estimated 3,000 cases of bacterial meningitis, 50,000 cases of bacteremia and over seven million ear infections each year. Young children are the most susceptible to all forms of pneumococcal disease. The majority of them carry the bacteria in their noses and/or throats at any given time, so pneumococcal disease can spread easily in a daycare setting. About 60 percent of children under six attend daycare in the U.S., according to the National Center for Education Statistics.
Traditionally antibiotics have been used to treat pneumococcal infections, but many strains of pneumococcal bacteria are rapidly growing resistant to antibiotics, rendering the drugs increasingly ineffective. Resistance to penicillin and other antibiotics is a worldwide problem. In some parts of the United States as well as in some other parts of the world, more than 20 percent of pneumococcal bacteria is resistant to penicillin.
"We are losing our weapons against pneumococcal disease," said Dr. Dagan. "If we can prevent the disease, we can limit our use of antibiotics and stave off antibiotic resistance. This study suggests that, with this vaccine, it is possible. We have shown that use of the vaccine in children who are in daycare has a major impact on illness and antibiotic use."
The study involved 264 children, age 12 to 35 months, from eight daycare centers in Israel. Half were given the trial vaccine and half were given the control vaccine. Each was followed for two years and monitored for episodes of lower respiratory infections (such as bronchitis, asthma and pneumonia), otitis media and upper respiratory infections and fever and use of antibiotics. Results showed that for children in the trial vaccine group there was a:
* 15 percent reduction in all respiratory tract illness from any cause
* 16 percent reduction in lower respiratory infections from any cause
* 17 percent reduction in otitis media from any cause
* 15 percent reduction in upper respiratory infections and fever from any cause
* 53 percent reduction in antibiotic use for lower respiratory infections
* 20 percent reduction in antibiotic use for otitis media
The trial vaccine was a 9-valent (component) pneumococcal conjugate vaccine similar to a 7-valent pneumococcal vaccine, called Prevnar(TM), recently approved for use in the U.S. Prevnar targets the seven strains of pneumococcal bacteria that cause 80 percent of the pneumococcal disease in the U.S. They are also the strains most likely to be resistant to antibiotics. The vaccine used in this trial targets those seven plus two more pneumococcal strains most prevalent in many countries outside the U.S. including Israel.
Dr. Dagan is Professor of Pediatrics and Infectious Diseases at Ben-Gurion University, and Director of the Pediatric Infectious Diseases Unit, Soroka University Medical Center, Beer-Sheva, Israel. The study was conducted in collaboration with Wyeth Lederle Vaccines.