Semin Respir Crit Care Med 2009; 30(2): 189-209
DOI: 10.1055/s-0029-1202938
© Thieme Medical Publishers

Streptococcus pneumoniae: Epidemiology, Risk Factors, and Strategies for Prevention

Joseph P. Lynch1 , George G. Zhanel2
  • 1Division of Pulmonary, Critical Care Medicine, Allergy, and Clinical Immunology, David Geffen School of Medicine at UCLA, Los Angeles, California
  • 2Department of Medical Microbiology, Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
Further Information

Publication History

Publication Date:
18 March 2009 (online)

ABSTRACT

Streptococcus pneumoniae is the most common cause of community-acquired pneumonia, meningitis, and bacteremia in children and adults. Invasive pneumococcal disease (IPD) primarily affects young children, older adults (> 65 years of age), and individuals with comorbidities or impaired immune systems. Case fatality rates range from 10 to 30% in adults with IPD but are much lower (< 3%) in children. In this article, we describe the epidemiology of IPD, risk factors, and the influence of host- and organism-specific factors on outcomes. Most cases of IPD are caused by a limited number of serotypes that vary in infectivity and virulence. Vaccinating adults and high-risk patients with the pneumococcal polysaccharide vaccine reduces the incidence of IPD in populations at risk but does not affect nasopharyngeal colonization and has had limited benefit in the population at large. Use of the heptavalent pneumococcal conjugate vaccine (PCV7) in children in the United States since 2000 has resulted in a substantial decline of IPD in both children and adults (by herd immunity), but has facilitated the emergence of serotypes not encompassed in the PCV7 vaccine. Recent reports of “replacement” serotypes that have heightened virulence are worrisome. In this chapter, we discuss the role of vaccines (both polysaccharide and conjugate) and other preventive strategies to limit this important and potentially lethal disease.

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Joseph P Lynch IIIM.D. 

Division of Pulmonary, Critical Care Medicine, Allergy, and Clinical Immunology, The David Geffen School of Medicine at UCLA

10833 Le Conte Ave., Rm. 37-131 CHS, Los Angeles, CA 90095

Email: jplynch@mednet.ucla.edu

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