Pneumococcal Disease Remains a Significant Health Concern
Conference held in Belgrade highlights the ongoing rise of pneumococcal infections and the need for improved vaccination strategies.
A conference titled "How to Improve Population Protection Through Immunization Against Pneumococcal Bacteria" was held yesterday in Belgrade, supported by the Patients' Forum of Serbia.
Unlike other respiratory infections, pneumococcal diseases occur throughout the year, making vaccination essential as a means to protect citizens, especially young children, those over 65, and individuals with chronic illnesses from severe forms of the disease, hospitalization, and mortality.
Alexandar Sovtić, President of the Republic's Expert Commission for Pulmonology and Head of the Pulmonology Department at the Institute for Mother and Child 'Dr. Vukan Čupić', emphasized this point, noting that pneumococcal infections are on the rise in Serbia, necessitating an enhancement of childhood vaccination efforts.
He pointed out that pneumococcal disease, caused by the bacterium Streptococcus pneumoniae, continues to pose a serious public health issue, particularly for children and individuals aged 65 and older.
Despite the introduction of vaccines that have significantly reduced the incidence of severe infections, recent data from the Reference Laboratory for Streptococcus indicate an increase in pneumococcal serotypes not covered by the vaccine.
Sovtić explained that this bacterium is commonly found in the nasal and throat mucosa, especially in children, where colonization occurs in nearly 60% of children under two years of age.
While asymptomatic in healthy individuals, pneumococcus can lead to various illnesses under certain circumstances, ranging from otitis media, affecting nearly 80% of children by the age of two, to severe and potentially fatal infections such as pneumonia, sepsis, and meningitis.
The risk of severe disease significantly increases in individuals with chronic illnesses, such as diabetes, COPD, malignancies, and heart disease, as well as in those without a spleen or with severe immune dysfunction.
Pneumococcal pneumonia is the most common form of bacterial pneumonia, with an estimated mortality rate of about 15%.
More severe forms, known as invasive pneumococcal diseases, occur when the bacteria invade the bloodstream, brain, or pleura, with mortality rates from pneumococcal meningitis reaching up to 30%.
Sovtić noted an observed increase in the number of cases of complicated pneumonia among pediatricians and pulmonologists.
A clinical study indicated that the most common cause of complicated pneumonia was a pneumococcal serotype not included in the current vaccine.
He emphasized that while the vaccine in use significantly reduced cases of invasive pneumococcal disease upon its introduction, it does not protect against the currently rising strains, highlighting the need for an improved vaccination strategy.
The Republic's Expert Commission for Pulmonology has unanimously proposed to the Ministry of Health to include a conjugate vaccine with a broader serotype coverage in the immunization program, given all available data.
Similar recommendations have emerged in surrounding countries where immunization is conducted with vaccines containing a greater number of serotypes.
In Serbia, four pneumococcal vaccines are registered.
According to the Law on Protection Against Infectious Diseases, immunization with pneumococcal vaccines is mandatory for various indications and has been part of the mandatory immunization calendar for children since 2018. At that time, the state provided a vaccine containing 10 serotypes of pneumococcus (PCV10), ensuring protection for about 70% of children.
In 2022, the transition was made to a vaccine containing 13 serotypes (PCV13), which covers three additional serotypes, but due to economic reasons, in 2024, the country returned to PCV10.
Professor Dr. Natasha Opavski from the Institute for Microbiology and Immunology indicated that current analyses from the Reference Laboratory for Streptococcus show that the existing ten-valent vaccine protects only 11% of children under two years of age, while multivalent vaccines (PCV13, PCV15, PCV20) provide protection exceeding 50%.
The decrease in protection is attributed to the dominance of serotypes 3 and 19A in Serbia, which are not included in the ten-valent vaccine.
Similar trends have been observed in countries such as Belgium and New Zealand, which, after facing similar challenges, abandoned PCV10 in favor of more effective vaccines.
If the use of the ten-valent vaccine continues, protection will further decline, emphasizing the urgent need to revert to vaccines with a broader spectrum of coverage.
In adults at risk for pneumococcal diseases, the situation is even more critical.
Although vaccination is mandated by professional methodological guidelines, implementation has been minimal, putting individuals with chronic diseases at risk of severe pneumonia, sepsis, and meningitis that could be prevented by vaccination.
Unlike other respiratory infections, pneumococcal diseases occur throughout the year, making vaccination essential as a means to protect citizens, especially young children, those over 65, and individuals with chronic illnesses from severe forms of the disease, hospitalization, and mortality.
Alexandar Sovtić, President of the Republic's Expert Commission for Pulmonology and Head of the Pulmonology Department at the Institute for Mother and Child 'Dr. Vukan Čupić', emphasized this point, noting that pneumococcal infections are on the rise in Serbia, necessitating an enhancement of childhood vaccination efforts.
He pointed out that pneumococcal disease, caused by the bacterium Streptococcus pneumoniae, continues to pose a serious public health issue, particularly for children and individuals aged 65 and older.
Despite the introduction of vaccines that have significantly reduced the incidence of severe infections, recent data from the Reference Laboratory for Streptococcus indicate an increase in pneumococcal serotypes not covered by the vaccine.
Sovtić explained that this bacterium is commonly found in the nasal and throat mucosa, especially in children, where colonization occurs in nearly 60% of children under two years of age.
While asymptomatic in healthy individuals, pneumococcus can lead to various illnesses under certain circumstances, ranging from otitis media, affecting nearly 80% of children by the age of two, to severe and potentially fatal infections such as pneumonia, sepsis, and meningitis.
The risk of severe disease significantly increases in individuals with chronic illnesses, such as diabetes, COPD, malignancies, and heart disease, as well as in those without a spleen or with severe immune dysfunction.
Pneumococcal pneumonia is the most common form of bacterial pneumonia, with an estimated mortality rate of about 15%.
More severe forms, known as invasive pneumococcal diseases, occur when the bacteria invade the bloodstream, brain, or pleura, with mortality rates from pneumococcal meningitis reaching up to 30%.
Sovtić noted an observed increase in the number of cases of complicated pneumonia among pediatricians and pulmonologists.
A clinical study indicated that the most common cause of complicated pneumonia was a pneumococcal serotype not included in the current vaccine.
He emphasized that while the vaccine in use significantly reduced cases of invasive pneumococcal disease upon its introduction, it does not protect against the currently rising strains, highlighting the need for an improved vaccination strategy.
The Republic's Expert Commission for Pulmonology has unanimously proposed to the Ministry of Health to include a conjugate vaccine with a broader serotype coverage in the immunization program, given all available data.
Similar recommendations have emerged in surrounding countries where immunization is conducted with vaccines containing a greater number of serotypes.
In Serbia, four pneumococcal vaccines are registered.
According to the Law on Protection Against Infectious Diseases, immunization with pneumococcal vaccines is mandatory for various indications and has been part of the mandatory immunization calendar for children since 2018. At that time, the state provided a vaccine containing 10 serotypes of pneumococcus (PCV10), ensuring protection for about 70% of children.
In 2022, the transition was made to a vaccine containing 13 serotypes (PCV13), which covers three additional serotypes, but due to economic reasons, in 2024, the country returned to PCV10.
Professor Dr. Natasha Opavski from the Institute for Microbiology and Immunology indicated that current analyses from the Reference Laboratory for Streptococcus show that the existing ten-valent vaccine protects only 11% of children under two years of age, while multivalent vaccines (PCV13, PCV15, PCV20) provide protection exceeding 50%.
The decrease in protection is attributed to the dominance of serotypes 3 and 19A in Serbia, which are not included in the ten-valent vaccine.
Similar trends have been observed in countries such as Belgium and New Zealand, which, after facing similar challenges, abandoned PCV10 in favor of more effective vaccines.
If the use of the ten-valent vaccine continues, protection will further decline, emphasizing the urgent need to revert to vaccines with a broader spectrum of coverage.
In adults at risk for pneumococcal diseases, the situation is even more critical.
Although vaccination is mandated by professional methodological guidelines, implementation has been minimal, putting individuals with chronic diseases at risk of severe pneumonia, sepsis, and meningitis that could be prevented by vaccination.
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