Crovari, P

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Journal of Preventive Medicine and Hygiene (JPMH)

49J prev med hyg 2012; 53: 49Invasive bacterial diseases (meningitis, sepsis, bacter-emic pneumonia, etc.) are a major cause of morbidity, and are characterized by a high fatality rate and a high frequency of serious and often invalidating complica-tions [1, 2].The symptoms of these diseases display scant specifi-city with regard to the etiological agent. However, it is extremely important to know which specific agent is in-volved, not only for therapeutic purposes and prophy-laxis for those who come into contact with the patient, but also to implement primary prevention.Glycoconjugate vaccines for the prevention of infections due to type b Haemophilus influenzae (Hib), types ABC and W135 Neisseria meningitidis (meningococcus) and 13 serogroups/types of Streptococcus pneumoniae (pneumococcus) are currently available and are effica-cious in small children [3- 5]. It is essential to know the epidemiology of the diseases caused by these pathogens, in order to evaluate the percentage of preventable cases and the impact of extensive vaccination campaigns.In 1994, a special surveillance network was set up by the Istituto Superiore di Sanità. The data gathered by this net-work have provided, and continue to provide, a precise picture of the trends of these invasive diseases. For ex-ample, among 1348 cases of invasive disease reported in 2010, 851 of these were caused by S. pneumoniae, 150 by N. meningitidis and 70 by Haemophilus influentiae [6].In recent years, we have been witnessing a significant change in the natural history in the spread of infections due to S. pneumoniae, thanks to the introduction of the heptavalent conjugate vaccine in many advanced coun-tries. Moreover, the 13-valent conjugate vaccine has been available in Italy for several years, providing an even more effective weapon against the invasive dis-eases caused by this pathogen, such as meningitis and pneumonia [5].The monovalent conjugate vaccine against meningococ-cus C found considerable success in those countries, such as the United Kingdom, where extensive vaccination cam-paigns had been carried out [7]. Even smaller-scale strate-gies, such as the vaccination of children at risk,13-month-old infants and adolescents, which was introduced in Italy through the 2005-07 National Vaccination Plan, are be-ginning to impact on the circulation of meningococci of serogroup C. This is demonstrated by the predominance of serogroup B among the meningococci responsible for invasive disease in Italy in recent years [6].Given the resemblance between the capsular polysac-charide of meningococcus B and human antigens, the research group of Novartis Vaccines and Diagnostics has made major efforts in the last few years to develop a universal vaccine for meningococcus B [8, 9]. Sup-ported by top-level scientific research, these efforts en-abled the elusive mechanisms with which this pathogen is endowed to be better understood. In particular, the identification of proteins which play important roles in the adhesion of the microorganism to the cells of the re-spiratory tract, in its survival in the bloodstream, etc.The goal of producing vaccines covering the vast range of possible invasive pathogens has gradually been achieved. However, further research will be necessary, bearing in mind the considerable adaptive capabilities of these potential agents of disease, for which man is the only natural host.IntroductIonInvasive diseases: new vaccines and vaccination strategiesP. CROVARIDepartment of Health Sciences, University of Genoa, ItalyReferences [1] Tunkel A, Schilder AG. Acute meningitis. In: Mandell GL, Douglas RM, Bennet JE, eds. Mandell, Douglas, and Bennett’s Principles and practice of infectious diseases. Sixth Edition ed. Philadelphia: Elsevier 2005, pp. 1083-1126.[2] Angus DC, Linde-Zwirble WT, Lidicker J, et al. Epidemiol-ogy of severe sepsis in the United States: analysis of inci-dence, outcome, and associated costs of care. Crit Care Med 2001;29:1303-10.[3] Gasparini R, Panatto D. Meningococcal glycoconjugate vac-cines. Hum Vaccin 2011;7:170-82.[4] Gasparini R, Conversano M, Bona G, et al. Randomized trial on the safety, tolerability, and immunogenicity of MenACWY-CRM, an investigational quadrivalent meningococcal glyco-conjugate vaccine, administered concomitantly with a com-bined tetanus, reduced diphtheria, and acellular pertussis vaccine in adolescents and young adults. Clin Vaccine Im-munol 2010;17:537-44.[5] Sucher AJ, Chahine EB, Nelson M, et al. Prevnar 13, the new 13-valent pneumococcal conjugate vaccine. Ann Pharmacother 2011;45:1516-24.[6] Istituto Superiore di Sanità. Surveillance data of invasive bacte-rial diseases as at 30 September 2011. Available at http://www.simi.iss.it/files/Report_MBI.pdf.[7] Miller E, Salisbury D, Ramsay M. Planning, registration, and implementation of an immunisation campaign against meningo-coccal serogroup C disease in the UK: a success story. Vaccine 2001;20(Suppl 1):S58-67.[8] Giuliani MM, Adu-Bobie J, Comanducci M, et al. A universal vaccine for serogroup B meningococcus. Proc Natl Acad Sci USA 2006;103:10834-9.[9] Panatto D, Amicizia D, Lai PL, et al. Neisseria meningitidis B vaccines. Expert Rev Vaccines 2011;10:1337-51.n	 Correspondence: P. Crovari, Department of Health Sciences, Uni-versity of Genoa, via A. Pastore 1, 16132 Genoa, Italy - E-mail: crovari@unige.it

Invasive diseases: new vaccines and vaccination strategies

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Invasive diseases: new vaccines and vaccination strategies

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