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La introducción de la vacuna neumocócica conjugada heptavalente en algunos países ha dado lugar a cambios substanciales en la epidemiología de las infecciones producidas por esta bacteria. La mayor repercusión ha sido una disminución global de la enfermedad invasora, sobre todo por un descenso de las infecciones producidas por los serotipos vacunales. La vacuna ha generado una inmunidad de grupo muy efectiva, extendiendo su efecto protector a las personas no vacunadas de todas las edades, entre ellas los mayores de 65 años, una población en la que la infección conlleva una morbimortalidad elevada. La inmunidad de grupo se debe, en parte, a la inducción de respuestas inmunitarias en las mucosas respiratorias. El resultado es una disminución de la colonización nasofaríngea por los serotipos vacunales, que, sin embargo, son reemplazados por otros serotipos no contenidos en la vacuna. Como quiera que la colonización nasofaríngea es un hecho crucial en la epidemiología de las infecciones neumocócicas, no es de extrañar que los cambios en la misma den lugar a algunas consecuencias conocidas y otras que se empiezan a conocer. Más del 80% de las resistencias de neumococo van ligadas a 5 de los serotipos vacunales, cuya desaparición de la nasofaringe se ha acompañado de una disminución marcada de infecciones causadas por cepas resistentes. Un hecho preocupante ha sido la emergencia de serotipos no contenidos en la vacuna, como 19A, 3, 15, 33 y 6A, que podría, en un futuro, dar lugar a una disminución de la efectividad de la vacuna o a cambios en la epidemiología de la enfermedad.
Palabras clave:
Streptococcus pneumoniae
Vacunas neumocócicas conjugadas
Vacuna neumocócica conjugada heptavalente
Enfermedad invasiva neumocócica
Neumonía
Colonización nasofaríngea
Serotipos neumocócicos
The introduction of the heptavalent pneumococcal conjugate vaccine in some countries has substantially changed the epidemiology of pneumococcal infections. The greatest effect has been an overall reduction of invasive disease, especially due to a decrease in infections produced by vaccine serotypes. This vaccine has generated highly effective group immunity, extending its protective effect to non-vaccinated individuals of all ages, including those older than 65 years, a population in which infection carries high morbidity and mortality. Group immunity is partly due to induction of immune responses in the respiratory mucosa. The result is a decrease in nasopharyngeal colonization by vaccine serotypes which, however, can be replaced by other serotypes not contained in the vaccine. Since nasopharyngeal colonization is a crucial factor in the epidemiology of pneumococcal infections, changes in colonization lead to some known consequences and others that are beginning to be known. More than 80% of pneumococcal-resistant strains are linked to five vaccine serotypes; the disappearance of these vaccine serotypes from the nasopharynx has been accompanied by a marked decrease in infections caused by resistant strains. A worrying recent finding has been the emergence of serotypes not contained in the vaccine such as 19A, 3, 15, 33 and 6A, which could in future decrease the effectiveness of the vaccine or lead to changes in the epidemiology of pneumococcal disease.
Key words:
Streptococcus pneumoniae
Pneumococcal conjugate vaccines
Heptavalent pneumococcal conjugate vaccine
Pneumococcal invasive disease
Pneumonia
Nasopharyngeal colonization
Pneumococcal serotypes
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