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What is the history of Pneumococcal in America and other countries?
Streptococcus pneumoniae was first isolated independently in 1880, both in France, by Louis Pasteur, and in the United States, by Dr. George M. Sternberg, a U.S. Army physician. In the mid-1880s, an association between S. pneumoniae and lobar pneumonia was described in medical literature and in 1884, the discovery of the Gram Stain helped to distinguish the bacteria from other forms of pneumonia. During this decade, researchers also discovered that S. pneumoniae could cause meningitis.
At the turn of the 20th century, physicians became more aware of pneumococcus, its relationship to pneumonia, and the increasing mortality rates associated with it. Published papers began to appear in medical journals detailing the impact of pneumonia in the United States. In 1900, pneumonia (and influenza) was the leading cause of infectious disease death and the third leading cause of overall death in the U.S.
Research continued and by 1909, Ludwig Handel and Franz Neufeld of the Robert Koch Institute for Infectious Diseases in Berlin, developed a technique to categorize the different strains of pneumococci. Between 1915 and 1945, a great deal of research focused on further understanding the structure of the S. pneumoniae bacteria, its ability to cause disease, and the impact of disease on humans. By 1940, more than 80 types of S. pneumoniae had been identified and described.S. pneumoniae was noted to be genetically diverse and identifiable by its unique outer capsule surrounding the bacteria. The capsule was found to be crucial in maintaining the pneumococci’s ability to cause infection by preventing other cells from devouring it, in a process known as phagocytosis. The prevalence of a particular serotype was found to be dependent on geographical location, characteristics of the infected person, and the use of antibiotics and vaccines.
Changes in the prevalence of a particular S. pneumoniae serotype within a population were also noted to have occurred throughout its history and S. pneumoniae was determined to frequently transform through a process known as recombination, or capsular switching. In this process, the bacterial cell incorporates DNA from other closely related bacteria into its own genome, enabling it to adapt, and allowing it to resist antibiotics or evade vaccines.
As treatment of pneumococcal disease impacted the transformation of S. pneumoniae, medical interventions targeting the infection have been critical to its history. Early research into treatment options against the disease began nearly immediately after the bacteria’s identification.
One of the first antimicrobials to be studied as a possible treatment against pneumococcal disease was a quinine derivative known as optochin. Optochin, however, was found to have a narrow window of effectiveness between toxic and therapeutic doses. The development of Optochin as a potential treatment of S. pneumoniae was discontinued quickly due to the risk of toxicity.
The next treatment of S. pneumoniae involved the use of antiserum derived first from animals (rabbits and horses) then from humans. During the 1930s and 40s, human antiserum was considered the primary treatment option for pneumococcal pneumonia. During this time, treatment of the individual patient evolved into a “community” responsibility, and pneumonia became one of the leading health concerns in the U.S.
The Metropolitan Life Insurance Company, which had lost over $24 million dollars in death benefits in the wake of the 1918-1919 Spanish influenza, led as the largest campaign contributor in the fight against this respiratory disease. In 1937, it joined with the U.S. Health Service to produce a 12 minute film on pneumococcal pneumonia, which debuted at New York City’s famous Radio City Music Hall. Pneumococcal pneumonia was declared a national health emergency which required a coordinated effort between the public, physicians, and health agencies in order to advance and promote medical treatments to target the disease.
By 1940, approximately two thirds of the U.S. states and territories in would develop pneumonia-control programs and federal funding for pneumococcal increased nearly 60-fold in three years. In 1940, pneumonia and influenza was reported to be the fifth leading cause of infectious disease death in the U.S, and was reported to occur at a rate of 70.3 cases per 100,000 people.
During this era, a new pneumococcal treatment option became available in the form of an antimicrobial compound known as sulfapyridine. When published research noted its ability to reduce pneumococcal disease mortality rates, it quickly became the most popular treatment option against the disease. Its use increased even further when it was found to have successfully treated Sir Winston Churchill’s bacterial pneumonia.
The success of sulfapyridine, and eventually penicillin, against pneumococcal pneumonia resulted in a decline in the use of human antiserum and by the late 1940s, all pneumococcal control programs had been discontinued.
By the mid-1940s, penicillin had become more readily available and found to be highly effective against numerous infectious diseases, including pneumococcal disease. Penicillin quickly became recognized as one of the most effective treatments against S. pneumoniae associated infections. While several pneumococcal vaccines were developed for use between 1909 and the mid-1940s, the discovery of penicillin as an effective treatment and the preference of its use by doctors, resulted in limited use of these products.
The discovery of antimicrobials and antibiotics which were found to effectively treat a number of different infections, including S. pneumoniae, prompted a change in pneumococcal treatment protocols. The culturing and typing of infections were no longer routinely performed by clinicians, with many preferring to administer antibiotics for nearly any clinical sign of infection. Some clinicians believed that treating all infections prophylactically with antibiotics would be the safest and most effective way to prevent pneumococcal disease and others chose to prescribe antibiotics at the first sign of any illness.
By the early 1960s, pneumonia researchers, expressing concern over the indiscriminate use of antibiotic, reported that only 10 percent of all persons prescribed antibiotics actually required them. Sulfa resistant strains of S. pneumoniae had already been noted in the 1940s and by the 1960s, penicillin resistant strains had begun to emerge.
Concerns over antibiotic treatment failures and death rates resulting from invasive pneumococcal disease in the 1960s prompted a renewed interest in pneumococcal vaccination development; however, it took researchers until the early 1980s to publish papers suggesting that the overuse of unnecessary antibiotics may be responsible for the increasing number of antibiotic-resistant strains of infection, suggesting that this practice be curtailed. Despite published literature, the scientific community did not sound the alarm over the rise in antibiotic resistant strains of bacteria until the mid-1990s. By 1998, 24 percent of pneumococcal strains were found to be resistant to penicillin and 14 percent of strains were noted to be resistant to multiple antibiotics.
30 percent of all invasive S. pneumoniae infections are currently resistant to one or more antibiotics, with resistance noted to be dependent on geographical location. Adults over 65 and children under 5 are most likely to harbor antibiotic resistant strains of S. pneumoniae.
Antibiotic resistance pushed pneumococcal disease back into the public health spotlight and the need for new treatment approaches has been identified as a priority by both the World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC).
Over 90 strains of S. pneumoniae have been identified with 10 strains found to cause approximately 62 percent of all cases of invasive pneumococcal disease globally. In the U.S., 80 percent of invasive pneumococcal disease found in children 6 and under is the result of 7 common strains. In 2017, there were 16,620 reported cases of invasive pneumococcal disease in the U.S and 1,220 of those cases occurred in children under 5.
WHO estimates S. pneumoniae to be responsible for the death of half a million children worldwide every year. The majority of these deaths occur in developing countries located in Asia and sub-Saharan Africa. As with pneumococcal disease in the U.S., older adults and young children are most susceptible to infection, and only a small number of strains are responsible for the majority of infections.
IMPORTANT NOTE: NVIC encourages you to become fully informed about Pneumococcal and the Pneumococcal vaccine by reading all sections in the Table of Contents , which contain many links and resources such as the manufacturer product information inserts, and to speak with one or more trusted health care professionals before making a vaccination decision for yourself or your child. This information is for educational purposes only and is not intended as medical advice.