Disease & Vaccine Information

What is the history of Pneumococcal in America and other countries?

Updated May 04, 2024


disease history

Streptococcus pneumoniae was first isolated in 1880, 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.      It was during this decade that researchers discovered that S. pneumoniae could also cause meningitis. 

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.

 

At the turn of the 20th century, physicians became more aware of pneumococcus, its relationship to pneumonia, and the increasing mortality rates associated with the illness. During this period, published papers which detailed the impact of pneumonia in the U.S. began to appear in medical journals. 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.    

By 1909, Ludwig Handel and Franz Neufeld of the Robert Koch Institute for Infectious Diseases in Berlin had developed a technique to categorize the different strains of pneumococci.  Between 1915 and 1945, research focused on increasing the understanding of 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. This capsule was found to be crucial in maintaining the pneumococci’s ability to cause infection because it prevented other cells from devouring it, in a process known as phagocytosis. The prevalence of a particular serotype (strain) 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 strain within a population were also noted to have occurred throughout its history and it was determined that S. pneumoniae could 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 which enables it to adapt and allow it to become resistant to antibiotics or evade vaccine-acquired immunity. 

As treatment of pneumococcal disease impacted the transformation of S. pneumoniae, medical interventions targeting the infection were critical to the disease’s history. Research into treatment options against the disease began almost 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, had a narrow window of effectiveness between toxic and therapeutic doses. The development of Optochin as a potential treatment of S. pneumoniae was quickly discontinued 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 course of treatment for pneumococcal pneumonia. It was also during this timeframe that the treatment of the individual patient with pneumococcal disease 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 the 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 that 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 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 against the disease.     Its use increased even further when it was used to successfully treat 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 was 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, they were rarely used due to the discovery of penicillin and the preference of its use by doctors for the treatment of the disease.    

The discovery of antimicrobials and antibiotics which were found to effectively treat many 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 if there were any clinical signs of infection. Some clinicians believed that treating all infections prophylactically with antibiotics would be the safest and most effective way to prevent pneumococcal disease while 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 antibiotics, reported that only 10 percent of all persons prescribed antibiotics actually required them. Sulfa resistant strains of S. pneumoniae had already been documented 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 vaccine development;  however, it took researchers until the early 1980s to publish papers suggesting that the overuse of unnecessary antibiotics might be responsible for the increasing number of antibiotic-resistant strains of infection and that this practice should 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. 

Currently, 40 percent of all invasive S. pneumoniae infections are resistant to one or more antibiotics, with resistance found to be dependent on geographical location.      Adults over 65 and children under five are most likely to harbor antibiotic resistant strains of S. pneumoniae.  

Antibiotic resistance has pushed pneumococcal disease back into the public health spotlight    and both the World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC) consider the need for new treatment approaches to be a priority.   

Over 90 strains of S. pneumoniae have been identified with 10 strains found to be the cause of approximately 62 percent of all cases of invasive pneumococcal disease globally. In the U.S., 80 percent of invasive pneumococcal disease found in children six years of age and under were caused by seven common pneumococcal strains.  In 2020, there were 11,718 confirmed cases of invasive pneumococcal disease in the U.S, with 536 of those cases occurring in children under five. 

WHO estimates S. pneumoniae to be responsible for the death of 300,000 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. 

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