Since 2000, children have been routinely vaccinated with four doses of Prevnar, the vaccine that creates antibodies for seven different strains of pneumococcal bacteria. Prevnar is referred to as a “cell-wall antigen” vaccine. The vaccine consists of a small particle of the outer capsule of each streptococcus bacteria. After injecting part of the microbe’s cell wall, the body creates an antibody to bacteria’s protective coat. When exposed to one of the strains, the antibody latches onto the live pathogen and in effect kills it.

Prevnar contains antigens of the most common strains circulating in the U.S. even though there are more than 90 strains of pneumococci in nature. Prevnar was initially released to prevent invasive pneumococcal disease even though the chance of an infant contracting invasive pneumococcal disease was determined to be about 0.15%, Soon, Prevnar was promoted to parents to prevent ear infections even though the package insert admits that the vaccine only decreases ear infections by about 9 percent.

However, problems have arisen. Several studies have suggested that the use of Prevnar, and the elimination of the seven common bacterial strains, has lead to an increase in the frequency of non-vaccine strains in circulation.(1) A study published this week in JAMA reports that strains not covered by the vaccine have increased 140 percent in Native children compared with rates before the vaccine was used.(2)

Another affect of the widespread use of Prevnar has been the emergence of antibiotic resistant bacterial strains. In the 1970s, virtually all strains were exquisitely sensitive to penicillin; since the introduction of Prevnar, many strains have become highly resistant. In a study published in 2003, more than one third of pnumococcal isolates tested were also resistant to other common antibiotics, including ceftriaxone (Rocephin) (fourteen percent), erythromycin (twenty-two percent), and trimethoprim/sulfa (ie Bactrim) (thirty-one percent). A full twenty percent of S pneumoniae isolates in the study were resistant to all four antibiotics.(3)

Research published in 2005 by two Boston researchers suggests that natural immunity to pneumococcus may be more important for protecting against the disease than the vaccine. Lipsitch and Malley examined unvaccinated toddlers in the U.S., Israel, and Finland. They reported that the incidence of invasive pneumococcal disease decreased by nearly 50% in children between 1 and 2 years of age. Yet, during that same time frame, antibody concentrations increased only slightly. The researchers concluded that some mechanism, other than antibody protection, confers protection against the bacteria.(4)

What, then, might provide this protection? Researchers don’t know, but they state in their paper, “these observations make a strong case for the importance of one or more factors other than [the development of] antibodies” is necessary to confer protection against pneumococcal disease.” This means children have an element of natural protection, beyond the perceived benefit of the pneumococcal vaccine, we do not understand.

Instead of searching for the mechanism that conveys natural protection, researchers intend to use this information to develop a new vaccine, called a whole-cell vaccine, that can use all 90 strains of antigen in one vaccine. Researcher Malley admitted that the “ultimate goal” would be to test the vaccine in adult volunteers, and eventually in children.

But perhaps there is a better way.

Epidemiologic studies have shown that the frequency of ear infections can be achieved through breast-feeding, elimination of household tobacco smoking, frequent hand washing and use of small rather than large day-care centers for infants and toddlers.(5) However, since Prevar is one of the industry’s biggest-selling products, generating nearly $1 billion in revenue per year, the answer is once again, “follow the money.”
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