Updates in Pediatrics
Editor: Jack Wolfsdorf, MD, FAAP
header with photos of various children
October 20, 2021 | Volume 12 | Issue 42
Safety and immunogenicity of a 20-valent pneumococcal vaccine in healthy infants in the US

Pneumococcal disease from bacteria Streptococcus pneumoniae is acquired buy inhalation of the organism, leading to colonization of the nasopharynx (50-60% of children carry the bacteria asymptomatically); invasion of local tissues and bloodstream spread leading to ear infections, pneumonia, meningitis and potentially death. Disease prevention occurs best following vaccination.

At present there are 2 types of vaccine; Pneumococcal conjugate vaccine (PCV13 – Prevnar) which contains 13 serotypes of pneumococcal bacteria antigen and Pneumococcal Polysaccharide vaccine (PPSV23 – Pneumovax) which is primarily given to adults (there are >95 pneumococcal serotypes identified by a unique polysaccharide capsule). The CDC recommends PCV13 vaccine be given to infants at ages 2, 4, 6 and 12-15 months. Expanding the serotypes in vaccines may further reduce disease burden.
 
A double-blind, active control study of 460 infants randomized to receive either a 4-dose series of PCV20 or PCV13 at 2, 4, 6 and 12 months of age compared local reactions, systemic events/adverse incidents and immunogenicity.
“Administration of PCV20 to US infants is well-tolerated with a safety profile and induced serotype-specific immune response similar to PCV13”.
Acquired syphilis by non-sexual contact in childhood
Syphilis is a worldwide public heath concern today with syphilis cases continuing to increase recently. Syphilis is mostly a sexually transmitted disease (STD) caused by Treponema pallidum (family spirochaete), a gram negative helically shaped flat and wavy (corkscrew) bacterium (with a genome of 1.14 million base pairs -small!). Infection in children may occur vertically by transplacental spread from mother to baby during the later stages of pregnancy (Congenital syphilis), sexually Acquired (following abuse or infrequently sexual activity) or more commonly (23%), Acquired by transmission during delivery or through caregiver/family contact (via saliva during breastfeeding, fondling, kissing, mouth cleaning of feeding bottle nipples or pacifiers, bathing, utensils, etc.). Clinically infections present in 3 phases; a Primary painless sore (Chancre :10-90 days post infection) with lymphadenopathy (frequently missed) which heals after 3-6 weeks with or without treatment; a Secondary phase with a rough red/brown rash appearing over the palms/soles of feet or trunk with fever, sore throat, lymphadenopathy, joint/muscle pain and kidney and liver localization. If untreated this progresses to late stage Tertiary syphilis with damage to the brain, heart, eyes, bones and skin.
 
A prospective cohort study of 24 children with syphilis (mean age at diagnosis 4.2 years) examined demographics, clinical findings and laboratory data.
 
Most cases of syphilis in children are diagnosed with the appearance of the secondary skin rash (79.2%) and arise from overcrowded homes following contact with a family member positive for Treponema (29.5%).
 
 
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