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Future hopes of reducing childhood mortality by vaccination against pneumococcal infections do not lie solely in the vaccine formulations mentioned herein. Natural populations of pneumococci may switch their capsular genes, and the selective pressure of conjugate vaccination may lead to the spread of resistance genes to strains with nonvaccine-associated capsules. 125 As the capsule is the major virulence determinant of the pneumococcus, it is probable that the nonvaccine serotypes will remain less invasive. Although global use of pneumococcal conjugate vaccines may reduce the high rates of childhood mortality in developing countries, the geographic and temporal variation of S. pneumoniae isolated from children and the capsular switching events already demonstrated in a Mexican invasive strain suggest that species-wide, protein-based vaccines may be needed to provide more widespread protection against death and disease caused by the bacterial pathogen. 50 Additionally, the concerted efforts of public health authorities, pediatricians, and community members toward a more prudent use of antibiotics could enable better control and improve the outcomes of infections caused by S. pneumoniae and other bacterial infectious agents. Summary As one of the leading causes of bacteremia, meningitis, pneumonia, and otitis media in the pediatric population, S. pneumoniae represents a significant public health burden worldwide. Treatment and management of pneumococcal disease has become increasingly complex because of the growing incidence of antibiotic-resistant strains of S. pneumoniae; thus, the best management strategy may be prevention of the disease through vaccination. Although several pneumococcal vaccines have been studied in infants and children, only PNCRM7 is currently approved in the USA for the prevention of IPD in infants and young children. Vaccination with PNCRM7 is safe and effective in infants and young children, and routine vaccination may promote the significant improvement of outcomes for patients with pneumococcal disease. The routine use of PNCRM7 could improve patient outcomes by safeguarding against the development of antibiotic-resistant strains of pneumococcus, thus simplifying the management of pneumococcal disease. Additionally, the costs associated with treatment could be substantially reduced. The cost of pneumococcal conjugate vaccines may determine the ability of the global community to use these vaccines, particularly in developing countries where limited healthcare budgets may dictate that funds be used for.
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