Pnömokok Profilaksisi
Özet
Streptococcus pneumoniae (pnömokok), toplumda gelişen pnömonilerin %20-50'sinden sorumlu olan, üst ve alt solunum yolu enfeksiyonlarının yanı sıra menenjit ve sepsis gibi invazif hastalıklara da yol açabilen gram pozitif bir bakteridir. Bakterinin polisakkarit yapısındaki kapsülü, kompleman aktivitesini inhibe ederek fagositozdan kaçmasını sağlar ve sistemik virülansını artırır. İnvazif pnömokok enfeksiyonu riski, 65 yaş üstü bireylerde, kronik akciğer, kalp, karaciğer, böbrek hastalarında ve immün yetmezliği olanlarda belirgin şekilde yüksektir. Korunmada temel olarak iki tür aşı kullanılmaktadır: Pürifiye kapsül polisakkaritlerini içeren 23 valanlı polisakkarit aşı (PPV23) ve polisakkaritin immünojenisitesini artıran bir taşıyıcı proteine konjuge edildiği konjuge aşılar (PCV13, PCV15, PCV20). Aşılama şeması, hastanın yaşına, bağışıklık durumuna ve komorbiditelerine göre konjuge ve polisakkarit aşıların ardışık uygulanmasıyla planlanır. Son yıllarda penisilin ve makrolid grubu antibiyotiklere karşı pnömokok direncinin artması, profilaksinin önemini daha da artırmıştır. Yaygın aşılama sonrasında aşı suşlarına bağlı invazif enfeksiyonlarda ciddi azalma görülse de, aşı dışı serotiplerle gelişen enfeksiyonlarda artış gözlenmektedir; bu nedenle risk gruplarının takibi ve aşılanması kritik önem taşır.
Streptococcus pneumoniae (pneumococcus) is a gram-positive bacterium responsible for 20-50% of community-acquired pneumonia, capable of causing upper and lower respiratory tract infections, as well as invasive diseases like meningitis and sepsis. The bacterium's polysaccharide capsule contributes to its systemic virulence by inhibiting complement activity and evading phagocytosis. The risk of invasive pneumococcal disease increases significantly in individuals over 65 years old, and those with chronic lung, heart, liver, or kidney diseases, and immunodeficiencies. Prophylaxis relies on two major vaccine types: the 23-valent polysaccharide vaccine (PPV23) containing purified capsular polysaccharides, and conjugate vaccines (PCV13, PCV15, PCV20) where polysaccharides are bound to a carrier protein to enhance immunogenicity. Vaccination schedules are tailored based on the patient's age, immune status, and comorbidities, utilizing sequential administration of conjugate and polysaccharide vaccines. The rise in pneumococcal resistance to penicillin and macrolides since the late 20th century highlights the critical value of prophylaxis. Although widespread vaccination has markedly reduced invasive infections caused by vaccine serotypes, a subsequent rise in non-vaccine serotype infections underscores the ongoing necessity for clinician vigilance and routine immunization of high-risk populations.
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