Triptych of the Hermit Saints: pneumococcal polysaccharide vaccines for the elderly

Figures & data

Figure 1 Microbiological etiology of CAP. A total of 349 CAP patients from 2 clinical trials were enrolled. Conventional microbiological analysis (blood culture, urinalysis, and sputum culture) identified Streptococcus pneumoniae as a causative organism. Determination of serotype-specific antibodies in serum showed S. pneumoniae involvement in an additional 28% of patients. Most commonly identified pathogens in the other pathogens category were Coxiella burnetti, Legionella species, Mycoplasma pneumoniae, Haemophilus influenzae, Chlamydophila psittaci, influenza A virus, and Staphylococcus aureus. Data from van Mens et al.¹¹

Abbreviation: CAP, community-acquired pneumonia.

Table 1 Physical, chemical, and immunological characteristics of pneumococcal polysaccharides

Pneumococcal capsular polysaccharides
Chemical composition	Linear or (limited) branched polymer of 2–8 different monosaccharides
Molecular weight	Large molecules with a molecular weight of 100 to >1000 kDa
Stability	Poorly degraded in vivo, may remain present for months after pneumococcal infection
Immunological properties	Category of T-cell independent type 2 antigens, meaning that for antibody production no specific T lymphocytes are needed. Do not induce immunological memory. Do not induce an immune response in children below 2 years of age

Notes: Data from reference.¹¹⁸ Artist impression of the structure of pneumococcal polysaccharide by Hieronimus Bosch. The Triptych of the Hermit Saints (1493), Gallerie dell’Accademia, Venice, Italy.¹²⁰

Figure 2 Pneumococcal serotypes and pneumococcal vaccines.

Notes: The first generation of pneumococcal conjugate vaccines (PCV7) consists of the serotypes 4, 6B, 9V, 14, 18C, 19F, and 23F. The second generation is PCV10 (PCV7 serotypes + 1, 5, 7F) and PCV13 (PCV10 serotypes + 3, 6A, 19A). Related serotypes belong to serogroups included in the conjugate vaccines. The size of the serotype circles is proportional to the frequency in invasive pneumococcal diseases in the Netherlands before the introduction of pneumococcal conjugate vaccination. Data from Rodenburg et al.¹¹⁹

Table 2 Costs of hospitalization of community-acquired pneumonia

Country	Cost of inpatient hospitalization (in dollars)	GDP per capita (in dollars) 2010	References
Belgium	6246	44,241	^Citation110
The Czech Republic	1271	19,703	^Citation111
France	6406	40,667	^Citation110
Germany	5308	42,482	^Citation110
Greece	2740	26,782	^Citation110
Hungary	1040	13,007	^Citation111
Italy	5464	35,663	^Citation110
the Netherlands	6060–13,611	50,289	^Citation104,Citation107,Citation110,Citation116
Poland	740	12,426	^Citation111
Portugal	2933	22,514	^Citation110
Slovakia	1752	16,553	^Citation110
Spain	4297	30,720	^Citation110
Turkey	1129	10,111	^Citation110
UK	4063	38,741	^Citation110
USA	9492–43,611	48,291	^Citation112^–^Citation115

Note: GDP per capita (2010). Data from UN Data.¹²¹

Abbreviation: GDP, gross domestic product.

Figure 3 Detail of the right panel of The Triptych of the Hermit Saints by Hieronymus Bosch (1493), Gallerie dell’Accademia, Venice, Italy.

Note: Reprinted from Wikimedia Commons.¹²⁰

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