Espaçadores: deposição pulmonar, eficácia e efetividade clínicas

Abstract

With respect of the article published by Di Nuzzo & Fonseca 1 we would like to point out that the information provided on the subject of immunization against pneumococcal diseases require correction, as described below. In this article, four conjugated pneumococcal vaccines are presented. In Brazil, however, there is just one conjugated pneumococcal vaccine, the 7-valent vaccine conjugated with the CRM197 diphtheria toxin (serotypes 4, 6B, 9V, 14, 18C, 19F and 23F), which is indicated for administration from 2 months of age onwards (and not just from 2 months to 2 years) and can be given up to 5 years of age. Children who are first vaccinated with the 7-valent vaccine can later be given a dose of the 23-valent vaccine in special cases (high risk). 2,3 Immunodepressed children over 2 years of age should be given two doses of the 7-valent vaccine (with a 2-month interval) and a single dose of the 23-valent vaccine (2 months after the last dose of the 7-valent vaccine). Recent studies of the efficacy and immunogenicity of the vaccine for premature patients, and also for older children requiring protection from non-invasive diseases (e.g. acute otitis media) are the references that have been used to widen the indications and the target-population of the vaccine. 4-7 With respect of the 23-valent vaccine, this should be classified among the polysaccharide vaccines, composed of purified antigens from the polysaccharide capsules of 23 serotypes, being only available in our country for administration from 2 years of age onwards. The 9 and 11-valent conjugated vaccines are not yet available commercially being in the final phases of research.