Principles and Practice of Clinical Bacteriology Second Edition - Free

16 β-HAEMOLYTIC STREPTOCOCCI
(Kotloff et al. 2004), which has provided the first evidence that a
hybrid fusion protein is a feasible strategy for evoking type-specific
opsonic antibodies against multiple serotypes of GAS without eliciting
antibodies that cross-react with host tissues. This represents a critical
step in GAS vaccine development.
The conserved C-terminus of the M protein has also been considered
as a vaccine candidate. Conserved T-cell epitopes, which are thought
to be rheumatogenic, reside in the C-terminus of the protein
(Robinson, Case and Kehoe 1993; Pruksakorn et al. 1994), though
rheumatogenic T-cell epitopes may also exist in the variable N-terminus
(Guilherme et al. 2000). These considerations have greatly complicated
GAS vaccine development because of fears of precipitating RF in
vaccinated individuals (Pruksakorn et al. 1994; Brandt et al. 2000).
Recent studies suggest that opsonic antibodies to M protein alone
are insufficient for opsonophagocytosis of S. pyogenes, emphasising
the need to seek additional vaccine candidates. Certain non-M-protein
antigens have already been evaluated in preclinical models, including
the streptococcal C5a peptidase, the streptococcal cysteine protease
(SPEB) and the GAS carbohydrate.
Although maternal intrapartum antibiotic prophylaxis is clearly
effective and has reduced the incidence of early-onset GBS neonatal
disease substantially in the United States, it cannot prevent late-onset
GBS disease. Vaccination of women of childbearing age against GBS
could theoretically prevent both early-onset and late-onset GBS
disease in the neonate, in addition to preventing GBS disease in
pregnant women. Opsonic antibodies directed against the capsular
polysaccharide of GBS confer serotype-specific protection. Initial
vaccines developed focused on capsular type III isolates, but the
emergence of type V isolates in recent years has prompted the
development of a polyvalent GBS vaccine (Baker and Edwards
2003). Vaccines have been developed by coupling purified capsular
polysaccharide antigen of GBS with an immunogenic protein carrier.
Glycoconjugate vaccines against all nine currently identified GBS
serotypes have been synthesised and shown to be immunogenic in
animal models and in human phase I and II trials. The recent results
strongly suggest that GBS conjugate vaccines may be effective in the
prevention of GBS disease (Paoletti and Kasper 2003).
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