Progress in mucosal immunization for protection against pneumococcal pneumonia.

Lower respiratory tract infections are the fourth cause of death worldwide and pneumococcus is the leading cause of pneumonia. Nonetheless, existing pneumococcal vaccines are less effective against pneumonia than invasive diseases and serotype replacement is a major concern. Protein antigens could induce serotype-independent protection, and mucosal immunisation could offer local and systemic immune responses and induce protection against pneumococcal colonisation and lung infection. : Immunity induced in the experimental human pneumococcal carriage model, approaches to address the physiological barriers to mucosal immunisation and improve delivery of the vaccine antigens, different strategies already tested for pneumococcal mucosal vaccination, including live recombinant bacteria, nanoparticles, bacterium-like particles and nanogels as well as, nasal, pulmonary, sublingual and oral routes of vaccination. : The most promising delivery systems are based on nanoparticles, bacterial-like particles or nanogels, which possess greater immunogenicity than the antigen alone and are considered safer than approaches based on living cells or toxoids. These particles can protect the antigen from degradation, eliminating the refrigeration need during storage and allowing the manufacture of dry powder formulations. They can also increase antigen uptake, control release of antigen and trigger innate immune responses.