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Efficacy of a Protein Vaccine and a Conjugate Vaccine Against Co-colonization with Vaccine-type and Non-vaccine Type Pneumococci in Mice. Pathogens 2020; 9:pathogens9040278. [PMID: 32290340 PMCID: PMC7238145 DOI: 10.3390/pathogens9040278] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 04/06/2020] [Accepted: 04/08/2020] [Indexed: 11/29/2022] Open
Abstract
Widespread use of pneumococcal conjugate vaccines (PCVs) has led to substitution of vaccine-type (VT) strains by non-vaccine type (NVT) strains in nasopharyngeal carriage. We compared the efficacy of PCV13 and a nasal protein formulation containing pneumococcal surface protein A (PspA) adjuvanted with the whole-cell pertussis vaccine (wP) in the protection against co-colonization challenge models in mice with VT and NVT strains expressing different PspAs. Immunized mice were challenged with two different mixtures: i. VT4 (PspA3) + NVT33 (PspA1) and ii. VT23F (PspA2) + NVT15B/C (PspA4). Results from the first mixture showed a reduction in loads of VT4 strain in the nasopharynx of mice immunized with PCV13. A statistical difference between the loads of the VT and NVT strains was observed, indicating a competitive advantage for the NVT strain in PCV13-immunized animals. In the second mixture, no reduction was observed for the VT23F strain, probably due to low levels of anti-23F polysaccharide IgG induced by PCV13. Interestingly, a combination of the PspA formulation containing wP with PCV13 led to a reduction in colonization with both strains of the two mixtures tested, similar to the groups immunized nasally with wP or PspA plus wP. These results indicate that a combination of vaccines may be a useful strategy to overcome pneumococcal serotype replacement.
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Lecrenier N, Marijam A, Olbrecht J, Soumahoro L, Nieto Guevara J, Mungall B. Ten years of experience with the pneumococcal non-typeable Haemophilus influenzae protein D-conjugate vaccine (Synflorix) in children. Expert Rev Vaccines 2020; 19:247-265. [DOI: 10.1080/14760584.2020.1738226] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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53
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Development of Next Generation Streptococcus pneumoniae Vaccines Conferring Broad Protection. Vaccines (Basel) 2020; 8:vaccines8010132. [PMID: 32192117 PMCID: PMC7157650 DOI: 10.3390/vaccines8010132] [Citation(s) in RCA: 82] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 02/22/2020] [Accepted: 02/29/2020] [Indexed: 02/06/2023] Open
Abstract
Streptococcus pneumoniae is a major pathogen causing pneumonia with over 2 million deaths annually, especially in young children and the elderly. To date, at least 98 different pneumococcal capsular serotypes have been identified. Currently, the vaccines for prevention of S. pneumoniae infections are the 23-valent pneumococcal polysaccharide-based vaccine (PPV23) and the pneumococcal conjugate vaccines (PCV10 and PCV13). These vaccines only cover some pneumococcal serotypes and are unable to protect against non-vaccine serotypes and unencapsulated S. pneumoniae. This has led to a rapid increase in antibiotic-resistant non-vaccine serotypes. Hence, there is an urgent need to develop new, effective, and affordable pneumococcal vaccines, which could cover a wide range of serotypes. This review discusses the new approaches to develop effective vaccines with broad serotype coverage as well as recent development of promising pneumococcal vaccines in clinical trials. New vaccine candidates are the inactivated whole-cell vaccine strain (Δpep27ΔcomD mutant) constructed by mutations of specific genes and several protein-based S. pneumoniae vaccines using conserved pneumococcal antigens, such as lipoprotein and surface-exposed protein (PspA). Among the vaccines in Phase 3 clinical trials are the pneumococcal conjugate vaccines, PCV-15 (V114) and 20vPnC. The inactivated whole-cell and several protein-based vaccines are either in Phase 1 or 2 trials. Furthermore, the recent progress of nanoparticles that play important roles as delivery systems and adjuvants to improve the performance, as well as the immunogenicity of the nanovaccines, are reviewed.
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Kwambana-Adams BA, Mulholland EK, Satzke C. State-of-the-art in the pneumococcal field: Proceedings of the 11 th International Symposium on Pneumococci and Pneumococcal Diseases (ISPPD-11). Pneumonia (Nathan) 2020; 12:2. [PMID: 32042572 PMCID: PMC7001343 DOI: 10.1186/s41479-019-0064-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 12/06/2019] [Indexed: 12/18/2022] Open
Abstract
The International Symposium on Pneumococci and Pneumococcal Diseases (ISPPD) is the premier global scientific symposium dedicated to the exchange, advancement and dissemination of the latest research on the pneumococcus, one of the world's deadliest bacterial pathogens. Since the first ISPPD was held in 1998, substantial progress has been made to control pneumococcal disease, for instance, more than half of surviving infants (78.6 million) from 143 countries now have access to the life-saving pneumococcal conjugate vaccine (PCV). The 11th ISPPD (ISPPD-11) was held in Melbourne, Australia in April 2018 and the proceedings of the symposium are captured in this report. Twenty years on from the first ISPPD, there remain many challenges and unanswered questions such as the continued disparity in disease incidence in Indigenous populations, the slow roll-out of PCV in some regions such as Asia, the persisting burden of disease in adults, serotype replacement and diagnosis of pneumococcal pneumonia. ISPPD-11 also put the spotlight on cutting-edge science including metagenomic, transcriptomic, microscopy, medical imaging and mathematical modelling approaches. ISPPD-11 was highly diverse, bringing together 1184 delegates from 86 countries, representing various fields including academia, primary healthcare, pharmaceuticals, biotechnology, policymakers and public health.
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Affiliation(s)
- Brenda Anna Kwambana-Adams
- NIHR Global Health Research Unit on Mucosal Pathogens, Division of Infection and Immunity, University College London, London, UK
| | - E. Kim Mulholland
- Murdoch Children’s Research Institute, Parkville, VIC Australia
- Department of Paediatrics, The University of Melbourne, Parkville, VIC Australia
- London School of Hygiene and Tropical Medicine, London, WC1H UK
| | - Catherine Satzke
- Murdoch Children’s Research Institute, Parkville, VIC Australia
- Department of Paediatrics, The University of Melbourne, Parkville, VIC Australia
- Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria Australia
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55
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Cremers AJH, Mobegi FM, van der Gaast-de Jongh C, van Weert M, van Opzeeland FJ, Vehkala M, Knol MJ, Bootsma HJ, Välimäki N, Croucher NJ, Meis JF, Bentley S, van Hijum SAFT, Corander J, Zomer AL, Ferwerda G, de Jonge MI. The Contribution of Genetic Variation of Streptococcus pneumoniae to the Clinical Manifestation of Invasive Pneumococcal Disease. Clin Infect Dis 2020; 68:61-69. [PMID: 29788414 DOI: 10.1093/cid/ciy417] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 05/10/2018] [Indexed: 01/02/2023] Open
Abstract
Background Different clinical manifestations of invasive pneumococcal disease (IPD) have thus far mainly been explained by patient characteristics. Here we studied the contribution of pneumococcal genetic variation to IPD phenotype. Methods The index cohort consisted of 349 patients admitted to 2 Dutch hospitals between 2000-2011 with pneumococcal bacteremia. We performed genome-wide association studies to identify pneumococcal lineages, genes, and allelic variants associated with 23 clinical IPD phenotypes. The identified associations were validated in a nationwide (n = 482) and a post-pneumococcal vaccination cohort (n = 121). The contribution of confirmed pneumococcal genotypes to the clinical IPD phenotype, relative to known clinical predictors, was tested by regression analysis. Results Among IPD patients, the presence of pneumococcal gene slaA was a nationwide confirmed independent predictor of meningitis (odds ratio [OR], 10.5; P = .001), as was sequence cluster 9 (serotype 7F: OR, 3.68; P = .057). A set of 4 pneumococcal genes co-located on a prophage was a confirmed independent predictor of 30-day mortality (OR, 3.4; P = .003). We could detect the pneumococcal variants of concern in these patients' blood samples. Conclusions In this study, knowledge of pneumococcal genotypic variants improved the clinical risk assessment for detrimental manifestations of IPD. This provides us with novel opportunities to target, anticipate, or avert the pathogenic effects related to particular pneumococcal variants, and indicates that information on pneumococcal genotype is important for the diagnostic and treatment strategy in IPD. Ongoing surveillance is warranted to monitor the clinical value of information on pneumococcal variants in dynamic microbial and susceptible host populations.
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Affiliation(s)
- Amelieke J H Cremers
- Section of Pediatric Infectious Diseases, Laboratory of Medical Immunology, Radboud Institute for Molecular Life Sciences, Nijmegen, The Netherlands.,Radboud Center for Infectious Diseases, Center for Molecular and Biomolecular Informatics, Radboudumc, Nijmegen, The Netherlands.,Department of Medical Microbiology, Center for Molecular and Biomolecular Informatics, Radboudumc, Nijmegen, The Netherlands
| | - Fredrick M Mobegi
- Section of Pediatric Infectious Diseases, Laboratory of Medical Immunology, Radboud Institute for Molecular Life Sciences, Nijmegen, The Netherlands.,Radboud Center for Infectious Diseases, Center for Molecular and Biomolecular Informatics, Radboudumc, Nijmegen, The Netherlands.,Bacterial Genomics Group, Center for Molecular and Biomolecular Informatics, Radboudumc, Nijmegen, The Netherlands
| | - Christa van der Gaast-de Jongh
- Section of Pediatric Infectious Diseases, Laboratory of Medical Immunology, Radboud Institute for Molecular Life Sciences, Nijmegen, The Netherlands.,Radboud Center for Infectious Diseases, Center for Molecular and Biomolecular Informatics, Radboudumc, Nijmegen, The Netherlands
| | - Michelle van Weert
- Section of Pediatric Infectious Diseases, Laboratory of Medical Immunology, Radboud Institute for Molecular Life Sciences, Nijmegen, The Netherlands.,Radboud Center for Infectious Diseases, Center for Molecular and Biomolecular Informatics, Radboudumc, Nijmegen, The Netherlands
| | - Fred J van Opzeeland
- Section of Pediatric Infectious Diseases, Laboratory of Medical Immunology, Radboud Institute for Molecular Life Sciences, Nijmegen, The Netherlands.,Radboud Center for Infectious Diseases, Center for Molecular and Biomolecular Informatics, Radboudumc, Nijmegen, The Netherlands
| | - Minna Vehkala
- Department of Mathematics and Statistics, University of Helsinki, Finland
| | - Mirjam J Knol
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Hester J Bootsma
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Niko Välimäki
- Department of Mathematics and Statistics, University of Helsinki, Finland
| | - Nicholas J Croucher
- Medical Research Council Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, Imperial College London, United Kingdom
| | - Jacques F Meis
- Department of Medical Microbiology and Infectious Diseases, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Stephen Bentley
- Wellcome Trust Sanger Institute, Pathogen Genomics Group, Hinxton, Cambridge, United Kingdom
| | - Sacha A F T van Hijum
- Radboud Center for Infectious Diseases, Center for Molecular and Biomolecular Informatics, Radboudumc, Nijmegen, The Netherlands.,Bacterial Genomics Group, Center for Molecular and Biomolecular Informatics, Radboudumc, Nijmegen, The Netherlands.,NIZO, Ede, The Netherlands
| | - Jukka Corander
- Department of Mathematics and Statistics, University of Helsinki, Finland.,Wellcome Trust Sanger Institute, Pathogen Genomics Group, Hinxton, Cambridge, United Kingdom.,Department of Biostatistics, University of Oslo, Norway
| | - Aldert L Zomer
- Department of Infectious Diseases and Immunology, Faculty of Veterinary Medicine, Utrecht University, The Netherlands
| | - Gerben Ferwerda
- Section of Pediatric Infectious Diseases, Laboratory of Medical Immunology, Radboud Institute for Molecular Life Sciences, Nijmegen, The Netherlands.,Radboud Center for Infectious Diseases, Center for Molecular and Biomolecular Informatics, Radboudumc, Nijmegen, The Netherlands
| | - Marien I de Jonge
- Section of Pediatric Infectious Diseases, Laboratory of Medical Immunology, Radboud Institute for Molecular Life Sciences, Nijmegen, The Netherlands.,Radboud Center for Infectious Diseases, Center for Molecular and Biomolecular Informatics, Radboudumc, Nijmegen, The Netherlands
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Zintgraff J, Fossati S, Pereira CS, Veliz O, Regueira M, Moscoloni MA, Irazu L, Lara C, Napoli D. Distribution of PCV13 and PPSV23 Streptococcus pneumoniae serotypes in Argentinean adults with invasive disease, 2013-2017. Rev Argent Microbiol 2020; 52:189-194. [PMID: 31932112 DOI: 10.1016/j.ram.2019.11.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 10/30/2019] [Accepted: 11/18/2019] [Indexed: 01/31/2023] Open
Abstract
Streptococcus pneumoniae is a major cause of severe invasive disease associated with high mortality and morbidity worldwide. To identify the serotypes most commonly associated with infection in adults in Argentina, 791 pneumococcal isolates from 56 hospitals belonging to 16 provinces and Buenos Aires city were serotyped. The isolates were submitted as part of a National Surveillance Program for invasive pneumococcal disease in adults, which started in 2013. Serotypes 3, 8, 12F, 7F and 1 were the most prevalent among adult patients. During the study period there was no significant difference in serotype distribution between the age groups studied (18-64 and ≥65 years old), except for serotype 1, 3 and 23A. Most prevalent serotypes in pneumonia were serotype 7F, 1, 12F, 8, and 3. When the clinical diagnosis was meningitis, serotype 3 and 12F were the most prevalent, whereas when the diagnosis was sepsis/bacteremia the most prevalent was serotype 8. In this work, for the 18-64-year-old group, PPSV23 and PCV13 serotypes accounted for 74.56% and 44.54% respectively of the cases in the studied period. On the other hand, for the ≥65-year-old group, these serotypes represented 72.30% and 41.42% respectively. The aim of this work was to establish the knowledge bases of the serotypes that cause invasive pneumococcal diseases in the adult population in Argentina and to be able to detect changes in their distribution over time in order to explore the potential serotype coverage of the vaccines in current use.
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Affiliation(s)
- Jonathan Zintgraff
- Servicio de Bacteriología Clínica, INEI-ANLIS "Dr. Carlos G. Malbrán", Ciudad Autónoma de Buenos Aires, Argentina.
| | - Sofia Fossati
- Servicio de Bacteriología Clínica, INEI-ANLIS "Dr. Carlos G. Malbrán", Ciudad Autónoma de Buenos Aires, Argentina
| | - Cecilia Sorhouet Pereira
- Servicio de Bacteriología Clínica, INEI-ANLIS "Dr. Carlos G. Malbrán", Ciudad Autónoma de Buenos Aires, Argentina
| | - Omar Veliz
- Servicio de Bacteriología Clínica, INEI-ANLIS "Dr. Carlos G. Malbrán", Ciudad Autónoma de Buenos Aires, Argentina
| | - Mabel Regueira
- Servicio de Bacteriología Clínica, INEI-ANLIS "Dr. Carlos G. Malbrán", Ciudad Autónoma de Buenos Aires, Argentina
| | - Maria Alicia Moscoloni
- Servicio de Bacteriología Clínica, INEI-ANLIS "Dr. Carlos G. Malbrán", Ciudad Autónoma de Buenos Aires, Argentina
| | - Lucia Irazu
- Servicio de Bacteriología Clínica, INEI-ANLIS "Dr. Carlos G. Malbrán", Ciudad Autónoma de Buenos Aires, Argentina
| | - Claudia Lara
- Servicio de Bacteriología Clínica, INEI-ANLIS "Dr. Carlos G. Malbrán", Ciudad Autónoma de Buenos Aires, Argentina
| | - Daniela Napoli
- Servicio de Bacteriología Clínica, INEI-ANLIS "Dr. Carlos G. Malbrán", Ciudad Autónoma de Buenos Aires, Argentina
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57
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Ung L, Bispo PJM, Bryan NC, Andre C, Chodosh J, Gilmore MS. The Best of All Worlds: Streptococcus pneumoniae Conjunctivitis through the Lens of Community Ecology and Microbial Biogeography. Microorganisms 2019; 8:microorganisms8010046. [PMID: 31881682 PMCID: PMC7022640 DOI: 10.3390/microorganisms8010046] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 12/16/2019] [Accepted: 12/21/2019] [Indexed: 12/16/2022] Open
Abstract
The study of the forces which govern the geographical distributions of life is known as biogeography, a subject which has fascinated zoologists, botanists and ecologists for centuries. Advances in our understanding of community ecology and biogeography—supported by rapid improvements in next generation sequencing technology—have now made it possible to identify and explain where and why life exists as it does, including within the microbial world. In this review, we highlight how a unified model of microbial biogeography, one which incorporates the classic ecological principles of selection, diversification, dispersion and ecological drift, can be used to explain community dynamics in the settings of both health and disease. These concepts operate on a multiplicity of temporal and spatial scales, and together form a powerful lens through which to study microbial population structures even at the finest anatomical resolutions. When applied specifically to curious strains of conjunctivitis-causing, nonencapsulated Streptococcus pneumoniae, we show how this conceptual framework can be used to explain the possible evolutionary and disease-causing mechanisms which allowed these lineages to colonize and invade a separate biogeography. An intimate knowledge of this radical bifurcation in phylogeny, still the only known niche subspecialization for S. pneumoniae to date, is critical to understanding the pathogenesis of ocular surface infections, nature of host-pathogen interactions, and developing strategies to curb disease transmission.
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Affiliation(s)
- Lawson Ung
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA 02114, USA; (L.U.); (P.J.M.B.); (C.A.); (J.C.)
- Infectious Disease Institute, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA 02114, USA;
| | - Paulo J. M. Bispo
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA 02114, USA; (L.U.); (P.J.M.B.); (C.A.); (J.C.)
- Infectious Disease Institute, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA 02114, USA;
| | - Noelle C. Bryan
- Infectious Disease Institute, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA 02114, USA;
- Massachusetts Institute of Technology, Department of Earth, Atmospheric and Planetary Sciences, Cambridge, MA 02139, USA
| | - Camille Andre
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA 02114, USA; (L.U.); (P.J.M.B.); (C.A.); (J.C.)
- Infectious Disease Institute, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA 02114, USA;
| | - James Chodosh
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA 02114, USA; (L.U.); (P.J.M.B.); (C.A.); (J.C.)
- Infectious Disease Institute, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA 02114, USA;
| | - Michael S. Gilmore
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA 02114, USA; (L.U.); (P.J.M.B.); (C.A.); (J.C.)
- Infectious Disease Institute, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA 02114, USA;
- Correspondence: ; Tel.: +1-617-523-7900
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58
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van Deursen AMM, van Houten MA, Webber C, Patton M, Scott D, Patterson S, Jiang Q, Gruber WC, Schmoele-Thoma B, Grobbee DE, Bonten MJM, Sanders EAM. The Impact of the 13-Valent Pneumococcal Conjugate Vaccine on Pneumococcal Carriage in the Community Acquired Pneumonia Immunization Trial in Adults (CAPiTA) Study. Clin Infect Dis 2019; 67:42-49. [PMID: 29324986 DOI: 10.1093/cid/ciy009] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 01/05/2018] [Indexed: 01/08/2023] Open
Abstract
Background The impact of pneumococcal conjugate vaccination on the prevalence of nasopharyngeal carriage with pneumococci and other bacteria in adults is unknown. The direct effects of the 13-valent pneumococcal conjugate vaccine (PCV13) in community dwelling older adults was investigated as part of the randomized controlled Community Acquired Pneumonia immunization Trial in Adults (CAPiTA). Methods We determined the carriage of Streptococcus pneumoniae, Staphylococcus aureus, Haemophilus influenzae, and Moraxella catarrhalis before and 6, 12, and 24 months after vaccination using polymerase chain reaction (PCR)-based methods and conventional cultures of nasopharyngeal and oropharyngeal swab samples in 1006 PCV13 recipients and 1005 controls. Serotyping of the 13 vaccine-type (VT) pneumococci was performed by PCR targeting capsular synthesis genes and Quellung reaction of isolates. Results Before randomization and based on PCR, 339 of 1891 subjects had nasopharyngeal carriage with any pneumococci (17.9%), and 114 of 1891 (6.0%) carried VT pneumococci. At 6 months after vaccination, VT pneumococcal carriage was significantly lower in PCV13 recipients than in the placebo group (relative risk, 0.53; 95% confidence interval, .35-.80; P = .04). There was no difference between the groups at 12 and 24 months after vaccination. Carriage of non-VT pneumococci, S. aureus, H. influenzae, and M. catarrhalis did not change between groups. Conclusions In community-dwelling adults aged ≥65 years, a single dose of PCV13 seems to elicit a small and temporary reduction in VT carriage 6 months after vaccination. Neither replacement by non-VT serotypes nor impact on other nasopharyngeal bacteria was observed.
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Affiliation(s)
- Anna M M van Deursen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, the Netherlands.,Department of Immunology, Wilhelmina Children's Hospital, University Medical Center Utrecht, the Netherlands.,Spaarne Gasthuis Academy, Hoofddorp
| | | | - Chris Webber
- Pfizer Vaccine Clinical Research & Development, Pearl River, New York
| | - Michael Patton
- Pfizer Vaccine Clinical Research & Development, Hurley, United Kingdom
| | - Daniel Scott
- Pfizer Vaccine Clinical Research & Development, Pearl River, New York
| | - Scott Patterson
- Pfizer Vaccine Clinical Research & Development, Collegeville, Pennsylvania
| | - Qin Jiang
- Pfizer Vaccine Clinical Research & Development, Collegeville, Pennsylvania
| | - William C Gruber
- Pfizer Vaccine Clinical Research & Development, Pearl River, New York
| | | | - Diederick E Grobbee
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, the Netherlands.,Julius Clinical, Zeist, the Netherlands
| | - Marc J M Bonten
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, the Netherlands.,Department of Medical Microbiology, University Medical Center Utrecht, the Netherlands
| | - Elisabeth A M Sanders
- Department of Immunology, Wilhelmina Children's Hospital, University Medical Center Utrecht, the Netherlands
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59
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Oliveira DS, Chiaravalloti F, Mota TS, de Araujo DB, Sartori AMC. Spatial analysis of pneumococcal meningitis in São Paulo in the pre- and post-immunization era. Rev Saude Publica 2019. [PMID: 31340351 PMCID: PMC6629289 DOI: 10.11606/s1518-8787.201905300118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To analyze the pneumococcal meningitis incidence rates in the State of São Paulo, Brazil, by age group, municipalities and micro-regions, as well as the spatial distribution of pneumococcal meningitis incidence rates among children under 5 years old in the pre- (2005-2009) and post-vaccination (2011-2013) periods and its associations with socioeconomic variables and vaccination coverage. METHODS The data source was the Brazilian Notifiable Diseases Information System. For the pre- and post-vaccination periods, thematic maps were built for pneumococcal meningitis incidence in under-5 children, by São Paulo state micro-regions, vaccination coverage and socioeconomic variables, using QGIS 2.6.1 software. Scan statistics performed by the SatScan 9.2 software were used to analyze spatial and spatiotemporal clusters in São Paulo municipalities and micro-regions. A Bayesian inference for latent Gaussian model with zero-inflated Poisson model through the integrated nested Laplace approximation was used in the spatial analysis to evaluate associations between pneumococcal meningitis incidence rates and socioeconomic variables of interest in São Paulo micro-regions. RESULTS From 2005 to 2013, 3,963 pneumococcal meningitis cases were reported in São Paulo. Under-5 children were the most affected in the whole period. In the post-vaccination period, pneumococcal meningitis incidence rates decreased among this population, particularly among infants (from 4.17/100,000 in 2005 to 2.54/100,000 in 2013). Two clusters were found in pre-vaccination - one of low risk for pneumococcal meningitis, in the northwest of the state (OR = 0.45, p = 0.0003); and another of high risk in the southeast (OR = 1.62, p = 0.0000). In the post-vaccination period, only a high-risk cluster remained, in the southeast (RR = 1.97, p = 0.0570). In Bayesian analysis, wealth was the only variable positively associated to pneumococcal meningitis (RR = 1.026, 95%CI 1.002-1.052). CONCLUSIONS Pneumococcal meningitis is probably underdiagnosed and underreported in São Paulo. Differentiated rates of pneumococcal meningitis diagnosis and reporting in each microregion, according to the São Paulo Index of Social Responsibility, might explain our results.
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Affiliation(s)
- Danise Senna Oliveira
- Universidade Federal de Pelotas. Faculdade de Medicina. Departamento de Clínica Médica. Pelotas, RS, Brasil
| | - Francisco Chiaravalloti
- Universidade de São Paulo. Faculdade de Saúde Pública. Departamento de Epidemiologia. São Paulo, SP, Brasil
| | - Thiago Santos Mota
- Faculdade de Tecnologia de Botucatu. Departamento de Estatística. Botucatu, SP, Brasil
| | - Daniel Brito de Araujo
- Universidade Federal de Pelotas. Faculdade de Medicina. Departamento de Clínica Médica. Pelotas, RS, Brasil
| | - Ana Marli Christovam Sartori
- Universidade de São Paulo. Faculdade de Medicina. Departamento de Moléstias Infecciosas e Parasitárias. São Paulo, SP, Brasil
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60
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Oliveira DS, Chiaravalloti Neto F, Mota TS, Araujo DBD, Sartori AMC. Spatial analysis of pneumococcal meningitis in São Paulo in the pre- and post-immunization era. Rev Saude Publica 2019; 53:59. [PMID: 31340351 DOI: 10.11606/s1518-8787.2019053001183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Accepted: 09/28/2018] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To analyze the pneumococcal meningitis incidence rates in the State of São Paulo, Brazil, by age group, municipalities and micro-regions, as well as the spatial distribution of pneumococcal meningitis incidence rates among children under 5 years old in the pre- (2005-2009) and post-vaccination (2011-2013) periods and its associations with socioeconomic variables and vaccination coverage. METHODS The data source was the Brazilian Notifiable Diseases Information System. For the pre- and post-vaccination periods, thematic maps were built for pneumococcal meningitis incidence in under-5 children, by São Paulo state micro-regions, vaccination coverage and socioeconomic variables, using QGIS 2.6.1 software. Scan statistics performed by the SatScan 9.2 software were used to analyze spatial and spatiotemporal clusters in São Paulo municipalities and micro-regions. A Bayesian inference for latent Gaussian model with zero-inflated Poisson model through the integrated nested Laplace approximation was used in the spatial analysis to evaluate associations between pneumococcal meningitis incidence rates and socioeconomic variables of interest in São Paulo micro-regions. RESULTS From 2005 to 2013, 3,963 pneumococcal meningitis cases were reported in São Paulo. Under-5 children were the most affected in the whole period. In the post-vaccination period, pneumococcal meningitis incidence rates decreased among this population, particularly among infants (from 4.17/100,000 in 2005 to 2.54/100,000 in 2013). Two clusters were found in pre-vaccination - one of low risk for pneumococcal meningitis, in the northwest of the state (OR = 0.45, p = 0.0003); and another of high risk in the southeast (OR = 1.62, p = 0.0000). In the post-vaccination period, only a high-risk cluster remained, in the southeast (RR = 1.97, p = 0.0570). In Bayesian analysis, wealth was the only variable positively associated to pneumococcal meningitis (RR = 1.026, 95%CI 1.002-1.052). CONCLUSIONS Pneumococcal meningitis is probably underdiagnosed and underreported in São Paulo. Differentiated rates of pneumococcal meningitis diagnosis and reporting in each microregion, according to the São Paulo Index of Social Responsibility, might explain our results.
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Affiliation(s)
- Danise Senna Oliveira
- Universidade Federal de Pelotas. Faculdade de Medicina. Departamento de Clínica Médica. Pelotas, RS, Brasil
| | | | - Thiago Santos Mota
- Faculdade de Tecnologia de Botucatu. Departamento de Estatística. Botucatu, SP, Brasil
| | - Daniel Brito de Araujo
- Universidade Federal de Pelotas. Faculdade de Medicina. Departamento de Clínica Médica. Pelotas, RS, Brasil
| | - Ana Marli Christovam Sartori
- Universidade de São Paulo. Faculdade de Medicina. Departamento de Moléstias Infecciosas e Parasitárias. São Paulo, SP, Brasil
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La Vincente SF, von Mollendorf C, Ulziibayar M, Satzke C, Dashtseren L, Fox KK, Dunne EM, Nguyen CD, de Campo J, de Campo M, Thomson H, Surenkhand G, Demberelsuren S, Bujinlkham S, Do LAH, Narangerel D, Cherian T, Mungun T, Mulholland EK. Evaluation of a phased pneumococcal conjugate vaccine introduction in Mongolia using enhanced pneumonia surveillance and community carriage surveys: a study protocol for a prospective observational study and lessons learned. BMC Public Health 2019; 19:333. [PMID: 30898094 PMCID: PMC6429832 DOI: 10.1186/s12889-019-6639-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 03/08/2019] [Indexed: 11/17/2022] Open
Abstract
Background Streptococcus pneumoniae causes substantial morbidity and mortality among children. The introduction of pneumococcal conjugate vaccines (PCV) has the potential to dramatically reduce disease burden. As with any vaccine, it is important to evaluate PCV impact, to help guide decision-making and resource-allocation. Measuring PCV impact can be complex, particularly to measure impact on one of the most common and significant diseases caused by the pneumococcus, namely pneumonia. Here we outline the protocol developed to evaluate the impact of 13-valent PCV (PCV13) on childhood pneumonia in Mongolia, and a number of lessons learned in implementing the evaluation that may be helpful to other countries seeking to undertake pneumonia surveillance. Methods From 2016 PCV13 was introduced in a phased manner into the routine immunisation programme with some catch-up by the Government of Mongolia. We designed an evaluation to measure vaccine impact in children aged 2–59 months with hospitalised radiological pneumonia as a primary outcome, with secondary objectives to measure impact on clinically-defined pneumonia, nasopharyngeal carriage of S. pneumoniae among pneumonia patients and in the community, and severe respiratory infection associated with RSV and/or influenza. We enhanced an existing hospital-based pneumonia surveillance system by incorporating additional study components (nasopharyngeal swabbing using standard methods, C-reactive protein, risk factor assessment) and strengthening clinical practices, such as radiology as well as monitoring and training. We conducted cross-sectional community carriage surveys to provide data on impact on carriage among healthy children. Discussion Establishing a robust surveillance system is an important component of monitoring the impact of PCV within a country. The enhanced surveillance system in Mongolia will facilitate assessment of PCV13 impact on pneumonia, with radiological confirmed disease as the primary outcome. Key lessons arising from this evaluation have included the importance of establishing a core group of in-country staff to be responsible for surveillance activities and to work closely with this team; to be aware of external factors that could potentially influence disease burden estimates; to be flexible in data collection processes to respond to changing circumstances and lastly to ensure a consistent application of the pneumonia surveillance case definition throughout the study period.
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Affiliation(s)
- S F La Vincente
- Pneumococcal Research Group, Murdoch Children's Research Institute, Melbourne, Australia. .,Department of Paediatrics, The University of Melbourne, Melbourne, Australia. .,Telethon Kids Institute, Perth, Australia.
| | - C von Mollendorf
- Pneumococcal Research Group, Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Australia
| | - M Ulziibayar
- National Center of Communicable Diseases, Ulaanbaatar, Mongolia
| | - C Satzke
- Pneumococcal Research Group, Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Australia.,Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - L Dashtseren
- National Center of Communicable Diseases, Ulaanbaatar, Mongolia
| | - K K Fox
- World Health Organization Western Pacific Regional Office, Manila, Philippines
| | - E M Dunne
- Pneumococcal Research Group, Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Australia
| | - C D Nguyen
- Pneumococcal Research Group, Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Australia
| | - J de Campo
- Pneumococcal Research Group, Murdoch Children's Research Institute, Melbourne, Australia.,Department of Radiology, The University of Melbourne, Melbourne, Australia
| | - M de Campo
- Pneumococcal Research Group, Murdoch Children's Research Institute, Melbourne, Australia.,Department of Radiology, The University of Melbourne, Melbourne, Australia
| | - H Thomson
- Pneumococcal Research Group, Murdoch Children's Research Institute, Melbourne, Australia
| | - G Surenkhand
- National Center of Communicable Diseases, Ulaanbaatar, Mongolia
| | - S Demberelsuren
- World Health Organization Country Office, Ulaanbaatar, Mongolia
| | - S Bujinlkham
- National Center of Communicable Diseases, Ulaanbaatar, Mongolia
| | - L A H Do
- Pneumococcal Research Group, Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Australia
| | | | - T Cherian
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
| | - T Mungun
- National Center of Communicable Diseases, Ulaanbaatar, Mongolia
| | - E K Mulholland
- Pneumococcal Research Group, Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Australia.,London School of Hygiene and Tropical Medicine, London, UK
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Sader HS, Mendes RE, Le J, Denys G, Flamm RK, Jones RN. Antimicrobial Susceptibility of Streptococcus pneumoniae from North America, Europe, Latin America, and the Asia-Pacific Region: Results From 20 Years of the SENTRY Antimicrobial Surveillance Program (1997-2016). Open Forum Infect Dis 2019; 6:S14-S23. [PMID: 30895211 PMCID: PMC6419902 DOI: 10.1093/ofid/ofy263] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background The SENTRY Antimicrobial Surveillance Program monitors the frequency of occurrence and antimicrobial susceptibility of organisms from various infection types worldwide. In this investigation, we evaluated the antimicrobial susceptibility of Streptococcus pneumoniae isolates collected worldwide over 20 years (1997–2016). Methods A total of 65 993 isolates were consecutively collected (1 per infection episode) from North America (NA; n = 34 626; 2 nations), Europe (EUR; n = 19 123; 23 nations), the Asia-Pacific region (APAC; n = 7111; 10 nations), and Latin America (LATAM; n = 5133; 7 nations) and tested for susceptibility using reference broth microdilution methods. Resistant subgroups included multidrug-resistant (MDR; nonsusceptible to ≥3 classes of agents) and extensively drug-resistant (XDR; nonsusceptible to ≥5 classes). Results The isolates were collected primarily from respiratory tract infections (77.3%), and 25.4% were from pediatric patients. Penicillin susceptibility (≤0.06 mg/L) rates varied from 70.7% in EUR to 52.4% in APAC for all years combined. In NA, there was a slight improvement in susceptibility for the first few years of the program, from 66.5% in 1997–1998 to 69.4% in 1999–2000, followed by a decline until 2011–2012 (57.0%). Similar declines in penicillin susceptibility rates were observed in all regions, with the lowest rates of 67.3% in EUR (2011–2012), 41.6% in the APAC region (2007–2008), and 48.2% in LATAM (2013–2014). These declines were followed by improved susceptibility rates in all regions in later program years, with susceptibility rates of 55.6% to 71.8% in 2015–2016 (65.8% overall). Susceptibility rates to ceftriaxone, erythromycin, clindamycin, tetracycline, and trimethoprim-sulfamethoxazole followed a similar pattern, with a decrease in the first 12–14 years and a continued increase in the last 6–8 years of the program. MDR and XDR frequencies were highest in APAC (49.8% and 17.3% overall, respectively) and lowest in LATAM (10.8% and 1.9% overall, respectively). The most active agents for MDR/XDR isolates were ceftaroline (99.7%/99.1% susceptible), tigecycline (96.8%/95.9% susceptible), linezolid (100.0%/100.0% susceptible), and vancomycin (100.0%/100.0% susceptible). Conclusions S. pneumoniae susceptibility to many antibiotics increased in all regions in the last few years, and these increases may be related to PCV13 immunization, which was introduced in 2010.
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Affiliation(s)
| | | | - Jennifer Le
- Skaggs School of Pharmacy, University of California San Diego, San Diego, California
| | - Gerald Denys
- Indiana University School of Medicine, Indianapolis, Indiana
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Affiliation(s)
- Mark van der Linden
- National Reference Center for Streptococci, Department of Medical Microbiology, University Hospital RWTH Aachen, Aachen, Germany
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Ngocho JS, Magoma B, Olomi GA, Mahande MJ, Msuya SE, de Jonge MI, Mmbaga BT. Effectiveness of pneumococcal conjugate vaccines against invasive pneumococcal disease among children under five years of age in Africa: A systematic review. PLoS One 2019; 14:e0212295. [PMID: 30779801 PMCID: PMC6380553 DOI: 10.1371/journal.pone.0212295] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Accepted: 01/30/2019] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Despite the widespread implementation of the pneumococcal conjugate vaccine, Streptococcus pneumoniae remains the leading cause of severe pneumonia associated with mortality among children less than 5 years of age worldwide, with the highest mortality rates recorded in Africa and Asia. However, information on the effectiveness and prevalence of vaccine serotypes post-roll out remains scarce in most African countries. Hence, this systematic review aimed to describe what is known about the decline of childhood invasive pneumococcal disease post-introduction of the pneumococcal conjugate vaccine in Africa. METHODS This systematic review included articles published between 2009 and 2018 on the implementation of the pneumococcal conjugate vaccine in Africa. We searched PubMed, Scopus and African Index Medicus for articles in English. Studies on implementation programmes of pneumococcal conjugate vaccine 10/13, with before and after data from different African countries, were considered eligible. The review followed the procedures published in PROSPERO (ID = CRD42016049192). RESULTS In total, 2,280 studies were identified through electronic database research, and only 8 studies were eligible for inclusion in the final analysis. Approximately half (n = 3) of these studies were from South Africa. The overall decline in invasive pneumococcal disease ranged from 31.7 to 80.1%. Invasive pneumococcal diseases caused by vaccine serotypes declined significantly, the decline ranged from 35.0 to 92.0%. A much higher decline (55.0-89.0%) was found in children below 24 months of age. Of all vaccine serotypes, the relative proportions of serotypes 1, 5 and 19A doubled following vaccine roll out. INTERPRETATION Following the introduction of the pneumococcal conjugate vaccine, a significant decline was observed in invasive pneumococcal disease caused by vaccine serotypes. However, data on the effectiveness in this region remain scarce, meriting continued surveillance to assess the effectiveness of pneumococcal vaccination to improve protection against invasive pneumococcal disease.
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Affiliation(s)
- James Samwel Ngocho
- Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Best Magoma
- Kilimanjaro Regional Health Management Team, Moshi, Tanzania
| | | | - Michael Johnson Mahande
- Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Sia Emmanueli Msuya
- Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Marien Isaäk de Jonge
- Section Pediatric Infectious Diseases, Laboratory of Medical Immunology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
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LeMeur JB, Lefebvre B, Proulx JF, De Wals P. Limited impact of pneumococcal vaccines on invasive pneumococcal disease in Nunavik (Quebec). CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2019; 110:36-43. [PMID: 30341482 PMCID: PMC6964480 DOI: 10.17269/s41997-018-0138-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 09/07/2018] [Indexed: 11/17/2022]
Abstract
OBJECTIVE In 2002, a mass immunization campaign using the 23-valent pneumococcal polysaccharide vaccine (PPV23) was carried out in Nunavik to control an outbreak caused by a virulent clone of serotype 1 Streptococcus pneumoniae. At the same time, the 7-valent pneumococcal conjugate vaccine (PCV7) was introduced for routine immunization of infants, replaced by the 10-valent vaccine (PCV10) in 2009, and the 13-valent vaccine (PCV13) in 2011. The objective of this study was to describe the epidemiology of invasive pneumococcal disease (IPD) in relation to pneumococcal vaccine use. METHOD Retrospective analysis of IPD cases identified by the Quebec Public Health Laboratory during the period 1997-2016. RESULTS One hundred thirty-two IPD cases were identified during the study period. In adults, serotype 1 incidence decreased following the 2002 PPV23 mass campaign, but breakthrough cases occurred. Following PCV use, the incidence of vaccine-type IPD decreased markedly in children and also in adults but serotypes not covered by conjugate vaccines increased. The overall IPD rate was 43/100,000 person-years in the 1997-1999 pre-vaccine era and 58/100,000 person-years in 2010-2016. CONCLUSIONS The 2002 PPV23 mass immunization campaign may have contributed to control the serotype 1 outbreaks in Nunavik, but its effect was short-lived as IPDs caused by serotypes included in this vaccine continued to occur after 2005. PCV use in children induced important modifications in the epidemiology of IPD, but most of the benefits were eroded by serotype replacement.
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Affiliation(s)
- Jean-Baptiste LeMeur
- Institut National de Santé Publique du Québec, Montréal, Canada
- Département de Médecine Sociale et Préventive, Université Laval, CRIUCPQ, 2725, Chemin Ste-Foy, Québec City, QC, G1V 4G5, Canada
| | - Brigitte Lefebvre
- Laboratoire de Santé Publique du Québec, Institut National de Santé Publique du Québec, Sainte-Anne-de-Bellevue, Canada
| | | | - Philippe De Wals
- Institut National de Santé Publique du Québec, Montréal, Canada.
- Département de Médecine Sociale et Préventive, Université Laval, CRIUCPQ, 2725, Chemin Ste-Foy, Québec City, QC, G1V 4G5, Canada.
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Invasive pneumococcal diseases in children and adults before and after introduction of the 10-valent pneumococcal conjugate vaccine into the Austrian national immunization program. PLoS One 2019; 14:e0210081. [PMID: 30629620 PMCID: PMC6328268 DOI: 10.1371/journal.pone.0210081] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 12/17/2018] [Indexed: 01/25/2023] Open
Abstract
Background In February 2012 the ten-valent pneumococcal conjugate vaccine (PCV10) with a 2+1 doses schedule (3, 5, 12 or 14 months of age) without catch-up vaccination was introduced in Austria. We assessed direct and indirect vaccine effects on invasive pneumococcal disease (IPD) by a population-based intervention study. Methods The study period was divided into pre- (2009–2011) and post-period (2013–2017, February), regarding 2012 as transition year. Outcomes were defined as PCV10 ST-IPD, the PCV10-related ST 6A and 19A IPD and non-PCV10 excluding ST 6A-/19A-IPD (NVT-IPD). We used national surveillance data and compared average monthly incidence rate (IR) between pre- and post-period among <5, 5–49 and ≥50 years old. Additionally, for the 5–49 and ≥50 years old, and the 50–59 and ≥60 years old, we analyzed monthly incidence data of the pre-, post-period, and estimated trend and level changes by using a segmented time-series regression. Results The PCV-10 IPD was reduced by 58% (95% CI: 30%; 74%) and 67% (95% CI: 32%; 84%) among <5 and ≥50 years old; the reduction in ≥60 years was 71% (95% CI: 36%; 88%). There were no significant changes in the pre-post-rate or incidence trend of NVT-IPD in the <5 and ≥50 years old. ST-specific analyses revealed no ST 6A- and ST 19A IPD decline in any age-group, and a ST 8 IPD increase among ≥50 years old (IR ratio: 3.5; 95% CI: 1.7; 7.2). We found no vaccine effects among 5–49 years old. Conclusions Our study adds to the evidence on direct and indirect protection of a childhood PCV10 vaccine program. Elderlies seem to benefit the most. Findings did not support PCV 10 cross-protection, but indicate replacement at least for ST 8 among the ≥50 years old. Follow-up analyses of IPD surveillance data are needed to fully characterize the magnitude of serotype replacement and further vaccine-attributable IPD reduction with time.
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Streptococcus pneumoniae Serotype 3 in Mexico (1994 to 2017): Decrease of the Unusual Clonal Complex 4909 Lineage following PCV13 Introduction. J Clin Microbiol 2019; 57:JCM.01354-18. [PMID: 30404945 DOI: 10.1128/jcm.01354-18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 10/27/2018] [Indexed: 11/20/2022] Open
Abstract
Streptococcus pneumoniae expressing serotype 3 has a high virulence and a high case fatality ratio. Most studies of serotype 3 pneumococci have focused on a single lineage, the widespread sequence type 180 (ST180). To evaluate the serotype 3 lineages causing infections in Mexico, we characterized 196 isolates recovered from 1994 to 2017. The isolates were mostly susceptible to all antimicrobials tested. A single meningitis isolate was resistant to penicillin, and the resistance to erythromycin was 5.2%. The isolates represented the widely disseminated clonal complex 180 (CC180; n = 140), the unusual CC4909 (n = 42), CC260 (n = 11), and a few singletons (n = 3). CC260 was less frequent among pneumococcal invasive disease isolates than CC180 and CC4909 (P = 0.015). There was a decrease of CC4909 (P < 0.001) following PCV13 introduction (2012 to 2017). The CC4909 isolates were represented mostly by ST1119 (n = 40), seemingly having a restricted geographic origin, with isolates in the PubMLST database having been recovered only in Mexico, the United States, and Germany. A genomic analysis of publicly available genomes showed that ST1119 isolates have less than 32% similarity with ST180 isolates, indicating that these lineages are more separated than revealed by traditional multilocus sequence typing. Considering the suggestions of a lower efficacy of the 13-valent pneumococcal conjugate vaccine against serotype 3, the different dynamics of the two major serotype 3 lineages in Mexico following the introduction of PCV13 should be closely monitored.
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Marrie TJ, Tyrrell GJ, Majumdar SR, Eurich DT. Invasive pneumococcal disease in Northern Alberta, not a Red Queen but a dark horse. Vaccine 2018; 36:2985-2990. [PMID: 29685595 DOI: 10.1016/j.vaccine.2018.04.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 04/10/2018] [Accepted: 04/12/2018] [Indexed: 01/04/2023]
Abstract
BACKGROUND The consequences of the introduction of various pneumococcal protein conjugate vaccines (PCV) for children and adults is poorly understood. OBJECTIVE We undertook a population-based cohort study of invasive pneumococcal disease (IPD) in Northern Alberta (Canada) from 2000 to 2014, years spanning pre-and early PCV (2000-2004) vs PCV-7 (2005-2009) vs PCV-13 (2010-2014) time periods. DESIGN We collected clinical, laboratory, and Streptococcus pneumoniae serotype information on all patients from 2000 to 2014. We determined changes in presentation, outcomes, serotypes, and incidence in children and adults across time periods. SETTING There were 509 cases of IPD in children, an 80% decrease over time. Rates of empyema (4.0-15.7%, p < 0.001), ICU admission (13.1-20%), and mortality (1.8-8.4%, p < 0.001) increased over time. There were 2417 cases of IPD in adults. Unlike children, incidence of IPD did not change nor did rates of empyema. ICU admissions increased (p = 0.004) and mortality decreased (18.7-16.5%, p = 0.002). The total number of serotypes causing IPD remained stable in children (22 vs 26 vs 20) while they decreased in adults (49 vs 47 vs 42). CONCLUSIONS AND RELEVANCE For children, PCV vaccination strategies resulted in decreased overall rates of IPD and we observed increased rates of empyema and mortality; for adults, there was no change in IPD rates although disease severity increased while mortality decreased. On a population-wide basis, our results suggest that current PCV vaccination strategies are associated with an overall decrease in IPD but disease severity seems to be increasing in both children and adults.
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Affiliation(s)
- Thomas J Marrie
- Department of Medicine, Dalhousie University, QEII Health Sciences Centre, VG Site, Suite 442 Bethune Building, 1276 South Park Street, Halifax, NS B3H 2Y9, Canada.
| | - Gregory J Tyrrell
- The Division of Diagnostic and Applied Microbiology, Department of Laboratory Medicine and Pathology, University of Alberta, and The Provincial Laboratory for Public Health, 8440 112 St, Edmonton, Alberta T6G 2J2, Canada.
| | - Sumit R Majumdar
- Department of Medicine, Faculty of Medicine & Dentistry, 2J2.00 Walter C Mackenzie Health Sciences Centre, 8440 112 St. NW, Edmonton, Alberta T6G 2R7, Canada.
| | - Dean T Eurich
- School of Public Health, University of Alberta, 2-040 Li Ka Shing HRIF, Edmonton, AB, T6G 2E1, Canada.
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Carmona Martinez A, Prymula R, Miranda Valdivieso M, Otero Reigada MDC, Merino Arribas JM, Brzostek J, Szenborn L, Ruzkova R, Horn MR, Jackowska T, Centeno-Malfaz F, Traskine M, Dobbelaere K, Borys D. Immunogenicity and safety of 11- and 12-valent pneumococcal non-typeable Haemophilus influenzae protein D-conjugate vaccines (11vPHiD-CV, 12vPHiD-CV) in infants: Results from a phase II, randomised, multicentre study. Vaccine 2018; 37:176-186. [PMID: 30054160 DOI: 10.1016/j.vaccine.2018.07.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Revised: 06/24/2018] [Accepted: 07/11/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND We assessed 2 investigational 11- and 12-valent vaccines, containing capsular polysaccharides of 10 serotypes as in the pneumococcal non-typeable Haemophilus influenzae protein D-conjugate vaccine (PHiD-CV) and CRM197-conjugated capsular polysaccharides of serotypes 19A (11-valent) or 19A and 6A (12-valent). METHODS In this phase II, partially-blind, multicentre study (NCT01204658), healthy infants were randomised (1:1:1:1) to receive 11vPHiD-CV, 12vPHiD-CV, PHiD-CV, or 13-valent CRM197-conjugate pneumococcal vaccine (PCV13), at 2, 3, and 4 (primary series), and 12-15 months of age (booster dose), co-administered with DTPa-HBV-IPV/Hib. Confirmatory objectives assessed non-inferiority of investigational vaccines to comparators (PHiD-CV for common serotypes; PCV13 for 19A and 6A), in terms of percentage of infants with pneumococcal antibody concentrations ≥0.2 μg/mL and antibody geometric mean concentrations, post-primary vaccination. Reactogenicity and safety were assessed. RESULTS 951 children received ≥1 primary dose, 919 a booster dose. Pre-defined immunological non-inferiority criteria were met simultaneously for 9/11 11vPHiD-CV serotypes (all except 23F and 19A) and 10/12 12vPHiD-CV serotypes (all except 19A and 6A); thus, non-inferiority objectives were reached. For each PHiD-CV serotype, percentages of children with antibody concentrations ≥0.2 µg/mL were ≥96.7% post-primary (except 6B [≥75.2%] and 23F [≥81.1%]), and ≥98.1% post-booster vaccination. For each PHiD-CV serotype except serotype 1, ≥81.0% and ≥93.9% of children had opsonophagocytic activity titres ≥8, post-primary and booster vaccination. AEs incidence was similar across all groups. SAEs were reported for 117 children (29 in the 11vPHiD-CV group, 26 in the 12vPHiD-CV group, 38 in the PHiD-CV group and 24 in the PCV13 group); 4 SAEs were considered vaccination-related. No fatal events were recorded. CONCLUSION Addition of 19A and 6A CRM197-conjugates did not alter immunogenicity of the PHiD-CV conjugates; for both investigational vaccines post-booster immune responses to 10 common serotypes appeared similar to those elicited by PHiD-CV. Safety and reactogenicity profiles of the investigational vaccines were comparable to PHiD-CV. Clinical trial registry: NCT01204658.
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Affiliation(s)
| | - Roman Prymula
- Department of Social Medicine, Faculty of Medicine in Hradec Králové, Charles University in Prague, Šimkova 870, 500 38 Hradec Králové, Czech Republic.
| | | | | | | | - Jerzy Brzostek
- Health Care Establishment in Debica, Infectious Diseases Outpatient Clinic, ul. Krakowska 91, 39-200 Debica, Poland.
| | - Leszek Szenborn
- Department of Paediatric Infectious Diseases, Wroclaw Medical University, 2-2A, Chalubinskiego, 50-368 Wroclaw, Poland.
| | - Renata Ruzkova
- Pediatric Office Dr. Renata Ruzkova, Kladenska 53, Medicentrum 6, s.r.o., 160 00 Prague, Czech Republic.
| | - Michael R Horn
- Pediatric Office Dr. Med. Michael Horn, Achenweg 1, 83471 Schönau am Königssee, Germany.
| | - Teresa Jackowska
- Department of Pediatrics, Centre of Postgraduate Medical Education, ul. Marymoncka 99/103, 01-813 Warsaw, Poland.
| | - Fernando Centeno-Malfaz
- Department of Pediatrics, Rio Hortega University Hospital, Calle Dulzaina, 2, 47012 Valladolid, Spain.
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Le Meur JB, Ayukawa H, Proulx JF, De Wals P. Prevalence of middle ear abnormalities from otitis media in relation with pneumococcal vaccine use in the Inuit population of Nunavik, province of Quebec, Canada. Vaccine 2018; 36:5180-5186. [PMID: 30026032 DOI: 10.1016/j.vaccine.2018.07.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 06/07/2018] [Accepted: 07/04/2018] [Indexed: 01/23/2023]
Abstract
BACKGROUND Otitis media (OM) constitutes an important public health problem in the Inuit population of Nunavik, Northern Quebec. One of the objectives of the childhood pneumococcal vaccination program is to reduce OM burden. The program was implemented in 2002, and 7-, 10-, and 13-valent conjugate vaccines were used sequentially, with doses offered at 2, 4, 6 and 12-18 months, respectively. OBJECTIVE To assess the prevalence of middle ear abnormalities at age 5 years in relation with exposure to different pneumococcal conjugate vaccines. METHODS Immunization cards and audiology screening tests at age 5 years of children born in 1994-2010 were reviewed. Children were classified according to the vaccine schedule recommended for their birth cohort or to the vaccines they actually received. Log-linked binomial regression models were used to assess the relative abnormalities risk according to different vaccination schedules. RESULTS Among 3517 children with complete documentation, the prevalences of minor and major abnormalities were 29% and 18%, respectively. Minor abnormalities frequency was higher in unvaccinated children (34%) and lower in children vaccinated with PCV7 (22%), PCV7 + PCV10 (17%), PCV10 (15%) and PCV10 + PCV13 (18%). No substantial differences among vaccine schedules were observed for major abnormalities. CONCLUSIONS Pneumococcal conjugate vaccination was associated with a decreased frequency of middle ear abnormalities although no effect was seen for major abnormalities which may be trigger by OM with early onset. Clinicaltrials.gov registration number: NCT01694329.
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Affiliation(s)
- J B Le Meur
- Department of Social and Preventive Medicine, Laval University, Quebec City, Canada; Direction des Risques biologiques et de la Santé au Travail, Institut national de Santé publique du Québec, Quebec City, Canada
| | - H Ayukawa
- Ungava Tulattavik Health Centre, Canada
| | - J F Proulx
- Public Health Directorate, Nunavik Regional Board of Health and Social Services, Kuujjuaq, Canada
| | - P De Wals
- Department of Social and Preventive Medicine, Laval University, Quebec City, Canada; Direction des Risques biologiques et de la Santé au Travail, Institut national de Santé publique du Québec, Quebec City, Canada; Quebec University Hospital Research Centre, Quebec City, Canada.
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Izurieta P, Bahety P, Adegbola R, Clarke C, Hoet B. Public health impact of pneumococcal conjugate vaccine infant immunization programs: assessment of invasive pneumococcal disease burden and serotype distribution. Expert Rev Vaccines 2018; 17:479-493. [DOI: 10.1080/14760584.2018.1413354] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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72
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Oligbu G, Collins S, Sheppard CL, Fry NK, Slack M, Borrow R, Ladhani SN. Childhood Deaths Attributable to Invasive Pneumococcal Disease in England and Wales, 2006-2014. Clin Infect Dis 2018; 65:308-314. [PMID: 28605414 DOI: 10.1093/cid/cix310] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 03/30/2017] [Indexed: 11/12/2022] Open
Abstract
Background Pneumococcal conjugate vaccines (PCVs) are highly effective in preventing invasive pneumococcal disease (IPD), but deaths due to IPD still occur. We aimed to describe children who died of IPD since PCV introduction in England and Wales. Methods Public Health England conducts enhanced IPD surveillance in England and Wales. IPD cases in PCV-eligible children aged <5 years (born since 4 September 2004 and diagnosed between 4 September 2006 and 3 September 2014) were actively followed up by postal questionnaires and, for fatal cases, detailed information was requested prospectively from multiple sources. Results During the 8-year period, there were 3146 IPD cases and 150 IPD-related deaths (case fatality rate, 4.8%). Overall, 132 isolates from fatal cases were serotyped (88%) and 35 distinct serotypes were identified, with no serotype predominance. Most deaths occurred in children aged <1 year (88/150 [59%]) and 1-year-olds (36/150 [24%]). One-third (53/150 [35%]) had a known risk factor for IPD. Clinical presentation varied with age but not by serotypes in the different conjugate vaccines. Meningitis was diagnosed in nearly half the fatal cases (71/150 [47%]). The IPD-related mortality rate declined after 7-valent PCV introduction from 1.25/100000 children in 2006-2007 to 0.60/100000 in 2009-2010, with a further reduction following 13-valent PCV introduction from April 2010 to 0.39/100000 in 2013-2014 (14 deaths; incidence rate ratio, 0.31 [95% confidence interval, .16-.61]; P = .0003), when most deaths were due to nonvaccine serotypes or in neonates. Conclusions Most fatal IPD cases are currently not vaccine-preventable. Additional strategies will be required to reduce childhood pneumococcal deaths in countries with established pneumococcal vaccination programs.
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Affiliation(s)
- Godwin Oligbu
- Paediatric Infectious Diseases Research Group, Institute for Infection and Immunity, St George's, University of London
| | | | - Carmen L Sheppard
- Respiratory and Vaccine Preventable Bacterial Reference Unit, Public Health England, London, United Kingdom
| | - Norman K Fry
- Respiratory and Vaccine Preventable Bacterial Reference Unit, Public Health England, London, United Kingdom
| | - Mary Slack
- Respiratory and Vaccine Preventable Bacterial Reference Unit, Public Health England, London, United Kingdom.,School of Medicine, Griffith University Gold Coast Campus, Queensland, Australia
| | - Ray Borrow
- Vaccine Evaluation Unit, Public Health England, Manchester Medical Microbiology Partnership, Manchester Royal Infirmary, United Kingdom
| | - Shamez N Ladhani
- Paediatric Infectious Diseases Research Group, Institute for Infection and Immunity, St George's, University of London.,Immunisation, Hepatitis and Blood Safety Department
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73
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Guevara JN, Izurieta P, Hoet B. Response to: Pneumococcal conjugate vaccines in Latin America: are PCV10 and PCV13 similar in terms of protection against serotype 19A? Expert Rev Vaccines 2018; 17:283-284. [PMID: 29611439 DOI: 10.1080/14760584.2018.1459247] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Javier Nieto Guevara
- a Global Medical Affairs, GlaxoSmithKline Panama , City of Knowledge , Clayton , Panama
| | - Patricia Izurieta
- b Global Medical Affairs , GlaxoSmithKline Biologicals , Wavre , Belgium
| | - Bernard Hoet
- b Global Medical Affairs , GlaxoSmithKline Biologicals , Wavre , Belgium
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74
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Accuracy of composite diagnostic standards for pneumococcal pneumonia in vaccine trials. Epidemiol Infect 2018; 146:712-715. [PMID: 29606164 DOI: 10.1017/s0950268818000651] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Because of a lack of gold standard diagnostics, a combination of multiple diagnostic tests, or composite diagnostic standard, has been used to measure pneumococcal pneumonia (PP) in pneumococcal vaccine trials. We estimated the accuracy of composite diagnostic standards for PP used in previous randomised controlled trials by simple formulas. A systematic literature review identified five eligible trials and all trials had used different combinations of diagnostic tests for PP. The estimated values of sensitivity and minimum specificity of composite diagnostic standards varied substantially between trials: 48.4% to 98.1% and 71.0% to 97.3%, respectively. Without standardizing the outcome measurements, pneumococcal vaccine efficacy estimates against PP are not comparable between trials and their pooled estimates are biased.
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75
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De Wals P, Lefebvre B, Deceuninck G, Longtin J. Incidence of invasive pneumococcal disease before and during an era of use of three different pneumococcal conjugate vaccines in Quebec. Vaccine 2018; 36:421-426. [DOI: 10.1016/j.vaccine.2017.11.054] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Revised: 11/11/2017] [Accepted: 11/16/2017] [Indexed: 10/18/2022]
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76
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Maraki S, Mavromanolaki VE, Stafylaki D, Hamilos G, Samonis G. The Evolving Epidemiology of Serotype Distribution and Antimicrobial Resistance of Streptococcus pneumoniae Strains Isolated from Adults in Crete, Greece, 2009-2016. Infect Chemother 2018; 50:328-339. [PMID: 30600656 PMCID: PMC6312900 DOI: 10.3947/ic.2018.50.4.328] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Accepted: 12/03/2018] [Indexed: 11/24/2022] Open
Abstract
Background Pneumococcal disease is a major cause of morbidity and mortality worldwide, especially in patients with comorbidities and advanced age. This study evaluated trends in epidemiology of adult pneumococcal disease in Crete, Greece, by identifying serotype distribution and antimicrobial resistance of consecutive Streptococcus pneumoniae strains isolated from adults during an 8-year time period (2009–2016) and the indirect effect of the infant pneumococcal higher-valent conjugate vaccines 10-valent pneumococcal conjugate vaccine (PCV10) and 13-valent pneumococcal conjugate vaccine (PCV13). Materials and Methods Antimicrobial susceptibility was performed by E-test and serotyping by Quellung reaction. Multidrug resistance (MDR) was defined as non-susceptibility to penicillin (PNSP) combined with resistance to ≥2 non-β-lactam antimicrobials. Results A total of 135 S. pneumoniae strains were isolated from adults during the study period. Twenty-one serotypes were identified with 17F, 15A, 3, 19A, and 11A, being the most common. The coverage rates of PCV10, and PCV13 were 17.8% and 37.8%, respectively. PCV13 serotypes decreased significantly from 68.4% in 2009 to 8.3% in 2016 (P = 0.002). The most important emerging non-PCV13 serotypes were 17F, 15A, and 11A, with 15A being strongly associated with antimicrobial resistance and MDR. Among all study isolates, penicillin-resistant and MDR strains represented 7.4% and 14.1%, respectively. Predominant PNSP serotypes were 19A (21.7%), 11A (17.4%), and 15A (17.4%). Erythromycin, clindamycin, tetracycline, trimethoprim-sulfamethoxazole, and levofloxacin resistant rates were 30.4%, 15.6%, 16.3%, 16.3%, and 1.5%, respectively. Conclusion Although pneumococcal disease continues to be a health burden in adults in Crete, our study reveals a herd protection effect of the infant pneumococcal higher-valent conjugate vaccination. Surveillance of changes in serotype distribution and antimicrobial resistance among pneumococcal isolates are necessary to guide optimal prevention and treatment strategies.
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Affiliation(s)
- Sofia Maraki
- Department of Clinical Microbiology and Microbial Pathogenesis, University Hospital of Heraklion, Crete, Greece.
| | | | - Dimitra Stafylaki
- Department of Clinical Microbiology and Microbial Pathogenesis, University Hospital of Heraklion, Crete, Greece
| | - George Hamilos
- Department of Clinical Microbiology and Microbial Pathogenesis, University Hospital of Heraklion, Crete, Greece
| | - George Samonis
- Infectious Diseases Unit, University Hospital of Heraklion and University of Crete Medical School, Heraklion, Crete, Greece
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77
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Atkins KE, Lafferty EI, Deeny SR, Davies NG, Robotham JV, Jit M. Use of mathematical modelling to assess the impact of vaccines on antibiotic resistance. THE LANCET. INFECTIOUS DISEASES 2017; 18:e204-e213. [PMID: 29146178 DOI: 10.1016/s1473-3099(17)30478-4] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 06/16/2017] [Accepted: 07/25/2017] [Indexed: 12/27/2022]
Abstract
Antibiotic resistance is a major global threat to the provision of safe and effective health care. To control antibiotic resistance, vaccines have been proposed as an essential intervention, complementing improvements in diagnostic testing, antibiotic stewardship, and drug pipelines. The decision to introduce or amend vaccination programmes is routinely based on mathematical modelling. However, few mathematical models address the impact of vaccination on antibiotic resistance. We reviewed the literature using PubMed to identify all studies that used an original mathematical model to quantify the impact of a vaccine on antibiotic resistance transmission within a human population. We reviewed the models from the resulting studies in the context of a new framework to elucidate the pathways through which vaccination might impact antibiotic resistance. We identified eight mathematical modelling studies; the state of the literature highlighted important gaps in our understanding. Notably, studies are limited in the range of pathways represented, their geographical scope, and the vaccine-pathogen combinations assessed. Furthermore, to translate model predictions into public health decision making, more work is needed to understand how model structure and parameterisation affects model predictions and how to embed these predictions within economic frameworks.
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Affiliation(s)
- Katherine E Atkins
- Centre for the Mathematical Modelling of Infectious Diseases and Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK.
| | - Erin I Lafferty
- Centre for the Mathematical Modelling of Infectious Diseases and Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Nicholas G Davies
- Centre for the Mathematical Modelling of Infectious Diseases and Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Julie V Robotham
- Modelling and Economics Unit, National Infection Service, Public Health England, London, UK
| | - Mark Jit
- Centre for the Mathematical Modelling of Infectious Diseases and Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK; Modelling and Economics Unit, National Infection Service, Public Health England, London, UK
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78
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Trappetti C, Paton JC. Host-to-Host Transmission of the Pneumococcus-New Victims of a Toxic Relationship. Cell Host Microbe 2017; 21:5-6. [PMID: 28081444 DOI: 10.1016/j.chom.2016.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Host-to-host transmission is critical for survival of the human-adapted bacterium Streptococcus pneumoniae. In this issue of Cell Host & Microbe, Zafar et al. (2017) show that transmission is dependent on nasopharyngeal inflammation elicited by the toxin pneumolysin, causing increased shedding and enhanced survival of the bacterium in the environment.
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Affiliation(s)
- Claudia Trappetti
- Research Centre for Infectious Diseases, Department of Molecular and Cellular Biology, University of Adelaide, Adelaide 5005, Australia
| | - James C Paton
- Research Centre for Infectious Diseases, Department of Molecular and Cellular Biology, University of Adelaide, Adelaide 5005, Australia.
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79
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Vojtek I, Nordgren M, Hoet B. Impact of pneumococcal conjugate vaccines on otitis media: A review of measurement and interpretation challenges. Int J Pediatr Otorhinolaryngol 2017; 100:174-182. [PMID: 28802367 DOI: 10.1016/j.ijporl.2017.07.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 07/07/2017] [Accepted: 07/08/2017] [Indexed: 01/22/2023]
Abstract
Acute otitis media (AOM) is among the most frequent childhood diseases and is caused by various bacterial and viral etiological agents. In this article, we provide an overview of published studies assessing the impact of higher-valent pneumococcal conjugate vaccines (PCVs) on AOM. In some instances, reports of PCV impact on complications of AOM have been included. While randomized controlled trials (RCTs) allow for the most precise assessment of vaccine efficacy against AOM, observational studies provide answers to questions regarding the public health value of these vaccines in real-life settings. We discuss the challenges that arise when measuring PCV impact on AOM in observational studies: the local variability of viral and bacterial etiology, differences in case ascertainment, care-seeking behavior, standards of care and diagnosis of AOM (e.g. use of incisions), as well as declining baseline AOM incidence that can already be in place before PCV introduction, and how these factors can impact the results and their interpretation.
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80
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Koh SH, Shin SG, Andrade MJ, Go RH, Park S, Woo CH, Lim JH. Long pentraxin PTX3 mediates acute inflammatory responses against pneumococcal infection. Biochem Biophys Res Commun 2017; 493:671-676. [PMID: 28864415 DOI: 10.1016/j.bbrc.2017.08.133] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 08/29/2017] [Indexed: 01/01/2023]
Abstract
Streptococcus pneumoniae is an important human pathogen responsible for more than 2 million deaths annually worldwide. The airway epithelium acts as the first-line of defense against pneumococcal infections by regulating acute inflammation against invading pneumococcus. Despite the intact adaptive immunity, failure in early defense due to loss of pattern recognition receptors (PRRs) and/or acute phase proteins (APPs) results in detrimental damage and death. C-reactive protein (CRP), the first found APP, is a member of the pentraxin family of proteins and an important soluble PRR for pneumococcus. CRP and another short pentraxin, serum amyloid P, are critical for acute defense against pneumococcal infection. However, the role of the long pentraxin PTX3 in regulating pneumococcal infections is unknown. In this study, PTX3 expression was upregulated by pneumococcus in epithelial cells and in lungs of mice. In addition, PTX3 potentiated pneumococcal inflammation; overexpression of PTX3 enhanced pneumococcus-induced cytokine expression, whereas knock-down of PTX3 with siPTX3 inhibited the cytokine expression. Furthermore, PTX3 deficiency indeed ameliorated acute inflammation and protected mice against death following pneumococcal infection. Pneumococcal toxin pneumolysin was responsible for PTX3 expression and upregulated PTX3 expression via JNK MAPK signaling. These data implicate PTX3 as a novel therapeutic target for the control of acute inflammation by pneumococcus.
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Affiliation(s)
- Seo Hyun Koh
- Department of Microbiology, College of Medicine, Ewha Womans University, 1071 Anyangcheon-ro, Yangcheon-gu, Seoul 07985, Republic of Korea
| | - Seul Gi Shin
- Department of Microbiology, College of Medicine, Ewha Womans University, 1071 Anyangcheon-ro, Yangcheon-gu, Seoul 07985, Republic of Korea
| | - Maria Jose Andrade
- Department of Microbiology, College of Medicine, Ewha Womans University, 1071 Anyangcheon-ro, Yangcheon-gu, Seoul 07985, Republic of Korea
| | - Ryun-Hee Go
- Department of Microbiology, College of Medicine, Ewha Womans University, 1071 Anyangcheon-ro, Yangcheon-gu, Seoul 07985, Republic of Korea
| | - Seonghee Park
- Department of Physiology, College of Medicine, Ewha Womans University, 1071 Anyangcheon-ro, Yangcheon-gu, Seoul 07985, Republic of Korea
| | - Chang-Hoon Woo
- Department of Pharmacology and Smart-Aging Convergence Research Center, Yeungnam University College of Medicine, 170 Hyeonchung-ro, Nam-gu, Daegu 42415, Republic of Korea.
| | - Jae Hyang Lim
- Department of Microbiology, College of Medicine, Ewha Womans University, 1071 Anyangcheon-ro, Yangcheon-gu, Seoul 07985, Republic of Korea.
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The epidemiology of invasive pneumococcal disease in older adults in the post-PCV era. Has there been a herd effect? Epidemiol Infect 2017; 145:2390-2399. [PMID: 28712384 DOI: 10.1017/s0950268817001194] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
The 7 and 13-valent pneumococcal conjugate vaccines (PCVs) have reduced the incidence of invasive pneumococcal disease (IPD) in children in many countries. The objective of this work was to assess the impact of PCVs and potential herd-protection in older adults in Ireland. IPD notification and typing data from adults ⩾65 years of age from July 2007 to June 2016 was assessed using national surveillance data. There was a 94% reduction in PCV7 serotypes from 2007-2008 to 2015-2016, incidence rate ratio (IRR 0·05, P < 0·0001). However, there was no decline in the additional PCV13 (PCV13-7) serotypes over the same period (IRR 0·90) nor in comparison with the pre-PCV13 period 2009-2010 (IRR 0·92). The incidence of serotypes in the 23-valent pneumococcal polysaccharide vaccine only (PPV23-PCV13) and non-vaccine types (NVTs) increased significantly (IRR 2·17, P = 0·0002 and IRR 3·43, P = 0·0001 respectively). Consequently, the overall IPD incidence rate in adults has remained relatively unchanged (from 28·66/100 000 to 28·88/100 000, IRR 1·01, P = 0·9477). Serotype 19A and NVTs were mainly responsible for penicillin resistance in recent years. The decline of PCV7 serotypes indicate that the introduction of PCV7 resulted in herd-protection for adults. However, increases in PPV23-PCV13 and NVTs suggest that changes in vaccination strategy amongst older adults are needed to build on the success of PCVs in children.
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82
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Hospitalisation for lower respiratory tract infection in children in the province of Quebec, Canada, before and during the pneumococcal conjugate vaccine era. Epidemiol Infect 2017; 145:2770-2776. [PMID: 28803551 DOI: 10.1017/s0950268817001510] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Streptococcus pneumoniae is an important cause of community-acquired pneumonia and pneumococcal conjugate vaccines (PCVs) may reduce this burden. This study's goal was to analyse trends in lower respiratory tract infections (LRTI) hospitalisations before and during a routine vaccination programme targeting all newborns with PCV was started in the province of Quebec, Canada in December 2004. The study population included hospital admissions with a main diagnosis of LRTI among 6-59 month-old Quebec residents from April 2000 to December 2014. Trends in proportions and rates were analysed using Cochran-Armitage tests and Poisson regression models. We observed a general downward trend in all LTRI hospitalisations rate: from 11·55/1000 person-years in 2000-2001 to 9·59/1000 in 2013-2014, a 17·0% reduction, which started before the introduction of PCV vaccination. Downward trends in hospitalisation rates were more pronounced for all-cause of pneumonia (minus 17·8%) than for bronchiolitis (minus 15·4%). There was also a decrease in the mean duration of hospital stay. There was little evidence that all-cause pneumonia decreased over the study period due mainly to the introduction of PCVs. Trends may be related to changes in clinical practice. This study casts doubt on the interpretation of ecological analyses of the implementation of PCV vaccination programmes.
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83
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Kwambana-Adams B, Hanson B, Worwui A, Agbla S, Foster-Nyarko E, Ceesay F, Ebruke C, Egere U, Zhou Y, Ndukum M, Sodergren E, Barer M, Adegbola R, Weinstock G, Antonio M. Rapid replacement by non-vaccine pneumococcal serotypes may mitigate the impact of the pneumococcal conjugate vaccine on nasopharyngeal bacterial ecology. Sci Rep 2017; 7:8127. [PMID: 28811633 PMCID: PMC5557800 DOI: 10.1038/s41598-017-08717-0] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 07/13/2017] [Indexed: 01/07/2023] Open
Abstract
There is growing concern that interventions that alter microbial ecology can adversely affect health. We characterised the impact of the seven-valent pneumococcal conjugate vaccine (PCV7) on pneumococcal carriage and the bacterial component of the nasopharyngeal microbiome during infancy. Newborns were recruited into three groups as follows: Group1 (n = 33) was the control group and comprised infants who received PCV7 after 6 months and came from unvaccinated communities. Group 2 (n = 30) came from unvaccinated communities and Group 3 (n = 39) came from vaccinated communities. Both group 2 and 3 received PCV7 at 2, 3 and 4 months. Culture and 16 S rRNA gene sequencing were performed on nasopharyngeal specimens collected at regular intervals from infants. Nasopharyngeal carriage of PCV7 serotypes in Group 1 was significantly higher than in Group 2 and 3 (p < 0.01). However, pneumococcal carriage remained comparable due to an expansion of non-vaccine serotypes in Groups 2 and 3. Determination of phylogenetic dis(similarities) showed that the bacterial community structures were comparable across groups. A mixed effects model showed no difference in community richness (p = 0.15) and Shannon α-diversity (p = 0.48) across the groups. Immediate replacement of pneumococcal vaccine serotypes with non-vaccine serotypes may mitigate the impact of PCV7 on nasopharyngeal bacterial community structure and ecology.
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Affiliation(s)
- Brenda Kwambana-Adams
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia (MRCG), Fajara, The Gambia.
- London School of Hygiene and Tropical Medicine, London, UK.
| | - Blake Hanson
- The Jackson Laboratory for Genomic Medicine, Farmington, CT, USA
| | - Archibald Worwui
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia (MRCG), Fajara, The Gambia
| | - Schadrac Agbla
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia (MRCG), Fajara, The Gambia
- London School of Hygiene and Tropical Medicine, London, UK
| | - Ebenezer Foster-Nyarko
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia (MRCG), Fajara, The Gambia
| | - Fatima Ceesay
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia (MRCG), Fajara, The Gambia
| | - Chinelo Ebruke
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia (MRCG), Fajara, The Gambia
- London School of Hygiene and Tropical Medicine, London, UK
| | - Uzochukwu Egere
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia (MRCG), Fajara, The Gambia
| | - Yanjiao Zhou
- The Jackson Laboratory for Genomic Medicine, Farmington, CT, USA
| | - Maze Ndukum
- The Genome Instituted (Washington University in St Louis), St. Louis, Missouri, USA
| | - Erica Sodergren
- The Jackson Laboratory for Genomic Medicine, Farmington, CT, USA
| | - Michael Barer
- Infection, Immunity and Inflammation, University of Leicester, Leicester, UK
| | | | - George Weinstock
- The Jackson Laboratory for Genomic Medicine, Farmington, CT, USA
| | - Martin Antonio
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia (MRCG), Fajara, The Gambia
- London School of Hygiene and Tropical Medicine, London, UK
- Division of Microbiology & Immunity, Warwick Medical School, University Of Warwick, Coventry, UK
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84
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Hausdorff WP, Black S. What is the heterogeneity in the impact seen with pneumococcal conjugate vaccines telling us? Vaccine 2017; 35:3797-3800. [DOI: 10.1016/j.vaccine.2017.05.089] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 05/26/2017] [Accepted: 05/31/2017] [Indexed: 11/16/2022]
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85
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Balsells E, Guillot L, Nair H, Kyaw MH. Serotype distribution of Streptococcus pneumoniae causing invasive disease in children in the post-PCV era: A systematic review and meta-analysis. PLoS One 2017; 12:e0177113. [PMID: 28486544 PMCID: PMC5423631 DOI: 10.1371/journal.pone.0177113] [Citation(s) in RCA: 257] [Impact Index Per Article: 36.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2016] [Accepted: 04/21/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Routine immunisation with pneumococcal conjugate vaccines (PCV7/10/13) has reduced invasive pneumococcal disease (IPD) due to vaccine serotypes significantly. However, an increase in disease due to non-vaccine types, or serotype replacement, has been observed. Serotypes' individual contributions to IPD play a critical role in determining the overall effects of PCVs. This study examines the distribution of pneumococcal serotypes in children to identify leading serotypes associated with IPD post-PCV introduction. METHODS A systematic search was performed to identify studies and surveillance reports (published between 2000 and December 2015) of pneumococcal serotypes causing childhood IPD post-PCV introduction. Serotype data were differentiated based on the PCV administered during the study period: PCV7 or higher valent PCVs (PCV10 or PCV13). Meta-analysis was conducted to estimate the proportional contributions of the most frequent serotypes in childhood IPD in each period. RESULTS We identified 68 studies reporting serotype data among IPD cases in children. We analysed data from 38 studies (14 countries) where PCV7 was administered and 20 (24 countries) where PCV10 or PCV13 have been introduced. Studies reported early and late periods of PCV7 administration (range: 2001∓13). In these settings, serotype 19A was the most predominant cause of childhood IPD, accounting for 21.8% (95%CI 18.6∓25.6) of cases. In countries that have introduced higher valent PCVs, study periods were largely representative of the transition and early years of PCV10 or PCV13. In these studies, the overall serotype-specific contribution of 19A was lower (14.2% 95%CI 11.1∓18.3). Overall, non-PCV13 serotypes contributed to 42.2% (95%CI 36.1∓49.5%) of childhood IPD cases. However, regional differences were noted (57.8% in North America, 71.9% in Europe, 45.9% in Western Pacific, 28.5% in Latin America, 42.7% in one African country, and 9.2% in one Eastern Mediterranean country). Predominant non-PCV13 serotypes overall were 22F, 12F, 33F, 24F, 15C, 15B, 23B, 10A, and 38 (descending order), but their rank order varied by region. CONCLUSION Childhood IPD is associated with a wide number of serotypes. In the early years after introduction of higher valent PCVs, non-PCV13 types caused a considerable proportion of childhood IPD. Serotype data, particularly from resource-limited countries with high burden of IPD, are needed to assess the importance of serotypes in different settings. The geographic diversity of pneumococcal serotypes highlights the importance of continued surveillance to guide vaccine design and recommendations.
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Affiliation(s)
- Evelyn Balsells
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Medical School, Teviot Place, Edinburgh, United Kingdom
| | - Laurence Guillot
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Medical School, Teviot Place, Edinburgh, United Kingdom
| | - Harish Nair
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Medical School, Teviot Place, Edinburgh, United Kingdom
| | - Moe H. Kyaw
- Sanofi Pasteur, Swiftwater, Pennsylvania, United States of America
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86
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Cohen R, Cohen JF, Chalumeau M, Levy C. Impact of pneumococcal conjugate vaccines for children in high- and non–high-income countries. Expert Rev Vaccines 2017; 16:625-640. [DOI: 10.1080/14760584.2017.1320221] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Robert Cohen
- Université Paris Est, IMRB-GRC GEMINI, Créteil, France
- ACTIV, Association Clinique et Thérapeutique Infantile du Val de Marne, Saint-Maur des Fossés, France
- Clinical Research Center (CRC), Centre Hospitalier Intercommunal Créteil, France
- Unité Court Séjour, Petits Nourrissons, Service de Néonatologie, Centre Hospitalier Intercommunal Créteil, France
| | - Jérémie François Cohen
- Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Paris Descartes University, INSERM U1153, Paris, France
- Service de Pédiatrie Générale, Hôpital Necker-Enfants Malades; AP-HP; Université Paris Descartes, Paris, France
| | - Martin Chalumeau
- Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Paris Descartes University, INSERM U1153, Paris, France
- Service de Pédiatrie Générale, Hôpital Necker-Enfants Malades; AP-HP; Université Paris Descartes, Paris, France
| | - Corinne Levy
- Université Paris Est, IMRB-GRC GEMINI, Créteil, France
- ACTIV, Association Clinique et Thérapeutique Infantile du Val de Marne, Saint-Maur des Fossés, France
- Clinical Research Center (CRC), Centre Hospitalier Intercommunal Créteil, France
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87
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Hakansson AP, Bergenfelz C. Low NF-κB Activation and Necroptosis in Alveolar Macrophages: A New Virulence Property of Streptococcus pneumoniae. J Infect Dis 2017; 216:402-404. [DOI: 10.1093/infdis/jix161] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 03/22/2017] [Indexed: 01/31/2023] Open
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From Immunologically Archaic to Neoteric Glycovaccines. Vaccines (Basel) 2017; 5:vaccines5010004. [PMID: 28134792 PMCID: PMC5371740 DOI: 10.3390/vaccines5010004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 11/14/2016] [Accepted: 01/22/2017] [Indexed: 12/13/2022] Open
Abstract
Polysaccharides (PS) are present in the outermost surface of bacteria and readily come in contact with immune cells. They interact with specific antibodies, which in turn confer protection from infections. Vaccines with PS from pneumococci, meningococci, Haemophilus influenzae type b, and Salmonella typhi may be protective, although with the important constraint of failing to generate permanent immunological memory. This limitation has in part been circumvented by conjugating glycovaccines to proteins that stimulate T helper cells and facilitate the establishment of immunological memory. Currently, protection evoked by conjugated PS vaccines lasts for a few years. The same approach failed with PS from staphylococci, Streptococcus agalactiae, and Klebsiella. All those germs cause severe infections in humans and often develop resistance to antibiotic therapy. Thereby, prevention is of increasing importance to better control outbreaks. As only 23 of more than 90 pneumococcal serotypes and 4 of 13 clinically relevant Neisseria meningitidis serogroups are covered by available vaccines there is still tremendous clinical need for PS vaccines. This review focuses on glycovaccines and the immunological mechanisms for their success or failure. We discuss recent advances that may facilitate generation of high affinity anti-PS antibodies and confer specific immunity and long-lasting protection.
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Zhou Z, Deceuninck G, Lefebvre B, De Wals P. Forecasting Trends in Invasive Pneumococcal Disease among Elderly Adults in Quebec. THE CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY = JOURNAL CANADIEN DES MALADIES INFECTIEUSES ET DE LA MICROBIOLOGIE MEDICALE 2017; 2017:4347206. [PMID: 28246534 PMCID: PMC5299213 DOI: 10.1155/2017/4347206] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Accepted: 01/04/2017] [Indexed: 11/18/2022]
Abstract
Background. In Canada, the current recommendation is to offer PPV23 to adults ≥ 65 years. PCV13 is now licensed for adults. Methods. Invasive pneumococcal disease (IPD) cases in adults 65-74 years of age in the Quebec notifiable diseases registry were classified into five serotype categories. Poisson regression models were fitted to monthly rates observed in 2000-2014 and predictions were made for 2015-2024, using theoretical assumptions regarding indirect effects of childhood vaccination and serotype replacement. Results. IPD rates caused by PCV7 serotypes decreased markedly since PCV7 introduction for children in December 2004. This trend is also underway for additional PCV13 serotypes except serotype 3. Additional PPV23 serotypes and nonvaccine serotypes have been on rise since 2004 and this is expected to continue. A small decrease in overall IPD incidence in the next decade is predicted. The proportion of PCV13 serotypes represented 33% of IPD cases in 2014 and would be 20% (95% CI: 15% to 28%) in 2024. PPV23 coverage was 53% in 2014 and is expected to be 47% (95% CI: 26% to 85%) in 2024. Conclusion. The potential usefulness of a combined PCV13 + PPV23 program for elderly adults would decrease over time but PCV13 would be the only option to prevent serotype 3 IPD.
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Affiliation(s)
- Z. Zhou
- Quebec University Hospital Research Center, Quebec City, QC, Canada
| | - G. Deceuninck
- Quebec University Hospital Research Center, Quebec City, QC, Canada
| | - B. Lefebvre
- Laboratoire de Santé Publique du Québec, Institut National de Santé Publique du Québec, Sainte-Anne-de-Bellevue, QC, Canada
| | - P. De Wals
- Quebec University Hospital Research Center, Quebec City, QC, Canada
- Department of Social and Preventive Medicine, Laval University, Quebec City, QC, Canada
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90
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Sugimoto N, Yamagishi Y, Hirai J, Sakanashi D, Suematsu H, Nishiyama N, Koizumi Y, Mikamo H. Invasive pneumococcal disease caused by mucoid serotype 3 Streptococcus pneumoniae: a case report and literature review. BMC Res Notes 2017; 10:21. [PMID: 28057059 PMCID: PMC5217555 DOI: 10.1186/s13104-016-2353-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 12/16/2016] [Indexed: 11/10/2022] Open
Abstract
Background Among the different serotypes of Streptococcus pneumoniae, serotype 3 has received global attention. We report the fatal case of a 76-year-old Japanese man who had an invasive pneumococcal disease associated with pneumonia caused by serotype 3 S. pneumoniae. Case presentation The patient had a history of hypertension, laryngeal cancer, chronic obstructive pulmonary disease, and type 2 diabetes mellitus. Following a cerebral arteriovenous malformation hemorrhage, he underwent surgery to remove the hematoma and began rehabilitation. On day 66 of hospitalization, he suddenly developed a fever, and coarse crackles and wheezes were heard in his right lung. A diagnosis of hospital-acquired aspiration pneumonia was made, and initial treatment with piperacillin/tazobactam was started. Teicoplanin was added after S. pneumoniae was isolated from the blood culture, however, the patient died 5 days later. The S. pneumoniae detected in the sputum smear was serotype 3, showed mucoid colonies and susceptibility to penicillins, cephalosporins, carbapenems, and levofloxacin, but resistance to erythromycin. Conclusion We experienced a fatal case of pneumonia caused by mucoid serotype 3 S. pneumoniae with a thick capsule. Serotype 3-associated pneumonia may develop a wider pulmonary infiltrative shadow, a prolonged therapeutic or hospitalization course, and a poor outcome. Careful observation and intervention are required, and the use of additional antibiotics or intravenous immunoglobulins should be considered in such cases. Pneumococcal immunization is also an important public health measure to minimize the development of severe infections caused by serotype 3 strains.
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Affiliation(s)
- Naomi Sugimoto
- Department of Clinical Infectious Diseases, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Yuka Yamagishi
- Department of Clinical Infectious Diseases, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Jun Hirai
- Department of Clinical Infectious Diseases, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Daisuke Sakanashi
- Department of Clinical Infectious Diseases, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Hiroyuki Suematsu
- Department of Clinical Infectious Diseases, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Naoya Nishiyama
- Department of Clinical Infectious Diseases, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Yusuke Koizumi
- Department of Clinical Infectious Diseases, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Hiroshige Mikamo
- Department of Clinical Infectious Diseases, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan.
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Abstract
In 2015, the World Health Organization (WHO) declared tuberculosis (TB) to be responsible for more deaths than any other single infectious disease. The burden of TB among children has frequently been dismissed as relatively low with resulting deaths contributing very little to global under-five all-cause mortality, although without rigorous estimates of these statistics, the burden of childhood TB was, in reality, unknown. Recent work in the area has resulted in a WHO estimate of 1 million new cases of childhood TB in 2014 resulting in 136,000 deaths. Around 3% of these cases likely have multidrug-resistant TB and at least 40,000 are in HIV-infected children. TB is now thought to be a major or contributory cause of many deaths in children under five years old, despite not being recorded as such, and is likely in the top ten causes of global mortality in this age group. In particular, recent work has shown that TB is an under-lying cause of a substantial proportion of pneumonia deaths in TB-endemic countries. Childhood TB should be given higher priority: we need to identify children at greatest risk of TB disease and death and make more use of tools such as active case-finding and preventive therapy. TB is a preventable and treatable disease from which no child should die.
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Affiliation(s)
- Helen E. Jenkins
- Department of Biostatistics, Boston University School of Public Health, Boston, MA 02118 USA
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