1
|
Bardach A, Ruvinsky S, Palermo MC, Alconada T, Sandoval MM, Brizuela ME, Wierzbicki ER, Cantos J, Gagetti P, Ciapponi A. Invasive pneumococcal disease in Latin America and the Caribbean: Serotype distribution, disease burden, and impact of vaccination. A systematic review and meta-analysis. PLoS One 2024; 19:e0304978. [PMID: 38935748 PMCID: PMC11210815 DOI: 10.1371/journal.pone.0304978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 04/09/2024] [Indexed: 06/29/2024] Open
Abstract
BACKGROUND Invasive pneumococcal diseases (IPD) are associated with high morbidity, mortality, and health costs worldwide, particularly in Latin America and the Caribbean (LAC). Surveillance about the distribution of serotypes causing IPD and the impact of pneumococcal vaccination is an important epidemiological tool to monitor disease activity trends, inform public health decision-making, and implement relevant prevention and control measures. OBJECTIVES To estimate the serotype distribution for IPD and the related disease burden in LAC before, during, and after implementing the pneumococcal vaccine immunization program in LAC. METHODS Systematic literature review following Cochrane methods of studies from LAC. We evaluated the impact of the pneumococcal vaccine on hospitalization and death during or after hospitalizations due to pneumococcal disease and serotype-specific disease over time. We also analyzed the incidence of serotyped IPD in pneumococcal conjugate vaccine PCV10 and PCV13. The protocol was registered in PROSPERO (ID: CRD42023392097). RESULTS 155 epidemiological studies were screened and provided epidemiological data on IPD. Meta-analysis of invasive diseases in children <5 years old found that 57%-65% of causative serotypes were included in PCV10 and 66%-84% in PCV13. After PCV introduction, vaccine serotypes declined in IPD, and the emergence of non-vaccine serotypes varied by country. CONCLUSIONS Pneumococcal conjugate vaccines significantly reduced IPD and shifted serotype distribution in Latin America and the Caribbean. PCV10/PCV13 covered 57-84% of serotypes in children under 5, with marked decline in PCV serotypes post-vaccination. Continuous surveillance remains crucial for monitoring evolving serotypes and informing public health action.
Collapse
Affiliation(s)
- Ariel Bardach
- Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Buenos Aires, Argentina
- Centro de Investigaciones Epidemiológicas y Salud Pública (CIESP-IECS), CONICET, Buenos Aires, Argentina
| | - Silvina Ruvinsky
- Departamento de Investigación, Hospital Garrahan, Buenos Aires, Argentina
- Departamento de Evaluación de Tecnologías Sanitarias y Economía de la Salud, Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina
| | - M. Carolina Palermo
- Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Buenos Aires, Argentina
| | - Tomás Alconada
- Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Buenos Aires, Argentina
| | - M. Macarena Sandoval
- Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Buenos Aires, Argentina
| | - Martín E. Brizuela
- Unidad de Pediatría, Hospital General de Agudos Vélez Sarsfield, Buenos Aires, Argentina
| | | | - Joaquín Cantos
- Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Buenos Aires, Argentina
| | - Paula Gagetti
- Servicio Antimicrobianos, Instituto Nacional de Enfermedades Infecciosas (INEI)-ANLIS ‘‘Dr. Carlos G. Malbrán”, Buenos Aires, Argentina
| | - Agustín Ciapponi
- Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Buenos Aires, Argentina
- Centro de Investigaciones Epidemiológicas y Salud Pública (CIESP-IECS), CONICET, Buenos Aires, Argentina
| |
Collapse
|
2
|
Camacho-Moreno G, Leal AL, Patiño-Niño J, Vasquez-Hoyos P, Gutiérrez I, Beltrán S, Álvarez-Olmos MI, Mariño AC, Londoño-Ruiz JP, Barrero R, Rojas JP, Espinosa F, Arango-Ferreira C, Suarez MA, Trujillo M, López-Medina E, López P, Coronell W, Ramos N, Restrepo A, Montañez A, Moreno VM. Serotype distribution, clinical characteristics, and antimicrobial resistance of pediatric invasive pneumococcal disease in Colombia during PCV10 mass vaccination (2017-2022). Front Med (Lausanne) 2024; 11:1380125. [PMID: 38841583 PMCID: PMC11150640 DOI: 10.3389/fmed.2024.1380125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 04/08/2024] [Indexed: 06/07/2024] Open
Abstract
Introduction Invasive Pneumococcal Disease (IPD) causes significant morbidity and mortality in children under 5 y. Colombia introduced PCV10 vaccination in 2012, and the Neumocolombia network has been monitoring IPD in pediatric patients since 2008. Materials and methods This study is a secondary analysis of a prospective cohort involving pediatric patients with IPD admitted to 17 hospitals in Colombia, from January 1st, 2017, to December 31st, 2022. We present data on serotypes (Spn), clinical characteristics, and resistance patterns. Results We report 530 patients, 215 (40.5%) were younger than 24 months. Among these, 344 cases (64.7%) presented with pneumonia, 95 (17.9%) with primary bacteremia, 53 (10%) with meningitis, 6 (1.1%) had pneumonia and meningitis, and 32 (6%) had other IPD diagnosis. The median hospital stay was 12 days (RIQ 8-14 days), and 268 (50.6%) were admitted to the ICU, of whom 60 (11.3%) died. Serotyping was performed in 298 (56.1%). The most frequent serotypes were Spn19A (51.3%), Spn6C (7.7%), Spn3 (6.7%), Spn6A (3.6%), and Spn14 (3.6%). Of 495 (93%) isolates with known susceptibility, 46 (9.2%) were meningeal (M) and 449 (90.7%) non-meningeal (NM). Among M isolates, 41.3% showed resistance to penicillin, and 21.7% decreased susceptibility to ceftriaxone. For NM isolates, 28.2% had decreased susceptibility to penicilin, and 24.2% decreased susceptibility to ceftriaxone. Spn19A showed the highest resistant to penicillin at 47% and was linked to multiresistance. Conclusion The prevalence of PCV10-included serotypes decreased, while serotypes 19A and 6C increased, with Spn19A being associated with multiresistance. These findings had played a crucial role in the decision made by Colombia to modify its immunization schedule by switching to PCV13 in July 2022.
Collapse
Affiliation(s)
- Germán Camacho-Moreno
- Red Neumocolombia, Bogotá, Colombia
- Universidad Nacional de Colombia, Bogotá, Colombia
- HOMI, Fundación Hospital Pediatrico de la Misericordia, Bogotá, Colombia
- Hospital Infantil Universitario de San José, Bogotá, Colombia
| | - Aura Lucia Leal
- Red Neumocolombia, Bogotá, Colombia
- Universidad Nacional de Colombia, Bogotá, Colombia
- Grupo Para el Control de la Resistencia Bacteriana en Bogotá, GREBO, Bogotá, Colombia
| | - Jaime Patiño-Niño
- Red Neumocolombia, Bogotá, Colombia
- Fundación Valle del Lili, Cali, Colombia
| | - Pablo Vasquez-Hoyos
- Red Neumocolombia, Bogotá, Colombia
- Universidad Nacional de Colombia, Bogotá, Colombia
| | - Ivan Gutiérrez
- Red Neumocolombia, Bogotá, Colombia
- Clínica Infantil Colsubsidio, Bogotá, Colombia
- Clinicas Colsanitas—Clinica Santa Maria del Lago, Bogotá, Colombia
| | - Sandra Beltrán
- Red Neumocolombia, Bogotá, Colombia
- Clínicas Colsanitas—Clínica Reina Sofia pediátrica y Mujer, Bogotá, Colombia
| | - Martha I. Álvarez-Olmos
- Red Neumocolombia, Bogotá, Colombia
- Fundación Cardioinfantil—Instituto de Cardiología, Bogotá, Colombia
| | - Ana-Cristina Mariño
- Red Neumocolombia, Bogotá, Colombia
- Hospital Militar Central, Bogotá, Colombia
| | | | - Rocio Barrero
- Red Neumocolombia, Bogotá, Colombia
- Hospital Universitario Clínica San Rafael, Bogotá, Colombia
- Unidad de Servicios de Salud Santa Clara, Subred Centro Oriente, Bogotá, Colombia
| | - Juan Pablo Rojas
- Red Neumocolombia, Bogotá, Colombia
- Fundación Clínica Infantil Club Noel, Cali, Colombia
- Universidad Libre Seccional Cali, Cali, Colombia
- Universidad del Valle, Cali, Colombia
| | - Fabio Espinosa
- Red Neumocolombia, Bogotá, Colombia
- Universidad del Valle, Cali, Colombia
| | - Catalina Arango-Ferreira
- Red Neumocolombia, Bogotá, Colombia
- Hospital Universitario San Vicente Fundación, Medellín, Colombia
| | - María Alejandra Suarez
- Red Neumocolombia, Bogotá, Colombia
- Unidad de Servicio de Salud Tunal, Bogotá, Colombia
- Hospital Universitario San Ignacio, Bogotá, Colombia
| | - Monica Trujillo
- Red Neumocolombia, Bogotá, Colombia
- Hospital Pablo Tobón Uribe, Medellín, Colombia
| | - Eduardo López-Medina
- Red Neumocolombia, Bogotá, Colombia
- Universidad del Valle, Cali, Colombia
- Centro Médico Imbanaco, Cali, Colombia
| | - Pio López
- Red Neumocolombia, Bogotá, Colombia
- Universidad del Valle, Cali, Colombia
- Hospital Universitario del Valle, Cali, Colombia
| | - Wilfrido Coronell
- Red Neumocolombia, Bogotá, Colombia
- Hospital Infantil Napoleón Franco Pareja, Cartagena, Colombia
| | - Nicolas Ramos
- Red Neumocolombia, Bogotá, Colombia
- Clínica el Bosque—Los Cobos Medical Center, Bogotá, Colombia
| | | | | | | |
Collapse
|
3
|
Alexandrova AS, Setchanova LP, Pencheva DR, Mitov IG. Phenotypic and genotypic characterization of serogroup 6 Streptococcus pneumoniae isolates collected during 10-valent pneumococcal conjugate vaccine era in Bulgaria. Acta Microbiol Immunol Hung 2020; 67:91-99. [PMID: 31813257 DOI: 10.1556/030.66.2019.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 10/01/2019] [Indexed: 11/19/2022]
Abstract
Serogroup 6 remains common in the pneumococcal-conjugated vaccine era in Bulgaria; therefore, we investigated its clonal and serotype dynamics. The antibiotic susceptibilities were assessed by broth microdilution. Strains identified as serogroup 6 with latex agglutination method were subjected to serotype-specific PCRs. Erythromycin-resistant strains were analyzed by PCR for presence of ermB and mefE genes. MLST was performed to define clonal composition of the sequence types (STs). Serogroup 6 was represented by 40 (13.3%) from 301 invasive and non-invasive Streptococcus pneumoniae isolates. Molecular serotyping revealed new emerging serotype 6C (6.6%), not detected in pre-vaccine era. Among unvaccinated patients, mostly we observed serotypes 6А (57.1%) and 6В (28.6%). Serotype 6C was distinctive for vaccinated children (64%), followed by 6A (24%). Penicillin and ceftriaxone non-susceptible serogroup 6 strains were 65% and 5%, respectively; erythromycin- and clindamycin-resistant were 70.0% and 52.5%, respectively. Multidrug-resistant strains were 57.5%. Prevalent genetic determinant for macrolide resistance was ermB gene (75%). MLST revealed 17 STs into 5 clonal complexes and 7 singletons. Predominant genetic lineage was CC386, represented by MDR-6C non-invasive strains. Serotype 6B, principally responsible for invasive diseases in the pre-vaccine era, retreated this position to serotype 6A.
Collapse
Affiliation(s)
| | - Lena Petrova Setchanova
- Department of Medical Microbiology, Medical Faculty, Medical University of Sofia, Sofia, Bulgaria
| | - Daniela Rosenova Pencheva
- Molecular Medicine Center, Department of Medical Chemistry and Biochemistry, Medical Faculty, Medical University of Sofia, Sofia, Bulgaria
| | - Ivan Gergov Mitov
- Department of Medical Microbiology, Medical Faculty, Medical University of Sofia, Sofia, Bulgaria
| |
Collapse
|