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Chang IF, Lin IF, Liu YC, Chou CC, Chang TH, Yen TY, Lu CY, Chang LY, Lai F, Huang LM. Outcomes of pediatric community-acquired pneumonia before and after national pneumococcal immunization in Taiwan. Pediatr Pulmonol 2023; 58:3246-3254. [PMID: 37642277 DOI: 10.1002/ppul.26651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 07/11/2023] [Accepted: 08/15/2023] [Indexed: 08/31/2023]
Abstract
OBJECTIVE In Taiwan, the incidence of invasive pneumococcal disease (IPD) in children declined after the catch-up primary vaccination programs and the full national immunization program (NIP) with PCV13. The objective of the study was to investigate the clinical outcomes of pediatric community-acquired pneumonia (CAP) before and after the NIP. METHODS The study included patients aged 3 months to 17 years who were diagnosed with CAP and treated at the National Taiwan University Hospital between 2007 and 2019. Patients were assigned to three birth cohorts according to their birth years and vaccination eligibility: non-NIP, catch-up, and full NIP. We compared the rates of severe outcomes, including case fatality and pathogens. RESULTS A total of 6557 patients who met the CAP criteria were enrolled during the study period. The case-fatality rate decreased from 3.2% (94/2984) in the non-NIP cohort to 0.3% (7/2176) in the catch-up cohort and 0.8% (11/1397) in the full NIP cohort (p < 0.001). Furthermore, there was a significant decrease in invasive ventilation from the non-NIP (17.9%) to both catch-up (6.8%) and full NIP cohorts (9.1%). The rate of IPD declined from the non-NIP cohort to the catch-up cohort (1.8% vs. 0.6%, p < 0.001) and from the catch-up to the full NIP cohort (0.6% vs. 0.07%, p = 0.014). In contrast, the rates of infections with other pathogens increased after NIP. CONCLUSION The introduction of PCV13 showed significant reduction in case-fatality and IPD rates. The increasing rates of other pathogens warrant further surveillance for their clinical significance.
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Affiliation(s)
- I-Fan Chang
- Department of Pediatrics, Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan
| | - I-Fan Lin
- Department of Pediatrics, College of Medicine, National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan
| | - Yun-Chung Liu
- Department of Pediatrics, College of Medicine, National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan
| | - Chia-Ching Chou
- Institute of Applied Mechanics, National Taiwan University, Taipei, Taiwan
| | - Tu-Hsuan Chang
- Department of Pediatrics, Chi-Mei Medical Center, Tainan, Taiwan
| | - Ting-Yu Yen
- Department of Pediatrics, College of Medicine, National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan
| | - Chun-Yi Lu
- Department of Pediatrics, College of Medicine, National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan
| | - Luan-Yin Chang
- Department of Pediatrics, College of Medicine, National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan
| | - Feipei Lai
- Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei, Taiwan
- Department of Computer Science and Information Engineering, National Taiwan University, Taipei, Taiwan
- Department of Electrical Engineering, National Taiwan University, Taipei, Taiwan
| | - Li-Min Huang
- Department of Pediatrics, College of Medicine, National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan
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Kostoff RN, Briggs MB, Kanduc D, Dewanjee S, Kandimalla R, Shoenfeld Y, Porter AL, Tsatsakis A. Modifiable contributing factors to COVID-19: A comprehensive review. Food Chem Toxicol 2023; 171:113511. [PMID: 36450305 PMCID: PMC9701571 DOI: 10.1016/j.fct.2022.113511] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 11/01/2022] [Accepted: 11/03/2022] [Indexed: 11/29/2022]
Abstract
The devastating complications of coronavirus disease 2019 (COVID-19) result from an individual's dysfunctional immune response following the initial severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Multiple toxic stressors and behaviors contribute to underlying immune system dysfunction. SARS-CoV-2 exploits the dysfunctional immune system to trigger a chain of events ultimately leading to COVID-19. The current study identifies eighty immune system dysfunction-enabling toxic stressors and behaviors (hereafter called modifiable contributing factors (CFs)) that also link directly to COVID-19. Each CF is assigned to one of the five categories in the CF taxonomy shown in Section 3.3.: Lifestyle (e.g., diet, substance abuse); Iatrogenic (e.g., drugs, surgery); Biotoxins (e.g., micro-organisms, mycotoxins); Occupational/Environmental (e.g., heavy metals, pesticides); Psychosocial/Socioeconomic (e.g., chronic stress, lower education). The current study shows how each modifiable factor contributes to decreased immune system capability, increased inflammation and coagulation, and increased neural damage and neurodegeneration. It is unclear how real progress can be made in combatting COVID-19 and other similar diseases caused by viral variants without addressing and eliminating these modifiable CFs.
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Affiliation(s)
- Ronald Neil Kostoff
- Independent Consultant, Gainesville, VA, 20155, USA,Corresponding author. Independent Consultant, 13500 Tallyrand Way, Gainesville, VA, 20155, USA
| | | | - Darja Kanduc
- Dept. of Biosciences, Biotechnologies, and Biopharmaceutics, University of Bari, Via Orabona 4, Bari, 70125, Italy
| | - Saikat Dewanjee
- Advanced Pharmacognosy Research Laboratory, Department of Pharmaceutical Technology, Jadavpur University, Kolkata, 700032, India
| | - Ramesh Kandimalla
- Applied Biology, CSIR-Indian Institute of Chemical Technology, Uppal Road, Tarnaka, Hyderabad, 500007, Telangana, India
| | - Yehuda Shoenfeld
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, 5265601, Israel
| | - Alan L. Porter
- School of Public Policy, Georgia Institute of Technology, Atlanta, GA, 30332, USA
| | - Aristidis Tsatsakis
- Department of Forensic Sciences and Toxicology, Faculty of Medicine, University of Crete, 71003, Heraklion, Greece
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Increase in Streptococcus pneumoniae serotype 3 associated parapneumonic pleural effusion/empyema after the introduction of PCV13 in Germany. Vaccine 2019; 38:570-577. [PMID: 31735502 DOI: 10.1016/j.vaccine.2019.10.056] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 10/19/2019] [Accepted: 10/21/2019] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Pediatric pneumococcal pneumonia complicated by parapneumonic pleural effusion/empyema (PPE/PE) remains a major concern despite general immunization with pneumococcal conjugate vaccines (PCVs). METHODS In a nationwide pediatric hospital surveillance study in Germany we identified 584 children <18 years of age with bacteriologically confirmed PPE/PE from October 2010 to June 2018. Streptococcus pneumoniae was identified by culture and/or PCR of blood samples and/or pleural fluid and serotyped. RESULTS S. pneumoniae was identified in 256 of 584 (43.8%) children by culture (n = 122) and/or PCR (n = 207). The following pneumococcal serotypes were detected in 114 children: serotype 3 (42.1%), 1 (25.4%), 7F (12.3%), 19A (7.9%), other PCV13 serotypes (4.4%) and non-PCV13 serotypes (7.9%). Between October 2010 and June 2014 serotype 1 (38.1%) and serotype 3 (25.4%) were most prevalent, whereas between July 2014 and June 2018 serotype 3 (62.7%) and non-PCV13 serotypes (15.7%) were dominant. Compared to children with other pneumococcal serotypes, children with serotype 3 associated PPE/PE were younger (median 3.2 years [IQR 2.1-4.3 years] vs. median 5.6 years [IQR 3.8-8.2 years]; p < 0.001) and more frequently admitted to intensive care (43 [89.6%] vs. 48 [73.8%]; p = 0.04). Seventy-six of 114 (66.7%) children with pneumococcal PPE/PE had been vaccinated with pneumococcal vaccines. Thirty-nine of 76 (51.3%) had received a vaccine covering the serotype detected. Thirty of these 39 breakthrough cases were age-appropriately vaccinated with PCV13 and considered vaccine failures, including 26 children with serotype 3, three children with serotype 19A and one child with serotype 1. CONCLUSION Following the introduction of PCV13 in general childhood vaccination we observed a strong emergence of serotype 3 associated PPE/PE in the German pediatric population, including a considerable number of younger children with serotype 3 vaccine breakthrough cases and failures. Future PCVs should not only cover newly emerging serotypes, but also include a more effective component against serotype 3.
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Lu CY, Chiang CS, Chiu CH, Wang ET, Chen YY, Yao SM, Chang LY, Huang LM, Lin TY, Chou JH. Successful Control of Streptococcus pneumoniae 19A Replacement With a Catch-up Primary Vaccination Program in Taiwan. Clin Infect Dis 2019; 69:1581-1587. [DOI: 10.1093/cid/ciy1127] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 02/15/2019] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Streptococcus pneumoniae infections in Taiwan mostly occur in children aged 2–4 years. Because of a significant increase in the incidence of serotype 19A-related infections, the 13-valent pneumococcal conjugate vaccine (PCV13) was initially introduced in the national immunization program for children 2–5 years of age, prior to the national programs for infants. We have assessed the impact of such vaccination programs in reducing the incidence of invasive pneumococcal disease (IPD) in Taiwanese children.
Methods
We analyzed the national data on IPDs from the Taiwan Centers for Disease Control between 2008 and 2017. We calculated the incidence rates of IPD and incidence rate ratios (IRRs) between years for different serotypes to estimate the effectiveness of the vaccination programs.
Results
The national catch-up primary vaccination schedule successfully reduced the incidence rate of IPD from 17.8/100 000 in 2012 to 5.5/100 000 in 2017 among children aged 0–5 years. The IRR (2017 over 2012) was 0.31, corresponding to a 69% reduction. A modest herd effect was also observed, with a 37% reduction in the incidence of IPD in elderly people (≥70 years) from 2012 to 2017. The incidence of IPD caused by serotype 19A in children aged 0–5 years was reduced by 32.6–44.3% yearly from 2012 to 2017. In 2015, serogroup 15 outnumbered 19A, to become the leading serotypes in children 0–5 years old.
Conclusions
Special catch-up vaccination programs starting from children 2–5 years of age with PCV13 have been highly effective in reducing the incidence of IPD, especially as caused by serotype 19A, in Taiwanese children.
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Affiliation(s)
- Chun-Yi Lu
- Department of Pediatrics, National Taiwan University Children’s Hospital, Taoyuan City , Taiwan
| | - Chuen-Sheue Chiang
- Centers for Disease Control, Ministry of Health and Welfare, Taoyuan City, Taiwan
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taoyuan City, Taiwan
| | - Cheng-Hsun Chiu
- Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
- College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - En-Tzu Wang
- Centers for Disease Control, Ministry of Health and Welfare, Taoyuan City, Taiwan
| | - Ying-Yan Chen
- Centers for Disease Control, Ministry of Health and Welfare, Taoyuan City, Taiwan
| | - Shu-Man Yao
- Centers for Disease Control, Ministry of Health and Welfare, Taoyuan City, Taiwan
| | - Luan-Yin Chang
- Department of Pediatrics, National Taiwan University Children’s Hospital, Taoyuan City , Taiwan
| | - Li-Min Huang
- Department of Pediatrics, National Taiwan University Children’s Hospital, Taoyuan City , Taiwan
| | - Tzou-Yien Lin
- Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
- College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Jih-Haw Chou
- Centers for Disease Control, Ministry of Health and Welfare, Taoyuan City, Taiwan
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Tai SS. Streptococcus pneumoniae Serotype Distribution and Pneumococcal Conjugate Vaccine Serotype Coverage among Pediatric Patients in East and Southeast Asia, 2000-2014: a Pooled Data Analysis. Vaccines (Basel) 2016; 4:E4. [PMID: 26907356 PMCID: PMC4810056 DOI: 10.3390/vaccines4010004] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Revised: 01/24/2016] [Accepted: 02/14/2016] [Indexed: 11/29/2022] Open
Abstract
Pneumococcal infection is one of the leading causes of death worldwide, especially in children of developing and underdeveloped countries. Capsular polysaccharide-based vaccines are available for the prevention of this disease. A 7-valent pneumococcal conjugate vaccine (PCV7) was licensed in 2000 for use in children less than two years of age. Subsequently, to broaden the protection, 10-valent (PCV10) and 13-valent (PCV13) vaccines were licensed in 2009 and 2010, respectively. All of these conjugate vaccines elicit an immune response that only provides protection against the infection of S. pneumoniae serotypes included in the formulation. Profiles of S. pneumoniae serotype distribution and serotype coverage for both PCV7 and PCV13 have been reported in some Asian countries/territories. But the published results cannot provide conclusive information due to the difference in studied population and geographic areas. The goals of this review are to obtain an accurate estimate of serotype coverage for PCV7, PCV10, and PCV13 and examine the change in the S. pneumoniae serotype distribution after PCV7 use among pediatric patients in East and Southeast Asia through the analysis of pooled data that were published in the English literature between 2000 and 2014.
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Affiliation(s)
- Stanley S Tai
- Department of Microbiology, College of Medicine, Howard University, Washington, DC 20059, USA.
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Affiliation(s)
- Mohamed A Hendaus
- Hamad Medical Corporation, Doha, Qatar Weill-Cornell Medical College, Ar-Rayyan, Qatar
| | - Ibrahim A Janahi
- Hamad Medical Corporation, Doha, Qatar Weill-Cornell Medical College, Ar-Rayyan, Qatar
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Hsiao HJ, Wu CT, Huang JL, Chiu CH, Huang YC, Lin JJ, Huang IA, Chan OW, Chou IJ, Hsia SH. Clinical features and outcomes of invasive pneumococcal disease in a pediatric intensive care unit. BMC Pediatr 2015; 15:85. [PMID: 26184113 PMCID: PMC4504450 DOI: 10.1186/s12887-015-0387-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Accepted: 05/27/2015] [Indexed: 02/07/2023] Open
Abstract
Background Invasive pneumococcal disease (IPD) results in high morbidity and mortality globally each year, although it is a vaccine-preventable disease. This study aimed to characterize the clinical features of IPD in a pediatric intensive care unit (PICU) in Taiwan. The seven-valent pneumococcal conjugate vaccine (PCV7) was introduced in the private sector in October 2005. The estimated coverage rate of PCV7 vaccination in 2010 was 45.5 % among children <5 years of age. Methods We conducted a retrospective study at a single center in northern Taiwan for invasive pneumococcal disease in a PICU from 2009 to 2013. Demographic characteristics, clinical courses, serotype, antibiotic susceptibility, and outcomes were analyzed. Results Over the 5-year study period, 2167 patients were admitted to the PICU; 48 (2.2 %) had IPD. There were 29 female and 19 male patients. Their mean age was 3.7 years (range 0.7–12.5 years, with the peak age at 2–5 years; n = 30, 63 %). Pneumonia was the most frequent type (n = 38, 79 %), followed by meningitis (n = 10, 21 %). In total, three patients died, all within 72 h after admission; the final diagnoses were all meningitis. Thirty-four children with pneumonia received chest tube insertion for pleural effusion drainage. Of them, 22 (65 %) finally still underwent video-assisted thoracoscopic surgery. Eight (17 %) children had hemolytic uremic syndrome, and seven of them underwent hemodialysis. In total, 37 serotypes were detected; 95 % were covered by PCV13. Serotype 19A was most common (54 %) overall; however, in those with meningitis, serotype 19 F was most common. Conclusions Meningitis is the most severe type of invasive pneumococcal disease in our pediatric intensive care unit. It may progress rapidly even when subjects are given antibiotics promptly. The most common serotype in meningitis is 19 F, which is vaccine preventable. Thus, universal mass pneumococcal vaccination is still needed.
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Affiliation(s)
- Hsiang-Ju Hsiao
- Department of Pediatrics, Chang Gung Memorial Hospital, Keelung, Taiwan. .,Chang Gung University College of Medicine, Taoyuan, Taiwan.
| | - Chang-Teng Wu
- Chang Gung University College of Medicine, Taoyuan, Taiwan. .,Division of General Pediatrics, Department of Pediatrics, Chang Gung Memorial Hospital, Linkou, Taiwan.
| | - Jing-Long Huang
- Chang Gung University College of Medicine, Taoyuan, Taiwan. .,Division of Asthma, Allergy, and Rheumatology, Department of Pediatrics, Chang Gung Memorial Hospital, Linkou, Taiwan.
| | - Cheng-Hsun Chiu
- Chang Gung University College of Medicine, Taoyuan, Taiwan. .,Molecular Infectious Disease Research Center, Division of Pediatric Infection, Chang Gung Memorial Hospital, Linkou, Taiwan.
| | - Yhu-Chering Huang
- Chang Gung University College of Medicine, Taoyuan, Taiwan. .,Division of Pediatric Infectious Diseases, Department of Pediatrics, Chang Gung Memorial Hospital, Linkou, Taiwan.
| | - Jainn-Jim Lin
- Chang Gung University College of Medicine, Taoyuan, Taiwan. .,Division of Pediatric Critical Care Medicine, Department of Pediatrics, Chang Gung Memorial Hospital, Linkou, Taiwan.
| | - I-Anne Huang
- Department of Pediatrics, Chang Gung Memorial Hospital, Keelung, Taiwan. .,Chang Gung University College of Medicine, Taoyuan, Taiwan.
| | - Oi-Wa Chan
- Chang Gung University College of Medicine, Taoyuan, Taiwan. .,Division of Pediatric Critical Care Medicine, Department of Pediatrics, Chang Gung Memorial Hospital, Linkou, Taiwan.
| | - I-Jun Chou
- Chang Gung University College of Medicine, Taoyuan, Taiwan. .,Division of General Pediatrics, Department of Pediatrics, Chang Gung Memorial Hospital, Linkou, Taiwan.
| | - Shao-Hsuan Hsia
- Chang Gung University College of Medicine, Taoyuan, Taiwan. .,Division of Pediatric Critical Care Medicine, Department of Pediatrics, Chang Gung Memorial Hospital, Linkou, Taiwan.
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Shen CF, Wang SM, Ho TS, Liu CC. Reply to: "Serotype transition in invasive pneumococcal infection in postvaccine era". J Formos Med Assoc 2015; 114:787-8. [PMID: 26100467 DOI: 10.1016/j.jfma.2015.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Accepted: 03/25/2015] [Indexed: 10/23/2022] Open
Affiliation(s)
- Ching-Fen Shen
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Center for Infection Control, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Shih-Min Wang
- Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Center of Infectious Disease and Signaling Research, National Cheng Kung University, Tainan, Taiwan
| | - Tzong-Shiann Ho
- Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ching-Chuan Liu
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Center for Infection Control, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Center of Infectious Disease and Signaling Research, National Cheng Kung University, Tainan, Taiwan.
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Huang WC. Serotype transition in invasive pneumococcal infection in postvaccine era. J Formos Med Assoc 2015; 114:565. [PMID: 25800504 DOI: 10.1016/j.jfma.2015.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Accepted: 02/07/2015] [Indexed: 11/17/2022]
Affiliation(s)
- Wen-Chan Huang
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan.
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10
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Lu CY, Ting YT, Huang LM. Severe Streptococcus pneumoniae 19A pneumonia with empyema in children vaccinated with pneumococcal conjugate vaccines. J Formos Med Assoc 2014; 114:783-4. [PMID: 24674951 DOI: 10.1016/j.jfma.2014.02.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Accepted: 02/17/2014] [Indexed: 10/25/2022] Open
Affiliation(s)
- Chun-Yi Lu
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
| | - Yung-Tien Ting
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
| | - Li-Min Huang
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan.
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Fletcher MA, Schmitt HJ, Syrochkina M, Sylvester G. Pneumococcal empyema and complicated pneumonias: global trends in incidence, prevalence, and serotype epidemiology. Eur J Clin Microbiol Infect Dis 2014; 33:879-910. [PMID: 24563274 PMCID: PMC4110404 DOI: 10.1007/s10096-014-2062-6] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Accepted: 01/15/2014] [Indexed: 12/23/2022]
Abstract
This review evaluates the serotype epidemiology of complicated pneumococcal pneumonia (CPP) during the period 1990–2012. PubMed and EMBASE were searched using the terms “empyema”, “complicated pneumonia”, “pleural infection”, “necrotizing pneumonia”, “pleural effusion”, “parapneumonic effusion”, “pneumatocele”, or “lung abscess”; “pneumococcal” or “Streptococcus pneumoniae”; and “serotype” for studies on the epidemiology of complicated pneumonias published from January 1, 1990 to October 1, 2013. Studies with data on incidence and serotypes were included; reviews, case reports, and conference abstracts were excluded. Of 152 papers, 84 fitted the inclusion criteria. A few pneumococcal serotypes were predominant causes of CPP, particularly serotypes 1, 19A, 3, 14, and 7F. CPP was a more common manifestation of pneumococcal disease among older (>2 years old) than younger children. The data support increases in both reported incidence rates and proportions of CPP in children and adults during the period 1990–2012; specific increases varied by geographic region. The proportions of serotype 3 and, particularly in Asia, serotype 19A CPP have increased, whereas most studies show declines in serotype 14. Serotype 1 has been a predominant cause of CPP since 1990, while antibiotic resistance was infrequent among serotype 1 isolates. The reported incidence and proportions of CPP among pneumonia cases steadily increased from 1990 to 2012. Several factors might account for these increases, including enhanced disease detection due to a higher index of suspicion, more sophisticated diagnostic assays, and changes in the prevalence of serotypes with capacity to invade the pleural space that were not targeted by the 7-valent pneumococcal conjugate vaccine (PCV7).
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Affiliation(s)
- M A Fletcher
- Pfizer, Inc., 23-25, avenue du Dr Lannelongue, 75668, Paris Cedex 14, France,
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Lee LH, Gu XX, Nahm MH. Towards New Broader Spectrum Pneumococcal Vaccines: The Future of Pneumococcal Disease Prevention. Vaccines (Basel) 2014; 2:112-28. [PMID: 26344470 PMCID: PMC4494192 DOI: 10.3390/vaccines2010112] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Revised: 01/18/2014] [Accepted: 02/06/2014] [Indexed: 01/13/2023] Open
Abstract
Seven-valent pneumococcal conjugate vaccine (PCV7) introduction and routine pediatric use has substantially reduced the burden of Streptococcus pneumoniae disease worldwide. However, a significant amount of disease burden, due to serotypes not contained in PCV7, still exists globally. A newly recognized serotype, 6C, was until recently, identified and reported as serotype 6A. This review summarizes the serotype epidemiology of pneumococcal disease pre- and post-introduction of PCV7, available post-marketing surveillance data following the introduction of higher valency pneumococcal vaccines (PCV10, PCV13) and future prospects for the development of new pneumococcal vaccines.
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Affiliation(s)
- Lucia H Lee
- Center for Biologics Evaluation and Research, Food and Drug Administration, Rockville, MD 20852, USA.
| | - Xin-Xing Gu
- National Institute of Allergy and Infectious Diseases, Bethesda, MD 20892, USA.
| | - Moon H Nahm
- Departments of Microbiology and Pathology, University of Alabama at Birmingham, Birmingham, AL 35233, USA.
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