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 DOI: 10.1371/journal.pone.0304978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [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
|
Fu Y, Wang Y, Tang W, Yang Q, Wang G, Li M. Clinical characteristics and risk factors for poor outcomes of invasive pneumococcal disease in pediatric patients in China. BMC Infect Dis 2024; 24:602. [PMID: 38898407 PMCID: PMC11186143 DOI: 10.1186/s12879-024-09493-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 06/11/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND Invasive pneumococcal disease (IPD) is a significant health concern in children worldwide. In this study, we aimed to analyze the clinical features, antibiotic resistance, and risk variables for poor outcomes in patients with IPD in Hangzhou. METHODS A retrospective single-centre study was performed using the pediatric intensive care (PIC) database from 2010 to 2018. The clinical characteristics, laboratory data, antimicrobial resistance, and risk factors for in-hospital mortality and sepsis in patients with IPD in intensive care units (ICUs) were analyzed systematically. RESULTS A total of 178 IPD patients were included in the study. The majority of the IPD children were 2-10 years old. Antimicrobial resistance tests of S. pneumoniae isolates revealed high resistance to erythromycin, tetracycline and compound sulfamethoxazole (SMZ-Co). All the isolates were sensitive to vancomycin, linezolid, moxifloxacin, telithromycin, ofloxacin, and levofloxacin. IPD patients may experience poor outcomes, including death and sepsis. The in-hospital mortality was 3.93%, and 34.27% of patients suffered from sepsis. Temperature (OR 3.80, 95% CI 1.62-8.87; P = 0.0021), Partial Pressure of Oxygen in Arterial Blood (PaO2) (OR 0.99, 95% CI 0.98-1.00; P = 0.0266), and albumin (OR 0.89, 95% CI 0.80-0.99; P = 0.0329) were found to be independent risk factors for sepsis in children with IPD. CONCLUSION Pediatric IPD deserves attention in China. Appropriate surveillance and antibiotic selection are crucial in managing resistant strains. Early identification of high-risk individuals with risk factors contributes to the development of appropriate treatment strategies.
Collapse
Affiliation(s)
- Yanan Fu
- Department of Medical Engineering, Qilu Hospital of Shandong University, Jinan, Shandong Province, China
| | - Yingchun Wang
- Department of Pediatrics, Qilu Hospital of Shandong University, No.107 West Wenhua Road, Jinan, 250012, Shandong Province, China
| | - Wei Tang
- Department of Pediatrics, Qilu Hospital of Shandong University, No.107 West Wenhua Road, Jinan, 250012, Shandong Province, China
| | - Qing Yang
- Department of Pediatrics, Qilu Hospital of Shandong University, No.107 West Wenhua Road, Jinan, 250012, Shandong Province, China
| | - Guan Wang
- Department of Pediatrics, Qilu Hospital of Shandong University, No.107 West Wenhua Road, Jinan, 250012, Shandong Province, China
| | - Meng Li
- Department of Pediatrics, Qilu Hospital of Shandong University, No.107 West Wenhua Road, Jinan, 250012, Shandong Province, China.
| |
Collapse
|
3
|
Fernández-Fradejas J, Delgado-Silveira E, González-Burgos E, Álvarez-Díaz AM, Vélez-Díaz-Pallarés M. Potentially inappropriate prescriptions and potential prescription omissions in older people living with HIV. HIV Med 2024; 25:587-599. [PMID: 38258538 DOI: 10.1111/hiv.13616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 01/11/2024] [Indexed: 01/24/2024]
Abstract
OBJECTIVES This study aimed to determine the prevalence of potentially inappropriate prescriptions (PIPs) and potential prescription omissions (PPOs) in a Spanish cohort of people living with HIV (PLWH) aged ≥65 years and to identify risk factors for the presence of PIPs and PPOs. METHODS This retrospective cross-sectional study was conducted across 10 public hospitals in the Autonomous Community of Madrid, Spain. Clinical and demographic data were cross-checked against hospital and community pharmacy dispensation registries. PIPs and PPOs were assessed using the American Geriatrics Society (AGS)/Beers and Screening Tool of Older Persons' Prescriptions (STOPP)/Screening Tool to Alert Doctors to Right Treatment (START) criteria. Risk factors for PIPs and PPOs and agreement between AGS/Beers and STOPP/START criteria were statistically analysed. RESULTS This study included 313 PLWH (median age 72 years), of whom 80.5% were men. PIP prevalence rates were 29.4% and 44.4% based on the AGS/Beers and STOPP criteria, respectively. The concordance between AGS/Beers and STOPP criteria was moderate. Benzodiazepines and proton pump inhibitors were the chronic comedications most commonly involved in PIPs. PPOs were observed in 61.4% of the patients. The leading omissions were insufficient influenza and pneumococcal vaccine coverage and inadequate bone health-related treatments. The number of chronic comedications, female sex, neuropsychiatric disorders, and cancer diagnosis were risk factors for PIPs, whereas osteopenia and osteoporosis were risk factors for PPOs. CONCLUSIONS A high prevalence of PIPs and PPOs was observed in our cohort of older PLWH. These findings emphasize the importance of comprehensive medication reviews in this population to reduce inappropriate medication use and address their specific and underserved therapeutic needs.
Collapse
Affiliation(s)
- Jorge Fernández-Fradejas
- Pharmacy Department, University Hospital Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Eva Delgado-Silveira
- Pharmacy Department, University Hospital Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Elena González-Burgos
- Department of Pharmacology, Pharmacognosy and Botany, Faculty of Pharmacy, Complutense University of Madrid, Madrid, Spain
| | - Ana María Álvarez-Díaz
- Pharmacy Department, University Hospital Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Manuel Vélez-Díaz-Pallarés
- Pharmacy Department, University Hospital Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| |
Collapse
|
4
|
Madu A, Alex-Okoro T, Okoduwa A, Cotton J. Austrian syndrome: Report of one case and a systematic review of case reports - new insights. Clin Med (Lond) 2024; 24:100205. [PMID: 38649138 PMCID: PMC11109293 DOI: 10.1016/j.clinme.2024.100205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 02/23/2024] [Indexed: 04/25/2024]
Abstract
OBJECTIVE The objective of this review was to gain new insight into the rare condition, Austrian syndrome: the triad of endocarditis, meningitis and pneumonia caused by Streptococcus pneumoniae. METHODS A systematic review of case reports was conducted using the PRISMA guideline. Cases were rigorously screened to meet a set of well-defined inclusion criteria. Relevant data was aggregated and reported using descriptive statistics. RESULTS Seventy-one cases from 69 case reports were included in the final review. The mean age was 56.5 years with a male-to-female ratio of 2.4:1. Alcoholism was reported in 41% of patients. Altered mental state (69%) and fever (65%) (mean temperature on admission = 38.9°C) were the commonest presenting symptoms. The mean duration of symptoms before presentation to the hospital was 8 days. The aortic valve was most commonly affected (56%). The mean duration of antibiotic therapy was 5.6 weeks. Seventy percent of patients were admitted to the intensive care unit (ICU). Fifty-six percent of patients had valvular surgery. The average length of stay in the hospital was 36.9 days. Mortality was recorded in 28% of patients. CONCLUSION Austrian syndrome is rare but deadly. The true incidence is unknown but is commoner in middle-aged men and in alcoholics. Affected patients are usually critically unwell, often requiring ICU admission and prolonged hospital stays. Treatment is aggressive including prolonged courses of antibiotics and often, surgery. Despite these, the case fatality rate is high, with death occurring in over a quarter of patients. Surgery appears to be associated with better prognosis.
Collapse
Affiliation(s)
- Alpha Madu
- Internal Medicine Trainee, New Cross Hospital, Royal Wolverhampton NHS Trust, Wolverhampton, UK.
| | - Tochi Alex-Okoro
- Physician Assistant, Dandelion Allergy Centre, Milton, Ontario, Canada
| | - Abosede Okoduwa
- Clinical Assistant, Health Science Centre, Winnipeg, Manitoba, Canada
| | - James Cotton
- Professor of Cardiology, University of Wolverhampton, United Kingdom, Consultant Interventional Cardiologist, New Cross Hospital, Royal Wolverhampton NHS Trust, Wolverhampton, UK
| |
Collapse
|
5
|
Cornelisse VJ, Riley B, Medland NA. Australian consensus statement on doxycycline post-exposure prophylaxis (doxy-PEP) for the prevention of syphilis, chlamydia and gonorrhoea among gay, bisexual and other men who have sex with men. Med J Aust 2024; 220:381-386. [PMID: 38479437 DOI: 10.5694/mja2.52258] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Accepted: 02/12/2024] [Indexed: 04/15/2024]
Abstract
INTRODUCTION Doxycycline post-exposure prophylaxis (doxy-PEP) involves consuming 200 mg of doxycycline up to 72 hours after a condomless sex act to reduce the risk of bacterial sexually transmitted infections (STIs). Recent clinical trials of doxy-PEP have demonstrated significant reductions in syphilis, chlamydia and, to a lesser degree, gonorrhoea among gay, bisexual and other men who have sex with men (GBMSM). There is a high level of interest in doxy-PEP in the GBMSM community and, in response, the Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine (ASHM) held a national consensus conference with the aim of creating preliminary guidance for clinicians, community, researchers and policy makers. MAIN RECOMMENDATIONS There was broad agreement that doxy-PEP should be considered primarily for the prevention of syphilis in GBMSM who are at risk of this STI, with a secondary benefit of reductions in other bacterial STIs. At the end of the consensus process, there remained some disagreement, as some stakeholders felt strongly that doxy-PEP should be considered only for the prevention of syphilis in GBMSM, and that the risk of increasing antimicrobial resistance outweighed any potential benefit from reductions in other bacterial STIs in the target population. The national roundtable made several other recommendations for clinicians, community, researchers and policy makers, as detailed in this article. ASHM will support the development of detailed clinical guidelines and education materials on doxy-PEP (www.ashm.org.au/doxy-pep). CHANGES IN MANAGEMENT AS A RESULT OF THIS CONSENSUS STATEMENT For GBMSM at high risk of syphilis, and perhaps other bacterial STIs, clinicians may consider prescribing doxy-PEP for a limited period of time, followed by a review of ongoing need. Unlike human immunodeficiency virus (HIV) pre-exposure prophylaxis (PrEP), doxy-PEP may not be suitable as a population-level intervention and should instead be used more selectively.
Collapse
Affiliation(s)
- Vincent J Cornelisse
- Monash University, Melbourne, VIC
- Kirby Institute, University of New South Wales, Sydney, NSW
| | | | | |
Collapse
|
6
|
Nagra D, Bechman K, Russell MD, Yang Z, Adas M, Subesinghe S, Rutherford A, Alveyn E, Patel S, Wincup C, Mahto A, Baldwin C, Karafotias I, Cope A, Norton S, Galloway J. No Waning of Pneumococcal Vaccine Responses over Time in People with Inflammatory Arthritis: Findings from a Single Centre Cohort. Vaccines (Basel) 2024; 12:69. [PMID: 38250882 PMCID: PMC10818273 DOI: 10.3390/vaccines12010069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 01/03/2024] [Accepted: 01/08/2024] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND Vaccination against pneumococcus reduces the risk of infective events, hospitalisation, and death in individual with inflammatory arthritis, particularly in those on immunomodulating therapy who are at risk of worse outcomes from pneumococcal disease. The objective of this study was to investigate the serological protection following vaccination against pneumococcal serovars over time. Methods: This was a single centre, retrospective cohort study of individuals with rheumatoid arthritis, psoriatic arthritis, or axial spondylarthritis who had previously received the PPSV23 polysaccharide pneumococcal vaccine (Pneumovax). Data were retrieved between January 2021 to August 2023. Dates of previous pneumococcal vaccination were identified using linked primary care records. Serum serotype levels were collected. The primary outcome was serological response defined as a titre ≥0.35 mcg/mL in at least five from a total of 12 evaluated pneumococcal serovars, examined using a Luminex platform. Multivariate logistic regression models adjusting for age, gender, ethnicity, co-morbidities, and the use of prednisolone, conventional synthetic and biological DMARDs were used to determine the odds of a sustained serological response according to time categorised into ≤5 years, 5-10 years, and ≥10 years since vaccination. Results: Serological response was measured in 296 individuals with inflammatory arthritis, with rheumatoid arthritis the most common diagnosis (74% of patients). The median time between pneumococcal vaccine administration and serological assessment was 6 years (interquartile range 2.4 to 9.9). A positive serological response to at least 5 serovars was present in 195/296 (66%) of patients. Time since vaccination did not significantly associate with serological protection compared with those vaccinated <5 years, the adjusted ORs of vaccine response was 1.15 (95% CI 0.64 to 2.07) in those 5-10 years and 1.26 (95% CI: 0.64 to 2.48) in those vaccinated over 10 years ago. No individual variable from the multivariate model reached statistical significance as an independent predictor of vaccine response, although steroid use at the time of vaccine had a consistent detrimental impact on serological immunity. Conclusions: We demonstrated that antibody titres following vaccination against pneumococcal serovars do not appear to wane over time. It appears more critical to focus on maximising the initial vaccine response, which is known to be diminished in this patient population.
Collapse
Affiliation(s)
- Deepak Nagra
- Centre for Rheumatic Disease, King’s College London, London WC2R 2LS, UK (S.S.); (J.G.)
| | - Katie Bechman
- Centre for Rheumatic Disease, King’s College London, London WC2R 2LS, UK (S.S.); (J.G.)
| | - Mark D. Russell
- Centre for Rheumatic Disease, King’s College London, London WC2R 2LS, UK (S.S.); (J.G.)
| | - Zijing Yang
- Centre for Rheumatic Disease, King’s College London, London WC2R 2LS, UK (S.S.); (J.G.)
| | - Maryam Adas
- Centre for Rheumatic Disease, King’s College London, London WC2R 2LS, UK (S.S.); (J.G.)
| | - Sujith Subesinghe
- Centre for Rheumatic Disease, King’s College London, London WC2R 2LS, UK (S.S.); (J.G.)
| | - Andrew Rutherford
- Centre for Rheumatic Disease, King’s College London, London WC2R 2LS, UK (S.S.); (J.G.)
| | - Edward Alveyn
- Centre for Rheumatic Disease, King’s College London, London WC2R 2LS, UK (S.S.); (J.G.)
| | - Samir Patel
- Centre for Rheumatic Disease, King’s College London, London WC2R 2LS, UK (S.S.); (J.G.)
| | - Chris Wincup
- King’s College Hospital NHS Trust, London SE5 9RS, UK
| | - Arti Mahto
- King’s College Hospital NHS Trust, London SE5 9RS, UK
| | - Christopher Baldwin
- Centre for Rheumatic Disease, King’s College London, London WC2R 2LS, UK (S.S.); (J.G.)
| | - Ioasaf Karafotias
- Centre for Rheumatic Disease, King’s College London, London WC2R 2LS, UK (S.S.); (J.G.)
| | - Andrew Cope
- Centre for Rheumatic Disease, King’s College London, London WC2R 2LS, UK (S.S.); (J.G.)
| | - Sam Norton
- Centre for Rheumatic Disease, King’s College London, London WC2R 2LS, UK (S.S.); (J.G.)
| | - James Galloway
- Centre for Rheumatic Disease, King’s College London, London WC2R 2LS, UK (S.S.); (J.G.)
| |
Collapse
|
7
|
Doherty K, Dula D, Chirwa A, Nsomba E, Nkhoma VS, Toto N, Chikaonda T, Kamng'ona R, Phiri J, Reiné J, Ndaferankhande J, Makhaza L, Banda P, Jambo K, Ferreira DM, Gordon SB. Experimental pneumococcal carriage in people living with HIV in Malawi: the first controlled human infection model in a key at-risk population. Wellcome Open Res 2024; 9:2. [PMID: 38362541 PMCID: PMC10864820 DOI: 10.12688/wellcomeopenres.19949.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2023] [Indexed: 02/17/2024] Open
Abstract
Background: As well as suffering a high burden of pneumococcal disease people living with HIV (PLHIV) may contribute to community transmission in sub-Saharan African (sSA) settings. Pneumococcal vaccination is not currently offered to PLHIV in sSA but may prevent disease and reduce transmission. More evidence of vaccine effectiveness against carriage in PLHIV is needed. An Experimental Human Pneumococcal Carriage model (EHPC) has been safely and acceptably used in healthy adults in Malawi to evaluate pneumococcal vaccines against carriage and to identify immune correlates of protection from carriage. This study will establish the same model in PLHIV and will be the first controlled human infection model (CHIM) in this key population. Methods: Healthy participants with and without HIV will be inoculated intranasally with Streptococcus pneumoniae serotype 6B. Sequential cohorts will be challenged with increasing doses to determine the optimal safe challenge dose to establish experimental carriage. Nasal fluid, nasal mucosal, and blood samples will be taken before inoculation and on days 2, 7, 14, and 21 following inoculation to measure pneumococcal carriage density and identify immune correlates of protection from carriage. The vast majority of natural pneumococcal carriage events in PLHIV do not result in invasive disease and no invasive disease is expected in this study. However, robust participant safety monitoring is designed to identify signs of invasive disease early should they develop, and to implement treatment immediately. Participants will complete a Likert-style questionnaire at study-end to establish acceptability. Interpretations: We expect the EHPC model to be safely and acceptably implemented in PLHIV. The CHIM can then be used to accelerate pneumococcal vaccine evaluations in this population, and an evidence-based pneumococcal vaccination policy for PLHIV in sSA.
Collapse
Affiliation(s)
- Klara Doherty
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Southern Region, Malawi
- Liverpool School of Tropical Medicine, Liverpool, L3 5QA, UK
| | - Dingase Dula
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Southern Region, Malawi
| | - Anthony Chirwa
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Southern Region, Malawi
| | - Edna Nsomba
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Southern Region, Malawi
| | - Vitumbiko S. Nkhoma
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Southern Region, Malawi
| | - Neema Toto
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Southern Region, Malawi
| | - Tarsizio Chikaonda
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Southern Region, Malawi
| | - Raphael Kamng'ona
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Southern Region, Malawi
| | - Joseph Phiri
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Southern Region, Malawi
| | - Jesús Reiné
- Liverpool School of Tropical Medicine, Liverpool, L3 5QA, UK
- Oxford Vaccine Group, University of Oxford, Oxford, England, UK
| | - John Ndaferankhande
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Southern Region, Malawi
| | - Lumbani Makhaza
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Southern Region, Malawi
| | - Peter Banda
- Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Kondwani Jambo
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Southern Region, Malawi
- Liverpool School of Tropical Medicine, Liverpool, L3 5QA, UK
| | - Daniela M Ferreira
- Liverpool School of Tropical Medicine, Liverpool, L3 5QA, UK
- Oxford Vaccine Group, University of Oxford, Oxford, England, UK
| | - Stephen B Gordon
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Southern Region, Malawi
- Liverpool School of Tropical Medicine, Liverpool, L3 5QA, UK
| |
Collapse
|
8
|
Kobayashi M, Pilishvili T, Farrar JL, Leidner AJ, Gierke R, Prasad N, Moro P, Campos-Outcalt D, Morgan RL, Long SS, Poehling KA, Cohen AL. Pneumococcal Vaccine for Adults Aged ≥19 Years: Recommendations of the Advisory Committee on Immunization Practices, United States, 2023. MMWR Recomm Rep 2023; 72:1-39. [PMID: 37669242 PMCID: PMC10495181 DOI: 10.15585/mmwr.rr7203a1] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/07/2023] Open
Abstract
This report compiles and summarizes all published recommendations from CDC’s Advisory Committee on Immunization Practices (ACIP) for use of pneumococcal vaccines in adults aged ≥19 years in the United States. This report also includes updated and new clinical guidance for implementation from CDC Before 2021, ACIP recommended 23-valent pneumococcal polysaccharide vaccine (PPSV23) alone (up to 2 doses), or both a single dose of 13-valent pneumococcal conjugate vaccine (PCV13) in combination with 1–3 doses of PPSV23 in series (PCV13 followed by PPSV23), for use in U.S. adults depending on age and underlying risk for pneumococcal disease. In 2021, two new pneumococcal conjugate vaccines (PCVs), a 15-valent and a 20-valent PCV (PCV15 and PCV20), were licensed for use in U.S. adults aged ≥18 years by the Food and Drug Administration ACIP recommendations specify the use of either PCV20 alone or PCV15 in series with PPSV23 for all adults aged ≥65 years and for adults aged 19–64 years with certain underlying medical conditions or other risk factors who have not received a PCV or whose vaccination history is unknown. In addition, ACIP recommends use of either a single dose of PCV20 or ≥1 dose of PPSV23 for adults who have started their pneumococcal vaccine series with PCV13 but have not received all recommended PPSV23 doses. Shared clinical decision-making is recommended regarding use of a supplemental PCV20 dose for adults aged ≥65 years who have completed their recommended vaccine series with both PCV13 and PPSV23 Updated and new clinical guidance for implementation from CDC includes the recommendation for use of PCV15 or PCV20 for adults who have received PPSV23 but have not received any PCV dose. The report also includes clinical guidance for adults who have received 7-valent PCV (PCV7) only and adults who are hematopoietic stem cell transplant recipients
Collapse
|
9
|
Tortellini E, Fosso Ngangue YC, Dominelli F, Guardiani M, Falvino C, Mengoni F, Carraro A, Marocco R, Pasculli P, Mastroianni CM, Ciardi MR, Lichtner M, Zingaropoli MA. Immunogenicity and Efficacy of Vaccination in People Living with Human Immunodeficiency Virus. Viruses 2023; 15:1844. [PMID: 37766251 PMCID: PMC10534440 DOI: 10.3390/v15091844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 08/17/2023] [Accepted: 08/21/2023] [Indexed: 09/29/2023] Open
Abstract
People living with HIV (PLWH) remain at high risk of mortality and morbidity from vaccine-preventable diseases, even though antiretroviral therapy (ART) has restored life expectancy and general well-being. When, which, and how many doses of vaccine should be administered over the lifetime of PLWH are questions that have become clinically relevant. Immune responses to most vaccines are known to be impaired in PLWH. Effective control of viremia with ART and restored CD4+ T-cell count are correlated with an improvement in responsiveness to routine vaccines. However, the presence of immune alterations, comorbidities and co-infections may alter it. In this article, we provide a comprehensive review of the literature on immune responses to different vaccines in the setting of HIV infection, emphasizing the potential effect of HIV-related factors and presence of comorbidities in modulating such responses. A better understanding of these issues will help guide vaccination and prevention strategies for PLWH.
Collapse
Affiliation(s)
- Eeva Tortellini
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy; (Y.C.F.N.); (F.D.); (M.G.); (C.F.); (F.M.); (A.C.); (P.P.); (C.M.M.); (M.R.C.); (M.A.Z.)
| | - Yann Collins Fosso Ngangue
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy; (Y.C.F.N.); (F.D.); (M.G.); (C.F.); (F.M.); (A.C.); (P.P.); (C.M.M.); (M.R.C.); (M.A.Z.)
| | - Federica Dominelli
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy; (Y.C.F.N.); (F.D.); (M.G.); (C.F.); (F.M.); (A.C.); (P.P.); (C.M.M.); (M.R.C.); (M.A.Z.)
| | - Mariasilvia Guardiani
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy; (Y.C.F.N.); (F.D.); (M.G.); (C.F.); (F.M.); (A.C.); (P.P.); (C.M.M.); (M.R.C.); (M.A.Z.)
| | - Carmen Falvino
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy; (Y.C.F.N.); (F.D.); (M.G.); (C.F.); (F.M.); (A.C.); (P.P.); (C.M.M.); (M.R.C.); (M.A.Z.)
| | - Fabio Mengoni
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy; (Y.C.F.N.); (F.D.); (M.G.); (C.F.); (F.M.); (A.C.); (P.P.); (C.M.M.); (M.R.C.); (M.A.Z.)
| | - Anna Carraro
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy; (Y.C.F.N.); (F.D.); (M.G.); (C.F.); (F.M.); (A.C.); (P.P.); (C.M.M.); (M.R.C.); (M.A.Z.)
| | - Raffaella Marocco
- Infectious Diseases Unit, SM Goretti Hospital, Sapienza University of Rome, 00185 Latina, Italy; (R.M.); (M.L.)
| | - Patrizia Pasculli
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy; (Y.C.F.N.); (F.D.); (M.G.); (C.F.); (F.M.); (A.C.); (P.P.); (C.M.M.); (M.R.C.); (M.A.Z.)
| | - Claudio Maria Mastroianni
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy; (Y.C.F.N.); (F.D.); (M.G.); (C.F.); (F.M.); (A.C.); (P.P.); (C.M.M.); (M.R.C.); (M.A.Z.)
| | - Maria Rosa Ciardi
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy; (Y.C.F.N.); (F.D.); (M.G.); (C.F.); (F.M.); (A.C.); (P.P.); (C.M.M.); (M.R.C.); (M.A.Z.)
| | - Miriam Lichtner
- Infectious Diseases Unit, SM Goretti Hospital, Sapienza University of Rome, 00185 Latina, Italy; (R.M.); (M.L.)
- Department of Neurosciences, Mental Health, and Sense Organs, NESMOS, Sapienza University of Rome, 00185 Rome, Italy
| | - Maria Antonella Zingaropoli
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy; (Y.C.F.N.); (F.D.); (M.G.); (C.F.); (F.M.); (A.C.); (P.P.); (C.M.M.); (M.R.C.); (M.A.Z.)
| |
Collapse
|
10
|
Afshari E, Ahangari Cohan R, Shams Nosrati MS, Mousavi SF. Development of a bivalent protein-based vaccine candidate against invasive pneumococcal diseases based on novel pneumococcal surface protein A in combination with pneumococcal histidine triad protein D. Front Immunol 2023; 14:1187773. [PMID: 37680628 PMCID: PMC10480505 DOI: 10.3389/fimmu.2023.1187773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 08/01/2023] [Indexed: 09/09/2023] Open
Abstract
Extensive efforts have been made toward improving effective strategies for pneumococcal vaccination, focusing on evaluating the potential of multivalent protein-based vaccines and overcoming the limitations of pneumococcal polysaccharide-based vaccines. In this study, we investigated the protective potential of mice co-immunization with the pneumococcal PhtD and novel rPspA proteins against pneumococcal sepsis infection. The formulations of each antigen alone or in combination were administered intraperitoneally with alum adjuvant into BALB/c mice three times at 14-day intervals. The production of antigen-specific IgG, IgG1 and IgG2a subclasses, and IL-4 and IFN-γ cytokines, were analyzed. Two in vitro complement- and opsonophagocytic-mediated killing activities of raised antibodies on day 42 were also assessed. Finally, the protection against an intraperitoneal challenge with 106 CFU/mouse of multi-drug resistance of Streptococcus pneumoniae ATCC49619 was investigated. Our findings showed a significant increase in the anti-PhtD and anti-rPspA sera IgG levels in the immunized group with the PhtD+rPspA formulation compared to each alone. Moreover, the results demonstrated a synergistic effect with a 6.7- and 1.3- fold increase in anti-PhtD and anti-rPspA IgG1, as well as a 5.59- and 1.08- fold increase in anti-PhtD and anti-rPspA IgG2a, respectively. Co-administration of rPspA+PhtD elicited a mixture of Th-2 and Th-1 immune responses, more towards Th-2. In addition, the highest complement-mediated killing activity was observed in the sera of the immunized group with PhtD+rPspA at 1/16 dilution, and the opsonophagocytic activity was increased from 74% to 86.3%. Finally, the survival rates showed that mice receiving the rPspA+PhtD formulation survived significantly longer (100%) than those receiving protein alone or PBS and exhibited the strongest clearance with a 2 log10 decrease in bacterial load in the blood 24h after challenge compared to the control group. In conclusion, the rPspA+PhtD formulation can be considered a promising bivalent serotype-independent vaccine candidate for protection against invasive pneumococcal infection in the future.
Collapse
Affiliation(s)
- Elnaz Afshari
- Department of Biology, Science and Research Branch, Islamic Azad University, Tehran, Iran
- Department of Microbiology, Pasteur Institute of Iran, Tehran, Iran
| | - Reza Ahangari Cohan
- Department of Nanobiotechnology, New Technologies Research Group, Pasteur Institute of Iran, Tehran, Iran
| | | | | |
Collapse
|
11
|
Tan Y, Chen Z, Zeng Z, Wu S, Liu J, Zou S, Wang M, Liang K. Microbiomes Detected by Bronchoalveolar Lavage Fluid Metagenomic Next-Generation Sequencing among HIV-Infected and Uninfected Patients with Pulmonary Infection. Microbiol Spectr 2023; 11:e0000523. [PMID: 37436163 PMCID: PMC10434007 DOI: 10.1128/spectrum.00005-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 06/25/2023] [Indexed: 07/13/2023] Open
Abstract
Comparison of lung microbiomes between HIV-infected and uninfected patients with pulmonary infection by metagenomic next-generation sequencing (mNGS) has not been described in China. The lung microbiomes detected in bronchoalveolar fluid (BALF) by mNGS among HIV-infected and uninfected patients with pulmonary infection were reviewed in the First Hospital of Changsha between January 2019 and June 2022. In total, 476 HIV-infected and 280 uninfected patients with pulmonary infection were enrolled. Compared with HIV-uninfected patients, the proportions of Mycobacterium (P = 0.011), fungi (P < 0.001), and viruses (P < 0.001) were significantly higher in HIV-infected patients. The higher positive rate of Mycobacterium tuberculosis (MTB; P = 0.018), higher positive rates of Pneumocystis jirovecii and Talaromyces marneffei (all P < 0.001), and higher positive rate of cytomegalovirus (P < 0.001) contributed to the increased proportions of Mycobacterium, fungi, and viruses among HIV-infected patients, respectively. The constituent ratios of Streptococcus pneumoniae (P = 0.007) and Tropheryma whipplei (P = 0.002) in the bacteria spectrum were significantly higher, while the constituent ratio of Klebsiella pneumoniae (P = 0.005) was significantly lower in HIV-infected patients than in HIV-uninfected patients. Compared with HIV-uninfected patients, the constituent ratios of P. jirovecii and T. marneffei (all P < 0.001) in the fungal spectrum were significantly higher, while the constituent ratios of Candida and Aspergillus (all P < 0.001) were significantly lower in HIV-infected patients. In comparison to HIV-infected patients without antiretroviral therapy (ART), the proportions of T. whipplei (P = 0.001), MTB (P = 0.024), P. jirovecii (P < 0.001), T. marneffei (P < 0.001), and cytomegalovirus (P = 0.008) were significantly lower in HIV-infected patients on ART. Significant differences in lung microbiomes exist between HIV-infected and uninfected patients with pulmonary infection, and ART influences the lung microbiomes among HIV-infected patients with pulmonary infection. IMPORTANCE A better understanding of lung microorganisms is conducive to early diagnosis and treatment and will improve the prognosis of HIV-infected patients with pulmonary infection. Currently, few studies have systematically described the spectrum of pulmonary infection among HIV-infected patients. This study is the first to provide comprehensive information on the lung microbiomes of HIV-infected patients with pulmonary infection (as assessed by more sensitive metagenomic next-generation sequencing of bronchoalveolar fluid) compared with those from HIV-uninfected patients, which could provide a reference for the etiology of pulmonary infection among HIV-infected patients.
Collapse
Affiliation(s)
- Yuting Tan
- Department of Infectious Diseases, Zhongnan Hospital of Wuhan University, Wuhan, China
- Wuhan Research Center for Infectious Diseases and Cancer, Chinese Academy of Medical Sciences, Wuhan, China
| | - Zhong Chen
- Department of Infection and Immunology, The First Hospital of Changsha City, Changsha, China
| | - Ziwei Zeng
- Graduate Collaborative Training Base of the First Hospital of Changsha, Hengyang Medical School, University of South China, Hengyang, China
| | - Songjie Wu
- Wuhan Research Center for Infectious Diseases and Cancer, Chinese Academy of Medical Sciences, Wuhan, China
- Department of Nosocomial Infection Management, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Jie Liu
- Department of Infectious Diseases, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Shi Zou
- Department of Infectious Diseases, Zhongnan Hospital of Wuhan University, Wuhan, China
- Wuhan Research Center for Infectious Diseases and Cancer, Chinese Academy of Medical Sciences, Wuhan, China
| | - Min Wang
- Department of Infection and Immunology, The First Hospital of Changsha City, Changsha, China
| | - Ke Liang
- Department of Infectious Diseases, Zhongnan Hospital of Wuhan University, Wuhan, China
- Wuhan Research Center for Infectious Diseases and Cancer, Chinese Academy of Medical Sciences, Wuhan, China
- Department of Nosocomial Infection Management, Zhongnan Hospital of Wuhan University, Wuhan, China
- Hubei Engineering Center for Infectious Disease Prevention, Control and Treatment, Wuhan, China
| |
Collapse
|
12
|
Shapiro Ben David S, Shamai-Lubovitz O, Mourad V, Goren I, Cohen Iunger E, Alcalay T, Irony A, Greenfeld S, Adler L, Cahan A. A Nationwide Digital Multidisciplinary Intervention Aimed at Promoting Pneumococcal Vaccination in Immunocompromised Patients. Vaccines (Basel) 2023; 11:1355. [PMID: 37631923 PMCID: PMC10458143 DOI: 10.3390/vaccines11081355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 08/07/2023] [Accepted: 08/08/2023] [Indexed: 08/29/2023] Open
Abstract
Immunocompromised patients (IPs) are at high risk for infections, some of which are vaccine-preventable. The Israeli Ministry of Health recommends pneumococcal conjugate vaccine 13 (PCV13) and pneumococcal polysaccharide vaccine 23 (PPSV23) for IP, but vaccine coverage is suboptimal. We assessed the project's effectiveness in improving the pneumococcal vaccination rate among IP. An automated population-based registry of IP was developed and validated at Maccabi Healthcare Services, an Israeli health maintenance organization serving over 2.6 million members. Included were transplant recipients, patients with asplenia, HIV or advanced kidney disease; or those receiving immunosuppressive therapy. A personalized electronic medical record alert was activated reminding clinicians to consider vaccination during IP encounters. Later, IP were invited to get vaccinated via their electronic patient health record. Pre- and post-intervention vaccination rates were compared. Between October 2019 and October 2021, overall PCV13 vaccination rates among 32,637 IP went up from 11.9% (n = 3882) to 52% (n = 16,955) (p < 0.0001). The PPSV23 vaccination rate went up from 39.4% (12,857) to 57.1% (18,652) (p < 0.0001). In conclusion, implementation of targeted automated patient- and clinician-facing alerts, a remarkable increase in pneumococcal vaccine uptake was observed among IP. The outlined approach may be applied to increase vaccination uptake in large health organizations.
Collapse
Affiliation(s)
- Shirley Shapiro Ben David
- Health Division, Maccabi Healthcare Services, Tel Aviv 6812509, Israel (A.I.); (L.A.)
- Tel Aviv School of Medicine, Tel Aviv University, Tel Aviv 6139001, Israel
| | - Orna Shamai-Lubovitz
- Health Division, Maccabi Healthcare Services, Tel Aviv 6812509, Israel (A.I.); (L.A.)
| | - Vered Mourad
- Health Division, Maccabi Healthcare Services, Tel Aviv 6812509, Israel (A.I.); (L.A.)
| | - Iris Goren
- Health Division, Maccabi Healthcare Services, Tel Aviv 6812509, Israel (A.I.); (L.A.)
| | - Erica Cohen Iunger
- Health Division, Maccabi Healthcare Services, Tel Aviv 6812509, Israel (A.I.); (L.A.)
| | - Tamar Alcalay
- Health Division, Maccabi Healthcare Services, Tel Aviv 6812509, Israel (A.I.); (L.A.)
| | - Angela Irony
- Health Division, Maccabi Healthcare Services, Tel Aviv 6812509, Israel (A.I.); (L.A.)
| | - Shira Greenfeld
- Health Division, Maccabi Healthcare Services, Tel Aviv 6812509, Israel (A.I.); (L.A.)
| | - Limor Adler
- Health Division, Maccabi Healthcare Services, Tel Aviv 6812509, Israel (A.I.); (L.A.)
- Tel Aviv School of Medicine, Tel Aviv University, Tel Aviv 6139001, Israel
| | - Amos Cahan
- Infectious Diseases Unit, Samson Assuta Ashdod University Hospital, Ashdod 774762, Israel;
| |
Collapse
|
13
|
Tinggaard M, Slotved HC, Jørgensen CS, Kronborg G, Benfield T. Predictors of serological non-response to the 13-valent pneumococcal conjugate vaccine followed by the 23-valent polysaccharide vaccine among adults living with HIV. Vaccine 2023; 41:4414-4421. [PMID: 37316406 DOI: 10.1016/j.vaccine.2023.06.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 05/16/2023] [Accepted: 06/04/2023] [Indexed: 06/16/2023]
Abstract
BACKGROUND People living with HIV (PLWH) have higher incidence of pneumococcal disease compared to people without HIV. Immunization with pneumococcal vaccines is recommended, but serological non-response to pneumococcal vaccination is common for largely unknown reasons. METHODS PLWH on antiretroviral treatment and no prior pneumococcal vaccination received the 13-valent pneumococcal conjugate vaccine (PCV13) followed 60 days later by the 23-valent polysaccharide vaccine (PPV23). Serological response was evaluated 30 days post-PPV23 by antibodies against 12 serotypes covered by both PCV13 and PPV23. Seroprotection was defined as a ≥2-fold rise to a level above 1.3 µg/ml in geometric mean concentration (GMC) across all serotypes. Associations with non-responsiveness were evaluated by logistic regression. RESULTS Fifty-two virologically suppressed PLWH (median age of 50 years (IQR 44-55) and median CD4 count of 634 cells/mm3 (IQR 507-792)) were included. Forty-six percent (95 % CI 32-61, n = 24) achieved seroprotection. Serotypes 14, 18C and 19F had the highest, and serotypes 3, 4 and 6B the lowest GMCs. Pre-vaccination GMC levels less than 100 ng/ml were associated with increased odds of non-responsiveness compared to levels above 100 ng/ml (adjusted OR 8.7, 95 % CI 1.2-63.6, p = 0.0438). CONCLUSION Less than half of our study population achieved anti-pneumococcal seroprotective levels following PCV13 and PPV23 immunization. Low pre-vaccination GMC levels were associated with non-response. Further research is required to optimize vaccination strategies that achieve higher seroprotection in this high-risk group.
Collapse
Affiliation(s)
- Michaela Tinggaard
- Department of Infectious Diseases, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark.
| | - Hans-Christian Slotved
- Department of Bacteria, Parasites and Fungi, Statens Serum Institut, Copenhagen, Denmark
| | | | - Gitte Kronborg
- Department of Infectious Diseases, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Thomas Benfield
- Department of Infectious Diseases, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
14
|
Mamani RF, López TDA, Jalo WM, Alves MR, Nunes EP, Pereira MS, Silva EADSRD, Lourenço MCDS, Veloso VG, Grinsztejn BJ, Cardoso SW, Lamas CDC. Invasive Pneumococcal Disease in People Living with HIV: A Retrospective Case-Control Study in Brazil. Trop Med Infect Dis 2023; 8:328. [PMID: 37368746 DOI: 10.3390/tropicalmed8060328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 06/05/2023] [Accepted: 06/09/2023] [Indexed: 06/29/2023] Open
Abstract
HIV-infected patients are at particular risk for invasive pneumococcal disease (IPD). We describe cases of IPD in people living with HIV/AIDS (PLWHA) and find associated risk factors for infection and death. METHODS A retrospective case-control study, nested in a cohort, including PLWHA with and without IPD, conducted in Brazil, 2005-2020. Controls were of the same gender/age and seen at the same time/place as cases. RESULTS We identified 55 episodes of IPD (cases) in 45 patients and 108 controls. The incidence of IPD was 964/100,000 person-years. A total of 42 of 55 (76.4%) IPD episodes presented with pneumonia and 11 (20%) with bacteremia without a focus and 38/45 (84.4%) were hospitalized. Blood cultures were positive in 54/55 (98.2%). Liver cirrhosis and COPD were the only factors associated with IPD in PLWHA in univariate analysis, although no associated factors were found in multivariate analysis. Penicillin resistance was found in 4/45 (8.9%). Regarding antiretroviral therapy (ART), 40/45 (88.9%) cases vs. 80/102 controls (74.1%) were in use (p = 0.07). Patients with HIV and IPD had a higher CD4 count of 267 cells/mm3 compared with the control group, in which it was 140 cells/mm3 (p = 0.027). Pneumococcal vaccination was documented in 19%. Alcoholism (p = 0.018), hepatic cirrhosis (p = 0.003), and lower nadir CD4 count (p = 0.033) were associated with the risk of death in patients with IPD. In-hospital mortality among PLWHA and IPD was 21.1%, and it was associated with thrombocytopenia and hypoalbuminemia, elevated band forms, creatinine, and aspartate aminotransferase (AST). CONCLUSIONS The incidence of IPD in PLWHA remained high despite ART. The vaccination rate was low. Liver cirrhosis was associated with IPD and death.
Collapse
Affiliation(s)
- Roxana Flores Mamani
- Instituto Nacional de Infectologia Evandro Chagas, Fiocruz, Avenida Brasil 4365-Manguinhos, Rio de Janeiro 21040-360, RJ, Brazil
| | - Tiago de Assunção López
- Barra da Tijuca Campus, Department of Medicine, Universidade do Grande Rio/Afya, Avenida Ayrton Senna, 2.200, Barra da Tijuca 22775-003, RJ, Brazil
| | - Waldir Madany Jalo
- Instituto Nacional de Infectologia Evandro Chagas, Fiocruz, Avenida Brasil 4365-Manguinhos, Rio de Janeiro 21040-360, RJ, Brazil
| | - Marcelo Ribeiro Alves
- Instituto Nacional de Infectologia Evandro Chagas, Fiocruz, Avenida Brasil 4365-Manguinhos, Rio de Janeiro 21040-360, RJ, Brazil
| | - Estevão Portela Nunes
- Instituto Nacional de Infectologia Evandro Chagas, Fiocruz, Avenida Brasil 4365-Manguinhos, Rio de Janeiro 21040-360, RJ, Brazil
| | - Mario Sérgio Pereira
- Instituto Nacional de Infectologia Evandro Chagas, Fiocruz, Avenida Brasil 4365-Manguinhos, Rio de Janeiro 21040-360, RJ, Brazil
| | | | - Maria Cristina da Silva Lourenço
- Instituto Nacional de Infectologia Evandro Chagas, Fiocruz, Avenida Brasil 4365-Manguinhos, Rio de Janeiro 21040-360, RJ, Brazil
| | - Valdiléa Gonçalves Veloso
- Instituto Nacional de Infectologia Evandro Chagas, Fiocruz, Avenida Brasil 4365-Manguinhos, Rio de Janeiro 21040-360, RJ, Brazil
| | - Beatriz Jegerhorn Grinsztejn
- Instituto Nacional de Infectologia Evandro Chagas, Fiocruz, Avenida Brasil 4365-Manguinhos, Rio de Janeiro 21040-360, RJ, Brazil
| | - Sandra Wagner Cardoso
- Instituto Nacional de Infectologia Evandro Chagas, Fiocruz, Avenida Brasil 4365-Manguinhos, Rio de Janeiro 21040-360, RJ, Brazil
| | - Cristiane da Cruz Lamas
- Instituto Nacional de Infectologia Evandro Chagas, Fiocruz, Avenida Brasil 4365-Manguinhos, Rio de Janeiro 21040-360, RJ, Brazil
- Instituto Nacional de Cardiologia, Rua das Laranjeiras, 374-Laranjeiras, Rio de Janeiro 22240-006, RJ, Brazil
| |
Collapse
|
15
|
Calderon LM, Pope JE, Shah AA, Domsic RT. Preventative Care in Scleroderma: What Is the Best Approach to Vaccination? Rheum Dis Clin North Am 2023; 49:401-410. [PMID: 37028843 PMCID: PMC10875978 DOI: 10.1016/j.rdc.2023.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2023]
Abstract
Systemic sclerosis (SSc) is a rare multisystem autoimmune disease characterized by fibrosis, vasculopathy, and autoimmunity. There are multiple complications inherent to SSc and its management. One of these complications is increased infection risk, which can lead to decreased quality of life and increased morbidity and mortality. Patients with SSc have lower vaccination rates and decreased vaccine seroconversion secondary to immunosuppressive medications compared with the general population. The purpose of this review is to provide clinicians with an approach to vaccinations in SSc.
Collapse
Affiliation(s)
- Leonardo Martin Calderon
- Department of Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
| | - Janet E Pope
- Department of Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada; Division of Rheumatology, St. Joseph's Health Care, London, Ontario, Canada
| | - Ami A Shah
- Division of Rheumatology, Johns Hopkins University School of Medicine, Johns Hopkins Scleroderma Center, Baltimore, MD, USA
| | - Robyn T Domsic
- Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine, 3500 Terrace Street, Pittsburgh, PA 15261, USA.
| |
Collapse
|
16
|
Okinaka K, Inoue Y, Uchida N, Toya T, Ogawa H, Ozawa Y, Eto T, Mori T, Sugita J, Kondo T, Kato K, Suzuki R, Fukuda T. Clinical characteristics and risk factors of pneumococcal diseases in recipients of allogeneic hematopoietic stem cell transplants in the late phase: A retrospective registry study. J Infect Chemother 2023; 29:726-730. [PMID: 37088144 DOI: 10.1016/j.jiac.2023.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 04/07/2023] [Accepted: 04/20/2023] [Indexed: 04/25/2023]
Abstract
Pneumococcal diseases are one of the most important infectious complications in the late period following allogeneic hematopoietic stem cell transplantation (allo-HSCT). The importance of long-term follow-up care is increasing, as the number of long-term survivors following allo-HSCT increases, but there has been a dearth of research specifically focusing on pneumococcal diseases during the late post-transplant period (day >100). Using a transplant registry database between January 1, 2001 and December 31, 2011, we aimed to assess the clinical spectrum and risk factors for pneumococcal diseases in the late post-transplant period. Among the 22,514 recipients who received allo-HSCT over an 11-year period and could be followed for ≥100 days, 43 patients developed 49 episodes of pneumococcal diseases. Six of the 43 patients died from pneumococcal diseases, and four of these six patients died within a week, despite having undergone allo-HSCT two or more years ago. A history of chronic graft-versus-host disease (odds ratio [OR], 2.31; 95% confidence interval [CI], 1.15-4.66; P = 0.02), viral infection (OR, 3.38; 95% CI, 1.70-6.72; P < 0.01), and complete remission of the underlying disease at the time of transplantation (OR, 2.38; 95%CI, 1.10-5.14; P = 0.03) were identified as risk factors. Given the risk of sudden death and the high mortality rate, attention should be paid to pneumococcal diseases in providing long-term follow-up care, even several years after allo-HSCT.
Collapse
Affiliation(s)
- Keiji Okinaka
- Department of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan.
| | - Yoshitaka Inoue
- Department of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan
| | - Naoyuki Uchida
- Department of Hematology, Federation of National Public Service Personnel Mutual Aid Associations Toranomon Hospital, Tokyo, Japan
| | - Takashi Toya
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Hiroyasu Ogawa
- Division of Hematology, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan
| | - Yukiyasu Ozawa
- Department of Hematology, Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital, Nagoya, Japan
| | - Tetsuya Eto
- Department of Hematology, Hamanomachi Hospital, Fukuoka, Japan
| | - Takehiko Mori
- Division of Hematology, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Junichi Sugita
- Department of Hematology, Hokkaido University Hospital, Sapporo, Japan
| | - Tadakazu Kondo
- Department of Hematology/Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Koji Kato
- Department of Hematology and Oncology, Children's Medical Center, Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital, Nagoya, Japan
| | - Ritsuro Suzuki
- Department of HSCT Data Management and Biostatistics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takahiro Fukuda
- Department of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan
| |
Collapse
|
17
|
The impact of immunomodulating treatment on the immunogenicity of COVID-19 vaccines in patients with immune-mediated inflammatory rheumatic diseases compared to healthy controls. A Swedish nationwide study (COVID19-REUMA). Vaccine 2023; 41:3247-3257. [PMID: 37076360 PMCID: PMC10070777 DOI: 10.1016/j.vaccine.2023.03.065] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 03/10/2023] [Accepted: 03/29/2023] [Indexed: 04/07/2023]
Abstract
Objectives To elucidate antibody responses after the second and third dose of COVID-19 vaccine in patients with inflammatory rheumatic diseases (IRD) treated with biologic/targeted disease modifying anti-rheumatic drugs (b/ts DMARDs). Methods Antibody levels to antigens representing spike full length protein and spike S1 were measured before vaccination, 2-12 weeks after the second dose, before and after the third dose using multiplex bead-based serology assay. Positive antibody response was defined as antibody levels over cut off (seropositivity) in seronegative individuals or ≥4-fold increase in antibodies in individuals seropositive for both spike proteins. Results Patients (n=414) receiving b/ts DMARDs (283 had arthritis, 75 systemic vasculitis and 56 other autoimmune diseases) and controls (n=61) from five Swedish regions participated. Treatments groups were: rituximab (n=145); abatacept (n=22); Interleukin 6 receptor inhibitors [IL6i (n=79)]; JAnus Kinase Inhibitors [JAKi (n=58)], Tumour Necrosis Factor inhibitor [TNFi (n=68)] and Interleukin12/23/17 inhibitors [IL12/23/17i (n=42)]. Percentage of patients with positive antibody response after two doses was significantly lower in rituximab (33,8%) and abatacept (40,9%) (p<0,001) but not in IL12/23/17i, TNFi or JAKi groups compared to controls (80,3%). Higher age, rituximab treatment and shorter time between last rituximab course and vaccination predicted impaired antibody response. Antibody levels collected 21-40 weeks after second dose decreased significantly (IL6i: p=0,02; other groups: p<0,001) compared to levels at 2-12 week but most participants remained seropositive. Proportion of patients with positive antibody response increased after third dose but was still significantly lower in rituximab (p<0,001). Conclusions Older individuals and patients on maintenance rituximab have an impaired response after two doses of COVID-19 vaccine which improves if the time between last rituximab course and vaccination extends and also after an additional vaccine dose. Rituximab patients should be prioritized for booster vaccine doses. TNFi, JAKi and IL12/23/17i does not diminished humoral response to primary and an additional vaccination.
Collapse
|
18
|
Walti LN, Mugglin C, Mombelli M, Manuel O, Hirsch HH, Khanna N, Mueller NJ, Berger C, Boggian K, Garzoni C, Neofytos D, van Delden C, Mäusezahl M, Hirzel C. Vaccine-Preventable Infections Among Solid Organ Transplant Recipients in Switzerland. JAMA Netw Open 2023; 6:e2310687. [PMID: 37115546 PMCID: PMC10148200 DOI: 10.1001/jamanetworkopen.2023.10687] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/29/2023] Open
Abstract
Importance Vaccine responses are decreased in solid organ transplant (SOT) recipients, and given the complexity of implementation, vaccination programs may be suboptimal. The actual burden of vaccine-preventable infections (VPIs) among SOT recipients remains unclear. Objectives To assess the incidence rate of VPIs among SOT recipients and to evaluate whether SOT recipients are at increased risk for specific VPIs compared with the general population. Design, Setting, and Participants This nationwide cohort study used data from the Swiss Transplant Cohort Study on VPIs in individuals who underwent SOT from May 2008 to June 2019 (follow-up until December 2019) and data from the Swiss Federal Office of Public Health on notifiable VPIs in the general population in the same period. Data were analyzed from January 2021 to June 2022. Exposures Solid organ transplant. Main Outcomes and Measures The main outcomes were the incidence rate of the following VPIs in SOT recipients: hepatitis A and B, diphtheria, Haemophilus influenzae infection, influenza, measles, mumps, pertussis, pneumococcal disease, poliomyelitis, meningococcal disease, rubella, tetanus, tick-borne encephalitis, and varicella zoster virus infection. Age-adjusted standardized incidence ratios were used to assess whether VPIs occurred more frequently in SOT recipients compared with the general population. For SOT recipients, factors associated with occurrence of VPIs were explored and the associated morbidity and mortality assessed. Results Of 4967 SOT recipients enrolled (median age, 54 years [IQR, 42-62 years]; 3191 [64.2%] male), 593 (11.9%) experienced at least 1 VPI. The overall VPI incidence rate was higher in the population that underwent SOT (30.57 per 1000 person-years [PY]; 95% CI, 28.24-33.10 per 1000 PY) compared with the general population (0.71 per 1000 PY). The standardized age-adjusted incidence ratio for notifiable VPIs in SOT recipients was higher compared with the general population (27.84; 95% CI, 25.00-31.00). In SOT recipients, influenza and varicella zoster virus infection accounted for most VPI episodes (16.55 per 1000 PY [95% CI, 14.85-18.46 per 1000 PY] and 12.83 per 1000 PY [95% CI, 11.40-14.44 per 1000 PY], respectively). A total of 198 of 575 VPI episodes in the population that underwent SOT (34.4%) led to hospital admission, and the occurrence of a VPI was associated with an increased risk for death and/or graft loss (hazard ratio, 2.44; 95% CI, 1.50-3.99; P = .002). In multivariable analysis, age 65 years or older at the time of transplant (incidence rate ratio [IRR], 1.29; 95% CI, 1.02-1.62) and receipt of a lung (IRR, 1.77; 95% CI, 1.38-2.26) or a heart (IRR, 1.40; 95% CI, 1.05-1.88) transplant were associated with an increased risk of VPI occurrence. Conclusions and Relevance In this study, 11.9% of SOT recipients experienced VPIs, and the incidence rate was higher than in the general population. There was significant morbidity and mortality associated with these infections in the population that underwent SOT, which highlights the need for optimizing immunization strategies.
Collapse
Affiliation(s)
- Laura N Walti
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland
- Division of Infectious Diseases, Multi-Organ Transplant Program, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Catrina Mugglin
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Matteo Mombelli
- Transplantation Center and Service of Infectious Diseases, Lausanne University Hospital, Lausanne, Switzerland
| | - Oriol Manuel
- Transplantation Center and Service of Infectious Diseases, Lausanne University Hospital, Lausanne, Switzerland
| | - Hans H Hirsch
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
| | - Nina Khanna
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
| | - Nicolas J Mueller
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich and University Zurich, Zurich, Switzerland
| | - Christoph Berger
- Division of Infectious Diseases and Hospital Epidemiology, University Children's Hospital Zurich, Zurich, Switzerland
| | - Katia Boggian
- Division of Infectious Diseases and Hospital Hygiene, Cantonal Hospital St Gallen, St Gallen, Switzerland
| | - Christian Garzoni
- Clinic of Internal Medicine and Infectious Diseases, Clinica Luganese, Lugano, Switzerland
| | - Dionysios Neofytos
- Transplant Infectious Diseases Unit, University Hospitals of Geneva and Faculty of Medicine, Geneva, Switzerland
| | - Christian van Delden
- Transplant Infectious Diseases Unit, University Hospitals of Geneva and Faculty of Medicine, Geneva, Switzerland
| | - Mirjam Mäusezahl
- Swiss Federal Office of Public Health, Epidemiological Evaluation and Surveillance Section, Bern, Switzerland
| | - Cédric Hirzel
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland
| |
Collapse
|
19
|
Ishige T, Shimizu T, Watanabe K, Arai K, Kamei K, Kudo T, Kunisaki R, Tokuhara D, Naganuma M, Mizuochi T, Murashima A, Inoki Y, Iwata N, Iwama I, Koinuma S, Shimizu H, Jimbo K, Takaki Y, Takahashi S, Cho Y, Nambu R, Nishida D, Hagiwara SI, Hikita N, Fujikawa H, Hosoi K, Hosomi S, Mikami Y, Miyoshi J, Yagi R, Yokoyama Y, Hisamatsu T. Expert consensus on vaccination in patients with inflammatory bowel disease in Japan. J Gastroenterol 2023; 58:135-157. [PMID: 36629948 PMCID: PMC9838549 DOI: 10.1007/s00535-022-01953-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 12/28/2022] [Indexed: 01/12/2023]
Abstract
Immunosuppressive therapies can affect the immune response to or safety of vaccination in patients with inflammatory bowel disease (IBD). The appropriateness of vaccination should be assessed prior to the initiation of IBD treatment because patients with IBD frequently undergo continuous treatment with immunosuppressive drugs. This consensus was developed to support the decision-making process regarding appropriate vaccination for pediatric and adult patients with IBD and physicians by providing critical information according to the published literature and expert consensus about vaccine-preventable diseases (VPDs) [excluding cervical cancer and coronavirus disease 2019 (COVID-19)] in Japan. This consensus includes 19 important clinical questions (CQs) on the following 4 topics: VPDs (6 CQs), live attenuated vaccines (2 CQs), inactivated vaccines (6 CQs), and vaccination for pregnancy, childbirth, and breastfeeding (5 CQs). These topics and CQs were selected under unified consensus by the members of a committee on intractable diseases with support by a Health and Labour Sciences Research Grant. Physicians should provide necessary information on VPDs to their patients with IBD and carefully manage these patients' IBD if various risk factors for the development or worsening of VPDs are present. This consensus will facilitate informed and shared decision-making in daily IBD clinical practice.
Collapse
Affiliation(s)
- Takashi Ishige
- Department of Pediatrics, Gunma University Graduate School of Medicine, 3-39-22, Showa-Machi, Maebashi, Gunma, 371-8511, Japan.
| | - Toshiaki Shimizu
- Department of Pediatrics and Adolescent Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Kenji Watanabe
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Hyogo Medical University, Nishinomiya, Japan
| | - Katsuhiro Arai
- Division of Gastroenterology, Center for Pediatric Inflammatory Bowel Disease, National Center for Child Health and Development, Tokyo, Japan
| | - Koichi Kamei
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan
| | - Takahiro Kudo
- Department of Pediatrics, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Reiko Kunisaki
- Inflammatory Bowel Disease Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Daisuke Tokuhara
- Department of Pediatrics, Wakayama Medical University, Wakayama, Japan
| | - Makoto Naganuma
- Department of Gastroenterology and Hepatology, Kansai Medical University, Osaka, Japan
| | - Tatsuki Mizuochi
- Department of Pediatrics and Child Health, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Atsuko Murashima
- Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center of Child Health and Development, Tokyo, Japan
| | - Yuta Inoki
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan
| | - Naomi Iwata
- Department of Infection and Immunology, Aichi Children's Health and Medical Center, Obu, Japan
| | - Itaru Iwama
- Division of Gastroenterology and Hepatology, Saitama Children's Medical Center, Saitama, Japan
| | - Sachi Koinuma
- Japan Drug Information Institute in Pregnancy, National Center of Child Health and Development, Tokyo, Japan
| | - Hirotaka Shimizu
- Division of Gastroenterology, Center for Pediatric Inflammatory Bowel Disease, National Center for Child Health and Development, Tokyo, Japan
| | - Keisuke Jimbo
- Department of Pediatrics, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Yugo Takaki
- Department of Pediatrics, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan
| | - Shohei Takahashi
- Department of Pediatrics, Kyorin University School of Medicine, Tokyo, Japan
| | - Yuki Cho
- Department of Pediatrics, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Ryusuke Nambu
- Division of Gastroenterology and Hepatology, Saitama Children's Medical Center, Saitama, Japan
| | - Daisuke Nishida
- Inflammatory Bowel Disease Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Shin-Ichiro Hagiwara
- Department of Pediatric Gastroenterology, Nutrition and Endocrinology, Osaka Women's and Children's Hospital, Osaka, Japan
| | - Norikatsu Hikita
- Department of Pediatrics, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Hiroki Fujikawa
- Division of Gastroenterology, Center for Pediatric Inflammatory Bowel Disease, National Center for Child Health and Development, Tokyo, Japan
| | - Kenji Hosoi
- Division of Gastroenterology, Tokyo Metro Children's Medical Center, Tokyo, Japan
| | - Shuhei Hosomi
- Department of Gastroenterology, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Yohei Mikami
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Jun Miyoshi
- Department of Gastroenterology and Hepatology, Kyorin University School of Medicine, Tokyo, Japan
| | - Ryusuke Yagi
- Department of Pediatrics, Gunma University Graduate School of Medicine, 3-39-22, Showa-Machi, Maebashi, Gunma, 371-8511, Japan
| | - Yoko Yokoyama
- Department of Intestinal Inflammation Research, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Tadakazu Hisamatsu
- Department of Gastroenterology and Hepatology, Kyorin University School of Medicine, Tokyo, Japan
| |
Collapse
|
20
|
Feredj E, Audureau E, Boueilh A, Fihman V, Fourati S, Lelièvre JD, Gallien S, Grimbert P, Matignon M, Melica G. Impact of a Dedicated Pretransplant Infectious Disease Consultation on Respiratory Tract Infections in Kidney Allograft Recipients: A Retrospective Study of 516 Recipients. Pathogens 2023; 12:pathogens12010074. [PMID: 36678422 PMCID: PMC9867402 DOI: 10.3390/pathogens12010074] [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: 11/18/2022] [Revised: 12/19/2022] [Accepted: 12/24/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Respiratory tract infections (RTIs) are a leading cause of death after kidney transplant. Preventive strategies may be implemented during a dedicated infectious disease consultation (IDC) before transplantation. Impact of IDC on RTIs after transplant has not been determined. METHODS We conducted a monocentric retrospective cohort analysis including all kidney transplant recipients from January 2015 to December 2019. We evaluated the impact of IDC on RTIs and identified risk and protective factors associated with RTIs. RESULTS We included 516 kidney transplant recipients. Among these, 145 had an IDC before transplant. Ninety-five patients presented 123 RTIs, including 75 (61%) with pneumonia. Patient that benefited from IDC presented significantly less RTIs (p = 0.049). RTIs were an independent risk factor of mortality (HR = 3.64 (1.97-6.73)). Independent risk factors for RTIs included HIV (OR = 3.33 (1.43-7.74)) and HCV (OR = 3.76 (1.58-8.96)). IDC was identified as an independent protective factor (OR = 0.48 (0.26-0.88)). IDC prior to transplantation is associated with diminished RTIs and is an independent protective factor. RTIs after kidney transplant are an independent risk factor of death. Implementing systematic IDC may have an important impact on reducing RTIs and related morbidity and mortality.
Collapse
Affiliation(s)
- Elsa Feredj
- Infectious Disease Department, Groupe Hospitalier Henri-Mondor/Albert Chenevier, Assistance Publique-Hôpitaux de Paris (AP-HP), 94010 Créteil, France
- IMRB (Institut Mondor de Recherche Biomédicale), Université Paris-Est-Créteil (UPEC), INSERM U955, Equipe 16, 94010 Créteil, France
- Correspondence:
| | - Etienne Audureau
- Department of Public Health, Hôpitaux Universitaires Henri Mondor, Assistance Publique—Hôpitaux de Paris, 94010 Créteil, France
| | - Anna Boueilh
- Nephrology and Renal Transplantation Department, Groupe Hospitalier Henri-Mondor/Albert-Chenevier, Assistance Publique-Hôpitaux de Paris (AP-HP), 94010 Créteil, France
| | - Vincent Fihman
- Virology, Bacteriology and Infection Control Units, Clinical Microbiology Department, AP-HP (Assistance Publique-Hôpitaux de Paris, 94010 Créteil, France
- IMRB (Institut Mondor de Recherche Biomédicale), VIC (Virologie Immunité Cancer), DHU (Département Hospitalo-Universitaire), Université Paris-Est-Créteil (UPEC), INSERM U955, Equipe 18, 94010 Créteil, France
- Ecole Vétérinaire de Maison Alfort, EA Dynamyc, Université Paris Est Créteil, 94000 Créteil, France
| | - Slim Fourati
- Virology, Bacteriology and Infection Control Units, Clinical Microbiology Department, AP-HP (Assistance Publique-Hôpitaux de Paris, 94010 Créteil, France
- IMRB (Institut Mondor de Recherche Biomédicale), VIC (Virologie Immunité Cancer), DHU (Département Hospitalo-Universitaire), Université Paris-Est-Créteil (UPEC), INSERM U955, Equipe 18, 94010 Créteil, France
| | - Jean-Daniel Lelièvre
- Infectious Disease Department, Groupe Hospitalier Henri-Mondor/Albert Chenevier, Assistance Publique-Hôpitaux de Paris (AP-HP), 94010 Créteil, France
- IMRB (Institut Mondor de Recherche Biomédicale), Université Paris-Est-Créteil (UPEC), INSERM U955, Equipe 16, 94010 Créteil, France
| | - Sébastien Gallien
- Infectious Disease Department, Groupe Hospitalier Henri-Mondor/Albert Chenevier, Assistance Publique-Hôpitaux de Paris (AP-HP), 94010 Créteil, France
- Ecole Vétérinaire de Maison Alfort, EA Dynamyc, Université Paris Est Créteil, 94000 Créteil, France
| | - Philippe Grimbert
- Nephrology and Renal Transplantation Department, Groupe Hospitalier Henri-Mondor/Albert-Chenevier, Assistance Publique-Hôpitaux de Paris (AP-HP), 94010 Créteil, France
- IMRB (Institut Mondor de Recherche Biomédicale), VIC (Virus-Immunité-Cancer), DHU (Département Hospitalo-Universitaire), Université Paris-Est-Créteil (UPEC), INSERM U955, Equipe 21, 94010 Créteil, France
- Clinical Investigation Center-Biotherapies 504, Groupe Hospitalier Henri-Mondor/Albert Chenevier Assistance Publique-Hôpitaux de Paris (AP-HP), 94010 Créteil, France
| | - Marie Matignon
- Nephrology and Renal Transplantation Department, Groupe Hospitalier Henri-Mondor/Albert-Chenevier, Assistance Publique-Hôpitaux de Paris (AP-HP), 94010 Créteil, France
- IMRB (Institut Mondor de Recherche Biomédicale), VIC (Virus-Immunité-Cancer), DHU (Département Hospitalo-Universitaire), Université Paris-Est-Créteil (UPEC), INSERM U955, Equipe 21, 94010 Créteil, France
| | - Giovanna Melica
- Infectious Disease Department, Groupe Hospitalier Henri-Mondor/Albert Chenevier, Assistance Publique-Hôpitaux de Paris (AP-HP), 94010 Créteil, France
- IMRB (Institut Mondor de Recherche Biomédicale), Université Paris-Est-Créteil (UPEC), INSERM U955, Equipe 16, 94010 Créteil, France
| |
Collapse
|
21
|
Del Riccio M, Boccalini S, Cosma C, Vaccaro G, Bonito B, Zanella B, Salvati C, Giorgetti D, Rigon L, Biamonte MA, Monami M, Bonanni P, Bechini A. Effectiveness of pneumococcal vaccination on hospitalization and death in the adult and older adult diabetic population: a systematic review. Expert Rev Vaccines 2023; 22:1179-1184. [PMID: 37990793 DOI: 10.1080/14760584.2023.2286374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 11/17/2023] [Indexed: 11/23/2023]
Abstract
INTRODUCTION Diabetic patients are at a higher risk of getting pneumococcal disease and are therefore recommended to get vaccinated. The aim of our systematic review is the retrieval and analysis of all available evidence on the effect of pneumococcal vaccination on the risk of hospitalization and death in adult patients with diabetes. RESEARCH DESIGN AND METHODS MEDLINEand EMBASE were searched from inception until January 2023. We included all studies investigating whether pneumococcal vaccination reduces the risk of dying or being hospitalized in diabetic patients. The Newcastle-Ottawa scale was used to assess risk of bias. RESULTS Only two studies, encompassing a total of 68,246 subjects, were considered eligible for inclusion and of high quality. In both studies polysaccharide pneumococcal vaccination was associated with a reduction of the risk of hospitalization or death in adult diabetic patients (aHR: 0.76 in one study, aOR: 0.97 in the other one). However, in neither of the two included studies the lower risk was statistically significant. CONCLUSIONS Further research is needed due to the potentially major clinical implications for diabetic patients. The results of this systematic review can serve as a foundation for future studies, indicating the importance of continuing research in this area to improve patient outcomes.
Collapse
Affiliation(s)
- Marco Del Riccio
- Department of Health Sciences, University of Florence, Firenze, Italy
| | - Sara Boccalini
- Department of Health Sciences, University of Florence, Firenze, Italy
| | - Claudia Cosma
- Medical School of Specialization in Hygiene and Preventive Medicine, University of Florence, Firenze, Italy
| | - Gabriele Vaccaro
- Medical School of Specialization in Hygiene and Preventive Medicine, University of Florence, Firenze, Italy
| | - Benedetta Bonito
- Department of Health Sciences, University of Florence, Firenze, Italy
| | - Beatrice Zanella
- Department of Health Sciences, University of Florence, Firenze, Italy
| | - Cristina Salvati
- Department of Health Sciences, University of Florence, Firenze, Italy
| | - Duccio Giorgetti
- Medical School of Specialization in Hygiene and Preventive Medicine, University of Florence, Firenze, Italy
| | - Lisa Rigon
- Medical School of Specialization in Hygiene and Preventive Medicine, University of Florence, Firenze, Italy
| | | | - Matteo Monami
- Diabetology, Careggi Hospital, University of Florence, Florence, Italy
| | - Paolo Bonanni
- Department of Health Sciences, University of Florence, Firenze, Italy
| | - Angela Bechini
- Department of Health Sciences, University of Florence, Firenze, Italy
| |
Collapse
|
22
|
Immunogenicity of three versus four doses of 13-valent pneumococcal conjugate vaccine followed by 23-valent pneumococcal polysaccharide vaccine in allogeneic haematopoietic stem cell transplantation recipients: a multicentre, randomized controlled trial. Clin Microbiol Infect 2022; 29:482-489. [PMID: 36503114 DOI: 10.1016/j.cmi.2022.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 11/16/2022] [Accepted: 12/02/2022] [Indexed: 12/13/2022]
Abstract
OBJECTIVE This multicentre, phase 2, randomized, controlled study of allogeneic haematopoietic stem cell transplantation (allo-HSCT) recipients compared the immunogenicity of two anti-pneumococcal vaccine regimens: four doses of 13-valent pneumococcal conjugate vaccine (PCV13) followed by 23-valent pneumococcal polysaccharide vaccine (PPSV23) (3+1+1 experimental group), and three doses of PCV13 followed by PPSV23 (3+0+1 group). METHODS Allo-HSCT recipients without active graft-versus-host disease at enrolment were eligible. The primary endpoint was the IgG response rate (≥0.20 mg/mL) for all eight measured serotypes at 5 months after the PPSV23 booster. RESULTS Seventy-two recipients were randomized, and seventy recipients who received over one PCV13 dose were analysed. The mean ages were 47.2 years (standard deviation, 14.4) in the 3+1+1 group (n = 35) and 49.0 years (standard deviation, 14.3) in the 3+0+1 group (n = 35). There was no significant difference in the overall IgG response rate at 5 months after the PPSV23 booster between the 3+1+1 and 3+0+1 groups (100% (26/26) vs. 93% (27/29), respectively, relative risk (RR): 1.07; 95% confidence interval (CI): 0.97-1.19). This rate was high immediately before the PPSV23 booster in the 3+1+1 group (100% (26/26) compared with 81% (21/26), respectively, RR: 1.24; 95% CI: 1.03-1.49), but this difference disappeared 1 month after the PPSV23 booster (100% (26/26) vs. 97% (28/29), respectively, RR: 1.04; 95% CI; 0.97-1.11). No serious adverse events leading to study dropout occurred. DISCUSSION We were not able to determine the efficacy of the experimental arm based on the IgG response rate at 5 months after the PPSV23 booster in allo-HSCT recipients.
Collapse
|
23
|
Thindwa D, Mwalukomo TS, Msefula J, Jambo KC, Brown C, Kamng’ona A, Mwansambo C, Ojal J, Flasche S, French N, Heyderman RS, Swarthout TD. Risk factors for pneumococcal carriage in adults living with HIV on antiretroviral therapy in the infant pneumococcal vaccine era in Malawi. AIDS 2022; 36:2045-2055. [PMID: 35983828 PMCID: PMC10503545 DOI: 10.1097/qad.0000000000003365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 08/15/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Adults living with HIV (ALWHIV) on antiretroviral therapy (ART) are at high risk of pneumococcal carriage and disease. To help evaluate carriage risk in African ALWHIV at least 4 years after infant pneumococcal conjugate vaccination introduction in 2011, we assessed association between pneumococcal carriage and potential risk factors. METHODS Nasopharyngeal swabs were collected from adults aged 18-40 years attending an ART clinic during rolling, cross-sectional surveys in Blantyre, Malawi between 2015 and 2019. We fitted generalized additive models to estimate the risk of sex, social economic status (SES), living with a child less than 5 years, and ART duration on carriage. RESULTS Of 2067 adults, median age was 33 years (range 28-37), 1427 (69.0%) were women, 1087 (61.4%) were in low-middle socioeconomic-status (SES), 910 (44.0%) were living with a child less than 5 years, and median ART duration was 3 years (range 0.004-17). We estimated 38.2 and 60.6% reductions in overall and vaccine-serotype carriage prevalence. Overall carriage was associated with low SES, living with a child less than 5 years and shorter duration on ART. By contrast, vaccine-type carriage was associated with living without a child less than 5 years and male sex. CONCLUSION Despite temporal reductions in overall and vaccine-serotype carriage, there is evidence of incomplete vaccine-serotype indirect protection. A targeted-vaccination campaign should be considered for ALWHIV, along with other public health measures to further reduce vaccine-serotype carriage and therefore disease.
Collapse
Affiliation(s)
- Deus Thindwa
- Centre for the Mathematical Modelling of Infectious Diseases, Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
- Malawi-Liverpool-Wellcome Programme
| | - Thandie S. Mwalukomo
- School of Life Sciences and Allied Health Professions, Department of Biomedical Sciences, Kamuzu University of Health Sciences, Blantyre, Malawi
| | | | - Kondwani C. Jambo
- Malawi-Liverpool-Wellcome Programme
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | | | - Arox Kamng’ona
- School of Life Sciences and Allied Health Professions, Department of Biomedical Sciences, Kamuzu University of Health Sciences, Blantyre, Malawi
| | | | - John Ojal
- Centre for the Mathematical Modelling of Infectious Diseases, Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
- KEMRI-Wellcome Research Programme, Geographic Medicine Centre, Kilifi, Kenya
| | - Stefan Flasche
- Centre for the Mathematical Modelling of Infectious Diseases, Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Neil French
- Institute of Infection, Veterinary and Ecological Science, Department of Clinical Infection, Microbiology, and Immunology, University of Liverpool, Liverpool
| | - Robert S. Heyderman
- Division of Infection and Immunity, Research Department of Infection, NIHR Mucosal Pathogens Research Unit, University College London, London, UK
| | - Todd D. Swarthout
- Malawi-Liverpool-Wellcome Programme
- Division of Infection and Immunity, Research Department of Infection, NIHR Mucosal Pathogens Research Unit, University College London, London, UK
| |
Collapse
|
24
|
Beentjes D, Shears RK, French N, Neill DR, Kadioglu A. Mechanistic Insights into the Impact of Air Pollution on Pneumococcal Pathogenesis and Transmission. Am J Respir Crit Care Med 2022; 206:1070-1080. [PMID: 35649181 PMCID: PMC9704843 DOI: 10.1164/rccm.202112-2668tr] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 06/01/2022] [Indexed: 11/16/2022] Open
Abstract
Streptococcus pneumoniae (the pneumococcus) is the leading cause of pneumonia and bacterial meningitis. A number of recent studies indicate an association between the incidence of pneumococcal disease and exposure to air pollution. Although the epidemiological evidence is substantial, the underlying mechanisms by which the various components of air pollution (particulate matter and gases such as NO2 and SO2) can increase susceptibility to pneumococcal infection are less well understood. In this review, we summarize the various effects air pollution components have on pneumococcal pathogenesis and transmission; exposure to air pollution can enhance host susceptibility to pneumococcal colonization by impairing the mucociliary activity of the airway mucosa, reducing the function and production of key antimicrobial peptides, and upregulating an important pneumococcal adherence factor on respiratory epithelial cells. Air pollutant exposure can also impair the phagocytic killing ability of macrophages, permitting increased replication of S. pneumoniae. In addition, particulate matter has been shown to activate various extra- and intracellular receptors of airway epithelial cells, which may lead to increased proinflammatory cytokine production. This increases recruitment of innate immune cells, including macrophages and neutrophils. The inflammatory response that ensues may result in significant tissue damage, thereby increasing susceptibility to invasive disease, because it allows S. pneumoniae access to the underlying tissues and blood. This review provides an in-depth understanding of the interaction between air pollution and the pneumococcus, which has the potential to aid the development of novel treatments or alternative strategies to prevent disease, especially in areas with high concentrations of air pollution.
Collapse
Affiliation(s)
- Daan Beentjes
- Department of Clinical Immunology, Microbiology and Immunology, University of Liverpool, Liverpool, United Kingdom
| | - Rebecca K Shears
- Department of Clinical Immunology, Microbiology and Immunology, University of Liverpool, Liverpool, United Kingdom
| | - Neil French
- Department of Clinical Immunology, Microbiology and Immunology, University of Liverpool, Liverpool, United Kingdom
| | - Daniel R Neill
- Department of Clinical Immunology, Microbiology and Immunology, University of Liverpool, Liverpool, United Kingdom
| | - Aras Kadioglu
- Department of Clinical Immunology, Microbiology and Immunology, University of Liverpool, Liverpool, United Kingdom
| |
Collapse
|
25
|
Shapiro Ben David S, Goren I, Mourad V, Cahan A. Vaccination Coverage among Immunocompromised Patients in a Large Health Maintenance Organization: Findings from a Novel Computerized Registry. Vaccines (Basel) 2022; 10:vaccines10101654. [PMID: 36298519 PMCID: PMC9612260 DOI: 10.3390/vaccines10101654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 09/28/2022] [Accepted: 09/30/2022] [Indexed: 11/05/2022] Open
Abstract
Immune-compromised patients (IPs) are at high risk for infections, some of which are preventable by vaccines. Specific vaccines are recommended for IP; however, the vaccination rate is suboptimal. The aim of this study is to describe the development of an IP registry and to assess vaccination rates in this population. A population-based registry of IPs was developed using an automated extraction of patient electronic health-record data in Maccabi Healthcare Services (MHS), an Israeli health maintenance organization serving over 2.4 million members. Included in the registry were patients receiving immunosuppressive therapy (IT); patients living with HIV (PLWH); solid organ and bone marrow transplant recipients (TR); patients with advanced kidney disease (AKD), and asplenic patients. We evaluated the full schedule for each vaccine's uptake rates for influenza, pneumococcal, meningococcal, and hepatitis B. On 1 October 2019, 32,637 adult immune-compromised patients were identified by the registry. Of them, 1647 were PLWH; 2354 were asplenic; 5317 had AKD; 23,216 were on IT; and 1824 were TR. Their mean age was 57 and 52.4% were females. The crude rate of immune compromise among adult MHS members was 2%. Vaccine coverage rate was overall low for PCV13, with only 11.9% of all IPs in the registry having received one dose. Influenza and PPV23 vaccination rates were higher (45% and 39.4%, respectively). Only 5.3% of all IPs received all three vaccines. Overall, low vaccination coverage was found among IPs. Our registry can serve to identify target-patient populations for interventions and monitor their effectiveness.
Collapse
Affiliation(s)
- Shirley Shapiro Ben David
- Health Division, Maccabi Healthcare Services, Tel Aviv 6812509, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Correspondence: ; Tel.: +972-37952830
| | - Iris Goren
- Health Division, Maccabi Healthcare Services, Tel Aviv 6812509, Israel
| | - Vered Mourad
- Health Division, Maccabi Healthcare Services, Tel Aviv 6812509, Israel
| | - Amos Cahan
- Infectious Diseases Unit, Samson Assuta Ashdod University Hospital, Ashdod 7747629, Israel
| |
Collapse
|
26
|
Huang ST, Huang YC, Kuo E, Yang YM, Hsiao FY. Impacts of Catch-Up Immunization program with the 13-Valent pneumococcal Conjugate vaccine in Taiwan: Focus on age-stratified differences and high-risk population (2001-2015). Vaccine 2022; 40:6225-6234. [PMID: 36127209 DOI: 10.1016/j.vaccine.2022.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 08/08/2022] [Accepted: 09/01/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Taiwan commenced a national catch-up immunization program with a 13-valent pneumococcal conjugate vaccine (PCV13) in 2013 for children aged 2-5 years old and in 2014 for children aged 1-5 years old. However, real-world nationwide evidence of both the direct protection and indirect protection of all-cause pneumonia and pneumococcal pneumonia has been scarce, especially among high-risk populations, defined as patients with chronic diseases or immunosuppression. The aim of this study was to examine the impact of the national PCV13 catch-up program on all-cause pneumonia and pneumococcal pneumonia among overall and high-risk populations using interrupted time series analysis. METHODS Using the National Health Insurance Research Database (NHIRD) from January 2001 to December 2015, we assessed the impact of this catch-up program by interrupted time-series analyses age-stratified (0-1, 2-4, 5-9, 10-17, 18-34, 35-49, 50-64, 65 + years old) incidence of pneumococcal pneumonia and all-cause pneumonia (100,000 person-quarter) among the overall and high-risk populations. RESULTS The impact of this program was most profound on the incidence of pneumococcal pneumonia in children aged 2-4 years old (level change -10.56 per 100,000 person-quarters, p = 0.04; trend change -2.93, p less than 0.01). Indirect protection among unvaccinated children (0-1 years old: trend change -1.19, p = 0.01; 5-9 years old: trend change -1.04, p = 0.03; 10-17 years old: level change -1.42 per 100,000 person-quarters, p = 0.03) was also found. The incidence of all-cause pneumonia also decreased in children aged 2-4 (level change -234.91 per 100,000 person-quarter, p = 0.058) and 5-9 years old (level change -173.96 per 100,000 person-quarter, p = 0.0424). However, we did not find a significant impact among most high-risk populations. CONCLUSIONS Our study suggests that the introduction of this catch-up program with PCV13 was associated with significant declines in the incidence of pneumococcal pneumonia and all-cause pneumonia in vaccinated children, and indirect protection from the program was also found in unvaccinated children.
Collapse
Affiliation(s)
- Shih-Tsung Huang
- Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan; School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yhu-Chering Huang
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Edward Kuo
- Pfizer Biopharmaceuticals Group, Pfizer Taiwan
| | - Ya-Min Yang
- Pfizer Biopharmaceuticals Group, Pfizer Taiwan
| | - Fei-Yuan Hsiao
- Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan; School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan.
| |
Collapse
|
27
|
Fuller A, Hancox J, Vedhara K, Card T, Mallen C, Van-Tam JSN, Abhishek A. Barriers and facilitators to vaccination uptake against COVID-19, influenza, and pneumococcal pneumonia in immunosuppressed adults with immune-mediated inflammatory diseases: A qualitative interview study during the COVID-19 pandemic. PLoS One 2022; 17:e0267769. [PMID: 36084032 PMCID: PMC9462800 DOI: 10.1371/journal.pone.0267769] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 08/12/2022] [Indexed: 11/19/2022] Open
Abstract
Objectives
To explore barriers and facilitators to COVID-19, influenza, and pneumococcal vaccine uptake in immunosuppressed adults with immune-mediated inflammatory diseases (IMIDs).
Methods
Recruiting through national patient charities and a local hospital, participants were invited to take part in an in-depth, one-to-one, semi-structured interview with a trained qualitative researcher between November 2021 and January 2022. Data were analysed thematically in NVivo, cross-validated by a second coder and mapped to the SAGE vaccine hesitancy matrix.
Results
Twenty participants (75% female, 20% non-white) were recruited. Barriers and facilitators spanned contextual, individual/group and vaccine/vaccination-specific factors. Key facilitators to all vaccines were higher perceived infection risk and belief that vaccination is beneficial. Key barriers to all vaccines were belief that vaccination could trigger IMID flare, and active IMID. Key facilitators specific to COVID-19 vaccines included media focus, high incidence, mass-vaccination programme with visible impact, social responsibility, and healthcare professionals’ (HCP) confirmation of the new vaccines’ suitability for their IMID. Novel vaccine technology was a concern, not a barrier. Key facilitators of influenza/pneumococcal vaccines were awareness of eligibility, direct invitation, and, clear recommendation from trusted HCP. Key barriers of influenza/pneumococcal vaccines were unaware of eligibility, no direct invitation or recommendation from HCP, low perceived infection risk, and no perceived benefit from vaccination.
Conclusions
Numerous barriers and facilitators to vaccination, varying by vaccine-type, exist for immunosuppressed-IMID patients. Addressing vaccine benefits and safety for IMID-patients in clinical practice, direct invitation, and public-health messaging highlighting immunosuppression as key vaccination-eligibility criteria may optimise uptake, although further research should assess this.
Collapse
Affiliation(s)
- Amy Fuller
- Academic Rheumatology, School of Medicine, University of Nottingham, Nottingham, United Kingdom
- * E-mail:
| | - Jennie Hancox
- Centre for Academic Primary Care, Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Kavita Vedhara
- Centre for Academic Primary Care, Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Tim Card
- Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | | | - Jonathan S. Nguyen Van-Tam
- Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Abhishek Abhishek
- Academic Rheumatology, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| |
Collapse
|
28
|
Abouqal R, Beji M, Chakroun M, Marhoum El Filali K, Rammaoui J, Zaghden H. Trends in Adult and Elderly Vaccination: Focus on Vaccination Practices in Tunisia and Morocco. Front Public Health 2022; 10:903376. [PMID: 35844850 PMCID: PMC9286557 DOI: 10.3389/fpubh.2022.903376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 06/09/2022] [Indexed: 11/25/2022] Open
Abstract
Vaccine preventable diseases (VPDs) are a prevailing concern among the adult population, despite availability of vaccines. Unlike pediatric vaccination programs, adult vaccination programs lack the required reach, initiative, and awareness. Clinical studies and real-world data have proven that vaccines effectively reduce the disease burden of VPDs and increase life expectancy. In Tunisia and Morocco, the national immunization program (NIP) focuses more on pediatric vaccination and have limited vaccination programs for adults. However, some vaccination campaigns targeting adults are organized. For example, influenza vaccination campaigns prioritizing at risk adults which includes healthcare professionals, elderly, and patients with comorbidities. Women of childbearing age who have never been vaccinated or whose information is uncertain are recommended to receive tetanus vaccination. Tunisia NIP recommends rubella vaccine mainly for women of childbearing age, while in Morocco, national vaccination campaigns were organized for girls and women (up to 24 years of age) to eliminate rubella. Further, travelers from both countries are recommended to follow all requirements and recommendations in the travel destination. The objective of this manuscript is to provide an overview of the global disease burden of common VPDs including (but not limited to) meningococcal diseases, pneumococcal diseases, hepatitis, and influenza. The review also provides an overview of clinical data and guidelines/recommendations on adult vaccination practices, with special focus on Tunisia and Morocco. Some European and North American countries have concrete recommendations and strategies for adult vaccination to keep the VPDs in check. In Morocco and Tunisia, although, there are sporadic adult vaccination initiatives, the efforts still need upscaling and endorsements to boost vaccination awareness and uptake. There is a need to strengthen strategies in both countries to understand the disease burden and spread awareness. Additional studies are needed to generate economic evidence to support cost-effectiveness of vaccines. Integration of private and public healthcare systems may further improve vaccination uptake in adults.
Collapse
Affiliation(s)
- Redouane Abouqal
- Laboratory of Biostatistics, Clinical and Epidemiological Research, Faculty of Medicine and Pharmacy, Mohammed V University in Rabat, Rabat, Morocco
- Acute Medical Unit, Ibn Sina University Hospital, Rabat, Morocco
| | - Maher Beji
- Department of Internal Medicine, Military Hospital Bizerte, Bizerte, Tunisia
- Faculty of Medicine of Tunis, University El Manar, Tunis, Tunisia
- Tunisian Society of Tropical Medicine and Travel, Tunis, Tunisia
| | - Mohamed Chakroun
- Infectious Diseases Department, University Hospital, Monastir, Tunisia
| | | | | | | |
Collapse
|
29
|
Immunogenicity of the 13-Valent Pneumococcal Conjugate Vaccine (PCV13) Followed by the 23-Valent Pneumococcal Polysaccharide Vaccine (PPSV23) in Adults with and without Immunosuppressive Therapy. Vaccines (Basel) 2022; 10:vaccines10050795. [PMID: 35632551 PMCID: PMC9146363 DOI: 10.3390/vaccines10050795] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 05/06/2022] [Accepted: 05/10/2022] [Indexed: 11/16/2022] Open
Abstract
Immunosuppressive therapy increases the risk of pneumococcal disease. This risk can be mitigated by pneumococcal vaccination. The objective of this study was to investigate the immunogenicity of the 13-valent pneumococcal conjugate vaccine (PCV13), followed by the 23-valent pneumococcal polysaccharide vaccine (PPSV23), in adults with and without immunosuppressive therapy. We performed a prospective cohort study among adults using conventional immunomodulators (cIM), biological immunomodulators (bIM), combination therapy, and controls during 12 months. The primary outcome was seroprotection, defined as the proportion of patients with a postimmunization IgG concentration of ≥1.3 µg/mL for at least 70% (17/24) of the serotypes of PCV13 + PPSV23. We included 214 participants. For all 24 vaccine serotypes, IgG levels increased significantly in both treatment subgroups and controls, with peak seroprotection rates of 44% (combination therapy), 58% (cIM), 57% (bIM), and 82% (controls). By month 12, seroprotection had decreased to 24%, 48%, 39%, and 63%, respectively. Although pneumococcal vaccination with PCV13 + PPSV23 was immunogenic in all treatment groups, impaired vaccination responses were observed in patients using immunosuppressive medication. Apart from the obvious recommendation to administer vaccines before such medication is started, alternative vaccination strategies, such as additional PCV13 doses or higher-valent pneumococcal vaccines, should be investigated.
Collapse
|
30
|
Garcia Garrido HM, Haggenburg S, Schoordijk MCE, Meijer E, Tanck MWT, Hazenberg MD, Rutten CE, Bree GJ, Nur E, Meek B, Grobusch MP, Goorhuis A. Immunogenicity of a 5-dose pneumococcal vaccination schedule following allogeneic hematopoietic stem cell transplantation. Am J Hematol 2022; 97:592-602. [PMID: 35147238 PMCID: PMC9303771 DOI: 10.1002/ajh.26493] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 01/13/2022] [Accepted: 02/07/2022] [Indexed: 12/24/2022]
Abstract
The optimal schedule of pneumococcal vaccination after allogeneic hematopoietic stem cell transplantation (allo‐HSCT) remains controversial. The objective of this study was to investigate the immunogenicity of a 5‐dose pneumococcal vaccination schedule in adult allo‐HSCT recipients with and without immunosuppressive therapy. In this prospective cohort study, allo‐HSCT recipients received four doses of the 13‐valent pneumococcal conjugate vaccine (PCV13) and one dose of the 23‐valent pneumococcal polysaccharide vaccine (PPSV23) starting 4–6 months after allo‐HSCT. PCV13 was administered at T0, T1, T2, and T8 (T = months from enrollment) and PPSV23 at T10. Serum was collected at T0, T4, T8, T10, and T12, and IgG levels were measured for all 24 vaccine serotypes by immunoassay. The primary outcome was overall seroprotection at T12 defined as an IgG concentration ≥1.3 μg/ml for 17/24 vaccine serotypes in allo‐HCST recipients with and without immunosuppressive therapy at baseline. Secondary outcomes were serotype‐specific seroprotection and dynamics of IgG levels. We included 89 allo‐HSCT recipients in the final analysis. Overall seroprotection was 47% (15/32) for patients without immunosuppressive therapy at baseline versus 24% (11/46) for patients with immunosuppressive therapy (p = .03). Seroprotection was higher for PCV13 serotypes (78% and 54% respectively; p = .03) and lower for PPSV23‐unique serotypes (28% and 13% respectively; p = .1). IgG concentrations increased significantly over time for all 24 serotypes. Concluding, although immunogenicity of PCV13 serotypes was reasonable, the poor response to PPSV23 serotypes resulted in an insufficient overall response to pneumococcal vaccination for allo‐HSCT recipients. Research into vaccination strategies with higher‐valent T‐cell‐dependent pneumococcal vaccines is needed.
Collapse
Affiliation(s)
- Hannah M. Garcia Garrido
- Amsterdam UMC, Centre of Tropical Medicine and Travel Medicine, Department of Infectious Diseases University of Amsterdam, Amsterdam institute for Infection and Immunity Amsterdam The Netherlands
| | - Sabine Haggenburg
- Amsterdam UMC, Department of Hematology, Amsterdam Institute for Infection and Immunity Cancer Center Amsterdam Amsterdam The Netherlands
| | - Marieke C. E. Schoordijk
- Amsterdam UMC, Department of Hematology, Amsterdam Institute for Infection and Immunity Cancer Center Amsterdam Amsterdam The Netherlands
| | - Ellen Meijer
- Amsterdam UMC, Department of Hematology, Amsterdam Institute for Infection and Immunity Cancer Center Amsterdam Amsterdam The Netherlands
| | - Michael W. T. Tanck
- Amsterdam UMC, Department of Epidemiology and Data Science University of Amsterdam Amsterdam The Netherlands
| | - Mette D. Hazenberg
- Amsterdam UMC, Department of Hematology, Amsterdam Institute for Infection and Immunity Cancer Center Amsterdam Amsterdam The Netherlands
- Department of Hematopoiesis Sanquin Research Amsterdam The Netherlands
| | - Caroline E. Rutten
- Amsterdam UMC, Department of Hematology, Amsterdam Institute for Infection and Immunity Cancer Center Amsterdam Amsterdam The Netherlands
| | - Godelieve J. Bree
- Amsterdam UMC, Centre of Tropical Medicine and Travel Medicine, Department of Infectious Diseases University of Amsterdam, Amsterdam institute for Infection and Immunity Amsterdam The Netherlands
| | - Erfan Nur
- Amsterdam UMC, Department of Hematology, Amsterdam Institute for Infection and Immunity Cancer Center Amsterdam Amsterdam The Netherlands
- Department of Hematopoiesis Sanquin Research Amsterdam The Netherlands
| | - Bob Meek
- Department of Medical Microbiology and Immunology St. Antonius Hospital Nieuwegein the Netherlands
| | - Martin P. Grobusch
- Amsterdam UMC, Centre of Tropical Medicine and Travel Medicine, Department of Infectious Diseases University of Amsterdam, Amsterdam institute for Infection and Immunity Amsterdam The Netherlands
| | - Abraham Goorhuis
- Amsterdam UMC, Centre of Tropical Medicine and Travel Medicine, Department of Infectious Diseases University of Amsterdam, Amsterdam institute for Infection and Immunity Amsterdam The Netherlands
| |
Collapse
|
31
|
Jiang M, Wang X, Zhu L, Yang YH, Yao KH, Dong F, Shi W, Wang Q, Song WQ, Liu G. Clinical characteristics, antimicrobial resistance, and risk factors for mortality in paediatric invasive pneumococcal disease in Beijing, 2012-2017. BMC Infect Dis 2022; 22:338. [PMID: 35382757 PMCID: PMC8981664 DOI: 10.1186/s12879-022-07179-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 02/18/2022] [Indexed: 12/03/2022] Open
Abstract
Background To analyse clinical characteristics, antibiotic susceptibility, and risk factors for mortality in paediatric invasive pneumococcal disease (IPD) in Beijing. Methods Paediatric IPD patients in our hospital were retrospectively collected from 2012 to 2017. Clinical manifestations, laboratory tests, antimicrobial susceptibility and serotype of isolates, and risk factors for mortality of IPD were analysed. Results Overall, 186 IPD cases were enrolled. The major manifestations were meningitis (76), pneumonia with bacteraemia (60), bacteraemia without focus (21), and pneumonia with empyaema (22). Of 72 cases with underlying diseases, leukaemia (18.0%), congenital heart disease (15.3%), primary immunodeficiency disease (12.5%), nephrotic syndrome (12.5%), and cerebrospinal fluid leakage (12.5%) were most common. In total 96.9% of isolates would have been covered by the pneumococcal conjugate vaccine (PCV13), including 19F (32.8%), 19A (23.4%), 4 (17.2%), and 23F (9.4%). Nonsusceptibility rates of penicillin, cefotaxime, and cefepime among nonmeningitis patients increased between 2012 and 2017; The mortality rate was 21.5%. Meningitis, respiratory failure, multiple organ failure, and white blood cell count < 4000 cells/μL were independent risk factors for mortality. Conclusion Meningitis was the most common clinical manifestation of IPD, and was frequently associated with death. Strains in the PCV13 vaccine would cover most of the cases, and so wider use of PCV13 should be considered.
Collapse
Affiliation(s)
- Man Jiang
- Key Laboratory of Major Diseases in Children, Ministry of Education, Department of Infectious Diseases, National Center for Children's Health, China, Beijing Children's Hospital Affiliated to Capital Medical University, No. 56 Nan Lishi Road, Beijing, 100045, China.,Department of Infectious Diseases, Shenzhen Children's Hospital, Shenzhen, 518035, China
| | - Xi Wang
- Key Laboratory of Major Diseases in Children, Ministry of Education, Department of Infectious Diseases, National Center for Children's Health, China, Beijing Children's Hospital Affiliated to Capital Medical University, No. 56 Nan Lishi Road, Beijing, 100045, China
| | - Liang Zhu
- Key Laboratory of Major Diseases in Children, Ministry of Education, Department of Infectious Diseases, National Center for Children's Health, China, Beijing Children's Hospital Affiliated to Capital Medical University, No. 56 Nan Lishi Road, Beijing, 100045, China
| | - Yong-Hong Yang
- Key Laboratory of Major Diseases in Children, Ministry of Education, National Key Discipline of Pediatrics (Capital Medical University), National Center for Children's Health, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, Beijing, 100045, China
| | - Kai-Hu Yao
- Key Laboratory of Major Diseases in Children, Ministry of Education, National Key Discipline of Pediatrics (Capital Medical University), National Center for Children's Health, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, Beijing, 100045, China
| | - Fang Dong
- Department of Laboratory Medicine, Beijing Children's Hospital, Capital Medical University, Beijing, 100045, China
| | - Wei Shi
- Key Laboratory of Major Diseases in Children, Ministry of Education, National Key Discipline of Pediatrics (Capital Medical University), National Center for Children's Health, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, Beijing, 100045, China
| | - Qing Wang
- Key Laboratory of Major Diseases in Children, Ministry of Education, National Key Discipline of Pediatrics (Capital Medical University), National Center for Children's Health, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, Beijing, 100045, China
| | - Wen-Qi Song
- Department of Laboratory Medicine, Beijing Children's Hospital, Capital Medical University, Beijing, 100045, China
| | - Gang Liu
- Key Laboratory of Major Diseases in Children, Ministry of Education, Department of Infectious Diseases, National Center for Children's Health, China, Beijing Children's Hospital Affiliated to Capital Medical University, No. 56 Nan Lishi Road, Beijing, 100045, China.
| |
Collapse
|
32
|
Mohapi L, Pinedo Y, Osiyemi O, Supparatpinyo K, Ratanasuwan W, Molina JM, Dagan R, Tamms G, Sterling T, Zhang Y, Pedley A, Hartzel J, Kan Y, Hurtado K, Musey L, Simon JK, Buchwald UK. Safety and immunogenicity of V114, a 15-valent pneumococcal conjugate vaccine, in adults living with HIV. AIDS 2022; 36:373-382. [PMID: 34750291 PMCID: PMC8815827 DOI: 10.1097/qad.0000000000003126] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 10/19/2021] [Accepted: 10/20/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To evaluate safety and immunogenicity of V114 [15-valent pneumococcal conjugate vaccine (PCV) containing serotypes 1, 3, 4, 5, 6A, 6B, 7F, 9V, 14, 18C, 19A, 19F, 22F, 23F, and 33F], followed by 23-valent pneumococcal polysaccharide vaccine (PPSV23) 8 weeks later, in adults living with HIV. DESIGN In this phase 3 study (V114-018; NCT03480802), pneumococcal vaccine-naive adults with HIV (CD4+ cell count ≥50 cells/μl, plasma HIV RNA <50 000 copies/ml, receiving antiretroviral therapy) were randomized 1 : 1 to receive one dose of V114 or licensed 13-valent PCV (PCV13) on day 1; participants received PPSV23 at week 8. METHODS Adverse events and serotype-specific opsonophagocytic activity (OPA) and immunoglobulin G (IgG) antibodies were evaluated after each vaccination. RESULTS Of 302 participants enrolled, 292 (96.7%) completed the study. Proportions of participants experiencing at least one adverse event were 73.0 and 62.7% in the V114 and PCV13 groups following PCV and 60.7 and 71.6% following PPSV23. Most solicited adverse events were of mild or moderate severity and short duration. OPA geometric mean titers (GMTs) and IgG geometric mean concentrations (GMCs) were generally comparable between groups for shared serotypes at day 30 and maintained at week 12. OPA and IgG responses for additional serotypes in V114 (22F, 33F) were higher following V114 than PCV13 at day 30 but comparable at week 12, 30 days post-PPSV23. CONCLUSION In pneumococcal vaccine-naive adults living with HIV, V114 was well tolerated and induced immune responses for all 15 pneumococcal serotypes. V114 can be followed by PPSV23 8 weeks later to broaden serotype coverage.
Collapse
Affiliation(s)
- Lerato Mohapi
- University of the Witwatersrand, Johannesburg, South Africa
| | | | | | | | | | | | - Ron Dagan
- Ben-Gurion University, Beer-Sheva, Israel
| | | | | | - Ying Zhang
- Merck & Co., Inc., Kenilworth, New Jersey, USA
| | | | - Jon Hartzel
- Merck & Co., Inc., Kenilworth, New Jersey, USA
| | - Yanqing Kan
- Merck & Co., Inc., Kenilworth, New Jersey, USA
| | - Kim Hurtado
- Merck & Co., Inc., Kenilworth, New Jersey, USA
| | - Luwy Musey
- Merck & Co., Inc., Kenilworth, New Jersey, USA
| | | | | |
Collapse
|
33
|
Min JY, Mwakingwe-Omari A, Riley M, Molo LY, Soni J, Girard G, Danier J. The Adjuvanted Recombinant Zoster Vaccine Co-Administered with the 13-valent Pneumococcal Conjugate Vaccine in Adults Aged ≥50 Years: a Randomized Trial. J Infect 2021; 84:490-498. [PMID: 34963639 DOI: 10.1016/j.jinf.2021.12.033] [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: 09/01/2021] [Revised: 12/15/2021] [Accepted: 12/22/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND Herpes zoster (HZ) results from reactivation of latent varicella-zoster virus. Adults at increased risk of HZ (due to immunocompromising conditions or older age) are also at risk of pneumococcal disease, both of which are preventable by vaccination. We evaluated simultaneous versus sequential administration of the adjuvanted recombinant zoster vaccine (RZV) and the 13-valent pneumococcal conjugate vaccine (PCV13) in adults aged ≥50 years. METHODS In this phase IIIB multinational trial (NCT03439657), participants were randomized 1:1 to receive either the first RZV dose and PCV13 simultaneously followed by the second RZV dose two months later (Co-Ad, N=449), or at two-month intervals, PCV13, the first RZV dose, and the second RZV dose sequentially (Control, N=463). Objectives were to demonstrate that immune responses to both vaccines are non-inferior when co-administered compared to sequential administration and to evaluate the safety of their co-administration. RESULTS The RZV vaccine response rate (VRR) in the Co-Ad group was 99.1% (95% confidence interval [CI]: 97.6-99.7), meeting the VRR success criterion. Non-inferiority criteria for the Co-Ad versus Control group were also met for anti-glycoprotein E antibodies (adjusted geometric mean concentration Control/Co-Ad ratio 1.07 [95%CI: 0.99-1.16]) and all PCV13 serotypes (adjusted antibody geometric mean titer Control/Co-Ad ratios 1.02 [95%CI: 0.86-1.22] to 1.36 [95%CI: 1.07-1.73]). Upon co-administration, the frequency of solicited local adverse events was consistent with the known safety profile of each individual vaccine, whereas solicited general adverse events were within the same range as for RZV alone. CONCLUSIONS RZV co-administered with PCV13 had an acceptable safety profile. Humoral immune responses to both vaccines were non-inferior when co-administered compared to sequential administration. These results suggest that adults may benefit from receiving RZV and a PCV at the same healthcare visit.
Collapse
Affiliation(s)
- Ji-Young Min
- GSK, 14200 Shady Grove Rd., Rockville, MD, United States
| | | | - Megan Riley
- GSK, 14200 Shady Grove Rd., Rockville, MD, United States
| | | | - Jyoti Soni
- GSK, Level 4, Prestige Trade Tower, 46, Palace Road, Sampangi Rama Nagar, Bengaluru, Karnataka 560001, India
| | | | - Jasur Danier
- GSK, 14200 Shady Grove Rd., Rockville, MD, United States.
| |
Collapse
|
34
|
Thindwa D, Wolter N, Pinsent A, Carrim M, Ojal J, Tempia S, Moyes J, McMorrow M, Kleynhans J, von Gottberg A, French N, Cohen C, Flasche S. Estimating the contribution of HIV-infected adults to household pneumococcal transmission in South Africa, 2016–2018: A hidden Markov modelling study. PLoS Comput Biol 2021; 17:e1009680. [PMID: 34941865 PMCID: PMC8699682 DOI: 10.1371/journal.pcbi.1009680] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 11/24/2021] [Indexed: 12/17/2022] Open
Abstract
Human immunodeficiency virus (HIV) infected adults are at a higher risk of pneumococcal colonisation and disease, even while receiving antiretroviral therapy (ART). To help evaluate potential indirect effects of vaccination of HIV-infected adults, we assessed whether HIV-infected adults disproportionately contribute to household transmission of pneumococci. We constructed a hidden Markov model to capture the dynamics of pneumococcal carriage acquisition and clearance observed during a longitudinal household-based nasopharyngeal swabbing study, while accounting for sample misclassifications. Households were followed-up twice weekly for approximately 10 months each year during a three-year study period for nasopharyngeal carriage detection via real-time PCR. We estimated the effect of participant’s age, HIV status, presence of a HIV-infected adult within the household and other covariates on pneumococcal acquisition and clearance probabilities. Of 1,684 individuals enrolled, 279 (16.6%) were younger children (<5 years-old) of whom 4 (1.5%) were HIV-infected and 726 (43.1%) were adults (≥18 years-old) of whom 214 (30.4%) were HIV-infected, most (173, 81.2%) with high CD4+ count. The observed range of pneumococcal carriage prevalence across visits was substantially higher in younger children (56.9–80.5%) than older children (5–17 years-old) (31.7–50.0%) or adults (11.5–23.5%). We estimate that 14.4% (95% Confidence Interval [CI]: 13.7–15.0) of pneumococcal-negative swabs were false negatives. Daily carriage acquisition probabilities among HIV-uninfected younger children were similar in households with and without HIV-infected adults (hazard ratio: 0.95, 95%CI: 0.91–1.01). Longer average carriage duration (11.4 days, 95%CI: 10.2–12.8 vs 6.0 days, 95%CI: 5.6–6.3) and higher median carriage density (622 genome equivalents per millilitre, 95%CI: 507–714 vs 389, 95%CI: 311.1–435.5) were estimated in HIV-infected vs HIV-uninfected adults. The use of ART and antibiotics substantially reduced carriage duration in all age groups, and acquisition rates increased with household size. Although South African HIV-infected adults on ART have longer carriage duration and density than their HIV-uninfected counterparts, they show similar patterns of pneumococcal acquisition and onward transmission. We assessed the contribution of HIV-infected adults to household pneumococcal transmission by applying a hidden Markov model to pneumococcal cohort data comprising 115,595 nasopharyngeal samples from 1,684 individuals in rural and urban settings in South Africa. We estimated 14.4% of sample misclassifications (false negatives), representing 85.6% sensitivity of a test that was used to detect pneumococcus. Pneumococcal carriage prevalence and acquisition rates, and average duration were usually higher in younger or older children than adults. The use of ART and antibiotics reduced the average carriage duration across all age and HIV groups, and carriage acquisition risks increased in larger household sizes. Despite the longer average carriage duration and higher median carriage density in HIV-infected than HIV-uninfected adults, we found similar carriage acquisition and onward transmission risks in the dual groups. These findings suggest that vaccinating HIV-infected adults on ART with PCV would reduce their risk for pneumococcal disease but may add little to the indirect protection against carriage of the rest of the population.
Collapse
Affiliation(s)
- Deus Thindwa
- Centre for the Mathematical Modelling of Infectious Diseases, Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Malawi Liverpool Wellcome Trust Clinical Research Programme, Blantyre, Malawi
- * E-mail:
| | - Nicole Wolter
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
- School of Pathology, University of the Witwatersrand, Johannesburg, South Africa
| | - Amy Pinsent
- Centre for the Mathematical Modelling of Infectious Diseases, Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Aquarius Population Health, London, United Kingdom
| | - Maimuna Carrim
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
| | - John Ojal
- Centre for the Mathematical Modelling of Infectious Diseases, Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
- KEMRI-Wellcome Trust Research Programme, Geographic Medicine Centre, Kilifi, Kenya
| | - Stefano Tempia
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
- Influenza Program, Centers for Disease Control and Prevention, Pretoria, South Africa
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- MassGenics, Duluth, Georgia, United States of America
| | - Jocelyn Moyes
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
| | - Meredith McMorrow
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Jackie Kleynhans
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
- School of Public Health, Faculty of Health Science, University of the Witwatersrand, Johannesburg, South Africa
| | - Anne von Gottberg
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
- School of Pathology, University of the Witwatersrand, Johannesburg, South Africa
| | - Neil French
- Malawi Liverpool Wellcome Trust Clinical Research Programme, Blantyre, Malawi
- Institute of Infection, Veterinary and Ecological Science, Department of Clinical Infection, Microbiology, and Immunology, University of Liverpool, Liverpool, United Kingdom
| | | | - Cheryl Cohen
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
- School of Public Health, Faculty of Health Science, University of the Witwatersrand, Johannesburg, South Africa
| | - Stefan Flasche
- Centre for the Mathematical Modelling of Infectious Diseases, Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| |
Collapse
|
35
|
Ljungman P. Infectious complications and vaccines. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2021; 2021:587-591. [PMID: 34889437 PMCID: PMC8791105 DOI: 10.1182/hematology.2021000294] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Infections are a major cause of morbidity and can result in mortality in long-term survivors after allogeneic hematopoietic cell transplantation. Chronic graft-versus-host disease and delayed immune reconstitution are recognized risk factors. Different strategies must be utilized depending on the individual patient's situation but include prolonged antimicrobial prophylaxis and vaccination. Some important infections due to pathogens preventable by vaccination are pneumococci, influenza, varicella-zoster virus, and SARS-CoV-2. Despite the fact that such recommendations have been in place for decades, implementation of these recommendations has been reported to be poor.
Collapse
Affiliation(s)
- Per Ljungman
- Correspondence Per Ljungman, Department of Cellular Therapy and Allogeneic Stem Cell Transplantation, M75, Karolinska University Hospital, Huddinge, SE-14186 Stockholm, Sweden; e-mail:
| |
Collapse
|
36
|
Loubet P, Rouvière J, Merceron A, Launay O, Sotto A. Patients' Perception and Knowledge about Influenza and Pneumococcal Vaccination during the COVID-19 Pandemic: An Online Survey in Patients at Risk of Infections. Vaccines (Basel) 2021; 9:vaccines9111372. [PMID: 34835303 PMCID: PMC8623007 DOI: 10.3390/vaccines9111372] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 11/16/2021] [Accepted: 11/17/2021] [Indexed: 01/23/2023] Open
Abstract
INTRODUCTION The objective of our study was to assess, in an at-risk population, perception and knowledge about influenza and pneumococcal vaccinations. METHODS An anonymous web-based survey was submitted to patients recruited in France, from both an Ipsos internal panel and AVNIR patient associations. The study was conducted between July and October 2020, in the context of the COVID-19 pandemic. RESULTS Overall, 2177 questionnaires from patients at risk of infection were analyzed. Almost all respondents (86%, 1869/2177) declared themselves to be favorable to vaccination. Nearly half of the patients (49%, 1069/2177) were aware of which vaccine was recommended for their specific situation. This percentage was significantly (p < 0.001) higher for members of a patient association and for people affected by multiple chronic conditions and varied according to the type of condition. Almost two-thirds of patients (1373/2177) declared having been vaccinated during the 2019/2020 influenza season, and 41% (894/2177) were certain about being up to date with the pneumococcal vaccination. The main barriers to vaccination for influenza are the fear of side effects, doubt regarding the efficacy of the vaccine and for pneumococcal vaccination, and the absence of suggestions by the healthcare professionals (HCPs), as 64% of respondents were not recommended to obtain pneumococcal vaccination. To improve vaccine coverage, information is of prime importance and GPs are recognized as the main HCP to inform about vaccination. Nearly two-thirds (62%, 1360/2177) of patients declared that the COVID-19 pandemic convinced them to have all the recommended vaccines. CONCLUSION Our study highlighted the nonoptimal vaccine coverage in at-risk populations despite a highly positive perception of vaccines and confirmed that physicians are on the front lines to suggest and recommend these vaccinations, especially in the current pandemic context, which may be used to promote other vaccines.
Collapse
Affiliation(s)
- Paul Loubet
- INSERM U1047, Department of Infectious and Tropical Diseases, CHU Nîmes, Université Montpellier, 30900 Nîmes, France;
- Correspondence: ; Tel.: +33-4-66-68-41-49
| | | | | | - Odile Launay
- Faculté de Médecine Paris Descartes, Université de Paris, AP-PH, Inserm, CIC Cochin Pasteur, 75231 Paris, France;
| | - Albert Sotto
- INSERM U1047, Department of Infectious and Tropical Diseases, CHU Nîmes, Université Montpellier, 30900 Nîmes, France;
| | | |
Collapse
|
37
|
Asai N, Mikamo H. Recent Topics of Pneumococcal Vaccination: Indication of Pneumococcal Vaccine for Individuals at a Risk of Pneumococcal Disease in Adults. Microorganisms 2021; 9:2342. [PMID: 34835468 PMCID: PMC8623678 DOI: 10.3390/microorganisms9112342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 11/05/2021] [Accepted: 11/06/2021] [Indexed: 11/16/2022] Open
Abstract
Pneumococcal disease is one of the most common and severe vaccine-preventable diseases (VPDs). Despite the advances in antimicrobial treatment, pneumococcal disease still remains a global burden and exhibits a high mortality rate among people of all ages worldwide. The immunization program of the pneumococcal conjugate vaccine (PCV) in children has decreased pneumococcal disease incidence in several countries. However, there are several problems regarding the pneumococcal vaccine, such as indications for immunocompetent persons with underlying medical conditions with a risk of pneumococcal disease, the balance of utility and cost, i.e., cost-effectiveness, vaccine coverage rate, serotype replacement, and adverse events. Especially for individuals aged 19-64 at risk of pneumococcal disease, physicians and vaccine providers should make a rational decision whether the patients should be vaccinated or not, since there is insufficient evidence supporting it. We describe this review regarding topics and problems regarding pneumococcal vaccination from the clinician's point of view.
Collapse
Affiliation(s)
- Nobuhiro Asai
- Department of Clinical Infectious Diseases, Aichi Medical University Hospital, Nagakute 480-1195, Japan;
- Department of Infection Control and Prevention, Aichi Medical University Hospital, Nagakute 480-1195, Japan
- Department of Pathology, University of Michigan, Ann Arbor, MI 48109, USA
| | - Hiroshige Mikamo
- Department of Clinical Infectious Diseases, Aichi Medical University Hospital, Nagakute 480-1195, Japan;
- Department of Infection Control and Prevention, Aichi Medical University Hospital, Nagakute 480-1195, Japan
| |
Collapse
|
38
|
Tinggaard M, Slotved HC, Fuursted K, Storgaard M, Dröse S, Johansen IS, Thorsteinsson K, Kronborg G, Lebech AM, Benfield T. Oral and anal carriage of Streptococcus pneumoniae among sexually active men with HIV who have sex with men. J Infect Dis 2021; 225:1575-1580. [PMID: 34622276 DOI: 10.1093/infdis/jiab512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 10/04/2021] [Indexed: 11/12/2022] Open
Abstract
People with HIV are at increased risk of pneumococcal disease. We investigate oral and anal carriage rates of Streptococcus pneumoniae by molecular methods among 82 men with HIV who have sex with men (MSM). A questionnaire, oral wash and anal swab samples were obtained at baseline and 12 months. Oral carriage rates were 32.9% (27/82) at baseline and 41.7% (30/72) at follow-up. Anal carriage rates were 2.4% (2/82) at baseline and 2.9% (2/70) at follow-up. Genogroup 24 was predominant. Results suggest high oral carriage rates of S. pneumoniae among MSM living with HIV. A minority were anal carriers.
Collapse
Affiliation(s)
- Michaela Tinggaard
- Department of Infectious Diseases, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
| | - Hans-Christian Slotved
- Department of Bacteria, Parasites and Fungi, Statens Serum Institut, Copenhagen, Denmark
| | - Kurt Fuursted
- Department of Bacteria, Parasites and Fungi, Statens Serum Institut, Copenhagen, Denmark
| | - Merete Storgaard
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
| | - Sandra Dröse
- Department of Infectious Diseases, Odense University Hospital, Odense, Denmark.,Research Unit for Infectious Diseases, Odense University Hospital, University of Southern Denmark, Denmark
| | - Isik Somuncu Johansen
- Department of Infectious Diseases, Odense University Hospital, Odense, Denmark.,Research Unit for Infectious Diseases, Odense University Hospital, University of Southern Denmark, Denmark
| | - Kristina Thorsteinsson
- Department of Infectious Diseases, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
| | - Gitte Kronborg
- Department of Infectious Diseases, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Anne-Mette Lebech
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Department of Infectious Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Thomas Benfield
- Department of Infectious Diseases, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
39
|
Navarro-Torné A, Montuori EA, Kossyvaki V, Méndez C. Burden of pneumococcal disease among adults in Southern Europe (Spain, Portugal, Italy, and Greece): a systematic review and meta-analysis. Hum Vaccin Immunother 2021; 17:3670-3686. [PMID: 34106040 PMCID: PMC8437551 DOI: 10.1080/21645515.2021.1923348] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 04/07/2021] [Accepted: 04/23/2021] [Indexed: 12/18/2022] Open
Abstract
The aim was to summarize pneumococcal disease burden data among adults in Southern Europe and the potential impact of vaccines on epidemiology. Of 4779 identified studies, 272 were selected. Invasive pneumococcal disease (IPD) incidence was 15.08 (95% CI 11.01-20.65) in Spain versus 2.56 (95% CI 1.54-4.24) per 100,000 population in Italy. Pneumococcal pneumonia incidence was 19.59 (95% CI 10.74-35.74) in Spain versus 2.19 (95% CI 1.36-3.54) per 100,000 population in Italy. Analysis of IPD incidence in Spain comparing pre-and post- PCV7 and PCV13 periods unveiled a declining trend in vaccine-type IPD incidence (larger and statistically significant for the elderly), suggesting indirect effects of childhood vaccination programme. Data from Portugal, Greece and, to a lesser extent, Italy were sparse, thus improved surveillance is needed. Pneumococcal vaccination uptake, particularly among the elderly and adults with chronic and immunosuppressing conditions, should be improved, including shift to a higher-valency pneumococcal conjugate vaccine when available.
Collapse
|
40
|
Malo JA, Ware RS, Lambert SB. Estimating the risk of recurrent invasive pneumococcal disease in Australia, 1991-2016. Vaccine 2021; 39:5748-5756. [PMID: 34483025 DOI: 10.1016/j.vaccine.2021.08.095] [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: 02/01/2021] [Revised: 08/24/2021] [Accepted: 08/26/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND Individuals who experience an initial episode of invasive pneumococcal disease (IPD) are at increased risk of recurrent episodes. However, the magnitude of risk has not been well-quantified in the pneumococcal conjugate vaccine era. Individuals with a previous episode of IPD are not commonly identified as a high-risk group in vaccination guidelines. METHODS Australian residents with at least one case of IPD between 1991 and 2016 were identified using routine public health surveillance data which included identified IPD risk factors. Incidence of recurrent IPD was calculated from 2001 onwards (after IPD became nationally notifiable) using time-to-event analyses with individuals contributing person-time at risk of recurrence if they survived greater than 14 days after initial episode onset. RESULTS From 1991 to 2016 there were 28,809 IPD episodes in 28,218 individuals. A total of 512 (1.8%) persons experienced 591 recurrent episodes. From 2001 to 2016 the incidence of recurrent IPD was 216.2 per 100,000 person-years, 27 times greater than the population rate of primary IPD during this period (8.0 per 100,000 population per year). Between 2011 and 2016, more than one-quarter of individuals experiencing recurrence had no IPD risk factors identified at first episode. CONCLUSIONS There is substantially increased risk of recurrent IPD after an initial episode. At least one-quarter of those with recurrent episodes have no identified risk factors at the initial episode. Given the potential preventability of future episodes, those with a previous IPD episode should be identified as a high-risk group and receive pneumococcal vaccination.
Collapse
Affiliation(s)
- Jonathan A Malo
- School of Population Health, The University of Queensland, Herston, Queensland, Australia.
| | - Robert S Ware
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Stephen B Lambert
- Centre for Children's Health Research, The University of Queensland, South Brisbane, Queensland, Australia; National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australian Capital Territory, Australia.
| |
Collapse
|
41
|
Jones JL, Tse F, Carroll MW, deBruyn JC, McNeil SA, Pham-Huy A, Seow CH, Barrett LL, Bessissow T, Carman N, Melmed GY, Vanderkooi OG, Marshall JK, Benchimol EI. Canadian Association of Gastroenterology Clinical Practice Guideline for Immunizations in Patients With Inflammatory Bowel Disease (IBD)-Part 2: Inactivated Vaccines. J Can Assoc Gastroenterol 2021; 4:e72-e91. [PMID: 34476339 PMCID: PMC8407486 DOI: 10.1093/jcag/gwab016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Indexed: 12/19/2022] Open
Abstract
Background and Aims The effectiveness and safety of vaccinations can be altered by
immunosuppressive therapies, and perhaps by inflammatory bowel disease (IBD)
itself. These recommendations developed by the Canadian Association of
Gastroenterology and endorsed by the American Gastroenterological
Association, aim to provide guidance on immunizations in adult and pediatric
patients with IBD. This publication focused on inactivated vaccines. Methods Systematic reviews evaluating the efficacy, effectiveness, and safety of
vaccines in patients with IBD, other immune-mediated inflammatory diseases,
and the general population were performed. Critical outcomes included
mortality, vaccine-preventable diseases, and serious adverse events.
Immunogenicity was considered a surrogate outcome for vaccine efficacy.
Certainty of evidence and strength of recommendations were rated according
to the GRADE (Grading of Recommendation Assessment, Development, and
Evaluation) approach. Key questions were developed through an iterative
online platform, and voted on by a multidisciplinary group. Recommendations
were formulated using the Evidence-to-Decision framework. Strong
recommendation means that most patients should receive the recommended
course of action, whereas a conditional recommendation means that different
choices will be appropriate for different patients. Results Consensus was reached on 15 of 20 questions. Recommendations address the
following vaccines: Haemophilus influenzae type b,
recombinant zoster, hepatitis B, influenza, pneumococcus, meningococcus,
tetanus-diphtheria-pertussis, and human papillomavirus. Most of the
recommendations for patients with IBD are congruent with the current Centers
for Disease Control and Prevention and Canada’s National Advisory
Committee on Immunization recommendations for the general population, with
the following exceptions. In patients with IBD, the panel suggested
Haemophilus influenzae type b vaccine for patients
older than 5 years of age, recombinant zoster vaccine for adults younger
than 50 year of age, and hepatitis B vaccine for adults without a risk
factor. Consensus was not reached, and recommendations were not made for 5
statements, due largely to lack of evidence, including double-dose hepatitis
B vaccine, timing of influenza immunization in patients on biologics,
pneumococcal and meningococcal vaccines in adult patients without risk
factors, and human papillomavirus vaccine in patients aged 27–45
years. Conclusions Patients with IBD may be at increased risk of some vaccine-preventable
diseases. Therefore, maintaining appropriate vaccination status in these
patients is critical to optimize patient outcomes. In general, IBD is not a
contraindication to the use of inactivated vaccines, but immunosuppressive
therapy may reduce vaccine responses.
Collapse
Affiliation(s)
- Jennifer L Jones
- Department of Medicine and Community Health and Epidemiology, Dalhousie University, Queen Elizabeth II Health Sciences Center, Halifax, Nova Scotia, Canada
| | - Frances Tse
- Division of Gastroenterology and Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Matthew W Carroll
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Jennifer C deBruyn
- Section of Pediatric Gastroenterology, Departments of Pediatrics and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Shelly A McNeil
- Division of Infectious Diseases, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Anne Pham-Huy
- Division of Infectious Diseases, Immunology and Allergy, Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
| | - Cynthia H Seow
- Division of Gastroenterology, Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Lisa L Barrett
- Division of Infectious Diseases, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Talat Bessissow
- Division of Gastroenterology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Nicholas Carman
- Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada.,CHEO Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Gil Y Melmed
- Inflammatory Bowel Disease Center, Cedars-Sinai Medical Center, Los Angeles, California, United States
| | - Otto G Vanderkooi
- Section of Infectious Diseases, Departments of Pediatrics, Microbiology, Immunology and Infectious Diseases, Pathology and Laboratory Medicine and Community Health Sciences, University of Calgary, Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
| | - John K Marshall
- Division of Gastroenterology and Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Eric I Benchimol
- Department of Pediatrics and School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada.,Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada, SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology Hepatology and Nutrition, The Hospital for Sick Children, Child Health Evaluative Sciences, SickKids Research Institute, ICES, Toronto, Ontario, Canada.,CHEO Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Eastern Ontario and CHEO Research Institute, Ottawa, Ontario, Canada.,ICES Ottawa, Ottawa, Ontario, Canada
| |
Collapse
|
42
|
The Risk of Invasive Pneumococcal Disease Differs between Risk Groups in Norway Following Widespread Use of the 13-Valent Pneumococcal Vaccine in Children. Microorganisms 2021; 9:microorganisms9081774. [PMID: 34442853 PMCID: PMC8398338 DOI: 10.3390/microorganisms9081774] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 08/17/2021] [Accepted: 08/18/2021] [Indexed: 01/18/2023] Open
Abstract
The elderly and adults with medical risk conditions remain at high risk of invasive pneumococcal disease (IPD), highlighting the importance of adequate preventive efforts. In an observational population-based study in Norway (pop ≥ 5 years, 2009-2017) covering six years post-PCV13 implementation, we explored the incidence and risk of IPD associated with age and comorbidities. We obtained the data on 5535 IPD cases from the Norwegian Surveillance System for Communicable Diseases and the population data from Statistics Norway. To define comorbidities, we obtained ICD-10 codes from the Norwegian Patient Registry for the cases and the Norwegian population. The average annual decrease in PCV13 IPD incidence was significant in all risk groups and decreased post-PCV13 introduction by 16-20% per risk group, implying a nondifferential indirect protection from the childhood vaccination. The IPD incidence remained high in the medical risk groups. The relative importance of medical risk conditions was 2.8 to 6 times higher in those aged 5-64 versus ≥65 years for all types of IPD, since age itself is a risk factor for IPD. In groups without medical risk, the risk of IPD was eight times higher in those aged ≥65 compared to those 5-64 years (RR 8.3 (95% CI 7.3-9.5)). Our results underscore the need for age- and risk-group-based prevention strategies.
Collapse
|
43
|
Peppa D, Reeves M. Poor Responses to Pneumococcal Vaccination in CKD Patients-Do We Need to Talk About Cytomegalovirus Again? Clin Infect Dis 2021; 73:e890-e891. [PMID: 33515456 DOI: 10.1093/cid/ciab084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Dimitra Peppa
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Matthew Reeves
- Institute of Immunity and Transplantation, University College London, London, UK
| |
Collapse
|
44
|
Punton H, Cisera K, Ojaimi S, Woolley I. Underutilised human immunodeficiency virus testing in the setting of invasive pneumococcal disease. Intern Med J 2021; 51:968-970. [PMID: 34155772 DOI: 10.1111/imj.15369] [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: 08/31/2020] [Revised: 09/27/2020] [Accepted: 09/28/2020] [Indexed: 12/15/2022]
Abstract
People living with human immunodeficiency virus (HIV) are at increased risk of invasive pneumococcal disease (IPD). We assessed whether patients with invasive Streptococcus pneumoniae, in blood or cerebrospinal fluid, underwent HIV serology testing over a 5-year period. We found that only 39 inpatients out of 156 (25%) with IPD were tested for HIV and thus conclude that such testing is not being undertaken according to some guidelines in patients with IPD. Education and implementation strategies are required to increase testing.
Collapse
Affiliation(s)
- Hannah Punton
- Monash Infectious Diseases, Monash Health, Melbourne, Victoria, Australia
| | - Kathryn Cisera
- Monash Infectious Diseases, Monash Health, Melbourne, Victoria, Australia
| | - Samar Ojaimi
- Monash Infectious Diseases, Monash Health, Melbourne, Victoria, Australia.,Centre for Inflammatory Diseases, Monash University, Melbourne, Victoria, Australia
| | - Ian Woolley
- Monash Infectious Diseases, Monash Health, Melbourne, Victoria, Australia.,Centre for Inflammatory Diseases, Monash University, Melbourne, Victoria, Australia
| |
Collapse
|
45
|
Kates OS, Stohs EJ, Pergam SA, Rakita RM, Michaels MG, Wolfe CR, Danziger-Isakov L, Ison MG, Blumberg EA, Razonable RR, Gordon EJ, Diekema DS. The limits of refusal: An ethical review of solid organ transplantation and vaccine hesitancy. Am J Transplant 2021; 21:2637-2645. [PMID: 33370501 PMCID: PMC8298607 DOI: 10.1111/ajt.16472] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 11/30/2020] [Accepted: 12/21/2020] [Indexed: 01/25/2023]
Abstract
Patients pursuing solid organ transplantation are encouraged to receive many vaccines on an accelerated timeline. Vaccination prior to transplantation offers the best chance of developing immunity and may expand the pool of donor organs that candidates can accept without needing posttransplant therapy. Furthermore, transplant recipients are at greater risk for acquiring vaccine-preventable illnesses or succumbing to severe sequelae of such illnesses. However, a rising rate of vaccine refusal has challenged transplant centers to address the phenomenon of vaccine hesitancy. Transplant centers may need to consider adopting a policy of denial of solid organ transplantation on the basis of vaccine refusal for non-medical reasons (i.e., philosophical or religious objections or personal beliefs that vaccines are unnecessary or unsafe). Arguments supporting such a policy are motivated by utility, stewardship, and beneficence. Arguments opposing such a policy emphasize justice and respect for persons, and seek to avoid worsening inequities or medical coercion. This paper examines these arguments and situates them within the special cases of pediatric transplantation, emergent transplantation, and living donation. Ultimately, a uniform national policy addressing vaccine refusal among transplant candidates is needed to resolve this ethical dilemma and establish a consistent, fair, and standard approach to vaccine refusal in transplantation.
Collapse
Affiliation(s)
- Olivia S. Kates
- Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA, USA,Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Erica J. Stohs
- Division of Infectious Diseases, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Steven A. Pergam
- Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA, USA,Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Robert M. Rakita
- Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA, USA
| | - Marian G. Michaels
- Department of Pediatrics, Division of Pediatric Infectious Diseases, University of Pittsburgh, School of Medicine, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Cameron R. Wolfe
- Division of Infectious Diseases, Duke University Medical School, Durham, NC, USA
| | - Lara Danziger-Isakov
- Division of Infectious Diseases, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Michael G. Ison
- Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, IL, USA,Division of Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Emily A. Blumberg
- Department of Medicine, Perelman School of Medicine University of Pennsylvania, Philadelphia, PA, USA
| | - Raymund R. Razonable
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Elisa J. Gordon
- Division of Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Douglas S. Diekema
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
| |
Collapse
|
46
|
Jones JL, Tse F, Carroll MW, deBruyn JC, McNeil SA, Pham-Huy A, Seow CH, Barrett LL, Bessissow T, Carman N, Melmed GY, Vanderkooi OG, Marshall JK, Benchimol EI. Canadian Association of Gastroenterology Clinical Practice Guideline for Immunizations in Patients With Inflammatory Bowel Disease (IBD)-Part 2: Inactivated Vaccines. Gastroenterology 2021; 161:681-700. [PMID: 34334167 DOI: 10.1053/j.gastro.2021.04.034] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIMS The effectiveness and safety of vaccinations can be altered by immunosuppressive therapies, and perhaps by inflammatory bowel disease (IBD) itself. These recommendations developed by the Canadian Association of Gastroenterology and endorsed by the American Gastroenterological Association, aim to provide guidance on immunizations in adult and pediatric patients with IBD. This publication focused on inactivated vaccines. METHODS Systematic reviews evaluating the efficacy, effectiveness, and safety of vaccines in patients with IBD, other immune-mediated inflammatory diseases, and the general population were performed. Critical outcomes included mortality, vaccine-preventable diseases, and serious adverse events. Immunogenicity was considered a surrogate outcome for vaccine efficacy. Certainty of evidence and strength of recommendations were rated according to the GRADE (Grading of Recommendation Assessment, Development, and Evaluation) approach. Key questions were developed through an iterative online platform, and voted on by a multidisciplinary group. Recommendations were formulated using the Evidence-to-Decision framework. Strong recommendation means that most patients should receive the recommended course of action, whereas a conditional recommendation means that different choices will be appropriate for different patients. RESULTS Consensus was reached on 15 of 20 questions. Recommendations address the following vaccines: Haemophilus influenzae type b, recombinant zoster, hepatitis B, influenza, pneumococcus, meningococcus, tetanus-diphtheria-pertussis, and human papillomavirus. Most of the recommendations for patients with IBD are congruent with the current Centers for Disease Control and Prevention and Canada's National Advisory Committee on Immunization recommendations for the general population, with the following exceptions. In patients with IBD, the panel suggested Haemophilus influenzae type b vaccine for patients older than 5 years of age, recombinant zoster vaccine for adults younger than 50 year of age, and hepatitis B vaccine for adults without a risk factor. Consensus was not reached, and recommendations were not made for 5 statements, due largely to lack of evidence, including double-dose hepatitis B vaccine, timing of influenza immunization in patients on biologics, pneumococcal and meningococcal vaccines in adult patients without risk factors, and human papillomavirus vaccine in patients aged 27-45 years. CONCLUSIONS Patients with IBD may be at increased risk of some vaccine-preventable diseases. Therefore, maintaining appropriate vaccination status in these patients is critical to optimize patient outcomes. In general, IBD is not a contraindication to the use of inactivated vaccines, but immunosuppressive therapy may reduce vaccine responses.
Collapse
Affiliation(s)
- Jennifer L Jones
- Department of Medicine and Community Health and Epidemiology, Dalhousie University, Queen Elizabeth II Health Sciences Center, Halifax, Nova Scotia, Canada.
| | - Frances Tse
- Division of Gastroenterology and Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Matthew W Carroll
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Jennifer C deBruyn
- Section of Pediatric Gastroenterology, Departments of Pediatrics and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Shelly A McNeil
- Division of Infectious Diseases, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Anne Pham-Huy
- Division of Infectious Diseases, Immunology and Allergy, Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
| | - Cynthia H Seow
- Division of Gastroenterology, Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Lisa L Barrett
- Division of Infectious Diseases, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Talat Bessissow
- Division of Gastroenterology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Nicholas Carman
- Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada, CHEO Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Gil Y Melmed
- Inflammatory Bowel Disease Center, Cedars-Sinai Medical Center, Los Angeles, California
| | - Otto G Vanderkooi
- Section of Infectious Diseases, Departments of Pediatrics, Microbiology, Immunology and Infectious Diseases, Pathology and Laboratory Medicine and Community Health Sciences, University of Calgary, Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
| | - John K Marshall
- Division of Gastroenterology and Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Eric I Benchimol
- Department of Pediatrics and School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada, CHEO Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Eastern Ontario and CHEO Research Institute, Ottawa, Ontario, Canada, ICES Ottawa, Ottawa, Ontario, Canada; Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada, SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology Hepatology and Nutrition, The Hospital for Sick Children, Child Health Evaluative Sciences, SickKids Research Institute, ICES, Toronto, Ontario, Canada.
| |
Collapse
|
47
|
Demirdal T, Sen P, Emir B. Predictors of mortality in invasive pneumococcal disease: a meta-analysis. Expert Rev Anti Infect Ther 2021; 19:927-944. [PMID: 33382642 DOI: 10.1080/14787210.2021.1858799] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To assess risk factors for mortality in invasive pneumococcal disease (IPD). METHODS We conducted a systemic literature search in January 2019. The main outcome measure included death within 30 days after diagnosis of IPD. The study protocol was registered in PROSPERO (CRD42019120189). RESULTS After reviewing 2514 potentially relevant records, remaining 190 articles were included in the analysis. A total of 228,782 IPD patients were identified and the mortality rate was 17.2% in the included articles. No significant evidence of publication bias was found according to the funnel plot and Egger's test (t = 1.464, p = 0.145). Male sex, older age, alcohol abuse, previous tuberculosis, meningitis, hospital acquired infections, multilobar infiltrate or effusion, Pitt bacteremia score≥4, Pneumonia Severity Index≥4, clinical conditions requiring intensive care, underlying clinical conditions, disease caused by serotypes 3, 6B, 9 N, 10A, 11A, 16 F, 17 F, 19, 19 F, 22 F, 23A, 23 F, 31 and 35 F, previous antibiotic use, inappropriate initial antibiotic therapy, penicillin resistance, and vancomycin use during the course of treatment were predicators of 30-day mortality. CONCLUSIONS This meta-analysis highlights important risk factors for IPD-related mortality, many of which may be targeted through preventive measures.
Collapse
Affiliation(s)
- Tuna Demirdal
- Department of Infectious Diseases and Clinical Microbiology, Izmir Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey
| | - Pinar Sen
- Department of Infectious Diseases and Clinical Microbiology, Izmir Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey
| | - Busra Emir
- Department of Biostatistics, Izmir Katip Celebi University School of Medicine, Izmir, Turkey
| |
Collapse
|
48
|
Rezahosseini O, Møller DL, Sørensen SS, Perch M, Gustafsson F, Gelpi M, Knudsen J, Helleberg M, Rasmussen A, Nielsen SD, Harboe ZB. An Observational Prospective Cohort Study of Incidence and Outcome of Streptococcus pneumoniae and Hemophilus influenzae Infections in Adult Solid Organ Transplant Recipients. Microorganisms 2021; 9:1371. [PMID: 34202542 PMCID: PMC8304095 DOI: 10.3390/microorganisms9071371] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 06/21/2021] [Accepted: 06/22/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Streptococcus pneumoniae (S. pneumoniae) and Hemophilus influenzae (H. influenzae) are among the main vaccine-preventable bacterial infections in immunocompromised individuals including solid organ transplant (SOT) recipients. There is a lack of information about incidence and outcomes of these infections in SOT recipients. METHODS We determined the incidence of S. pneumoniae and H. influenzae, the related hospitalization, and 30- and 180-days mortality in a large cohort of 1182 adult SOT recipients. We calculated 95% confidence intervals (CI) of incidence rate (IR) using Byar's approximation to the Poisson distribution. RESULTS The overall IR of S. pneumoniae and H. influenzae were 1086 (95% CI, 796-1448) and 1293 (95% CI, 974-1687) per 100,000 person-years of follow-up (PYFU), respectively. The IR of invasive infections were 76 (95% CI, 21-202) and 25 (95% CI, 2.3-118) per 100,000 PYFU, respectively. Hospital admission was required in >50%, 30-days mortality was 0, and 180-days mortality was 8.8% and 4.5% after S. pneumoniae and H. influenzae infections, respectively. CONCLUSIONS The IR of invasive S. pneumoniae and H. influenzae infections in SOT recipients were much higher than reports from the general population in Denmark. Furthermore, a large proportion of infected SOT recipients were hospitalized. These findings highlight the need for further studies to assess uptake and immunogenicity of vaccines against S. pneumoniae and H. influenzae in SOT recipients.
Collapse
Affiliation(s)
- Omid Rezahosseini
- Viro-Immunology Research Unit, Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, 2100 Copenhagen, Denmark; (O.R.); (D.L.M.); (M.G.); (S.D.N.)
| | - Dina Leth Møller
- Viro-Immunology Research Unit, Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, 2100 Copenhagen, Denmark; (O.R.); (D.L.M.); (M.G.); (S.D.N.)
| | - Søren Schwartz Sørensen
- Department of Nephrology, Rigshospitalet, University of Copenhagen, 2100 Copenhagen, Denmark;
- Department of Clinical Medicine, University of Copenhagen, 2100 Copenhagen, Denmark; (M.P.); (F.G.)
| | - Michael Perch
- Department of Clinical Medicine, University of Copenhagen, 2100 Copenhagen, Denmark; (M.P.); (F.G.)
- Section for Lung Transplantation, Department of Cardiology, Rigshospitalet, University of Copenhagen, 2100 Copenhagen, Denmark
| | - Finn Gustafsson
- Department of Clinical Medicine, University of Copenhagen, 2100 Copenhagen, Denmark; (M.P.); (F.G.)
- Department of Cardiology, Rigshospitalet, University of Copenhagen, 2100 Copenhagen, Denmark
| | - Marco Gelpi
- Viro-Immunology Research Unit, Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, 2100 Copenhagen, Denmark; (O.R.); (D.L.M.); (M.G.); (S.D.N.)
| | - Jenny Knudsen
- Department of Clinical Microbiology, Rigshospitalet, University of Copenhagen, 2100 Copenhagen, Denmark;
| | - Marie Helleberg
- Centre of Excellence for Health, Immunity and Infections, Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, 2100 Copenhagen, Denmark;
| | - Allan Rasmussen
- Department of Surgical Gastroenterology and Transplantation, Rigshospitalet, University of Copenhagen, 2100 Copenhagen, Denmark;
| | - Susanne Dam Nielsen
- Viro-Immunology Research Unit, Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, 2100 Copenhagen, Denmark; (O.R.); (D.L.M.); (M.G.); (S.D.N.)
- Department of Clinical Medicine, University of Copenhagen, 2100 Copenhagen, Denmark; (M.P.); (F.G.)
| | - Zitta Barrella Harboe
- Viro-Immunology Research Unit, Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, 2100 Copenhagen, Denmark; (O.R.); (D.L.M.); (M.G.); (S.D.N.)
- Department of Bacteria, Parasites and Fungi, Statens Serum Institut, 2100 Copenhagen, Denmark
- Department of Pulmonary and Infectious Diseases, Hospital of Nordsjælland, University of Copenhagen, 2100 Copenhagen, Denmark
| |
Collapse
|
49
|
The association between antimicrobial resistance and HIV infection: a systematic review and meta-analysis. Clin Microbiol Infect 2021; 27:846-853. [PMID: 33813126 DOI: 10.1016/j.cmi.2021.03.026] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 02/23/2021] [Accepted: 03/14/2021] [Indexed: 12/22/2022]
Abstract
OBJECTIVES People living with HIV (PLWH) are at increased risk of infections with resistant organisms due to more frequent healthcare utilization. Our objective was to investigate the association between HIV and antimicrobial resistance (AMR). METHODS We searched MEDLINE, EMBASE, Web of Science, LILACS and African Journals Online. Studies were eligible if they reported on AMR for colonization or infection with bacterial pathogens (excluding mycobacteria and bacteria causing sexually transmitted infections) and were stratified by HIV status, species and antimicrobials tested. Pooled odds ratios were used to evaluate the association between HIV and resistance. RESULTS In total, 92 studies published between 1995 and 2020 were identified. The studies included the following organisms: Staphylococcusaureus (n = 47), Streptococcus pneumoniae (n = 28), Escherichia coli (n = 6) and other Gram-negative bacteria. PLWH had a 2.12 (95%CI 1.36-3.30) higher odds for colonization and 1.90 (95%CI 1.45-2.48) higher odds for infection with methicillin-resistant S. aureus, a 2.28 (95%CI 1.75-2.97) higher odds of infection with S. pneumoniae with decreased penicillin susceptibility, and a 1.59 (95%CI 0.83-3.05) higher odds of resistance to third-generation cephalosporins in E. coli and Klebsiella pneumoniae. CONCLUSION This review shows an increased risk of AMR in PLWH across a range of bacterial pathogens and multiple drug classes. The lack of laboratory capacity for identifying AMR, and limited access to alternative treatment options in countries with the highest burden of HIV, highlight the need for more research on AMR in PLWH. Overall, the quality of studies was moderate or low, which may impact the findings of this review.
Collapse
|
50
|
Root-Bernstein R. Pneumococcal and Influenza Vaccination Rates and Pneumococcal Invasive Disease Rates Set Geographical and Ethnic Population Susceptibility to Serious COVID-19 Cases and Deaths. Vaccines (Basel) 2021; 9:474. [PMID: 34066697 PMCID: PMC8151685 DOI: 10.3390/vaccines9050474] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 05/01/2021] [Accepted: 05/05/2021] [Indexed: 12/21/2022] Open
Abstract
This study examines the relationship of pneumococcal vaccination rates, influenza, measles-mumps-rubella (MMR) diphtheria-tetanus-pertussis vaccinations (DTP), polio, Haemophilus influenzae type B (Hib), and Bacillus Calmette-Guerin (tuberculosis) vaccination rates to COVID-19 case and death rates for 51 nations that have high rates of COVID-19 testing and for which nearly complete childhood, at-risk adult and elderly pneumococcal vaccination data were available. The study is unique in a large number of nations examined, the range of vaccine controls, in testing effects of combinations of vaccinations, and in examining the relationship of COVID-19 and vaccination rates to invasive pneumococcal disease (IPD). Analysis of Italian regions and the states of the United States were also performed. Significant positive correlations were found between IPD (but not lower respiratory infections) and COVID-19 rates, while significant negative correlations were found between pneumococcal vaccination and COVID-19 rates. Influenza and MMR vaccination rates were negatively correlated with lower respiratory infection (LRI) rates and may synergize with pneumococcal vaccination rates to protect against COVID-19. Pneumococcal and influenza vaccination rates were independent of other vaccination rates. These results suggest that endemic rates of bacterial pneumonias, for which pneumococci are a sentinel, may set regional and national susceptibility to severe COVID-19 disease and death.
Collapse
Affiliation(s)
- Robert Root-Bernstein
- Department of Physiology, 567 Wilson Road, Room 1104 Biomedical and Physical Sciences Building, Michigan State University, East Lansing, MI 48824, USA
| |
Collapse
|