1
|
Zucco R, Pileggi C, Vancheri M, Papadopoli R, Nobile CGA, Pavia M. Preventable pediatric hospitalizations and access to primary health care in Italy. PLoS One 2019; 14:e0221852. [PMID: 31644581 PMCID: PMC6808327 DOI: 10.1371/journal.pone.0221852] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 08/18/2019] [Indexed: 12/02/2022] Open
Abstract
The aim of this study was to quantify the burden of avoidable pediatric hospital admissions for Ambulatory care-sensitive conditions (ACSC) and to identify factors related to these preventable hospitalizations. The study was conducted by retrospectively reviewing all medical records of children admitted in a non-teaching 474-bed acute care hospital located in Catanzaro (Italy) for an avoidable hospitalization diagnosis. Two control clinical records involving children hospitalized for clinical conditions not classified as ACSC were randomly selected for each clinical record that included an ACSC. Among the 4293 pediatric hospitalizations, 451 (10.5%) were judged to be preventable. Of these, the most frequent discharge diagnoses were: dehydration (29.7%), pneumonia (17.7%), seizures (15.7%) and chronic obstructive pulmonary disease (12.9%).Children admitted for a preventable hospitalization were more likely to be females, to be younger, to be residents in the same province as the hospital and less likely to have had at least one Community-Based Pediatrician (CBP) access in the previous year and to have used the district health service. The burden of pediatric preventable hospitalizations found in this study is quite high, and the results show that there is still work that lies ahead on the way to improve interaction between hospital and community-based services.
Collapse
Affiliation(s)
- Rossella Zucco
- Department of Health Sciences, University of Catanzaro "Magna Græcia", Catanzaro, Italy
| | - Claudia Pileggi
- Department of Health Sciences, University of Catanzaro "Magna Græcia", Catanzaro, Italy
| | - Martina Vancheri
- Department of Health Sciences, University of Catanzaro "Magna Græcia", Catanzaro, Italy
| | - Rosa Papadopoli
- Department of Health Sciences, University of Catanzaro "Magna Græcia", Catanzaro, Italy
| | | | - Maria Pavia
- Department of Health Sciences, University of Catanzaro "Magna Græcia", Catanzaro, Italy
- * E-mail:
| |
Collapse
|
2
|
Lu J, Hou H, Wang D, Leenhouts K, Roosmalen MLV, Sun T, Gu T, Song Y, Jiang C, Kong W, Wu Y. Systemic and mucosal immune responses elicited by intranasal immunization with a pneumococcal bacterium-like particle-based vaccine displaying pneumolysin mutant Plym2. Immunol Lett 2017; 187:41-46. [PMID: 28487097 DOI: 10.1016/j.imlet.2017.05.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 04/12/2017] [Accepted: 05/04/2017] [Indexed: 12/18/2022]
Abstract
Pneumolysin (Ply) is an important virulence factor in pneumococcal infection and a conserved cholesterol-binding cytotoxin expressed by all serotypes of Streptococcus pneumoniae. We previously developed a highly detoxified Ply mutant designated Plym2 by replacement of two amino acids (C428G and W433F), which lost cytotoxicity but retained the ability to induce neutralizing antibodies. In the present work, we applied bacterium-like particles (BLPs) as a carrier and immunostimulant for the development of a Plym2 intranasal vaccine, in which the Plym2 protein was displayed on the surface of BLPs. Intranasal immunization of mice with BLP-Plym2 not only induced a high level of serum IgG antibodies but also a high level of mucosal SIgA antibodies in lung lavages. Antiserum induced by the BLP-Plym2 vaccine elicited high-titer neutralization activity which could inhibit the hemolysis of wild-type Ply. In conclusion, the BLP-Plym2 vaccine was demonstrated to be a promising strategy for intranasal immunization to enhance both systemic and mucosal immune responses.
Collapse
Affiliation(s)
- Jingcai Lu
- National Engineering Laboratory for AIDS Vaccine, School of Life Science, Jilin University, Changchun 130012, China; Changchun BCHT Biotechnology Co., Changchun 130012, China
| | - Hongjia Hou
- National Engineering Laboratory for AIDS Vaccine, School of Life Science, Jilin University, Changchun 130012, China
| | - Dandan Wang
- National Engineering Laboratory for AIDS Vaccine, School of Life Science, Jilin University, Changchun 130012, China
| | - Kees Leenhouts
- Mucosis B.V., L.J. Zielstraweg 1, 9713 GX Groningen, The Netherlands
| | | | - Tianxu Sun
- College of Life Science, Jilin Agricultural University, Changchun 130118, China
| | - Tiejun Gu
- National Engineering Laboratory for AIDS Vaccine, School of Life Science, Jilin University, Changchun 130012, China
| | - Yueshuang Song
- Changchun BCHT Biotechnology Co., Changchun 130012, China
| | - Chunlai Jiang
- National Engineering Laboratory for AIDS Vaccine, School of Life Science, Jilin University, Changchun 130012, China
| | - Wei Kong
- National Engineering Laboratory for AIDS Vaccine, School of Life Science, Jilin University, Changchun 130012, China
| | - Yongge Wu
- National Engineering Laboratory for AIDS Vaccine, School of Life Science, Jilin University, Changchun 130012, China.
| |
Collapse
|
3
|
Thomas K, Vassilopoulos D. Immunization in patients with inflammatory rheumatic diseases. Best Pract Res Clin Rheumatol 2016; 30:946-963. [PMID: 27964798 DOI: 10.1016/j.berh.2016.10.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Revised: 10/16/2016] [Accepted: 10/17/2016] [Indexed: 12/25/2022]
Abstract
Immunization represents the most efficient and simplest intervention to prevent certain viral and bacterial infections in the general population as well as in the vulnerable population of patients with inflammatory rheumatic diseases treated with immunosuppressives. Here, we present an updated review of literature data regarding the safety and efficacy of immunizations against different pathogens in rheumatic patients treated with conventional immunosuppressives or the newer biologic agents while at the same time we provide practical guidance for the appropriate vaccine administration in this patient population.
Collapse
Affiliation(s)
- Konstantinos Thomas
- Joint Rheumatology Program, Clinical Immunology-Rheumatology Unit, 2nd Department of Medicine and Laboratory, National and Kapodistrian University of Athens School of Medicine, Hippokration General Hospital, 114 Vass. Sophias Ave., 115 27, Athens, Greece
| | - Dimitrios Vassilopoulos
- Joint Rheumatology Program, Clinical Immunology-Rheumatology Unit, 2nd Department of Medicine and Laboratory, National and Kapodistrian University of Athens School of Medicine, Hippokration General Hospital, 114 Vass. Sophias Ave., 115 27, Athens, Greece.
| |
Collapse
|
4
|
Cost-effectiveness and Health Benefits of Pediatric 23-valent Pneumococcal Polysaccharide Vaccine, 7-valent Pneumococcal Conjugate Vaccine and Forecasting 13-valent Pneumococcal Conjugate Vaccine in China. Pediatr Infect Dis J 2016; 35:e353-e361. [PMID: 27753771 DOI: 10.1097/inf.0000000000001288] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Each year in China, approximately 700,000 children under 5 years old are diagnosed with pneumonia, and 30,000 die of the disease. Although 7-valent pneumococcal conjugate vaccine (PCV-7) and 23-valent pneumococcal polysaccharide vaccine (PPV-23) are available in China, the costs are borne by the consumer, resulting in low coverage for PCV-7. We aimed to conduct a simulation study to assess the cost-effectiveness and health benefits of PCV-7, 13-valent pneumococcal conjugate vaccine (PCV-13) and PPV-23 to prevent childhood pneumonia and other vaccine-preventive diseases in China. METHODS An economic evaluation was performed using a Markov simulation model. Parameters including demographic, epidemiological data, costs and efficacy of vaccines were obtained from previous studies. A hypothetical cohort of 100,000 newborns (focusing on pneumococcal diseases ≤7 years old) was followed up until death or 100 years of age. The model incorporated the impact of vaccination on reduction of incidence of pneumococcal diseases and mortality of children ≤7 years. Outcomes are presented in terms of disease cases averted, quality-adjusted life years (QALYs) and incremental cost-effectiveness ratio. RESULTS Under baseline assumptions, PPV-23 is currently the only cost-effective option, whereas PCV-13 showed the greatest impact on pneumococcal disease burden, reducing invasive pneumococcal diseases by 31.3%, pneumonia by 15.3% and gaining 73.8 QALYs (10,000 individuals at discount rate of 3%). Incremental cost-effectiveness ratios of PCV-13 and PCV-7 are US$29,460/QALY and US$104,094/QALY, respectively, showing no cost-effectiveness based on the World Health Organization recommended willingness-to-pay threshold. On the other hand, the incremental cost-effectiveness ratios of PCVs were most sensitive to vaccination costs; if it reduces 4.7% and 32.2% for PCV-7 and PCV-13, respectively, the vaccination will be cost-effective. CONCLUSIONS To scale up current vaccination strategies and achieve potential health benefits, the replacement of PCV-7 with PCV-13 should be considered. As well, PCV's costs need to be reduced by increasing public subsidies and providing financial support to poor families.
Collapse
|
5
|
Tregnaghi MW, Sáez-Llorens X, López P, Abate H, Smith E, Pósleman A, Calvo A, Wong D, Cortes-Barbosa C, Ceballos A, Tregnaghi M, Sierra A, Rodriguez M, Troitiño M, Carabajal C, Falaschi A, Leandro A, Castrejón MM, Lepetic A, Lommel P, Hausdorff WP, Borys D, Guiñazú JR, Ortega-Barría E, Yarzábal JP, Schuerman L. Efficacy of pneumococcal nontypable Haemophilus influenzae protein D conjugate vaccine (PHiD-CV) in young Latin American children: A double-blind randomized controlled trial. PLoS Med 2014; 11:e1001657. [PMID: 24892763 PMCID: PMC4043495 DOI: 10.1371/journal.pmed.1001657] [Citation(s) in RCA: 180] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Accepted: 04/24/2014] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND The relationship between pneumococcal conjugate vaccine-induced antibody responses and protection against community-acquired pneumonia (CAP) and acute otitis media (AOM) is unclear. This study assessed the impact of the ten-valent pneumococcal nontypable Haemophilus influenzae protein D conjugate vaccine (PHiD-CV) on these end points. The primary objective was to demonstrate vaccine efficacy (VE) in a per-protocol analysis against likely bacterial CAP (B-CAP: radiologically confirmed CAP with alveolar consolidation/pleural effusion on chest X-ray, or non-alveolar infiltrates and C-reactive protein ≥ 40 µg/ml); other protocol-specified outcomes were also assessed. METHODS AND FINDINGS This phase III double-blind randomized controlled study was conducted between 28 June 2007 and 28 July 2011 in Argentine, Panamanian, and Colombian populations with good access to health care. Approximately 24,000 infants received PHiD-CV or hepatitis control vaccine (hepatitis B for primary vaccination, hepatitis A at booster) at 2, 4, 6, and 15-18 mo of age. Interim analysis of the primary end point was planned when 535 first B-CAP episodes, occurring ≥2 wk after dose 3, were identified in the per-protocol cohort. After a mean follow-up of 23 mo (PHiD-CV, n = 10,295; control, n = 10,201), per-protocol VE was 22.0% (95% CI: 7.7, 34.2; one-sided p = 0.002) against B-CAP (conclusive for primary objective) and 25.7% (95% CI: 8.4%, 39.6%) against World Health Organization-defined consolidated CAP. Intent-to-treat VE was 18.2% (95% CI: 5.5%, 29.1%) against B-CAP and 23.4% (95% CI: 8.8%, 35.7%) against consolidated CAP. End-of-study per-protocol analyses were performed after a mean follow-up of 28-30 mo for CAP and invasive pneumococcal disease (IPD) (PHiD-CV, n = 10,211; control, n = 10,140) and AOM (n = 3,010 and 2,979, respectively). Per-protocol VE was 16.1% (95% CI: -1.1%, 30.4%; one-sided p = 0.032) against clinically confirmed AOM, 67.1% (95% CI: 17.0%, 86.9%) against vaccine serotype clinically confirmed AOM, 100% (95% CI: 74.3%, 100%) against vaccine serotype IPD, and 65.0% (95% CI: 11.1%, 86.2%) against any IPD. Results were consistent between intent-to-treat and per-protocol analyses. Serious adverse events were reported for 21.5% (95% CI: 20.7%, 22.2%) and 22.6% (95% CI: 21.9%, 23.4%) of PHiD-CV and control recipients, respectively. There were 19 deaths (n = 11,798; 0.16%) in the PHiD-CV group and 26 deaths (n = 11,799; 0.22%) in the control group. A significant study limitation was the lower than expected number of captured AOM cases. CONCLUSIONS Efficacy was demonstrated against a broad range of pneumococcal diseases commonly encountered in young children in clinical practice. TRIAL REGISTRATION www.ClinicalTrials.gov NCT00466947.
Collapse
Affiliation(s)
- Miguel W. Tregnaghi
- Centro de Desarrollo del Proyectos Avanzados en Pediatría, Córdoba, Argentina
| | - Xavier Sáez-Llorens
- Department of Infectious Diseases, Hospital del Niño, Panama City, Panama
- * E-mail:
| | - Pio López
- Centro de Estudios en Infectología Pediátrica, Cali, Colombia
| | - Hector Abate
- Department of Infectious Diseases, Hospital Notti, Mendoza, Argentina
| | - Enrique Smith
- Centro de Desarrollo del Proyectos Avanzados en Pediatría, Santiago del Estero, Argentina
| | - Adriana Pósleman
- Centro de Desarrollo del Proyectos Avanzados en Pediatría, San Juan, Argentina
| | - Arlene Calvo
- Health Research International, Panama City, Panama
| | - Digna Wong
- Instituto de Investigaciones Científicas y Servicios de Alta Tecnología, Panama City, Panama
| | | | - Ana Ceballos
- Centro de Desarrollo del Proyectos Avanzados en Pediatría, Córdoba, Argentina
| | - Marcelo Tregnaghi
- Centro de Desarrollo del Proyectos Avanzados en Pediatría, Córdoba, Argentina
| | | | - Mirna Rodriguez
- Instituto de Investigaciones Científicas y Servicios de Alta Tecnología, Panama City, Panama
| | | | - Carlos Carabajal
- Centro de Desarrollo del Proyectos Avanzados en Pediatría, Santiago del Estero, Argentina
| | - Andrea Falaschi
- Department of Infectious Diseases, Hospital Notti, Mendoza, Argentina
| | - Ana Leandro
- Department of Pediatrics, Hospital del Niño, Panama City, Panama
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
6
|
Influenza and pneumococcal vaccinations of patients with systemic lupus erythematosus: Current views upon safety and immunogenicity. Autoimmun Rev 2014; 13:75-84. [DOI: 10.1016/j.autrev.2013.07.007] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Accepted: 07/09/2013] [Indexed: 11/18/2022]
|
7
|
Vila-Corcoles A, Ochoa-Gondar O. Preventing pneumococcal disease in the elderly: recent advances in vaccines and implications for clinical practice. Drugs Aging 2013; 30:263-76. [PMID: 23420119 DOI: 10.1007/s40266-013-0060-5] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Streptococcus pneumoniae remains a major cause of morbidity and mortality throughout the world. To date, after the introduction of routine childhood immunization, elderly people (i.e., persons aged 65 years or older) suffer the greatest burden of pneumococcal disease in developed countries. At present, two anti-pneumococcal vaccines are available for use in adults: the 23-valent pneumococcal polysaccharide vaccine (PPV23) and the 13-valent protein-polysaccharide conjugate vaccine (PCV13). This article reviews current data about the burden of pneumococcal disease in the elderly, as well as evidence for immunogenicity, clinical efficacy, and possible cost-effectiveness of both vaccines. The main advantage of PCV13 is that it may be more effective than PPV23, but a major limitation is that it is directed against strains that are likely to be greatly reduced in the population since its introduction in childhood immunization. The main disadvantage of PPV23 is that it may be less effective than PCV13 against vaccine-type infections but a major advantage is that it may provide protection against ten additional serotypes. To date, expert committees have not changed recommendations for pneumococcal vaccination in adults. However, at present, they are evaluating different alternatives (basically, maintaining PPV23, changing from PPV23 to PCV13 in some groups, or adding PCV13 for all or some target adult population subgroups). Critical data (clinical efficacy reported in ongoing trials and magnitude of indirect effects of pediatric PCV13 programs) needed to make a well-informed decision could be available during 2013. Considering all concerns over indirect effects and replacement strains following the use of polysaccharide-based vaccines, efforts should be directed toward developing vaccines, such as protein-based pneumococcal vaccines, with potential serotype-independent protection. Meanwhile, according to current recommendations, PPV23 should continue to be used for high-risk adults and all elderly people (with and without additional high-risk conditions). Although it is only moderately effective, it has a considerable serotype coverage and at-risk persons can benefit from the vaccination. High-risk individuals could also obtain a benefit from adding PCV13, but more data are needed before a universal recommendation can be made.
Collapse
Affiliation(s)
- Angel Vila-Corcoles
- Primary Health Care Service of Tarragona, Institut Catala de la Salut, Prat de la Riba 39, 43001, Tarragona, Spain.
| | | |
Collapse
|
8
|
Cardinal-Fernández P, García Gabarrot G, Echeverria P, Zum G, Hurtado J, Rieppi G. Clinical and microbiological aspects of acute community-acquired pneumonia due to Streptococcus pneumoniae. Rev Clin Esp 2013. [DOI: 10.1016/j.rceng.2012.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
9
|
Cardinal-Fernández P, García Gabarrot G, Echeverria P, Zum G, Hurtado J, Rieppi G. Aspectos clínicos y microbiológicos de la neumonía aguda comunitaria a Streptococcus pneumoniae. Rev Clin Esp 2013. [DOI: 10.1016/j.rce.2012.09.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
10
|
Zhong W, Xu W, Wang H, Huang Y, Cao J, Gong Y, Xu X, Min X, Zhang Y, Dong J, Yin Y, Zhang X. Mucosal immunization with caseinolytic protease X elicited cross-protective immunity against pneumococcal infection in mice. Exp Biol Med (Maywood) 2012; 237:694-702. [DOI: 10.1258/ebm.2012.011383] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Streptococcus pneumoniae resides on the mucosal surface of the upper respiratory tract and is ready to spread and trigger clinical diseases. Hence the vaccine that can eliminate the nasopharyngeal colonization was thought to be an ideal protective strategy against pneumococcal invasive diseases. Caseinolytic protease X (ClpX), a pneumococcal caseinolytic protease ATPase subunit, was shown to be a non-transmembrane protein by bioinformatics analysis. Consistent with the in silico prediction, the secretory expression of ClpX, instead of surface exposure, was further confirmed by flow cytometry and Western blot. Furthermore, ClpX was highly conserved in nine different serotypes of S. pneumoniae at both gene and protein concentrations. In addition, the anti-ClpX IgG antibody levels in human serum samples were much higher in healthy children, compared with pediatric patients, and displayed an age-related increase. Finally, ClpX protein antigen was introduced to BALB/c mice through a mucosal route, and protection against nasopharyngeal colonization and lethal infection caused by different S. pneumoniae serotypes was successfully elicited. Our findings suggest that ClpX is a potential candidate antigen that could be incorporated in pneumococcal protein vaccines.
Collapse
Affiliation(s)
- Wen Zhong
- Key Laboratory of Diagnostic Medicine designated by the Ministry of Education, Department of Laboratory Medicine
| | - Wenchun Xu
- Key Laboratory of Diagnostic Medicine designated by the Ministry of Education, Department of Laboratory Medicine
| | - Hong Wang
- Key Laboratory of Diagnostic Medicine designated by the Ministry of Education, Department of Laboratory Medicine
| | - Yuanshuai Huang
- Key Laboratory of Diagnostic Medicine designated by the Ministry of Education, Department of Laboratory Medicine
| | - Ju Cao
- The First Affiliated Hospital, Chongqing Medical University, Chongqing 400016, People's Republic of China
| | - Yi Gong
- Key Laboratory of Diagnostic Medicine designated by the Ministry of Education, Department of Laboratory Medicine
| | - Xiuyu Xu
- Key Laboratory of Diagnostic Medicine designated by the Ministry of Education, Department of Laboratory Medicine
| | - Xun Min
- Key Laboratory of Diagnostic Medicine designated by the Ministry of Education, Department of Laboratory Medicine
| | - Yanqing Zhang
- Key Laboratory of Diagnostic Medicine designated by the Ministry of Education, Department of Laboratory Medicine
| | - Jie Dong
- Key Laboratory of Diagnostic Medicine designated by the Ministry of Education, Department of Laboratory Medicine
| | - Yibing Yin
- Key Laboratory of Diagnostic Medicine designated by the Ministry of Education, Department of Laboratory Medicine
| | - Xuemei Zhang
- Key Laboratory of Diagnostic Medicine designated by the Ministry of Education, Department of Laboratory Medicine
| |
Collapse
|