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Yamana H, Ono S, Michihata N, Uemura K, Jo T, Yasunaga H. Effect of the 23-valent pneumococcal polysaccharide vaccine on the incidence of hospitalisation with pneumonia in adults aged ≥65 years: retrospective cohort study using a population-based database in Japan. Clin Microbiol Infect 2023:S1198-743X(23)00161-1. [PMID: 37044276 DOI: 10.1016/j.cmi.2023.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 03/09/2023] [Accepted: 04/03/2023] [Indexed: 04/14/2023]
Abstract
OBJECTIVES The effectiveness of the 23-valent pneumococcal polysaccharide vaccine (PPV23) in preventing pneumonia in older adults remains controversial. Some studies have suggested differences in the effectiveness according to age or sex. METHODS We conducted an observational study using the database of vaccine subsidisation data and health insurance claims data for a city in Japan. Participants were residents from 2014 to 2018 turning 65, 70, 75, 80, 85, 90 or 95 years during a given fiscal year, and PPV23 during the first year of observation were identified. We matched vaccinated and non-vaccinated individuals of the same age using propensity scores for vaccination. Incidence of hospitalisation with pneumonia was compared using Fine-Gray regression model. We summarised the results for each age using random-effects meta-analysis and conducted a subgroup analysis by sex. RESULTS A total of 102,136 participants were included, of whom 35% received PPV23. Propensity score matching selected 32,510 pairs of vaccinated and non-vaccinated individuals. Overall, PPV23 administration was associated with a decreased incidence of hospitalisation with pneumonia (17.2 vs. 20.4 per 1,000 person-years, sub-distribution hazard ratio: 0.84, 95% confidence interval: 0.77 to 0.91). Vaccine effectiveness was highest among those aged 70 years and decreased with increasing age. No statistically significant effect was observed in those aged 90 or 95 years. Vaccine effectiveness was observed in both males and females. CONCLUSIONS PPV23 was associated with an overall decrease in hospitalisation with pneumonia in older adults. However, vaccine effectiveness was significant in those aged 65 to 85 years but not in older population.
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Affiliation(s)
- Hayato Yamana
- Data Science Center, Jichi Medical University, Shimotsuke, Japan; Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Bunkyo, Japan.
| | - Sachiko Ono
- Department of Eat-loss Medicine, Graduate School of Medicine, The University of Tokyo, Bunkyo, Japan
| | - Nobuaki Michihata
- Department of Health Services Research, Graduate School of Medicine, The University of Tokyo, Bunkyo, Japan
| | - Kohei Uemura
- Department of Biostatistics & Bioinformatics, Graduate School of Medicine, The University of Tokyo, Bunkyo, Japan
| | - Taisuke Jo
- Department of Health Services Research, Graduate School of Medicine, The University of Tokyo, Bunkyo, Japan; Department of Respiratory Medicine, The University of Tokyo Hospital, Bunkyo, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Bunkyo, Japan
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St Clair LA, Chaulagain S, Klein SL, Benn CS, Flanagan KL. Sex-Differential and Non-specific Effects of Vaccines Over the Life Course. Curr Top Microbiol Immunol 2023; 441:225-251. [PMID: 37695431 PMCID: PMC10917449 DOI: 10.1007/978-3-031-35139-6_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] [Indexed: 09/12/2023]
Abstract
Biological sex and age have profound effects on immune responses throughout the lifespan and impact vaccine acceptance, responses, and outcomes. Mounting evidence from epidemiological, clinical, and animal model studies show that males and females respond differentially to vaccination throughout the lifespan. Within age groups, females tend to produce greater vaccine-induced immune responses than males, with sex differences apparent across all age groups, but are most pronounced among reproductive aged individuals. Females report more adverse effects following vaccination than males. Females, especially among children under 5 years of age, also experience more non-specific effects of vaccination. Despite these known sex- and age-specific differences in vaccine-induced immune responses and outcomes, sex and age are often ignored in vaccine research. Herein, we review the known sex differences in the immunogenicity, effectiveness, reactogenicity, and non-specific effects of vaccination over the lifespan. Ways in which these data can be leveraged to improve vaccine research are described.
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Affiliation(s)
- Laura A St Clair
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sabal Chaulagain
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sabra L Klein
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Christine Stabell Benn
- Institute of Clinical Research and Danish Institute for Advanced Study, University of Southern Denmark, Odense, Denmark
| | - Katie L Flanagan
- Tasmanian Vaccine Trial Centre, Clifford Craig Foundation, Launceston General Hospital, Launceston, TAS, Australia.
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3
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Comparative meta-analysis of host transcriptional response during Streptococcus pneumoniae carriage or infection. Microb Pathog 2022; 173:105816. [DOI: 10.1016/j.micpath.2022.105816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 09/16/2022] [Accepted: 10/03/2022] [Indexed: 11/06/2022]
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4
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Abstract
There is a growing awareness of the importance of sex and gender in medicine and research. Women typically have stronger immune responses to self and foreign antigens than men, resulting in sex-based differences in autoimmunity and infectious diseases. In both animals and humans, males are generally more susceptible than females to bacterial infections. At the same time, gender differences in health-seeking behavior, quality of health care, and adherence to treatment recommendations have been reported. This review explores our current understanding of differences between males and females in bacterial diseases. We describe how genetic, immunological, hormonal, and anatomical factors interact to influence sex-based differences in pathophysiology, epidemiology, clinical presentation, disease severity, and prognosis, and how gender roles affect the behavior of patients and providers in the health care system.
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Dhoubhadel BG, Suzuki M, Ishifuji T, Yaegashi M, Asoh N, Ishida M, Hamaguchi S, Aoshima M, Yasunami M, Ariyoshi K, Morimoto K. High prevalence of multiple serotypes of pneumococci in patients with pneumonia and their associated risk factors. Thorax 2022; 77:thoraxjnl-2021-217979. [PMID: 35474029 PMCID: PMC9606540 DOI: 10.1136/thoraxjnl-2021-217979] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 04/03/2022] [Indexed: 12/28/2022]
Abstract
BACKGROUND Multiple serotypes of pneumococci have epidemiological and clinical implications, such as the emergence of non-vaccine serotypes and the acquisition of antimicrobial resistance. Prevalence of multiple serotypes of pneumococci in adults and their risk factors are not known. METHODS We enrolled adult patients from age ≥15 years with radiologically confirmed pneumonia in four hospitals across Japan. Pneumococcal pneumonia was defined with a pneumococcal bacterial density of ≥104/mL in sputum by lytA quantitative PCR, and serotypes were determined. Pneumonias with a single serotype were categorised as single-serotype pneumococcal pneumonia and with two or more serotypes as multiple-serotype pneumococcal pneumonia. Multivariable logistic regression was used to assess the risk factors. RESULTS 3470 patients (median age 77 years, IQR 65-85) were enrolled. Pneumococcal pneumonia was identified in 476 (18.3%, n=2605) patients. Multiple serotypes were detected in 42% of them. Risk of having multiple serotypes was low among patients who had received 23-valent pneumococcal polysaccharide vaccine (PPSV23) vaccines (adjusted OR 0.51 (95% CI 0.27 to 0.94)). Proportion of non-PCV7 PPSV23 serotypes in overall distribution of multiple serotypes was 67.4% (n=324/481) compared with 46.4% (n=128/276) in that of single serotypes (p=0.001). Serotypes 5, 9N/9L, 10A, 12/22/46, 17F and 35F were associated with multiple-serotype pneumonia, and serotypes 6A/6B, 23F, 11 and 6C/6D were associated with single-serotype pneumonia. Proportion of more invasive serotypes (serotypes 1, 5, 7F, 8) was significantly higher in multiple-serotype pneumonia (p=0.001). CONCLUSIONS Multiple serotypes of pneumococci are common in sputum of adult patients with pneumonia. The risk of multiple-serotype pneumococcal pneumonia is lower than that of single-serotype pneumococcal pneumonia among PPSV23-vaccinated patients. TRIAL REGISTRATION NUMBER UMIN000006909.
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Affiliation(s)
- Bhim Gopal Dhoubhadel
- Department of Respiratory Infections, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
- Department of Global Health, School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Motoi Suzuki
- Infectious Disease Surveillance Center, National Institute of Infectious Diseases, Tokyo, Japan
| | - Tomoko Ishifuji
- Department of Clinical Medicine, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
| | - Makito Yaegashi
- Department of General Internal Medicine, Kameda Medical Center, Chiba, Japan
| | - Norichika Asoh
- Department of Internal Medicine, Juzenkai Hospital, Nagasaki, Japan
| | - Masayuki Ishida
- Department of Internal Medicine, Chikamori Hospital, Kochi, Japan
| | - Sugihiro Hamaguchi
- Department of General Internal Medicine, Fukushima Medical University, Fukushima, Japan
| | | | - Michio Yasunami
- Life Science Institute, Saga-Ken Medical Centre Koseikan, Saga, Japan
| | - Koya Ariyoshi
- Department of Global Health, School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
- Department of Clinical Medicine, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
| | - Konosuke Morimoto
- Department of Respiratory Infections, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
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Sun X, Guo X, Qiu J, Zhao G, Xu X, Wagner AL, Jiang H, Huang Z, Ren J, Ma X, Liang X, Yao Y, Wu J, Lu Y. Effectiveness of 23-Valent Pneumococcal Polysaccharide Vaccine Against Pneumococcal Diseases Among the Elderly Aged 60 Years or Older: A Matched Test Negative Case-Control Study in Shanghai, China. Front Public Health 2021; 9:620531. [PMID: 34616702 PMCID: PMC8488431 DOI: 10.3389/fpubh.2021.620531] [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: 10/23/2020] [Accepted: 08/23/2021] [Indexed: 11/23/2022] Open
Abstract
Background:Streptococcus pneumoniae infection among adults, especially in adults over 60 years old in China results in a large number of hospitalizations and a substantial financial burden. This study assessed the vaccine effectiveness (VE) of 23-valent pneumococcal polysaccharide vaccine (PPV23) against pneumococcal diseases among the elderly aged 60 years or older in Shanghai, China. Methods: We conducted a test-negative case–control study among the elderly aged 60 years or older who sought care at hospitals in 13 districts of Shanghai from September 14, 2013 to August 31, 2019. A case was defined as pneumococcal disease and testing positive for Streptococcus pneumoniae. Controls had symptoms congruent with pneumococcal disease but were negative for Streptococcus pneumoniae. We conducted 1:2 matching by gender, age, hospital and admission date. Vaccination status was verified from the immunization system database. VE was calculated with conditional logistic regression according to the formula (1–OR) ×100%. Results: Overall, 603 adults aged 60 years or older with pneumococcal disease and positive for Streptococcus pneumoniae were included as cases, and 19.6% (118 persons) had a recorded PPV23 vaccination. The controls included 1,206 adults, whose vaccination rate was 23.8% (287 persons). The VE against pneumococcal diseases among the whole population was 24% (95% CI: 2%, 40%) and among women 44% (95% CI: 6%, 67%). After adjusting for multiple variables, the effectiveness of PPV23 against pneumococcal diseases was still statistically significant with VE for all of 25% (95% CI: 3%, 42%) and VE for women of 49% (95% CI: 11%, 71%). Conclusion: PPV23 was effective against pneumococcal diseases in adults aged 60 years or older in Shanghai, China. Its relatively high effectiveness among women warrants this group to be particularly targeted for vaccination, with further research on why vaccination effectiveness is less among men.
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Affiliation(s)
- Xiaodong Sun
- Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Xiang Guo
- Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Jing Qiu
- Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Genming Zhao
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China
| | - Xinxin Xu
- Shanghai Municipal Center for Health Promotion, Shanghai, China
| | - Abram L Wagner
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, United States
| | - Hongli Jiang
- Department of Health Economics, School of Public Health, Fudan University, Shanghai, China
| | - Zhuoying Huang
- Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Jia Ren
- Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Xiaoying Ma
- Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Xiufang Liang
- Yangpu District Center for Disease Control and Prevention, Shanghai, China
| | - Yao Yao
- Chongming District Center for Disease Control and Prevention, Shanghai, China
| | - Jialing Wu
- Songjiang District Center for Disease Control and Prevention, Shanghai, China
| | - Yihan Lu
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China
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7
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Abstract
The proportion of the global population aged 65 and older is rapidly increasing. Infections in this age group, most recently with SARS-CoV-2, cause substantial morbidity and mortality. Major improvements have been made in vaccines for older people, either through the addition of novel adjuvants-as in the new recombinant zoster vaccine and an adjuvanted influenza vaccine-or by increasing antigen concentration, as in influenza vaccines. In this article we review improvements in immunization for the three most important vaccine preventable diseases of aging. The recombinant zoster vaccine has an efficacy of 90% that is minimally affected by the age of the person being vaccinated and persists for more than four years. Increasing antigen dose or inclusion of adjuvant has improved the immunogenicity of influenza vaccines in older adults, although the relative effectiveness of the enhanced influenza vaccines and the durability of the immune response are the focus of ongoing clinical trials. Conjugate and polysaccharide pneumococcal vaccines have similar efficacy against invasive pneumococcal disease and pneumococcal pneumonia caused by vaccine serotypes in older adults. Their relative value varies by setting, depending on the prevalence of vaccine serotypes, largely related to conjugate vaccine coverage in children. Improved efficacy will increase public confidence and uptake of these vaccines. Co-administration of these vaccines is feasible and important for maximal uptake in older people. Development of new vaccine platforms has accelerated following the arrival of SARS-CoV-2, and will likely result in new vaccines against other pathogens in the future.
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Affiliation(s)
- Anthony L Cunningham
- Centre for Virus Research, The Westmead Institute for Medical Research, Faculty of Medicine and Health, University of Sydney, Australia
| | - Peter McIntyre
- Women's and Children's Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Kanta Subbarao
- WHO CollaboratingCentre for Reference and Research on Influenza and Department of Microbiology and Immunology, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Robert Booy
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, The Children's Hospital at Westmead, New South Wales, Australia
- Marie Bashir Institute for Infectious Diseases and Biosecurity, School of Biological Sciences and Sydney Medical School, University of Sydney, Australia
| | - Myron J Levin
- Departments of Pediatrics and Medicine, University of Colorado School of Medicine Anschutz Medical Campus, Aurora, Colorado, USA
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8
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Niederman MS, Folaranmi T, Buchwald UK, Musey L, Cripps AW, Johnson KD. Efficacy and effectiveness of a 23-valent polysaccharide vaccine against invasive and noninvasive pneumococcal disease and related outcomes: a review of available evidence. Expert Rev Vaccines 2021; 20:243-256. [PMID: 33478306 DOI: 10.1080/14760584.2021.1880328] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Introduction: Routine pneumococcal vaccination for adults aged ≥60 or ≥65 years and those with underlying at-risk and high-risk conditions is recommended in many countries. However, studies estimating the effectiveness of 23-valent pneumococcal polysaccharide vaccine (PPSV23) have revealed mixed results, partly due to variability in study design and endpoints used to assess outcomes.Areas covered: The authors conducted a literature review of independently randomized trials and real-world studies published from 2010 to 2020 that assessed the effectiveness and efficacy of PPSV23 against vaccine-type or any-serotype invasive and noninvasive pneumococcal disease in adults aged ≥60 years. The authors also evaluated differences in study design that may contribute to the heterogeneity of available evidence.Expert opinion: Policy decisions regarding the inclusion of vaccines into national immunization plans should consider study quality and limitations. This review shows that PPSV23 is effective against vaccine-type invasive pneumococcal disease and vaccine-type pneumococcal pneumonia and can lower the burden of vaccine-type pneumococcal pneumonia. PPSV23-conferred protection may be lower in adults aged ≥75 years, those with certain underlying conditions, and individuals who were vaccinated >5 years before disease onset. This is an important finding that supports the benefit of PPSV23 vaccination for older adults.
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Affiliation(s)
- Michael S Niederman
- Weill Cornell Medical College, Department of Pulmonary Critical Care Medicine, New York, NY, USA
| | | | | | | | - Allan W Cripps
- Menzies Health Institute Queensland and School of Medicine, Mucosal Immunology Research Group, Griffith University, Queensland, Australia
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Kolditz M, Schmitt J, Pletz MW, Tesch F. Impact of the 13-Valent Pneumococcal Conjugate Vaccine on the Incidence of All-cause Pneumonia in Adults Aged ≥60 Years: A Population-based, Retrospective Cohort Study. Clin Infect Dis 2020; 68:2117-2119. [PMID: 30462172 DOI: 10.1093/cid/ciy993] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 11/19/2018] [Indexed: 11/12/2022] Open
Abstract
In this population-based study evaluating the effectiveness of the 13-valent pneumococcal conjugate vaccine (2012-2016) to prevent all-cause pneumonia in adults ≥60 years of age, we found significant, 0.63% absolute risk and 11.9% relative risk reductions on the 3-year (2014-2016) cumulative incidences of all-cause pneumonia after vaccination.
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Affiliation(s)
- Martin Kolditz
- Division of Pulmonology, Medical Department I, University Hospital Carl Gustav Carus, Germany
| | - Jochen Schmitt
- Dresden University Centre for Evidence-Based Healthcare, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Germany
| | - Mathias W Pletz
- Institute for Infectious Diseases and Infection Control, Jena University Hospital, Germany
| | - Falko Tesch
- Dresden University Centre for Evidence-Based Healthcare, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Germany
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10
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Sohn S, Hong K, Chun BC. Evaluation of the effectiveness of pneumococcal conjugate vaccine for children in Korea with high vaccine coverage using a propensity score matched national population cohort. Int J Infect Dis 2020; 93:146-150. [DOI: 10.1016/j.ijid.2020.01.034] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Revised: 01/08/2020] [Accepted: 01/19/2020] [Indexed: 01/06/2023] Open
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Chua H, Feng S, Lewnard JA, Sullivan SG, Blyth CC, Lipsitch M, Cowling BJ. The Use of Test-negative Controls to Monitor Vaccine Effectiveness: A Systematic Review of Methodology. Epidemiology 2020; 31:43-64. [PMID: 31609860 PMCID: PMC6888869 DOI: 10.1097/ede.0000000000001116] [Citation(s) in RCA: 85] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND The test-negative design is an increasingly popular approach for estimating vaccine effectiveness (VE) due to its efficiency. This review aims to examine published test-negative design studies of VE and to explore similarities and differences in methodological choices for different diseases and vaccines. METHODS We conducted a systematic search on PubMed, Web of Science, and Medline, for studies reporting the effectiveness of any vaccines using a test-negative design. We screened titles and abstracts and reviewed full texts to identify relevant articles. We created a standardized form for each included article to extract information on the pathogen of interest, vaccine(s) being evaluated, study setting, clinical case definition, choices of cases and controls, and statistical approaches used to estimate VE. RESULTS We identified a total of 348 articles, including studies on VE against influenza virus (n = 253), rotavirus (n = 48), pneumococcus (n = 24), and nine other pathogens. Clinical case definitions used to enroll patients were similar by pathogens of interest but the sets of symptoms that defined them varied substantially. Controls could be those testing negative for the pathogen of interest, those testing positive for nonvaccine type of the pathogen of interest, or a subset of those testing positive for alternative pathogens. Most studies controlled for age, calendar time, and comorbidities. CONCLUSIONS Our review highlights similarities and differences in the application of the test-negative design that deserve further examination. If vaccination reduces disease severity in breakthrough infections, particular care must be taken in interpreting vaccine effectiveness estimates from test-negative design studies.
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Affiliation(s)
- Huiying Chua
- From the World Health Organization Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Shuo Feng
- From the World Health Organization Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Joseph A Lewnard
- Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, CA
| | - Sheena G Sullivan
- WHO Collaborating Centre for Reference and Research on Influenza, Royal Melbourne Hospital, and Doherty Department, University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA
- Centre for Epidemiology and Biostatistics, School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Christopher C Blyth
- Division of Paediatrics, School of Medicine, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Western Australia, Australia
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Western Australia, Australia
- Department of Infectious Diseases, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Marc Lipsitch
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA
- Center for Communicable Disease Dynamics, Harvard T. H. Chan School of Public Health, Boston, MA
| | - Benjamin J Cowling
- From the World Health Organization Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, The University of Hong Kong, Hong Kong Special Administrative Region, China
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12
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Muhammad J, Rabbani M, Shabbir MZ, Muhammad K, Ghori MT, Chaudhry HR, Ul Hassnain Z, Jamil T, Abbas T, Chaudhry MH, Haisem-ur-Rasool M, Ali MA, Nisar M, Kirimanjeswara GS, Jayarao BM. Cross Sectional Study and Risk Factors Analysis of Francisella tularensis in Soil Samples in Punjab Province of Pakistan. Front Cell Infect Microbiol 2019; 9:89. [PMID: 31024860 PMCID: PMC6460113 DOI: 10.3389/fcimb.2019.00089] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 03/12/2019] [Indexed: 12/16/2022] Open
Abstract
Tularemia is an endemic zoonotic disease in many parts of the world including Asia. A cross-sectional study was conducted to determine genome-based prevalence of Francisella tularensis (Ft) in soil, assess an association between its occurrence in soil and likely predictors i.e., macro and micro-nutrients and several categorical variables, and determine seroconversion in small and large ruminants. The study included a total of 2,280 soil samples representing 456 villages in eight districts of the Punjab Province of Pakistan followed by an analysis of serum antibodies in 707 ruminants. The genome of Ft was detected in 3.25% (n = 74, 95% CI: 2.60-4.06) of soil samples. Soluble salts (OR: 1.276, 95% CI: 1.043-1.562, p = 0.015), Ni (OR: 2.910, 95%CI: 0.795-10.644, p = 0.106), Mn (OR:0.733, 95% CI:0.565-0.951, p = 0.019), Zn (OR: 4.922, 95% CI:0.929-26.064, p = 0.061) and nutrients clustered together as PC-1 (OR: 4.76, 95% CI: 2.37-9.54, p = 0.000) and PC-3 (OR: 0.357, 95% CI: 0.640, p = 0.001) were found to have a positive association for the presence of Ft in soil. The odds of occurrence of Ft DNA in soil were higher at locations close to a water source, including canals, streams or drains, [χ2 = 6.7, OR = 1.19, 95% CI:1.05-3.09, p = 0.004] as well as places where animals were present [χ2 = 4.09, OR = 2.06, 95% CI: 1.05-4.05, p = 0.02]. The seroconversion was detected in 6.22% (n = 44, 95% CI: 4.67-8.25) of domestic animals. An occurrence of Ft over a wide geographical region indicates its expansion to enzootic range, and demonstrates the need for further investigation among potential disease reservoirs and at-risk populations, such as farmers and veterinarians.
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Affiliation(s)
- Javed Muhammad
- University of Veterinary and Animal Sciences, Lahore, Pakistan
- University of Swabi, Swabi, Pakistan
| | - Masood Rabbani
- University of Veterinary and Animal Sciences, Lahore, Pakistan
| | | | - Khushi Muhammad
- University of Veterinary and Animal Sciences, Lahore, Pakistan
| | | | | | - Zia Ul Hassnain
- University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Tariq Jamil
- University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Tariq Abbas
- Department of Epidemiology and Public Health, Cholistan University of Veterinary and Animal Sciences, Bahawalpur, Pakistan
| | | | | | | | - Muhammad Nisar
- Department of Epidemiology and Public Health, Cholistan University of Veterinary and Animal Sciences, Bahawalpur, Pakistan
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13
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Echaniz-Aviles G, Garza-González E, Román-Mancha AL, Morfín-Otero R, Rodríguez-Noriega E, Ayala-Gaytán JJ, Guajardo-Lara CE, Soto-Nogueron A, Carnalla-Barajas MN, Camacho-Ortiz A. Clinical and microbiological characteristics of community-acquired pneumonia associated with Streptococcus pneumoniae in adult patients in Mexico. Rev Argent Microbiol 2019; 51:234-240. [PMID: 30635204 DOI: 10.1016/j.ram.2018.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 09/29/2018] [Accepted: 10/09/2018] [Indexed: 11/18/2022] Open
Abstract
The aim of this study was to assess the risk factors and clinical and microbiological characteristics of community-acquired pneumonia (CAP) in adult patients in Mexico. Streptococcus pneumoniae classified as the causative agent of CAP in adult patients and patients with invasive S. pneumoniae isolates presented to three tertiary teaching hospitals during the 15-year study period were selected. Serotyping and susceptibility testing were performed for all included isolates. Clinical and demographic data were recorded. A total of 96 patients infected with S. pneumoniae (71 with CAP, 25 with invasive disease) were included. The CAP group involved more males (74.6%) than the invasive disease group (p=0.03). Head trauma was more common in the CAP group (21.1%) than in the invasive disease group (4.0%; p=0.03). The most prevalent serotype was 19A, followed by serotypes 3 and 23F. After the introduction of the heptavalent conjugated pneumococcal vaccine (PCV7), the prevalence of included serotypes declined significantly; no such change was found after the introduction of the PCV13 vaccine, including in the prevalence of serotype 19A. Susceptibility to all antimicrobials tested except vancomycin declined over the study period. In conclusion, head trauma was the most common comorbidity in the CAP group. The most prevalent serotype was 19A. Decreased susceptibility to most antimicrobials tested was observed.
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Affiliation(s)
| | - Elvira Garza-González
- Servicio de Gastroenterología y Departamento de Patología Clínica, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico
| | - Alma Lucía Román-Mancha
- Coordinación de Epidemiología Hospitalaria, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico
| | - Rayo Morfín-Otero
- Departamento de Infectología, Hospital Civil Fray Antonio Alcalde, e Instituto de Patología Infecciosa, Guadalajara, Jalisco, Mexico
| | - Eduardo Rodríguez-Noriega
- Departamento de Infectología, Hospital Civil Fray Antonio Alcalde, e Instituto de Patología Infecciosa, Guadalajara, Jalisco, Mexico
| | | | | | | | | | - Adrián Camacho-Ortiz
- Coordinación de Epidemiología Hospitalaria, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico.
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Effect of Xylitol on the Growth and Survival of Streptococcus pneumoniae. Jundishapur J Microbiol 2018. [DOI: 10.5812/jjm.69319] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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15
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Gubbels Bupp MR, Potluri T, Fink AL, Klein SL. The Confluence of Sex Hormones and Aging on Immunity. Front Immunol 2018; 9:1269. [PMID: 29915601 PMCID: PMC5994698 DOI: 10.3389/fimmu.2018.01269] [Citation(s) in RCA: 172] [Impact Index Per Article: 28.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 05/22/2018] [Indexed: 12/17/2022] Open
Abstract
The immune systems of post-pubescent males and females differ significantly with profound consequences to health and disease. In many cases, sex-specific differences in the immune responses of young adults are also apparent in aged men and women. Moreover, as in young adults, aged women develop several late-adult onset autoimmune conditions more frequently than do men, while aged men continue to develop many cancers to a greater extent than aged women. However, sex differences in the immune systems of aged individuals have not been extensively investigated and data addressing the effectiveness of vaccinations and immunotherapies in aged men and women are scarce. In this review, we evaluate age- and sex hormone-related changes to innate and adaptive immunity, with consideration about how this impacts age- and sex-associated changes in the incidence and pathogenesis of autoimmunity and cancer as well as the efficacy of vaccination and cancer immunotherapy. We conclude that future preclinical and clinical studies should consider age and sex to better understand the ways in which these characteristics intersect with immune function and the resulting consequences for autoimmunity, cancer, and therapeutic interventions.
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Affiliation(s)
| | - Tanvi Potluri
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Ashley L Fink
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Sabra L Klein
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
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Flanagan KL, Fink AL, Plebanski M, Klein SL. Sex and Gender Differences in the Outcomes of Vaccination over the Life Course. Annu Rev Cell Dev Biol 2018; 33:577-599. [PMID: 28992436 DOI: 10.1146/annurev-cellbio-100616-060718] [Citation(s) in RCA: 328] [Impact Index Per Article: 54.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Both sex (i.e., biological differences) and gender (i.e., social or cultural influences) impact vaccine acceptance, responses, and outcomes. Clinical data illustrate that among children, young adults, and aged individuals, males and females differ in vaccine-induced immune responses, adverse events, and protection. Although males are more likely to receive vaccines, following vaccination, females typically develop higher antibody responses and report more adverse effects of vaccination than do males. Human, nonhuman animal, and in vitro studies reveal numerous immunological, genetic, hormonal, and environmental factors that differ between males and females and contribute to sex- and gender-specific vaccine responses and outcomes. Herein, we address the impact of sex and gender variables that should be considered in preclinical and clinical studies of vaccines.
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Affiliation(s)
- Katie L Flanagan
- Department of Immunology and Pathology, Monash University, Melbourne, Victoria, Australia, 3800; ,
| | - Ashley L Fink
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21205; ,
| | - Magdalena Plebanski
- Department of Immunology and Pathology, Monash University, Melbourne, Victoria, Australia, 3800; ,
| | - Sabra L Klein
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21205; ,
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17
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Yu Y, Shen M, Song Q, Xie J. Biological activities and pharmaceutical applications of polysaccharide from natural resources: A review. Carbohydr Polym 2017; 183:91-101. [PMID: 29352896 DOI: 10.1016/j.carbpol.2017.12.009] [Citation(s) in RCA: 719] [Impact Index Per Article: 102.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 11/22/2017] [Accepted: 12/05/2017] [Indexed: 12/26/2022]
Abstract
Pharmacotherapy using natural substances can be currently regarded as a very promising future alternative to conventional therapy. As biological macromolecules, polysaccharide together with protein and polynucleotide, are extremely important biomacromoleules which play important roles in the growth and development of living organism. Polysaccharide is important component of higher plants, membrane of the animal cell and the cell wall of microbes. It is also closely related to the physiological functions. Recently, increasing attention has been paid on polysaccharides as an important class of bioactive natural products. Numerous researches have demonstrated the bioactivities of natural polysaccharides, which lead to the application of polysaccharides in the treatment of disease. In this paper, the various aspects of the investigation results of the bioactivities of polysaccharides were summarized, including its diversity pharmacological applications, such as immunoregulatory, anti-tumor, anti-virus, antioxidation, and hypoglycemic activity, and their application of polysaccharides in the treatment of disease are also discussed. We hope this review can offer some theoretical basis and inspiration for the mechanism study of the bioactivity of polysaccharides.
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Affiliation(s)
- Yue Yu
- State Key Laboratory of Food Science and Technology, Nanchang University, Nanchang 330047, China; School of Food Science and Technology, Nanchang University, Nanchang 330047, China
| | - Mingyue Shen
- State Key Laboratory of Food Science and Technology, Nanchang University, Nanchang 330047, China; School of Food Science and Technology, Nanchang University, Nanchang 330047, China
| | - Qianqian Song
- State Key Laboratory of Food Science and Technology, Nanchang University, Nanchang 330047, China; School of Food Science and Technology, Nanchang University, Nanchang 330047, China
| | - Jianhua Xie
- State Key Laboratory of Food Science and Technology, Nanchang University, Nanchang 330047, China; School of Food Science and Technology, Nanchang University, Nanchang 330047, China.
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18
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Cafiero-Fonseca ET, Stawasz A, Johnson ST, Sato R, Bloom DE. The full benefits of adult pneumococcal vaccination: A systematic review. PLoS One 2017; 12:e0186903. [PMID: 29088258 PMCID: PMC5663403 DOI: 10.1371/journal.pone.0186903] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Accepted: 10/10/2017] [Indexed: 11/24/2022] Open
Abstract
Background Pneumococcal disease causes substantial morbidity and mortality, including among adults. Adult pneumococcal vaccines help to prevent these burdens, but they are underused. Accounting for the full benefits of adult pneumococcal vaccination may promote more rational resource allocation decisions with respect to adult pneumococcal vaccines. Objectives Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we conducted a systematic review to assess the extent to which the literature has empirically captured (e.g., through measurement or modeling) the full benefits of adult pneumococcal vaccination. Methods We systematically searched PubMed and Embase to identify studies published between January 1, 2010 and April 10, 2016 that examine adult pneumococcal vaccination. We included articles if they captured any health or economic benefit of an adult pneumococcal vaccine administered to adults age ≥ 50 or ≥ 18 in risk groups. Finally, we summarized the literature by categorizing the types of benefits captured, the perspective taken, and the strength of the evidence presented. Our protocol is number 42016038335 in the PROSPERO International prospective register of systematic reviews. Results We identified 5,857 papers and included 150 studies for analysis. While most capture health gains and healthcare cost savings, far fewer studies consider additional benefit categories, such as productivity gains. However, the studies with a broader approach still exhibit significant limitations; for example, many present only abstracts, while others offer no new measurements. Studies that examine the 13-valent pneumococcal conjugate vaccine focus more on broad economic benefits, but still have limitations. Conclusions This review highlights the need for more robust empirical accounting of the full benefits of adult pneumococcal vaccination. Literature outside this realm indicates that these broad benefits may be substantial. Failing to investigate the full benefits may lead society to undervalue vaccines' contributions and therefore underinvest in their development and adoption.
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Affiliation(s)
- Elizabeth T. Cafiero-Fonseca
- Data for Decisions, LLC, Waltham, Massachusetts, United States of America
- Performance Analysis and Improvement, Massachusetts General Hospital/Massachusetts General Physicians Organization, Boston, Massachusetts, United States of America
- * E-mail:
| | - Andrew Stawasz
- Data for Decisions, LLC, Waltham, Massachusetts, United States of America
| | - Sydney T. Johnson
- Data for Decisions, LLC, Waltham, Massachusetts, United States of America
- Harvard Center for Population and Development Studies, Harvard T.H. Chan School of Public Health, Cambridge, Massachusetts, United States of America
| | - Reiko Sato
- Global Health and Value, Pfizer Inc., Collegeville, Pennsylvania, United States of America
| | - David E. Bloom
- Data for Decisions, LLC, Waltham, Massachusetts, United States of America
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
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19
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Pneumococcal conjugate vaccination response in patients after community-acquired pneumonia, differences in patients with S. pneumoniae versus other pathogens. Vaccine 2017; 35:4886-4895. [DOI: 10.1016/j.vaccine.2017.07.088] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Revised: 07/15/2017] [Accepted: 07/25/2017] [Indexed: 11/19/2022]
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20
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Kolditz M, Schmitt J, Pletz MW, Tesch F. Impact of pneumococcal polysaccharide vaccine on incidence and mortality after pneumonia in adults aged ≥60 years-a population-based retrospective cohort study. Clin Microbiol Infect 2017; 24:500-504. [PMID: 28830805 DOI: 10.1016/j.cmi.2017.08.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Revised: 08/11/2017] [Accepted: 08/13/2017] [Indexed: 11/18/2022]
Abstract
OBJECTIVES The 23-valent pneumococcal polysaccharide vaccine (PPV) is recommended for prevention of pneumococcal diseases in adults at risk. Few data exist on time-, age- and sex-dependent vaccine effectiveness on outcomes in pneumonia. METHODS We performed a population-based cohort study including adults ≥60 years of age (n = 738 927) based on statutory health insurance data from 2005 to 2011. Primary outcomes were all-cause pneumonia incidence and 30-day all-cause mortality. Pneumonia was identified by International Classification of Diseases, 10th Revision, German Modification (ICD-10-GM) codes, with ambulatory cases validated by antibiotic prescription within 7 days. The effect of PPV within 5 years was analysed after propensity score-based matching (three controls per case with PPV vaccination) including comorbidities, care status, age, sex and influenza vaccination. Evaluations were stratified by age group, sex and time of PPV. RESULTS Two-year incidence of all-cause pneumonia in 213 431 vaccinated individuals was 7501 (3.51%) of 213 431 vs. 23 243 (3.63%) of 640 293 in matched controls (difference -0.11, 95% confidence interval (CI) -0.22 to -0.002, p 0.046). After sex-dependent analysis, PPV effectiveness on pneumonia incidence was observed only in women (difference -0.15, 95% CI -0.28 to -0.02, p 0.02). Thirty-day mortality in vaccinated individuals with pneumonia was 1302 (17.36%) of 7501 vs. 4267 (18.96%) of 22 503 in matched controls (difference -1.60%, 95% CI -2.83 to -0.38, p 0.011). After analysis according to age group, significant mortality reduction was present only in adults aged 60 to 79 years (difference -2.31, 95% CI -3.79 to -0.83, p 0.002). Year of PPV vaccination showed no effect on outcomes. CONCLUSIONS The findings support consideration of sex and age dependence of PPV effectiveness in future studies.
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Affiliation(s)
- M Kolditz
- Division of Pulmonology, Medical Department I, University Hospital Carl Gustav Carus, Dresden, Germany.
| | - J Schmitt
- Dresden University Centre for Evidence-Based Healthcare, Medical Faculty, Technische Universität Dresden, Dresden, Germany
| | - M W Pletz
- Center for Infectious Diseases and Infection Control, Jena University Hospital, Jena, Germany
| | - F Tesch
- Dresden University Centre for Evidence-Based Healthcare, Medical Faculty, Technische Universität Dresden, Dresden, Germany
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21
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Ochoa-Gondar O, Hospital I, Vila-Corcoles A, Aragon M, Jariod M, de Diego C, Satue E. Prevalence of high, medium and low-risk medical conditions for pneumococcal vaccination in Catalonian middle-aged and older adults: a population-based study. BMC Public Health 2017; 17:610. [PMID: 28662648 PMCID: PMC5492923 DOI: 10.1186/s12889-017-4529-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 06/21/2017] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Updated population-based data on the frequency and distribution of risk factors for pneumococcal disease is scarce. This study investigated the prevalence of distinct comorbidities and underlying risk conditions related to an increasing risk of pneumococcal disease among Catalonian middle-aged and older adults. METHODS Cross-sectional population-based study including 2,033,465 individuals aged 50 years or older registered at 01/01/2015 in the Catalonian Health Institute (Catalonia, Spain). The clinical research database of the Information System for the Development of Research in Primary Care (SIDIAP database) was used to identify high-risk (asplenia and/or immunocompromising conditions) and other increased-risk conditions (chronic pulmonary, cardiac or liver disease, diabetes mellitus, alcoholism and/or smoking) among study subjects. RESULTS Globally, 980,310 (48.2%) of the 2,033,465 study population had at least one risk condition of suffering pneumococcal disease (55.4% in men vs 42.0% in women, p < 0.001; 41.7% in people 50-64 years vs 54.7% in persons 65 years or older, p < 0.001). An amount of 176,600 individuals (8.7%) had high-risk conditions (basically immunocompromising conditions). On the other hand, 803,710 persons (39.5%) had one or more other risk conditions. In fact, 212,255 (10.4%) had chronic pulmonary diseases, 248,377 (12.2%) cardiac disease, 41,734 (2.1%) liver disease, 341,535 (16.8%) diabetes mellitus, 58,781 (2.9%) alcoholism and 317,558 (15.6%) were smokers. CONCLUSION In our setting, approximately 50 % of overall persons 50 years or older may be considered at-risk population for pneumococcal disease (almost 10 % have high-risk conditions and 40 % have other risk conditions).
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Affiliation(s)
- O. Ochoa-Gondar
- Primary Health Care Service “Camp de Tarragona”, Institut Catala de la Salut, Rambla Nova 124, D,1°A, 43001 Tarragona, Spain
- Unitat de Suport a la Recerca of Tarragona, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Tarragona, Spain
| | - I. Hospital
- Primary Health Care Service “Camp de Tarragona”, Institut Catala de la Salut, Rambla Nova 124, D,1°A, 43001 Tarragona, Spain
| | - A. Vila-Corcoles
- Primary Health Care Service “Camp de Tarragona”, Institut Catala de la Salut, Rambla Nova 124, D,1°A, 43001 Tarragona, Spain
- Unitat de Suport a la Recerca of Tarragona, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Tarragona, Spain
| | - M. Aragon
- Information System for the Improvement of Research in Primary Care (SIDIAP), Primary Care Research Institute Jordi Gol, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - M. Jariod
- Information Systems Department, Hospital Joan XXIII, Tarragona, Spain
| | - C. de Diego
- Primary Health Care Service “Camp de Tarragona”, Institut Catala de la Salut, Rambla Nova 124, D,1°A, 43001 Tarragona, Spain
| | - E. Satue
- Primary Health Care Service “Camp de Tarragona”, Institut Catala de la Salut, Rambla Nova 124, D,1°A, 43001 Tarragona, Spain
| | - EPIVAC Study Group
- Primary Health Care Service “Camp de Tarragona”, Institut Catala de la Salut, Rambla Nova 124, D,1°A, 43001 Tarragona, Spain
- Unitat de Suport a la Recerca of Tarragona, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Tarragona, Spain
- Information System for the Improvement of Research in Primary Care (SIDIAP), Primary Care Research Institute Jordi Gol, Universitat Autonoma de Barcelona, Barcelona, Spain
- Information Systems Department, Hospital Joan XXIII, Tarragona, Spain
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Sings HL. Pneumococcal conjugate vaccine use in adults - Addressing an unmet medical need for non-bacteremic pneumococcal pneumonia. Vaccine 2017; 35:5406-5417. [PMID: 28602602 DOI: 10.1016/j.vaccine.2017.05.075] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Revised: 05/04/2017] [Accepted: 05/24/2017] [Indexed: 11/17/2022]
Abstract
Streptococcus pneumoniae is a frequent cause of community acquired pneumonia (CAP), with the largest burden of disease attributed to non-bacteremic pneumonia. Due to the high persistent burden of disease, pneumococcal pneumonia, particularly non-bacteremic pneumococcal pneumonia, continues to be a major public health concern. There are currently two pneumococcal vaccines approved for use in adults in the United States (US) and other countries worldwide: a 23-valent pneumococcal simple polysaccharide vaccine (PPV23), and a 13-valent pneumococcal conjugate vaccine (PCV13). The capsular polysaccharides included in PPV23 induce antibodies primarily by a T-cell independent mechanism, thus the immune response is short lived and lacks the ability to elicit an anamnestic response. PCV13, on the other hand, has the bacterial polysaccharides covalently conjugated to an immunogenic carrier protein resulting in the formation of memory B lymphocytes, thus proving long-acting immunologic memory and an anamnestic response. Despite 30years of use, the question of PPV23 vaccine efficacy, particularly with respect to efficacy for non-bacteremic pneumonia, has been extensively debated and investigated; whereas PCV13 efficacy against vaccine-type pneumococcal CAP, both bacteremic and non-bacteremic, was confirmed in a large randomized controlled trial in older adults. PCV13 was approved under the US Food and Drug Administration's accelerated pathway, which allows for earlier approval of products that provide meaningful benefit over existing treatments - in this case, protection of adults from non-bacteremic pneumococcal pneumonia. Its use is now increasingly recommended globally. This article summarizes the history and use of PPV23 and PCV13 in adults and how vaccination of adults with PCV13 addresses an unmet medical need.
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23
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Tin Tin Htar M, Stuurman AL, Ferreira G, Alicino C, Bollaerts K, Paganino C, Reinert RR, Schmitt HJ, Trucchi C, Vestraeten T, Ansaldi F. Effectiveness of pneumococcal vaccines in preventing pneumonia in adults, a systematic review and meta-analyses of observational studies. PLoS One 2017; 12:e0177985. [PMID: 28542347 PMCID: PMC5441633 DOI: 10.1371/journal.pone.0177985] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 05/05/2017] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION S. pneumoniae can cause a wide spectrum of diseases, including invasive pneumococcal disease and pneumonia. Two types of pneumococcal vaccines are indicated for use in adults: 23-valent pneumococcal polysaccharide vaccines (PPV23) and a 13-valent pneumococcal conjugate vaccine (PCV13). OBJECTIVE To systematically review the literature assessing pneumococcal vaccine effectiveness (VE) against community-acquired pneumonia (CAP) in adults among the general population, the immunocompromised and subjects with underlying risk factors in real-world settings. METHODS We searched for peer-reviewed observational studies published between 1980 and 2015 in Pubmed, SciELO or LILACS, with pneumococcal VE estimates against CAP, pneumococcal CAP or nonbacteremic pneumococcal CAP. Meta-analyses and meta-regression for VE against CAP requiring hospitalization in the general population was performed. RESULTS 1159 unique articles were retrieved of which 33 were included. No studies evaluating PCV13 effectiveness were found. Wide ranges in PPV23 effectiveness estimates for any-CAP were observed among adults ≥65 years (-143% to 60%). The meta-analyzed VE estimate for any-CAP requiring hospitalization in the general population was 10.2% (95%CI: -12.6; 33.0). The meta-regression indicates that VE against any-CAP requiring hospitalization is significantly lower in studies with a maximum time since vaccination ≥60 months vs. <60 months and in countries with the pediatric PCV vaccine available on the private market. However, these results should be interpreted cautiously due to the high influence of two studies. The VE estimates for pneumococcal CAP hospitalization ranged from 32% (95%CI: -18; 61) to 51% (95%CI: 16; 71) in the general population. CONCLUSIONS Wide ranges in PPV23 effectiveness estimates for any-CAP were observed, likely due to a great diversity of study populations, circulation of S. pneumoniae serotypes, coverage of pediatric pneumococcal vaccination, case definition and time since vaccination. Despite some evidence for short-term protection, effectiveness of PPV23 against CAP was not consistent in the general population, the immunocompromised and subjects with underlying risk factors.
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Affiliation(s)
| | - Anke L. Stuurman
- P95 Epidemiology and Pharmacovigilance Consulting and Services, P95, Leuven, Belgium
| | - Germano Ferreira
- P95 Epidemiology and Pharmacovigilance Consulting and Services, P95, Leuven, Belgium
| | - Cristiano Alicino
- Department of Health Sciences (DiSSal), University of Genoa, Genoa, Italy
| | - Kaatje Bollaerts
- P95 Epidemiology and Pharmacovigilance Consulting and Services, P95, Leuven, Belgium
| | - Chiara Paganino
- Department of Health Sciences (DiSSal), University of Genoa, Genoa, Italy
| | - Ralf René Reinert
- Pfizer: Vaccines Medical Development and Scientific Clinical Affairs, Pfizer Inc, Paris, France
| | - Heinz-Josef Schmitt
- Pfizer: Vaccines Medical Development and Scientific Clinical Affairs, Pfizer Inc, Paris, France
| | - Cecilia Trucchi
- Department of Health Sciences (DiSSal), University of Genoa, Genoa, Italy
| | - Thomas Vestraeten
- P95 Epidemiology and Pharmacovigilance Consulting and Services, P95, Leuven, Belgium
| | - Filippo Ansaldi
- Department of Health Sciences (DiSSal), University of Genoa, Genoa, Italy
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Suzuki M, Dhoubhadel BG, Ishifuji T, Yasunami M, Yaegashi M, Asoh N, Ishida M, Hamaguchi S, Aoshima M, Ariyoshi K, Morimoto K. Serotype-specific effectiveness of 23-valent pneumococcal polysaccharide vaccine against pneumococcal pneumonia in adults aged 65 years or older: a multicentre, prospective, test-negative design study. THE LANCET. INFECTIOUS DISEASES 2017; 17:313-321. [DOI: 10.1016/s1473-3099(17)30049-x] [Citation(s) in RCA: 101] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 12/05/2016] [Accepted: 12/13/2016] [Indexed: 12/12/2022]
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25
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Izumi Y, Akazawa M, Akeda Y, Tohma S, Hirano F, Ideguchi H, Matsumura R, Miyamura T, Mori S, Fukui T, Iwanaga N, Jiuchi Y, Kozuru H, Tsutani H, Saisyo K, Sugiyama T, Suenaga Y, Okada Y, Katayama M, Ichikawa K, Furukawa H, Kawakami K, Oishi K, Migita K. The 23-valent pneumococcal polysaccharide vaccine in patients with rheumatoid arthritis: a double-blinded, randomized, placebo-controlled trial. Arthritis Res Ther 2017; 19:15. [PMID: 28122642 PMCID: PMC5264490 DOI: 10.1186/s13075-016-1207-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Accepted: 12/09/2016] [Indexed: 12/27/2022] Open
Abstract
Background Pneumococcal pneumonia is the most frequent form of pneumonia. We herein assessed the effectiveness of the 23-valent pneumococcal polysaccharide vaccine (PPSV23) in the prevention of pneumonia overall in rheumatoid arthritis (RA) patients at risk for infections. We hypothesized that PPSV23 vaccination is superior in preventing pneumococcal pneumonia compared with placebo in RA patients. Methods A prospective, multicenter, double-blinded, randomized, placebo-controlled (1:1) trial was conducted across departments of rheumatology in Japanese National Hospital Organization hospitals. RA patients (n = 900) who had been treated with biological or immunosuppressive agents were randomly assigned PPSV23 or placebo (sodium chloride). The primary endpoints were the incidences of all-cause pneumonia and pneumococcal pneumonia. The secondary endpoint was death from pneumococcal pneumonia, all-cause pneumonia, or other causes. Cox regression models were used to estimate the risk of pneumonia overall for the placebo group compared with the vaccine group. Results Seventeen (3.7%) of 464 patients in the vaccine group and 15 (3.4%) of 436 patients in the placebo group developed pneumonia. There was no difference in the rates of pneumonia between the two study groups. The overall rate of pneumonia was 21.8 per 1000 person-years for patients with RA. The presence of interstitial pneumonia (hazard ratio: 3.601, 95% confidence interval: 1.547–8.380) was associated with an increased risk of pneumonia in RA patients. Conclusion PPSV23 does not prevent against pneumonia overall in RA patients at relative risk for infections. Our results also confirm that the presence of interstitial lung disease is associated with pneumonia in Japanese patients with RA. Trial registration UMIN-CTR UMIN000009566. Registered 17 December 2012.
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Affiliation(s)
- Yasumori Izumi
- Japanese National Hospital Organization (NHO) (Evidence-based Medicine Study Group), Higashigaoka 2-5-23, Meguro, Tokyo, 152-8621, Japan
| | - Manabu Akazawa
- Department of Public Health and Epidemiology, Meiji Pharmaceutical University, Noshio 2-522-1, Kiyose, Tokyo, 204-8588, Japan
| | - Yukihiro Akeda
- Research Institute for Microbial Diseases, Osaka University, Yamadaoka 3-1, Suita, Osaka, 565-8563, Japan
| | - Shigeto Tohma
- Japanese National Hospital Organization (NHO) (Evidence-based Medicine Study Group), Higashigaoka 2-5-23, Meguro, Tokyo, 152-8621, Japan
| | - Fuminori Hirano
- Japanese National Hospital Organization (NHO) (Evidence-based Medicine Study Group), Higashigaoka 2-5-23, Meguro, Tokyo, 152-8621, Japan
| | - Haruko Ideguchi
- Japanese National Hospital Organization (NHO) (Evidence-based Medicine Study Group), Higashigaoka 2-5-23, Meguro, Tokyo, 152-8621, Japan
| | - Ryutaro Matsumura
- Japanese National Hospital Organization (NHO) (Evidence-based Medicine Study Group), Higashigaoka 2-5-23, Meguro, Tokyo, 152-8621, Japan
| | - Tomoya Miyamura
- Japanese National Hospital Organization (NHO) (Evidence-based Medicine Study Group), Higashigaoka 2-5-23, Meguro, Tokyo, 152-8621, Japan
| | - Shunsuke Mori
- Japanese National Hospital Organization (NHO) (Evidence-based Medicine Study Group), Higashigaoka 2-5-23, Meguro, Tokyo, 152-8621, Japan
| | - Takahiro Fukui
- Japanese National Hospital Organization (NHO) (Evidence-based Medicine Study Group), Higashigaoka 2-5-23, Meguro, Tokyo, 152-8621, Japan
| | - Nozomi Iwanaga
- Japanese National Hospital Organization (NHO) (Evidence-based Medicine Study Group), Higashigaoka 2-5-23, Meguro, Tokyo, 152-8621, Japan
| | - Yuka Jiuchi
- Japanese National Hospital Organization (NHO) (Evidence-based Medicine Study Group), Higashigaoka 2-5-23, Meguro, Tokyo, 152-8621, Japan
| | - Hideko Kozuru
- Japanese National Hospital Organization (NHO) (Evidence-based Medicine Study Group), Higashigaoka 2-5-23, Meguro, Tokyo, 152-8621, Japan
| | - Hiroshi Tsutani
- Japanese National Hospital Organization (NHO) (Evidence-based Medicine Study Group), Higashigaoka 2-5-23, Meguro, Tokyo, 152-8621, Japan
| | - Kouichirou Saisyo
- Japanese National Hospital Organization (NHO) (Evidence-based Medicine Study Group), Higashigaoka 2-5-23, Meguro, Tokyo, 152-8621, Japan
| | - Takao Sugiyama
- Japanese National Hospital Organization (NHO) (Evidence-based Medicine Study Group), Higashigaoka 2-5-23, Meguro, Tokyo, 152-8621, Japan
| | - Yasuo Suenaga
- Japanese National Hospital Organization (NHO) (Evidence-based Medicine Study Group), Higashigaoka 2-5-23, Meguro, Tokyo, 152-8621, Japan
| | - Yasumasa Okada
- Japanese National Hospital Organization (NHO) (Evidence-based Medicine Study Group), Higashigaoka 2-5-23, Meguro, Tokyo, 152-8621, Japan
| | - Masao Katayama
- Japanese National Hospital Organization (NHO) (Evidence-based Medicine Study Group), Higashigaoka 2-5-23, Meguro, Tokyo, 152-8621, Japan
| | - Kenji Ichikawa
- Japanese National Hospital Organization (NHO) (Evidence-based Medicine Study Group), Higashigaoka 2-5-23, Meguro, Tokyo, 152-8621, Japan
| | - Hiroshi Furukawa
- Japanese National Hospital Organization (NHO) (Evidence-based Medicine Study Group), Higashigaoka 2-5-23, Meguro, Tokyo, 152-8621, Japan
| | - Kenji Kawakami
- Japanese National Hospital Organization (NHO) (Evidence-based Medicine Study Group), Higashigaoka 2-5-23, Meguro, Tokyo, 152-8621, Japan
| | - Kazunori Oishi
- Infectious Diseases Surveillance Center, National Institute of Infectious Diseases, Toyama 1-23-1, Shinjuku, Tokyo, 162-8640, Japan
| | - Kiyoshi Migita
- Japanese National Hospital Organization (NHO) (Evidence-based Medicine Study Group), Higashigaoka 2-5-23, Meguro, Tokyo, 152-8621, Japan. .,Department of Rheumatology, Fukushima Medical University, Hikarigaoka 1, Fukushima, 960-1295, Japan.
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Falkenhorst G, Remschmidt C, Harder T, Hummers-Pradier E, Wichmann O, Bogdan C. Effectiveness of the 23-Valent Pneumococcal Polysaccharide Vaccine (PPV23) against Pneumococcal Disease in the Elderly: Systematic Review and Meta-Analysis. PLoS One 2017; 12:e0169368. [PMID: 28061505 PMCID: PMC5218810 DOI: 10.1371/journal.pone.0169368] [Citation(s) in RCA: 148] [Impact Index Per Article: 21.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 12/15/2016] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Routine vaccination of elderly people against pneumococcal diseases is recommended in many countries. National guidelines differ, recommending either the 23-valent polysaccharide vaccine (PPV23), the 13-valent conjugate vaccine (PCV13) or both. Considering the ongoing debate on the effectiveness of PPV23, we performed a systematic literature review and meta-analysis of the vaccine efficacy/effectiveness (VE) of PPV23 against invasive pneumococcal disease (IPD) and pneumococcal pneumonia in adults aged ≥60 years living in industrialized countries. METHODS We searched for pertinent clinical trials and observational studies in databases MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews. We assessed the risk of bias of individual studies using the Cochrane Risk of Bias tool for randomized controlled trials and the Newcastle-Ottawa Scale for observational studies. We rated the overall quality of the evidence by GRADE criteria. We performed meta-analyses of studies grouped by outcome and study design using random-effects models. We applied a sensitivity analysis excluding studies with high risk of bias. RESULTS We identified 17 eligible studies. Pooled VE against IPD (by any serotype) was 73% (95%CI: 10-92%) in four clinical trials, 45% (95%CI: 15-65%) in three cohort studies, and 59% (95%CI: 35-74%) in three case-control studies. After excluding studies with high risk of bias, pooled VE against pneumococcal pneumonia (by any serotype) was 64% (95%CI: 35-80%) in two clinical trials and 48% (95%CI: 25-63%) in two cohort studies. Higher VE estimates in trials (follow-up ~2.5 years) than in observational studies (follow-up ~5 years) may indicate waning protection. Unlike previous meta-analyses, we excluded two trials with high risk of bias regarding the outcome pneumococcal pneumonia, because diagnosis was based on serologic methods with insufficient specificity. CONCLUSIONS Our meta-analysis revealed significant VE of PPV23 against both IPD and pneumococcal pneumonia by any serotype in the elderly, comparable to the efficacy of PCV13 against vaccine-serotype disease in a recent clinical trial in elderly people. Due to its broader serotype coverage and the decrease of PCV13 serotypes among adults resulting from routine infant immunization with PCV13, PPV23 continues to play an important role for protecting adults against IPD and pneumococcal pneumonia.
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Affiliation(s)
- Gerhard Falkenhorst
- Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Cornelius Remschmidt
- Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Thomas Harder
- Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Eva Hummers-Pradier
- Department of General Practice, University Medical Center Göttingen, Göttingen, Germany
| | - Ole Wichmann
- Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Christian Bogdan
- Mikrobiologisches Institut – Klinische Mikrobiologie, Immunologie und Hygiene, Friedrich Alexander Universität (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
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Falkenhorst G, Remschmidt C, Harder T, Wichmann O, Glodny S, Hummers-Pradier E, Ledig T, Bogdan C. Background paper to the updated pneumococcal vaccination recommendation for older adults in Germany. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2016; 59:1623-1657. [DOI: 10.1007/s00103-016-2466-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Abstract
PURPOSE OF REVIEW Pneumococcal diseases (invasive diseases, pneumonia, otitis media, and sinusitis) are among the most frequent preventable infectious diseases carrying a very high morbidity and case fatality rate worldwide. Pneumococcal vaccination is a key element to reduce the global burden of the disease in children and adult population. Our aim is to discuss current knowledge of the epidemiology of pneumococcal disease and pneumococcal vaccines. RECENT FINDINGS After the introduction of conjugate vaccines (PCV7 and PCV13), rates of pneumococcal diseases because of vaccine serotypes have decreased considerably among children in the vaccine target and among nonvaccinated children and adults. Results of the Community-Acquired Pneumonia Immunization Trial in Adults demonstrated 45.6% efficacy of PCV13 against the first episode of pneumonia, 45% against first-episode nonbacteremic pneumococcal pneumonia, and 75% against the first episode of invasive pneumococcal diseases in adults older than 65 years. Recommendations for pneumococcal vaccination have changed recently in both the United States and Europe. SUMMARY The changing epidemiology of pneumococcal diseases should be closely investigated to assess the effectiveness and the usefulness of the current vaccination policies, and to identify future directions for preventing pneumococcal infections.
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Fink AL, Klein SL. Sex and Gender Impact Immune Responses to Vaccines Among the Elderly. Physiology (Bethesda) 2016; 30:408-16. [PMID: 26525340 DOI: 10.1152/physiol.00035.2015] [Citation(s) in RCA: 92] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
In response to the recommended vaccines in older-aged individuals, sex differences occur in response to those that protect against influenza, tetanus, pertussis, shingles, and pneumococcal infections. The efficacy of vaccines recommended for older-aged adults is consistently greater for females than for males. Gender differences as well as biological sex differences can influence vaccine uptake, responses, and outcome in older-aged individuals, which should influence guidelines, formulations, and dosage recommendations for vaccines in the elderly.
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Affiliation(s)
- Ashley L Fink
- The W. Harry Feinstone Department of Molecular Microbiology and Immunology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Sabra L Klein
- The W. Harry Feinstone Department of Molecular Microbiology and Immunology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Kong Y, Zhang W, Jiang Z, Wang L, Li C, Li Y, Xia J. Immunogenicity and safety of a 23-valent pneumococcal polysaccharide vaccine in Chinese healthy population aged >2 years: A randomized, double-blinded, active control, phase III trial. Hum Vaccin Immunother 2016; 11:2425-33. [PMID: 26083953 DOI: 10.1080/21645515.2015.1055429] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Streptococcus pneumoniae is an important pathogen causing invasive diseases such as sepsis, meningitis, and pneumonia. Vaccines have become the most effective way to prevent pneumococcal infections. This phase III trial was designed to evaluate the immunogenicity and safety of a 23-valent pneumococcal polysaccharide vaccine in Chinese healthy population aged >2 years. We conducted a randomized, double-blinded, active-controlled, multicenter trial in which 1660 healthy population (>2 years of age) were randomly assigned in a 1 : 1 ratio to receive 2 intramuscular doses of either the treatment vaccine or the active control vaccine, PNEUMOVAX 23. The surveillance period was 30 days. The primary end point was the 2-fold increase rate of anti-pneumococcal antibody for all 23 included serotypes in each group. In the intention-to-treat cohort, the 2-fold increase rate of anti-pneumococcal antibody for 23 included serotypes varied from 62.47% to 97.01% in the treatment group, and from 51.49% to 95.77% in the control group. According to -10% non-inferiority margin and 95% confidence intervals of rate difference, almost all included serotypes of the treatment group reached non-inferiority to control group except for serotype 6B, the lower limit of rate difference of which was -10.00%, equal to the non-inferiority margin. The 2-fold increase rates of anti-pneumococcal antibody were significantly higher in the treatment group for serotype 2, 3, 4, 10A, 11A and 20. Furthermore, for all 23 serotypes, IgG geometric mean concentrations (GMCs) at day 30 were significantly higher in treatment group for serotype 2, 3, 4, 9 V, 10A, 11A, 15 B, 18C, 19 A, 22 F and 33 F. Higher geometric mean fold increase (GMFI) were also observed in the treatment group correspondingly. Serious adverse events occurred in 3 of 830 participants in the treatment group (0.36%) and 2 of 830 participants in the control group (0.24%). No death occurred during the trial. The frequencies of both solicited and unsolicited adverse events (AEs) were small lower in the treatment group (34.34% vs 35.66% for solicited AEs, 4.34% vs 5.42% for unsolicited AEs). Both vaccines were well tolerated and most AEs were mild or moderate in intensity. The newly vaccine was well tolerated and immunologically non-inferior to the active control vaccine PNEUMOVAX 23 for all 23 vaccine serotypes in the Chinese population (>2 years of age).
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Affiliation(s)
- Yujia Kong
- a Department of Health Statistics ; School of Preventive Medicine; Fourth Military Medical University ; Xi'an , Shaanxi , China
| | - Wei Zhang
- a Department of Health Statistics ; School of Preventive Medicine; Fourth Military Medical University ; Xi'an , Shaanxi , China
| | - Zhiwei Jiang
- a Department of Health Statistics ; School of Preventive Medicine; Fourth Military Medical University ; Xi'an , Shaanxi , China
| | - Ling Wang
- a Department of Health Statistics ; School of Preventive Medicine; Fourth Military Medical University ; Xi'an , Shaanxi , China
| | - Chanjuan Li
- a Department of Health Statistics ; School of Preventive Medicine; Fourth Military Medical University ; Xi'an , Shaanxi , China
| | - Yanping Li
- b Center for Disease Control and Prevention of the Guangxi Zhuang Autonomous Region ; Nanning , China
| | - Jielai Xia
- a Department of Health Statistics ; School of Preventive Medicine; Fourth Military Medical University ; Xi'an , Shaanxi , China
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Sunagar R, Kumar S, Franz BJ, Gosselin EJ. Vaccination evokes gender-dependent protection against tularemia infection in C57BL/6Tac mice. Vaccine 2016; 34:3396-404. [PMID: 27182819 DOI: 10.1016/j.vaccine.2016.04.054] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 04/11/2016] [Accepted: 04/19/2016] [Indexed: 11/17/2022]
Abstract
Francisella tularensis (Ft) is a Category A biothreat agent for which there currently is no FDA-approved vaccine. Thus, there is a substantial effort underway to develop an effective tularemia vaccine. While it is well established that gender can significantly impact susceptibility to primary infection, the impact of gender on vaccine efficacy is not well established. Thus, development of a successful vaccine against tularemia will require an understanding of the impact gender has on vaccine-induced protection against this organism. In this study, a role for gender in vaccine-induced protection following Ft challenge is identified for the first time. In the present study, mucosal vaccination with inactivated Ft (iFt) LVS elicited gender-based protection in C57BL/6Tac mice against respiratory challenge with Ft LVS. Specifically, vaccinated male mice were more susceptible to subsequent Ft LVS challenge. This increased susceptibility in male mice correlated with increased bacterial burden, increased tissue inflammation, and increased proinflammatory cytokine production late in post-challenge infection. In contrast, improved survival of iFt-vaccinated female mice correlated with reduced bacterial burden and enhanced levels of Ft-specific Abs in serum and broncho-alveolar lavage (BAL) fluid post-challenge. Furthermore, vaccination with a live attenuated vaccine consisting of an Ft LVS superoxide dismutase (SodB) mutant, which has proven efficacious against the highly virulent Ft SchuS4 strain, demonstrated similar gender bias in protection post-Ft SchuS4 challenge. Of particular significance is the fact that these are the first studies to demonstrate that gender differences impact disease outcome in the case of lethal respiratory tularemia following mucosal vaccination. In addition, these studies further emphasize the fact that gender differences must be a serious consideration in any future tularemia vaccine development studies.
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Affiliation(s)
- Raju Sunagar
- Center for Immunology and Microbial Disease, Albany Medical College, Albany, NY 12208, United States
| | - Sudeep Kumar
- Center for Immunology and Microbial Disease, Albany Medical College, Albany, NY 12208, United States
| | - Brian J Franz
- Center for Immunology and Microbial Disease, Albany Medical College, Albany, NY 12208, United States
| | - Edmund J Gosselin
- Center for Immunology and Microbial Disease, Albany Medical College, Albany, NY 12208, United States.
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The effectiveness of pneumococcal polysaccharide vaccine 23 (PPV23) in the general population of 50 years of age and older: A systematic review and meta-analysis. Vaccine 2016; 34:1540-1550. [PMID: 26899372 DOI: 10.1016/j.vaccine.2016.02.024] [Citation(s) in RCA: 90] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Revised: 01/11/2016] [Accepted: 02/07/2016] [Indexed: 11/21/2022]
Abstract
UNLABELLED Two pneumococcal vaccines currently exist and have been recommended for the prevention of pneumococcal infection in adults 65 years of age and older: the 23-valent polysaccharide (PPV23) and the conjugate 13-valent (PCV13) vaccine. OBJECTIVE To evaluate and summarize the results from all studies reporting on the vaccine effectiveness of PPV23 in preventing invasive pneumococcal disease (IPD) and community-acquired pneumonia (CAP) in individuals over the age of 50. METHODS Systematic database searches were completed in PubMed, Medline, Embase, CINAHL, Web of Science, and Cochrane. Google Scholar and hand searches of seminal articles and past systematic reviews were employed. Studies were included if they independently evaluated the effect of PPV23 on IPD and/or CAP in adults (50+). Data extraction and quality assessment were both completed independently by two researchers. Quality was assessed using the National Advisory Committee on Immunization methodology for quality assessment. All conflicts were resolved by consensus. RESULTS The vaccine effectiveness for PPV23 in preventing IPD was 50% (95% CI: 21%-69%) for cohort studies and 54% (95% CI: 32%-69%) for case-control studies. The VE estimates for CAP were 4% (95% CI: -26%-26%) for trials, 17% (95% CI: -26%-45%) for cohort studies, and 7% (95% CI: -10%-21%) for case-control studies. CONCLUSIONS The vaccine effectiveness of PPV23 in preventing IPD and all-cause CAP was consistent with past systematic reviews and similar to the estimates that were reported in the CAPiTA trial evaluating the vaccine effectiveness of PCV13. Consistent benefits were also reported across ecological studies and reports of surveillance data for the general population 50 years and older. The results suggests that the current practice of vaccinating the adults 65 years of age and older with PPV23 would have similar benefits to PCV13 in preventing potential cases of all-serotype IPD and all-cause CAP.
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Prato R, Fortunato F, Martinelli D. Pneumococcal pneumonia prevention among adults: is the herd effect of pneumococcal conjugate vaccination in children as good a way as the active immunization of the elderly? Curr Med Res Opin 2016; 32:543-5. [PMID: 26652736 DOI: 10.1185/03007995.2015.1131150] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The indirect protection of adults as a result of pneumococcal conjugate vaccination of infants has been discussed from different epidemiological points of view. In some countries, including Italy, even after pediatric vaccination, vaccine serotypes are still responsible for most pneumonia and invasive diseases in the elderly. Although the Community-Acquired Pneumonia Immunization Trial in Adults (CAPITA) produced encouraging results, it has not showed the efficacy of the 13-valent conjugate vaccine in preventing pneumococcal community-acquired pneumonia regardless of the number of episodes and serotype. Addressing these points by monitoring the direct impact of adult vaccination in real life distinguished from the effects of herd immunity will assist public health decision-making on the most effective adult pneumococcal vaccination strategies.
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Affiliation(s)
- Rosa Prato
- a Department of Medical and Surgical Sciences , University of Foggia , Italy
| | - Francesca Fortunato
- a Department of Medical and Surgical Sciences , University of Foggia , Italy
| | - Domenico Martinelli
- a Department of Medical and Surgical Sciences , University of Foggia , Italy
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Gubbins PO, Li C. The Influence of Influenza and Pneumococcal Vaccines on Community-Acquired Pneumonia (CAP) Outcomes Among Elderly Patients. Curr Infect Dis Rep 2015; 17:49. [PMID: 26446610 DOI: 10.1007/s11908-015-0505-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Elderly are at high risk for hospitalization for community-acquired pneumonia (CAP), especially due to Streptococcus pneumoniae, and seasonal influenza viruses. Data suggest PPV23's influence on various CAP-related outcomes among the elderly may depend upon how many years have elapsed since they received this vaccine. PPV23's protection against invasive pneumococcal disease and CAP hospitalizations are often limited to moderately ill elderly, who are less than 75 years old, or female. PCV13 demonstrates broad protection against a variety of CAPs, but ultimately, its influence on their outcomes among the elderly may be limited by herd immunity from PCV7 use. Influenza vaccine's indirect protective effect against all-cause and non-invasive pneumococcal CAP in the elderly is difficult to ascertain. The use of both PPV23 and influenza vaccine shortens length of stay in hospitalized elderly with CAP, but whether that benefit would be realized in the presence of herd immunity is unknown.
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Affiliation(s)
- Paul O Gubbins
- Division of Pharmacy Practice and Administration, University of Missour Kansas City, UMKC School of Pharmacy at MSU, Bldg 1 Brick City, 327 West Mill Street #425, Springfield, MO, 65806, USA.
| | - Chenghui Li
- Division of Pharmaceutical Evaluation and Policy, Department of Pharmacy Practice, University of Arkansas for Medical Sciences College of Pharmacy, 4301 West Markham 522, Little Rock, AR, 72205, USA.
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Giefing-Kröll C, Berger P, Lepperdinger G, Grubeck-Loebenstein B. How sex and age affect immune responses, susceptibility to infections, and response to vaccination. Aging Cell 2015; 14:309-21. [PMID: 25720438 PMCID: PMC4406660 DOI: 10.1111/acel.12326] [Citation(s) in RCA: 469] [Impact Index Per Article: 52.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2014] [Indexed: 12/13/2022] Open
Abstract
Do men die young and sick, or do women live long and healthy? By trying to explain the sexual dimorphism in life expectancy, both biological and environmental aspects are presently being addressed. Besides age-related changes, both the immune and the endocrine system exhibit significant sex-specific differences. This review deals with the aging immune system and its interplay with sex steroid hormones. Together, they impact on the etiopathology of many infectious diseases, which are still the major causes of morbidity and mortality in people at old age. Among men, susceptibilities toward many infectious diseases and the corresponding mortality rates are higher. Responses to various types of vaccination are often higher among women thereby also mounting stronger humoral responses. Women appear immune-privileged. The major sex steroid hormones exhibit opposing effects on cells of both the adaptive and the innate immune system: estradiol being mainly enhancing, testosterone by and large suppressive. However, levels of sex hormones change with age. At menopause transition, dropping estradiol potentially enhances immunosenescence effects posing postmenopausal women at additional, yet specific risks. Conclusively during aging, interventions, which distinctively consider the changing level of individual hormones, shall provide potent options in maintaining optimal immune functions.
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Affiliation(s)
- Carmen Giefing-Kröll
- Institute for Biomedical Aging Research of Innsbruck University; Innsbruck Austria
| | - Peter Berger
- Institute for Biomedical Aging Research of Innsbruck University; Innsbruck Austria
| | - Günter Lepperdinger
- Institute for Biomedical Aging Research of Innsbruck University; Innsbruck Austria
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Li C, Gubbins PO, Chen GJ. Prior pneumococcal and influenza vaccinations and in-hospital outcomes for community-acquired pneumonia in elderly veterans. J Hosp Med 2015; 10:287-93. [PMID: 25676363 DOI: 10.1002/jhm.2328] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Revised: 01/13/2015] [Accepted: 01/14/2015] [Indexed: 11/09/2022]
Abstract
BACKGROUND Studies of adults hospitalized for community-acquired pneumonia (CAP) reported better outcomes associated with prior pneumococcal vaccination (PV), suggesting potential additional benefits of PV in hospitalized CAP patients. Influenza (flu) vaccination (FV) could independently/additively improve CAP outcomes in hospitalized patients. OBJECTIVE To examine the effect of prior PV and FV on in-hospital outcomes in elderly veterans hospitalized for CAP. DESIGN Retrospective cohort study. SETTING AND PATIENTS A total of 6,723 elderly veterans who were admitted to Veterans Affairs hospitals for CAP between October 1, 2002 and September 30, 2003. INTERVENTION PV in the 5 years and FV in the 1 year before admission. MEASUREMENTS The association of prior PV and/or FV with inpatient mortality and length of stay (LOS) (primary) and risk of any bacteremia and respiratory complications (secondary) were assessed using logistic regressions and generalized linear model, controlling for patient demographic and clinical characteristics. RESULTS Prior PV alone was not associated with shortened LOS, or reduced risk of inpatient mortality or respiratory complications. Lower risk of bacteremia was associated with prior PV (odds ratio: 0.66; 95% confidence interval [CI]: 0.48-0.90). After adjusting for patients' characteristics, risk of inpatient mortality was not statistically significantly different across the vaccination groups, but having had both PV and FV before CAP admission was associated with a 10% reduction in LOS (95% CI: 0.86-0.95) compared to having had neither vaccinations. CONCLUSION Significant survival benefit and improved in-hospital outcomes may not be expected among CAP-hospitalized elderly patients with prior PV alone. However, having both PV and FV before CAP admission may reduce LOS.
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Affiliation(s)
- Chenghui Li
- Division of Pharmaceutical Evaluation and Policy, University of Arkansas for Medical Sciences College of Pharmacy, Little Rock, Arkansas; Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock, Arkansas
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Teramoto S, Yoshida K, Hizawa N. Update on the pathogenesis and management of pneumonia in the elderly-roles of aspiration pneumonia. Respir Investig 2015; 53:178-84. [PMID: 26344607 DOI: 10.1016/j.resinv.2015.01.003] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Revised: 01/20/2015] [Accepted: 01/21/2015] [Indexed: 11/30/2022]
Abstract
Pneumonia in the elderly results in the highest mortality among cases of community-acquired pneumonia (CAP). The pathophysiology of pneumonia in the elderly is primarily due to aspiration pneumonia (ASP). ASP comprises two pathological conditions: airspace infiltration with bacterial pathogens and dysphagia-associated miss-swallowing. The first-line therapy for the treatment of bacterial pneumonia in the elderly is a narrow spectrum of antibiotics, including sulbactam/ampicillin, which are effective against major lower respiratory infection pathogens and anaerobes. The bacterial pathogens of ASP cases of pneumonia in the elderly are similar to those associated with adult CAP. In addition to an appropriate course of antibiotics, pharmacologic and non-pharmacologic approaches for dysphagia and upper airway management are necessary for the treatment and prevention of pneumonia. Swallowing rehabilitation, oral health care, pneumococcal vaccination, gastroesophageal reflux management, and a head-up position during the night are necessary for the treatment and prevention of repeated episodes of pneumonia in elderly patients. In addition, tuberculosis should always be considered for the differential diagnosis of pneumonia in this patient population.
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Affiliation(s)
- Shinji Teramoto
- Department of Pulmonary Medicine, Hitachinaka Medical Education and Research Center, University of Tsukuba, 20-1 Hitachinaka-shi, Ibaraki 329-8575, Japan.
| | - Kazufumi Yoshida
- Department of Pulmonary Medicine, Hitachinaka General Hospital, Hitachi Ltd., Ibaraki, Japan
| | - Nobuyuki Hizawa
- Department of Pulmonary Medicine, Graduate School of Comprehensive Human Science, University of Tsukuba, Ibaraki, Japan
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Leventer-Roberts M, Feldman BS, Brufman I, Cohen-Stavi CJ, Hoshen M, Balicer RD. Effectiveness of 23-valent pneumococcal polysaccharide vaccine against invasive disease and hospital-treated pneumonia among people aged ≥65 years: a retrospective case-control study. Clin Infect Dis 2015; 60:1472-80. [PMID: 25669354 DOI: 10.1093/cid/civ096] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Accepted: 02/01/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Streptococcus pneumoniae contributes considerably to the burden of pneumonia and invasive pneumococcal disease (IPD), with the effectiveness of the 23-valent pneumococcal polysaccharide vaccine (PPSV23) for preventing all-cause pneumonia still undetermined. The aim of this study was to control for common biases and confounders associated with previous observational studies and to assess PPSV23 vaccine effectiveness in preventing IPD and the most resource-intensive type of community-acquired pneumonia, hospital-treated pneumonia (HTP). METHODS This was a retrospective case-control study nested in a population-based cohort, with age-, sex-, and risk-matched controls as the base case. Demographic information, laboratory data, and diagnoses were extracted from the chronic disease registry and from inpatient and outpatient records in the Clalit Health Services database. Vaccine effectiveness for PPSV23 was assessed using multivariable conditional logistic regression. Subgroup, sensitivity, and secondary analyses were conducted to validate findings. RESULTS A total of 470 070 individuals aged ≥65 years were members of Clalit Health Services during the study period (1 January 2007 through 31 December 2010). The case cohort consisted of 212 participants with IPD and 23 441 with HTP. The adjusted association between vaccination and IPD was protective (odds ratio [OR], 0.58; 95% confidence interval [CI], .41-.81), whereas there was no demonstrated protective effect between vaccination and HTP (OR, 1.01; 95% CI, .97-1.04). The sensitivity analysis and all but 1 subgroup analysis provided consistent results to the base case. CONCLUSIONS The PPSV23 vaccine is effective against the most severe invasive forms of pneumococcal disease, but the lack of effectiveness of PPSV23 in protecting against all-cause HTP should be considered for future vaccine policies.
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Affiliation(s)
- Maya Leventer-Roberts
- Chief Physician's Office, Clalit Health Services, Clalit Research Institute, Tel Aviv, Israel Department of Preventive Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Becca S Feldman
- Chief Physician's Office, Clalit Health Services, Clalit Research Institute, Tel Aviv, Israel
| | - Ilan Brufman
- Chief Physician's Office, Clalit Health Services, Clalit Research Institute, Tel Aviv, Israel
| | - Chandra J Cohen-Stavi
- Chief Physician's Office, Clalit Health Services, Clalit Research Institute, Tel Aviv, Israel
| | - Moshe Hoshen
- Chief Physician's Office, Clalit Health Services, Clalit Research Institute, Tel Aviv, Israel
| | - Ran D Balicer
- Chief Physician's Office, Clalit Health Services, Clalit Research Institute, Tel Aviv, Israel Department of Epidemiology, Faculty of Health Sciences, Ben Gurion University, Be'er Sheva, Israel
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Feldman C, Anderson R. Review: Current and new generation pneumococcal vaccines. J Infect 2014; 69:309-25. [DOI: 10.1016/j.jinf.2014.06.006] [Citation(s) in RCA: 141] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Accepted: 06/16/2014] [Indexed: 12/22/2022]
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Schneeberg A, Bettinger JA, McNeil S, Ward BJ, Dionne M, Cooper C, Coleman B, Loeb M, Rubinstein E, McElhaney J, Scheifele DW, Halperin SA. Knowledge, attitudes, beliefs and behaviours of older adults about pneumococcal immunization, a Public Health Agency of Canada/Canadian Institutes of Health Research Influenza Research Network (PCIRN) investigation. BMC Public Health 2014; 14:442. [PMID: 24884433 PMCID: PMC4046143 DOI: 10.1186/1471-2458-14-442] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Accepted: 05/02/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Fewer Canadian seniors are vaccinated against pneumococcal disease than receive the influenza vaccine annually. Improved understanding of factors influencing pneumococcal vaccination among older adults is needed to improve vaccine uptake. METHODS A self-administered survey measuring knowledge, attitudes, beliefs and behaviours about pneumococcal vaccination was administered to a cohort of seniors participating in a clinical trial of seasonal influenza vaccines at eight centers across Canada. Eligible participants were ambulatory adults 65 years of age or older, in good health or with stable health conditions, previously given influenza vaccine. The primary outcome was self-reported receipt of pneumococcal vaccination. Multi-variable logistic regression was used to determine factors significantly associated with pneumococcal vaccine receipt. RESULTS A total of 863 participants completed questionnaires (response rate 92%); 58% indicated they had received the pneumococcal vaccine. Being offered the vaccine by a health care provider had the strongest relationship with vaccine receipt (AOR 23.4 (95% CI 13.4-40.7)). Other variables that remained significantly associated with vaccine receipt in the multivariable model included having heard of the vaccine (AOR 10.1(95% CI 4.7-21.7)), and strongly agreeing that it is important for adults > 65 to be vaccinated against pneumococcus (AOR 3.3 (95% CI 1.2-9.2)). Participants who were < 70 years of age were less likely to be vaccinated. CONCLUSIONS These results indicate healthcare recommendation significantly influenced vaccine uptake in this population of older adults. Measures to encourage healthcare providers to offer the vaccine may help increase coverage.
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Affiliation(s)
- Amy Schneeberg
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- Vaccine Evaluation Center, British Columbia Children’s Hospital and the University of British Columbia, Vancouver, British Columbia, Canada
| | - Julie A Bettinger
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- Vaccine Evaluation Center, British Columbia Children’s Hospital and the University of British Columbia, Vancouver, British Columbia, Canada
| | - Shelly McNeil
- Canadian Center for Vaccinology, Dalhousie University, Capital Health and IWK Health Centre Halifax, Halifax, Nova Scotia, Canada
| | - Brian J Ward
- Vaccine Study Centre, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Marc Dionne
- Research Center, Centre Hospitalier Universitaire, Quebec City, Quebec, Canada
| | - Curtis Cooper
- The Ottawa Hospital Research Institute, University of Ottawa, Ontario, Canada
| | - Brenda Coleman
- University of Toronto and Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Mark Loeb
- McMaster University, Hamilton, Ontario, Canada
| | - Ethan Rubinstein
- University of Manitoba, Department of Medicine, Winnipeg, Manitoba, Canada
| | - Janet McElhaney
- University of British Columbia, VITALiTY Research Center, Vancouver, British Columbia, Canada
| | - David W Scheifele
- Vaccine Evaluation Center, British Columbia Children’s Hospital and the University of British Columbia, Vancouver, British Columbia, Canada
| | - Scott A Halperin
- Canadian Center for Vaccinology, Dalhousie University, Capital Health and IWK Health Centre Halifax, Halifax, Nova Scotia, Canada
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