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King LM, Lewnard JA. Health-economic burden attributable to novel serotypes in candidate 24- and 31-valent pneumococcal conjugate vaccines. Vaccine 2024; 42:126310. [PMID: 39260055 DOI: 10.1016/j.vaccine.2024.126310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Revised: 08/07/2024] [Accepted: 08/29/2024] [Indexed: 09/13/2024]
Abstract
INTRODUCTION Next-generation pneumococcal vaccines currently in clinical trials include 24- and 31-valent pneumococcal conjugate vaccines (PCV24, PCV31), which aim to prevent upper-respiratory carriage and disease involving the targeted serotypes. We aimed to estimate the comprehensive health-economic burden associated with acute respiratory infections (ARIs) and invasive pneumococcal disease (IPD) attributable to PCV24- and PCV31-additional (non-PCV20) serotypes in the United States. MATERIAL AND METHODS We multiplied all-cause incidence rate estimates for acute otitis media (AOM), sinusitis, and non-bacteremic pneumonia by estimates of the proportions of each of these conditions attributable to pneumococci and the proportions of pneumococcal infections involving PCV24- and PCV31-additional serotypes. We estimated serotype-specific IPD incidence rates using US Active Bacterial Core surveillance data. We accounted for direct medical and non-medical costs associated with each condition to estimate resulting health-economic burden. Non-medical costs included missed work and lost quality-adjusted life years due to death and disability. RESULTS The health-economic burden of PCV24-additional serotypes totaled $1.3 ($1.1-1.7) billion annually in medical and non-medical costs, comprised of $0.9 ($0.7-1.2) billion due to ARIs and $0.4 ($0.3-0.5) billion due to IPD. For PCV31-additional serotypes, medical and non-medical costs totaled $7.5 ($6.6-8.6) billion annually, with $5.5 ($4.7-6.6) billion due to ARIs and $1.9 ($1.8-2.1) billion due to IPD. The largest single driver of costs was non-bacteremic pneumonia, particularly in adults aged 50-64 and ≥65 years. CONCLUSIONS Additional serotypes in PCV24 and PCV31, especially those included in PCV31, account for substantial health-economic burden in the United States.
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Affiliation(s)
- Laura M King
- School of Public Health, University of California, Berkeley, 2121 Berkeley Way, Berkeley, CA 94704, United States.
| | - Joseph A Lewnard
- School of Public Health, University of California, Berkeley, 2121 Berkeley Way, Berkeley, CA 94704, United States.
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Grant LR, Hanquet G, Sepúlveda-Pachón IT, Theilacker C, Baay M, Slack MPE, Jodar L, Gessner BD. Effects of PCV10 and PCV13 on pneumococcal serotype 6C disease, carriage, and antimicrobial resistance. Vaccine 2024; 42:2983-2993. [PMID: 38553292 DOI: 10.1016/j.vaccine.2024.03.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 02/26/2024] [Accepted: 03/24/2024] [Indexed: 04/22/2024]
Abstract
BACKGROUND The cross-protection of pneumococcal conjugate vaccines (PCV) against serotype 6C is not clearly documented, although 6C represents a substantial burden of pneumococcal disease in recent years. A systematic review by the World Health Organization that covered studies through 2016 concluded that available data were insufficient to determine if either PCV10 (which contains serotype 6B but not 6A) or PCV13 (containing serotype 6A and 6B) conferred protection against 6C. METHODS We performed a systematic review of randomized controlled trials and observational studies published between January 2010 - August 2022 (Medline/Embase), covering the direct, indirect, and overall effect of PCV10 and PCV13 against 6C invasive pneumococcal disease (IPD), non-IPD, nasopharyngeal carriage (NPC), and antimicrobial resistance (AMR). RESULTS Of 2548 publications identified, 112 were included. Direct vaccine effectiveness against 6C IPD in children ranged between 70 and 85 % for ≥ 1 dose PCV13 (n = 3 studies), was 94 % in fully PCV13 vaccinated children (n = 2), and -14 % for ≥ 1 dose of PCV10 (n = 1). Compared to PCV7, PCV13 efficacy against 6C NPC in children was 66 % (n = 1). Serotype 6C IPD rates or NPC prevalence declined post-PCV13 in most studies in children (n = 5/6) and almost half of studies in adults (n = 5/11), while it increased post-PCV10 for IPD and non-IPD in all studies (n = 6/6). Changes in AMR prevalence were inconsistent. CONCLUSIONS In contrast to PCV10, PCV13 vaccination consistently protected against 6C IPD and NPC in children, and provided some level of indirect protection to adults, supporting that serotype 6A but not 6B provides cross-protection to 6C. Vaccine policy makers and regulators should consider the effects of serotype 6A-containing PCVs against serotype 6C disease in their decisions.
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Affiliation(s)
- Lindsay R Grant
- Medical Development and Scientific Clinical Affairs, Pfizer Vaccines, 500 Arcola Road, Collegeville, PA 19426, USA.
| | - Germaine Hanquet
- P95 Epidemiology & Pharmacovigilance, Koning Leopold III-laan 1, 3001 Leuven, Belgium.
| | | | - Christian Theilacker
- Medical Development and Scientific Clinical Affairs, Pfizer Pharma GmbH, Berlin, Germany.
| | - Marc Baay
- P95 Epidemiology & Pharmacovigilance, Koning Leopold III-laan 1, 3001 Leuven, Belgium.
| | - Mary P E Slack
- School of Medicine & Dentistry, Griffith University Gold Coast Campus, Parklands Drive, Southport, Queensland, QLD 4222, Australia.
| | - Luis Jodar
- Medical Development and Scientific Clinical Affairs, Pfizer Vaccines, 500 Arcola Road, Collegeville, PA 19426, USA.
| | - Bradford D Gessner
- Medical Development and Scientific Clinical Affairs, Pfizer Vaccines, 500 Arcola Road, Collegeville, PA 19426, USA.
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Ricci Conesa H, Skröder H, Norton N, Bencina G, Tsoumani E. Clinical and economic burden of acute otitis media caused by Streptococcus pneumoniae in European children, after widespread use of PCVs-A systematic literature review of published evidence. PLoS One 2024; 19:e0297098. [PMID: 38564583 PMCID: PMC10986968 DOI: 10.1371/journal.pone.0297098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 12/21/2023] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Acute otitis media (AOM) is a common childhood disease frequently caused by Streptococcus pneumoniae. Pneumococcal conjugate vaccines (PCV7, PCV10, PCV13) can reduce the risk of AOM but may also shift AOM etiology and serotype distribution. The aim of this study was to review estimates from published literature of the burden of AOM in Europe after widespread use of PCVs over the past 10 years, focusing on incidence, etiology, serotype distribution and antibiotic resistance of Streptococcus pneumoniae, and economic burden. METHODS This systematic review included published literature from 31 European countries, for children aged ≤5 years, published after 2011. Searches were conducted using PubMed, Embase, Google, and three disease conference websites. Risk of bias was assessed with ISPOR-AMCP-NPC, ECOBIAS or ROBIS, depending on the type of study. RESULTS In total, 107 relevant records were identified, which revealed wide variation in study methodology and reporting, thus limiting comparisons across outcomes. No homogenous trends were identified in incidence rates across countries, or in detection of S. pneumoniae as a cause of AOM over time. There were indications of a reduction in hospitalization rates (decreases between 24.5-38.8% points, depending on country, PCV type and time since PCV introduction) and antibiotic resistance (decreases between 14-24%, depending on country), following the widespread use of PCVs over time. The last two trends imply a potential decrease in economic burden, though this was not possible to confirm with the identified cost data. There was also evidence of an increase in serotype distributions towards non-vaccine serotypes in all of the countries where non-PCV serotype data were available, as well as limited data of increased antibiotic resistance within non-vaccine serotypes. CONCLUSIONS Though some factors point to a reduction in AOM burden in Europe, the burden still remains high, residual burden from uncovered serotypes is present and it is difficult to provide comprehensive, accurate and up-to-date estimates of said burden from the published literature. This could be improved by standardised methodology, reporting and wider use of surveillance systems.
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Affiliation(s)
| | | | | | - Goran Bencina
- Center for Observational and Real-World Evidence, MSD, Madrid, Spain
| | - Eleana Tsoumani
- Center for Observational and Real-World Evidence, MSD, Athens, Greece
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Cathalau M, Michelet M, Rancé A, Martin-Blondel G, Abbo O, Dubois D, Labouret G, Grouteau E, Claudet I, Ricco L, Roditis L, Mansuy JM, Simon S, Bréhin C. Necrotizing pneumonia in children: Report of 25 cases between 2008 and 2018 at a French tertiary care center. Arch Pediatr 2024; 31:183-187. [PMID: 38485569 DOI: 10.1016/j.arcped.2023.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 11/21/2023] [Accepted: 12/30/2023] [Indexed: 04/07/2024]
Abstract
BACKGROUND Necrotizing pneumonia (NP) is a serious and rare disease in children. Pediatric data on NP are limited and the impact of the 13-valent pneumococcal conjugate vaccine has been very poorly evaluated. PATIENTS AND METHODS We conducted a retrospective study at Toulouse University Hospital between 2008 and 2018. Children who presented with thin-walled cavities in the areas of parenchymal consolidation on imaging were included in the study. RESULTS The incidence of NP did not decrease during this period. Bacterial identification occurred in 56% of cases (14/25) and included six cases of Streptococcus pneumoniae, five of Staphylococcus aureus, two of Streptococcus pyogenes, and one of Streptococcus viridans. Streptococcus pneumoniae NP are more frequently associated with empyema/parapneumonic effusion compared to S. aureus NP (p = 0.02). Patients with S. pyogenes NP more often required volume expansion than did S. pneumoniae cases (p = 0.03). When comparing children born before and after implementation of the 13-valent pneumococcal conjugate vaccine, we identified a relative modification of the bacterial epidemiology, with an increase in the proportion of S. pyogenes NP and S. aureus NP and a decrease in the proportion of NP caused by S. pneumoniae. CONCLUSION Future studies are needed to assess the epidemiology of NP in children. Continued surveillance of identified pneumococcal serotypes is essential to document epidemiological changes in the coming years.
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Affiliation(s)
- Manon Cathalau
- Children's Hospital, University Hospital Center of Toulouse, 330 avenue de Grande Bretagne, 31300, Toulouse, France
| | - Marine Michelet
- Pediatric Pneumology Department, University Hospital Center of Toulouse, 330 avenue de Grande Bretagne, 31300, Toulouse, France
| | - Aurélien Rancé
- Pediatric Pneumology Department, University Hospital Center of Toulouse, 330 avenue de Grande Bretagne, 31300, Toulouse, France
| | - Guillaume Martin-Blondel
- Infectious Diseases Department, University Hospital Center of Toulouse, 330 avenue de Grande Bretagne, 31300, Toulouse, France
| | - Olivier Abbo
- Infantile Visceral Surgery Department, University Hospital Center of Toulouse, 330 avenue de Grande Bretagne, 31300, Toulouse, France
| | - Damien Dubois
- Federal Institute of Biology, Bacteriology unit, University Hospital Center of Toulouse, 330 avenue de Grande Bretagne, 31300, Toulouse, France
| | - Géraldine Labouret
- Pediatric Pneumology Department, University Hospital Center of Toulouse, 330 avenue de Grande Bretagne, 31300, Toulouse, France
| | - Erick Grouteau
- General Pediatrics Unit, University Hospital Center of Toulouse, 330 avenue de Grande Bretagne, 31300, Toulouse, France
| | - Isabelle Claudet
- Pediatric Emergency Care Unit, University Hospital Center of Toulouse, 330 avenue de Grande Bretagne, 31300, Toulouse, France
| | - Lucas Ricco
- General Pediatrics Unit, University Hospital Center of Toulouse, 330 avenue de Grande Bretagne, 31300, Toulouse, France
| | - Léa Roditis
- Pediatric Pneumology Department, University Hospital Center of Toulouse, 330 avenue de Grande Bretagne, 31300, Toulouse, France
| | - Jean-Michel Mansuy
- Federal Institute of Biology, Virology unit, University Hospital Center of Toulouse, 330 avenue de Grande Bretagne, 31300, Toulouse, France
| | - Sophie Simon
- Pediatric Radiology Department, University Hospital Center of Toulouse, 330 avenue de Grande Bretagne, 31300, Toulouse, France
| | - Camille Bréhin
- General Pediatrics Unit, University Hospital Center of Toulouse, 330 avenue de Grande Bretagne, 31300, Toulouse, France.
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Ganaie FA, Saad JS, Lo SW, McGee L, van Tonder AJ, Hawkins PA, Calix JJ, Bentley SD, Nahm MH. Novel pneumococcal capsule type 33E results from the inactivation of glycosyltransferase WciE in vaccine type 33F. J Biol Chem 2023; 299:105085. [PMID: 37495106 PMCID: PMC10462825 DOI: 10.1016/j.jbc.2023.105085] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 06/14/2023] [Accepted: 07/19/2023] [Indexed: 07/28/2023] Open
Abstract
The polysaccharide (PS) capsule is essential for immune evasion and virulence of Streptococcus pneumoniae. Existing pneumococcal vaccines are designed to elicit anticapsule antibodies; however, the effectiveness of these vaccines is being challenged by the emergence of new capsule types or variants. Herein, we characterize a newly discovered capsule type, 33E, that appears to have repeatedly emerged from vaccine type 33F via an inactivation mutation in the capsule glycosyltransferase gene, wciE. Structural analysis demonstrated that 33E and 33F share an identical repeat unit backbone [→5)-β-D-Galf2Ac-(1→3)-β-D-Galp-(1→3)-α-D-Galp-(1→3)-β-D-Galf-(1→3)-β-D-Glcp-(1→], except that a galactose (α-D-Galp) branch is present in 33F but not in 33E. Though the two capsule types were indistinguishable using conventional typing methods, the monoclonal antibody Hyp33FM1 selectively bound 33F but not 33E pneumococci. Further, we confirmed that wciE encodes a glycosyltransferase that catalyzes the addition of the branching α-D-Galp and that its inactivation in 33F strains results in the expression of the 33E capsule type. Though 33F and 33E share a structural and antigenic similarity, our pilot study suggested that immunization with a 23-valent pneumococcal PS vaccine containing 33F PS did not significantly elicit cross-opsonic antibodies to 33E. New conjugate vaccines that target capsule type 33F may not necessarily protect against 33E. Therefore, studies of new conjugate vaccines require knowledge of the newly identified capsule type 33E and reliable pneumococcal typing methods capable of distinguishing it from 33F.
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Affiliation(s)
- Feroze A Ganaie
- Division of Pulmonary/Allergy/Critical Care, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jamil S Saad
- Department of Microbiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Stephanie W Lo
- Parasites and Microbes, Wellcome Sanger Institute, Cambridge, United Kingdom
| | - Lesley McGee
- Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Andries J van Tonder
- Department of Veterinary Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Paulina A Hawkins
- Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA; CDC Foundation, Atlanta, Georgia, USA
| | - Juan J Calix
- Division of Pulmonary/Allergy/Critical Care, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA; Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Stephen D Bentley
- Parasites and Microbes, Wellcome Sanger Institute, Cambridge, United Kingdom
| | - Moon H Nahm
- Division of Pulmonary/Allergy/Critical Care, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA.
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Yokota SI, Tsukamoto N, Sato T, Ohkoshi Y, Yamamoto S, Ogasawara N. Serotype replacement and an increase in non-encapsulated isolates among community-acquired infections of Streptococcus pneumoniae during post-vaccine era in Japan. IJID REGIONS 2023; 8:105-110. [PMID: 37554357 PMCID: PMC10404989 DOI: 10.1016/j.ijregi.2023.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 07/05/2023] [Accepted: 07/06/2023] [Indexed: 08/10/2023]
Abstract
OBJECTIVES It is feared that the serotype replacement of Streptococcus pneumoniae occurred by the introduction of pneumococcal vaccines as periodical inoculation leads to reduced efficacy of the approved vaccines and altered antimicrobial susceptibility. METHODS We determined serotypes of 351 S. pneumoniae isolates collected at a commercial clinical laboratory in Hokkaido prefecture, Japan, from December 2018 to February 2019 by using the polymerase chain reaction procedure of the US Centers for Disease Control and Prevention. Antimicrobial susceptibility and resistance gene profiles were also examined. RESULTS Vaccine coverage rates were 7.9% for 13-valent conjugate vaccine, and 32.5% for 23-valent polysaccharide vaccine, respectively. Non-typable strains were 19.7%. cpsA-positive isolates (group I), and null capsule clade (NCC)1, NCC2 and NCC3 (group II) comprised 31.3%, 28.4%, 32.8%, and 7.5% of the 69 non-typable strains, respectively. No penicillin-resistant/intermediate isolates were found; however, serotypes 35B and 15A/F showed low susceptibility to β-lactams. Only five strains (1.4%) were levofloxacin-resistant, and all were from the older persons, and three strains were serotype 35B. CONCLUSION The progression of serotype replacement in non-invasive pneumococcal infections has occurred during the post-vaccine era in Japan, and non-encapsulated isolates, such as NCC, have increased. Antimicrobial susceptibility is not worsened.
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Affiliation(s)
- Shin-ichi Yokota
- Department of Microbiology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | | | - Toyotaka Sato
- Laboratory of Veterinary Hygiene, Faculty of Veterinary Medicine, Hokkaido University, Sapporo, Japan
- Graduate School of Infectious Diseases, Hokkaido University, Sapporo, Japan
- One Health Research Center, Hokkaido University, Sapporo, Japan
| | - Yasuo Ohkoshi
- Department of Microbiology, Sapporo Medical University School of Medicine, Sapporo, Japan
- Department of Clinical Laboratory, NTT Medical Center Sapporo, Sapporo, Japan
| | - Soh Yamamoto
- Department of Microbiology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Noriko Ogasawara
- Department of Microbiology, Sapporo Medical University School of Medicine, Sapporo, Japan
- Department of Otolaryngology-Head and Neck Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
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Rybak A, Levy C, Ouldali N, Bonacorsi S, Béchet S, Delobbe JF, Batard C, Donikian I, Goldrey M, Assouline J, Cohen R, Varon E. Dynamics of Antibiotic Resistance of Streptococcus pneumoniae in France: A Pediatric Prospective Nasopharyngeal Carriage Study from 2001 to 2022. Antibiotics (Basel) 2023; 12:1020. [PMID: 37370339 DOI: 10.3390/antibiotics12061020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 05/23/2023] [Accepted: 05/31/2023] [Indexed: 06/29/2023] Open
Abstract
Epidemiological surveillance of nasopharyngeal pneumococcal carriage is important for monitoring serotype distribution and antibiotic resistance, particularly before and after the implementation of pneumococcal conjugate vaccines (PCVs). With a prospective surveillance study in France, we aimed to analyze the dynamics of pneumococcal carriage, antibiotic susceptibility and serotype distribution in children aged 6 to 24 months who had acute otitis media between 2001 and 2022 with a focus on the late PCV13 period from May 2014 to July 2022. Trends were analyzed with segmented linear regression with autoregressive error. For the 17,136 children enrolled, overall pneumococcal carriage was stable during the study. During the late PCV13 period, the five most frequent serotypes were all non-PCV13 serotypes: 15B/C (14.3%), 23B (11.0%), 11A (9.6%), 15A (7.4%) and 35B (6.5%). During the same period, we observed a rebound of penicillin non-susceptibility (+0.15% per month, 95% confidence interval, +0.08 to 0.22, p < 0.001). Five serotypes accounted for 64.4% of the penicillin non-susceptible strains: 11A (17.5%), 35B (14.9%), 15A (13.9%), 15B/C (9.9%) and 19F (8.2%); non-PCV13/PCV15 accounted for <1%, and non-PCV15/PCV20 accounted for 28%. The next generation PCVs, particularly PCV20, may disrupt nasopharyngeal carriage and contribute to decreasing the rate of antibiotic resistance among pneumococci.
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Affiliation(s)
- Alexis Rybak
- Activ, Association Clinique et Thérapeutique Infantile du Val-de-Marne, 94000 Créteil, France
- Afpa, Association Française de Pédiatrie Ambulatoire, 45000 Orléans, France
- Pediatric Emergency Department, Trousseau Hospital, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, 75012 Paris, France
- Clinical Epidemiology Unit, Eceve Inserm UMR-S 1123, Robert Debré University Hospital, Université de Paris, Assistance Publique-Hôpitaux de Paris, 75010 Paris, France
| | - Corinne Levy
- Activ, Association Clinique et Thérapeutique Infantile du Val-de-Marne, 94000 Créteil, France
- Afpa, Association Française de Pédiatrie Ambulatoire, 45000 Orléans, France
- IMRB-GRC GEMINI, Institut Mondor de Recherche Biomédicale-Groupe de Recherche Clinique Groupe d'Etude des Maladie Infectieuses Néonatales et Infantiles, Université Paris Est, 94000 Créteil, France
- GPIP, Groupe de Pathologie Infectieuse Pédiatrique, 06200 Nice, France
- CRC, Clinical Research Center, Centre Hospitalier Intercommunal de Créteil, 94000 Créteil, France
| | - Naïm Ouldali
- Activ, Association Clinique et Thérapeutique Infantile du Val-de-Marne, 94000 Créteil, France
- Department of General Pediatrics, Pediatric Infectious Disease and Internal Medicine, Robert Debré University Hospital, Université de Paris, Assistance Publique-Hôpitaux de Paris, 75019 Paris, France
- IAME, Infection, Antimicrobials, Modelling, Evolution, Inserm UMR 1137, Paris University, 75018 Paris, France
| | - Stéphane Bonacorsi
- Microbiology Unit, Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, 75019 Paris, France
| | - Stéphane Béchet
- Activ, Association Clinique et Thérapeutique Infantile du Val-de-Marne, 94000 Créteil, France
| | | | - Christophe Batard
- Activ, Association Clinique et Thérapeutique Infantile du Val-de-Marne, 94000 Créteil, France
- Afpa, Association Française de Pédiatrie Ambulatoire, 45000 Orléans, France
| | - Isabelle Donikian
- Afpa, Association Française de Pédiatrie Ambulatoire, 45000 Orléans, France
| | - Marie Goldrey
- Afpa, Association Française de Pédiatrie Ambulatoire, 45000 Orléans, France
| | - Jessica Assouline
- Afpa, Association Française de Pédiatrie Ambulatoire, 45000 Orléans, France
| | - Robert Cohen
- Activ, Association Clinique et Thérapeutique Infantile du Val-de-Marne, 94000 Créteil, France
- Afpa, Association Française de Pédiatrie Ambulatoire, 45000 Orléans, France
- IMRB-GRC GEMINI, Institut Mondor de Recherche Biomédicale-Groupe de Recherche Clinique Groupe d'Etude des Maladie Infectieuses Néonatales et Infantiles, Université Paris Est, 94000 Créteil, France
- GPIP, Groupe de Pathologie Infectieuse Pédiatrique, 06200 Nice, France
- CRC, Clinical Research Center, Centre Hospitalier Intercommunal de Créteil, 94000 Créteil, France
| | - Emmanuelle Varon
- IMRB-GRC GEMINI, Institut Mondor de Recherche Biomédicale-Groupe de Recherche Clinique Groupe d'Etude des Maladie Infectieuses Néonatales et Infantiles, Université Paris Est, 94000 Créteil, France
- Laboratory of Medical Biology and National Reference Centre for Pneumococci, Intercommunal Hospital of Créteil, 94000 Créteil, France
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Ganaie FA, Saad JS, Lo SW, McGee L, Bentley SD, van Tonder AJ, Hawkins P, Keenan JD, Calix JJ, Nahm MH. Discovery and Characterization of Pneumococcal Serogroup 36 Capsule Subtypes, Serotypes 36A and 36B. J Clin Microbiol 2023; 61:e0002423. [PMID: 36971549 PMCID: PMC10117043 DOI: 10.1128/jcm.00024-23] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 02/20/2023] [Indexed: 03/29/2023] Open
Abstract
Streptococcus pneumoniae can produce a wide breadth of antigenically diverse capsule types, a fact that poses a looming threat to the success of vaccines that target pneumococcal polysaccharide (PS) capsule. Yet, many pneumococcal capsule types remain undiscovered and/or uncharacterized. Prior sequence analysis of pneumococcal capsule synthesis (cps) loci suggested the existence of capsule subtypes among isolates identified as "serotype 36" according to conventional capsule typing methods. We discovered these subtypes represent two antigenically similar but distinguishable pneumococcal capsule serotypes, 36A and 36B. Biochemical analysis of their capsule PS structure reveals that both have the shared repeat unit backbone [→5)-α-d-Galf-(1→1)-d-Rib-ol-(5→P→6)-β-d-ManpNAc-(1→4)-β-d-Glcp-(1→] with two branching structures. Both serotypes have a β-d-Galp branch to Ribitol. Serotypes 36A and 36B differ by the presence of a α-d-Glcp-(1→3)-β-d-ManpNAc or α-d-Galp-(1→3)-β-d-ManpNAc branch, respectively. Comparison of the phylogenetically distant serogroup 9 and 36 cps loci, which all encode this distinguishing glycosidic bond, revealed that the incorporation of Glcp (in types 9N and 36A) versus Galp (in types 9A, 9V, 9L, and 36B) is associated with the identity of four amino acids in the cps-encoded glycosyltransferase WcjA. Identifying functional determinants of cps-encoded enzymes and their impact on capsule PS structure is key to improving the resolution and reliability of sequencing-based capsule typing methods and discovering novel capsule variants indistinguishable by conventional serotyping methods.
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Affiliation(s)
- Feroze A. Ganaie
- Department of Medicine, Division of Pulmonary/Allergy/Critical Care, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jamil S. Saad
- Department of Microbiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Stephanie W. Lo
- Parasites and Microbes, Wellcome Sanger Institute, Hinxton, Cambridge, United Kingdom
| | - Lesley McGee
- Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Stephen D. Bentley
- Parasites and Microbes, Wellcome Sanger Institute, Hinxton, Cambridge, United Kingdom
| | - Andries J. van Tonder
- Department of Veterinary Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Paulina Hawkins
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Jeremy D. Keenan
- Department of Ophthalmology, University of California, San Francisco, California, USA
| | - Juan J. Calix
- Department of Medicine, Division of Pulmonary/Allergy/Critical Care, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Moon H. Nahm
- Department of Medicine, Division of Pulmonary/Allergy/Critical Care, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Ruttkay Pereira DR, Pereira MR, Rotta Pereira MB, Costa SS, Mott MP, Cantarelli V. Otopathogens in the middle ear and nasopharynx of children with recurrent acute otitis media. Int J Pediatr Otorhinolaryngol 2023; 169:111552. [PMID: 37120991 DOI: 10.1016/j.ijporl.2023.111552] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 04/03/2023] [Accepted: 04/09/2023] [Indexed: 05/02/2023]
Abstract
OBJECTIVE This study aimed to describe the microbiology of the middle ear and nasopharynx, determining the prevalence of Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis in a group of children vaccinated with pneumococcal conjugate vaccine (PCV) who underwent ventilation tube insertion for recurrent acute otitis media. METHODS We analyzed 278 middle ear effusion and 139 nasopharyngeal samples obtained from 139 children who underwent myringotomy and ventilation tube insertion for recurrent acute otitis media between June 2017 and June 2021. The children's ages ranged from 9 months to 9 years, 10 months, with a median of 21 months. The patients had no signs of acute otitis media or respiratory tract infection and were not on antibiotic therapy at the time of the procedure. The middle ear effusion and nasopharyngeal samples were collected with an Alden-Senturia aspirator and a swab, respectively. Bacteriological studies and multiplex PCR were performed for the detection of the three pathogens. Direct molecular determination of pneumococcal serotypes was performed by real-time PCR. The chi-square test was used to verify associations between categorical variables and measures of strength of association based on prevalence ratios, considering a 95% confidence interval a 5% significance level. RESULTS Vaccination coverage was 77.7% with the basic regimen plus booster dose and 22.3% with the basic regimen alone. Middle ear effusion culture identified H. influenzae in 27 children (19.4%), S. pneumoniae in 7 (5.0%), and M. catarrhalis in 7 (5.0%). PCR detected H. influenzae in 95 children (68.3%), S. pneumoniae in 52 (37.4%), and M. catarrhalis in 23 (16.5%), a three-to seven-fold increase compared to culture. In the nasopharynx, culture isolated H. influenzae in 28 children (20.1%), S. pneumoniae in 29 (20.9%), and M. catarrhalis in 12 (8.6%). PCR identified H. influenzae in 84 children (60.4%), S. pneumoniae in 58 (41.7%), and M. catarrhalis in 30 (21.5%), a two-to three-fold increase in detection. The most common pneumococcal serotype was 19A, both in the ears and the nasopharynx. In the ears, of the 52 children who had pneumococcus, 24 (46.2%) had serotype 19A. In the nasopharynx, of the 58 patients who had pneumococcus, 37 (63.8%) had serotype 19A. Of all 139 children, 53 (38.1%) had polymicrobial samples (more than 1 of the 3 otopathogens) in the nasopharynx. Of the 53 children who had polymicrobial samples in the nasopharynx, 47 (88.7%) also had 1 of the 3 otopathogens in the middle ear, mainly H. influenzae (40%-75.5%), especially when it was found in the nasopharynx in conjunction with S. pneumoniae. CONCLUSION The prevalence of bacteria in a group of Brazilian children immunized with the PCV who required ventilation tube insertion for recurrent acute otitis media was similar to that reported in other parts of the world after the advent of PCV. H. influenzae was the most frequent bacteria, both in the nasopharynx and the middle ear, while S. pneumoniae serotype 19A was the most common pneumococcus in the nasopharynx and middle ear. Polymicrobial colonization of the nasopharynx was strongly associated with detection of H. influenzae in the middle ear.
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Affiliation(s)
- Denise Rotta Ruttkay Pereira
- School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), R. Ramiro Barcelos, 2400, 90035003, Porto Alegre, RS, Brazil.
| | - Manuel Ruttkay Pereira
- School of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Av. Ipiranga, 6681, 90619900, Porto Alegre, RS, Brazil.
| | | | - Sady Selaimen Costa
- School of Medicine, UFRGS, R. Ramiro Barcelos, 2400, 90035003, Porto Alegre, RS, Brazil.
| | - Mariana Preussler Mott
- Hospital de Clínicas de Porto Alegre (HCPA), Rua Ramiro Barcelos, 2350, 90035903, Porto Alegre, RS, Brazil.
| | - Vlademir Cantarelli
- Department of Basic Health Sciences, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), R. Sarmento Leite, 245, 90050170, Porto Alegre, RS, Brazil.
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10
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Frequent Transmission of Streptococcus pneumoniae Serotype 35B and 35D, Clonal Complex 558 Lineage, across Continents and the Formation of Multiple Clades in Japan. Antimicrob Agents Chemother 2023; 67:e0108322. [PMID: 36651739 PMCID: PMC9933736 DOI: 10.1128/aac.01083-22] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Streptococcus pneumoniae is a common bacterial pathogen that causes infections in children worldwide, even after administration of the pneumococcal conjugate vaccine. S. pneumoniae serotype 35B, especially the clonal complex 558 (CC558) lineage, has emerged globally following implementation of the 13-valent pneumococcal conjugate vaccine. Serotype 35B strains are also associated with multidrug resistance to both β-lactams and non-β-lactam drugs. In addition, a novel serotype, 35D, which is closely related to 35B and differs in polysaccharide structure, was recently reported. However, the genetic relationship among globally disseminating serotype 35B and D (35B/D) strains remains unknown. To investigate the molecular epidemiology of global serotype 35B/D strains, we conducted a genomic analysis of serotype 35B/D strains from various continents, including those from the Japanese national surveillance collection. A total of 87 isolates were identified as serotype 35B/D in the Japanese surveillance collection (n = 1,358). All the isolates were assigned to either CC558 or CC2755. Serotype 35D isolates were interspersed with serotype 35B isolates. Phylogenetic analysis revealed the formation of multiple clusters by the Japanese serotype 35B/D-CC558 isolates among the foreign isolates, which suggested multiple events of introduction of the clone into Japan. The global 35B/D-CC558 strains were found to share specific penicillin-binding protein profiles, pbp1a-4, pbp2b-7, and pbp2x-7, associated with penicillin, cephalosporin, and carbapenem nonsusceptibility. Moreover, 88.5% of the Japanese 35B/D-CC558 and 35B/D-CC2755 isolates were found to harbor the Tn916-like integrative and conjugative elements Tn2009, Tn2010, and Tn6002, associated with multidrug resistance to macrolides and tetracyclines. The results of this study imply that serotype 35B/D-CC558 strains could be frequently transmitted intercontinentally.
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11
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Marra LP, Sartori AL, Martinez-Silveira MS, Toscano CM, Andrade AL. Effectiveness of Pneumococcal Vaccines on Otitis Media in Children: A Systematic Review. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2022; 25:1042-1056. [PMID: 35667776 DOI: 10.1016/j.jval.2021.12.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 11/24/2021] [Accepted: 12/06/2021] [Indexed: 06/15/2023]
Abstract
OBJECTIVES We aimed to determine the effectiveness of pneumococcal vaccines on otitis media (OM) and acute otitis media (AOM) in children. METHODS We conducted a systematic search in databases PubMed (MEDLINE), Embase, Lilacs, and Web of Science. We included observational studies that evaluated any pneumococcal vaccine - including 7, 10, and 13-valent pneumococcal conjugate vaccines (PCV7, PCV10, and PCV13) and 23-valent polysaccharide vaccines (PPSV23) as the intervention, in children aged less than five years. RESULTS Out of the 2112 screened studies, 48 observational studies complied with the eligibility criteria and therefore were included in this review. Of the included studies, 30 (63%) were before-after, eleven (23%) cohort, six (13%) time series, and one (2%) case-control study designs. Vaccine effectiveness (VE) in preventing OM or AOM varied by vaccine type. In children under 24 months VE ranged from 8% and 42.7% (PCV7), 5.6% to 84% (PCV10) and 2.2% to 68% (PCV13). In children aged less than 60 months, VE ranged between 13.2% and 39% for PCV7, 11% to 39% for PCV10 (only children under 48 months), and 39% to 41% (PCV13). CONCLUSIONS Our results demonstrate significant effect of pneumococcal vaccination in decreasing OM or AOM in children under five years old in several countries supporting the public health value of introducing PCVs in national immunization programs.
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Affiliation(s)
- Lays P Marra
- Department of Community Health, Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiânia, Brazil.
| | - Ana L Sartori
- Institute of Health Sciences, Federal University of Mato Grosso, Sinop, Brazil
| | | | - Cristiana M Toscano
- Department of Community Health, Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiânia, Brazil
| | - Ana L Andrade
- Department of Community Health, Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiânia, Brazil
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12
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Willen L, Ekinci E, Cuypers L, Theeten H, Desmet S. Infant Pneumococcal Carriage in Belgium Not Affected by COVID-19 Containment Measures. Front Cell Infect Microbiol 2022; 11:825427. [PMID: 35111700 PMCID: PMC8801737 DOI: 10.3389/fcimb.2021.825427] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 12/30/2021] [Indexed: 12/31/2022] Open
Abstract
Streptococcus pneumoniae is an important and frequently carried respiratory pathogen that has the potential to cause serious invasive diseases, such as pneumonia, meningitis, and sepsis. Young children and older adults are among the most vulnerable to developing serious disease. With the arrival of the COVID-19 pandemic and the concomitant restrictive measures, invasive disease cases caused by respiratory bacterial species, including pneumococci, decreased substantially. Notably, the stringency of the containment measures as well as the visible reduction in the movement of people appeared to coincide with the drop in invasive disease cases. One could argue that wearing protective masks and adhering to social distancing guidelines to halt the spread of the SARS-CoV-2 virus, also led to a reduction in the person-to-person transmission of respiratory bacterial species. Although plausible, this conjecture is challenged by novel data obtained from our nasopharyngeal carriage study which is performed yearly in healthy daycare center attending children. A sustained and high pneumococcal carriage rate was observed amid periods of stringent restrictive measures. This finding prompts us to revisit the connection between nasopharyngeal colonization and invasion and invites us to look closer at the nasopharyngeal microbiome as a whole.
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Affiliation(s)
- Laura Willen
- Centre for the Evaluation of Vaccination, Vaccine and Infectious Disease Institute, University of Antwerp, Wilrijk, Belgium
- *Correspondence: Laura Willen,
| | - Esra Ekinci
- Centre for the Evaluation of Vaccination, Vaccine and Infectious Disease Institute, University of Antwerp, Wilrijk, Belgium
| | - Lize Cuypers
- Department of Laboratory Medicine, National Reference Centre for Pneumococci, University Hospitals Leuven, Leuven, Belgium
| | - Heidi Theeten
- Centre for the Evaluation of Vaccination, Vaccine and Infectious Disease Institute, University of Antwerp, Wilrijk, Belgium
| | - Stefanie Desmet
- Department of Laboratory Medicine, National Reference Centre for Pneumococci, University Hospitals Leuven, Leuven, Belgium
- Laboratory of Clinical Bacteriology and Mycology, Department of Microbiology, Immunology and Transplantation, Katholieke Universiteit Leuven, Leuven, Belgium
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13
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Fuji N, Pichichero M, Ehrlich RL, Mell JC, Ehrlich GD, Kaur R. Transition of Serotype 35B Pneumococci From Commensal to Prevalent Virulent Strain in Children. Front Cell Infect Microbiol 2021; 11:744742. [PMID: 34765566 PMCID: PMC8577857 DOI: 10.3389/fcimb.2021.744742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 09/13/2021] [Indexed: 11/13/2022] Open
Abstract
In our community-based prospective cohort study in young children, we observed a significant increase in pneumococcal serotype 35B nasopharyngeal (NP) commensal colonization during the 2011–2014 timeframe, but these strains were not associated with disease. Beginning in 2015 and continuing through to the present, the serotype 35B virulence changed, and it became the dominant bacteria isolated and associated with pneumococcal acute otitis-media (AOM) in our cohort. We performed comparative analyses of 250 35B isolates obtained from 140 children collected between 2006 and 2019. Changes in prevalence, clonal-complex composition, and antibiotic resistance were analyzed. Seventy-two (29%) of 35B isolates underwent whole-genome sequencing to investigate genomic changes associated with the shift in virulence that resulted in increased rates of 35B-associated AOM disease. 35B strains that were commensals and AOM disease-causing were mainly associated with sequence type (ST) 558. Antibiotic concentrations of β-lactams and ofloxacin necessary to inhibit growth of 35B strains rose significantly (2006–2019) (p<0.005). However, only isolates from the 35B/ST558 showed significant increases in MIC50 of penicillin and ofloxacin between the years 2006–2014 and 2015–2019 (p=0.007 and p<0.0001). One hundred thirty-eight SNPs located in 34 different genes were significantly associated with post-2015 strains. SNPs were found in nrdG (metal binding, 10%); metP and metN (ABC transporter, 9%); corA (Mg2+ transporter, 6%); priA (DNA replication, 5%); and on the enzymic gene ldcB (LD-carboxypeptidase, 3%). Pneumococcal serotype 35B strains was a common NP commensal during 2010–2014. In 2015, a shift in increasing number of AOM cases occurred in young children caused by 35B, that was associated with changes in genetic composition and antibiotic susceptibility.
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Affiliation(s)
- Naoko Fuji
- Center for Infectious Diseases and Immunology, Rochester General Hospital Research Institute, Rochester, NY, United States
| | - Michael Pichichero
- Center for Infectious Diseases and Immunology, Rochester General Hospital Research Institute, Rochester, NY, United States
| | - Rachel L Ehrlich
- Department of Microbiology and Immunology, Drexel University College of Medicine, and Center for Genomic Sciences, Institute of Molecular Medicine and Infectious Disease, Philadelphia, PA, United States
| | - Joshua Chang Mell
- Department of Microbiology and Immunology, Drexel University College of Medicine, and Center for Genomic Sciences, Institute of Molecular Medicine and Infectious Disease, Philadelphia, PA, United States
| | - Garth D Ehrlich
- Department of Microbiology and Immunology, Drexel University College of Medicine, and Center for Genomic Sciences, Institute of Molecular Medicine and Infectious Disease, Philadelphia, PA, United States.,Department of Otolaryngology-Head and Neck Surgery, Drexel University College of Medicine, Philadelphia, PA, United States
| | - Ravinder Kaur
- Center for Infectious Diseases and Immunology, Rochester General Hospital Research Institute, Rochester, NY, United States
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14
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Pneumococcal Conjugated Vaccines Decreased Acute Otitis Media Burden: A Population-Based Study in Israel. J Pediatr 2021; 235:233-238.e3. [PMID: 33894263 DOI: 10.1016/j.jpeds.2021.04.025] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Revised: 04/06/2021] [Accepted: 04/13/2021] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To study time trends in all-cause acute otitis media (AOM) burden by calculating incidence rates of AOM episodes and recurrent acute otitis media (rAOM) cases in highly immunized pediatric population during the pre- and post-pneumococcal conjugated vaccine (PCV) years. STUDY DESIGN In this population-based study, AOM episodes and rAOM cases were identified in Clalit Health Services-insured Israeli children aged 0-10 years between 2005 and 2018 by using a data-sharing platform. Because a near-sequential implementation of PCV-7/PCV-13 occurred within a 1-year period (2009/2010), we compared AOM visits before (2005-July 2009) and after (August 2009-2018) the introduction of PCVs. We focused on children younger than 2 years of age, who are the target population of PCVs and are at AOM peak age. RESULTS We identified 805 389 AOM episodes contributed by 270 137 children. The median number of AOM episodes was 2 (IQR 1-4). A downward trend of incidence rates of AOM episodes was observed during the post-PCV years in children younger than age 9 years (P < .001). The largest decrease (21%) was observed in children younger than 1 year, from 807/1000 children during the pre-PCV years to 640/1000 during the post-PCV years (P < .001). An average annual decrease of ∼14/1000 AOM episodes was calculated in children younger than 1 year old (β = -13.39, 95% CI -16.25 to -10.53, P < .001). Of rAOM cases, documented in 84 237 (31.2%) children, 74% were in children younger than 2 years, and 55% were in boys. The risk to develop rAOM significantly decreased during the post-PCV years in children younger than 2 years (hazard ratio 0.893, 95% CI 0.878-0.908; P < .001). CONCLUSIONS AOM burden significantly decreased following PCVs introduction in highly immunized children.
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15
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Cohen R, Levy C, Ouldali N, Goldrey M, Béchet S, Bonacorsi S, Varon E. Invasive Disease Potential of Pneumococcal Serotypes in Children After PCV13 Implementation. Clin Infect Dis 2021; 72:1453-1456. [PMID: 32804200 DOI: 10.1093/cid/ciaa917] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 06/26/2020] [Indexed: 01/08/2023] Open
Abstract
We aimed to assess the invasive disease potential of non-PCV13 serotypes after the implementation of this vaccine. Most non-PCV13 serotypes had low invasive disease potential. Among serotypes with the highest invasive disease potential (12F, 24F, 38, 8, 33F, 22F, and 10A), all but 24F and 38 were included in PCV20.
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Affiliation(s)
- Robert Cohen
- Association Clinique et Thérapeutique Infantile du Val-de-Marne, Créteil, France.,Groupe de Pathologie Infectieuse Pédiatrique, Paris, France.,Unité Court Séjour, Petits Nourrissons, Service de Néonatalogie, Centre Hospitalier Intercommunal de Créteil, Créteil, France.,Université Paris Est, IMRB-GRC GEMINI, Créteil, France.,Clinical Research Center, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - Corinne Levy
- Association Clinique et Thérapeutique Infantile du Val-de-Marne, Créteil, France.,Groupe de Pathologie Infectieuse Pédiatrique, Paris, France.,Université Paris Est, IMRB-GRC GEMINI, Créteil, France.,Clinical Research Center, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - Naim Ouldali
- Association Clinique et Thérapeutique Infantile du Val-de-Marne, Créteil, France.,Groupe de Pathologie Infectieuse Pédiatrique, Paris, France.,Unité d'Epidémiologie Clinique, Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, ECEVE INSERM UMR 1123, Paris, France
| | - Marie Goldrey
- Association Française de Pédiatrie Ambulatoire, Saint-Germain-en-Laye, France
| | - Stéphane Béchet
- Association Clinique et Thérapeutique Infantile du Val-de-Marne, Créteil, France
| | - Stéphane Bonacorsi
- Université Paris Diderot, Sorbonne Paris Cité, France.,Service de Microbiologie, Assistance Publique-Hôpitaux de Paris, Hôpital Robert-Debré, Paris, France
| | - Emmanuelle Varon
- Groupe de Pathologie Infectieuse Pédiatrique, Paris, France.,National Reference Center for Pneumococci, Centre Hospitalier Intercommunal de Créteil, Créteil, France
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16
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Ekinci E, Desmet S, Van Heirstraeten L, Mertens C, Wouters I, Beutels P, Verhaegen J, Malhotra-Kumar S, Theeten H. Streptococcus pneumoniae Serotypes Carried by Young Children and Their Association With Acute Otitis Media During the Period 2016-2019. Front Pediatr 2021; 9:664083. [PMID: 34291017 PMCID: PMC8286995 DOI: 10.3389/fped.2021.664083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 06/07/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Streptococcus pneumoniae (Sp) is a major cause of acute otitis media (AOM). Pneumococcal conjugate vaccine (PCV) programs have altered pneumococcal serotype epidemiology in disease and carriage. In this study, we used samples collected during a cross-sectional study to examine if the clinical picture of acute otitis media (AOM) in young children exposed to the PCV program in Belgium was related to the carried pneumococcal strains, and if their carriage profile differed from healthy children attending daycare centers. Material/Methods: In three collection periods from February 2016 to May 2018, nasopharyngeal swabs and background characteristics were collected from children aged 6-30 months either presenting at their physician with AOM (AOM-group) or healthy and attending day care (DCC-group). Clinical signs of AOM episodes and treatment schedule were registered by the physicians. Sp was detected, quantified, and characterized using both conventional culture analysis and real-time PCR analysis. Results: Among 3,264 collected samples, overall pneumococcal carriage and density were found at similar rates in both AOM and DCC. As expected non-vaccine serotypes were most frequent: 23B (AOM: 12.3%; DCC: 17.4%), 11A (AOM: 7.5%; DCC: 7.4%) and 15B (AOM: 7.5%; DCC: 7.1%). Serotypes 3, 6C, 7B, 9N, 12F, 17F, and 29 were more often found in AOM than in DCC (p-value < 0.05), whereas 23A and 23B were less often present in AOM (p-value < 0.05). Antibiotic non-susceptibility of Sp strains was similar in both groups. No predictors of AOM severity were identified. Conclusion: In the present study, overall carriage prevalence and density of S. pneumoniae were found similar in young children with AOM and in healthy children attending day-care centers in Belgium. Certain serotypes not currently included in the PCV vaccines were found to be carried more often in children with AOM than in DCC, a finding that might suggest a relationship between these serotypes and AOM.
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Affiliation(s)
- Esra Ekinci
- Centre for Evaluation of Vaccination, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
| | - Stefanie Desmet
- Reference Centre for Pneumococci, University Hospitals Leuven, Leuven, Belgium
| | - Liesbet Van Heirstraeten
- Laboratory of Medical Microbiology, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
| | - Colette Mertens
- Centre for Evaluation of Vaccination, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
| | - Ine Wouters
- Centre for Evaluation of Vaccination, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
| | - Philippe Beutels
- Centre for Health Economics Research and Modelling Infectious Diseases, University of Antwerp, Antwerp, Belgium
| | - Jan Verhaegen
- Reference Centre for Pneumococci, University Hospitals Leuven, Leuven, Belgium
| | - Surbhi Malhotra-Kumar
- Laboratory of Medical Microbiology, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
| | - Heidi Theeten
- Centre for Evaluation of Vaccination, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
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17
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Desmet S, Wouters I, Heirstraeten LV, Beutels P, Van Damme P, Malhotra-Kumar S, Maes P, Verhaegen J, Peetermans WE, Lagrou K, Theeten H. In-depth analysis of pneumococcal serotypes in Belgian children (2015-2018): Diversity, invasive disease potential, and antimicrobial susceptibility in carriage and disease. Vaccine 2020; 39:372-379. [PMID: 33308889 DOI: 10.1016/j.vaccine.2020.11.044] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 11/10/2020] [Accepted: 11/15/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Changes in serotype distribution have been described after the switch from the 13-valent pneumococcal conjugate vaccine (PCV13) to the 10-valent pneumococcal conjugate vaccine (PCV10) in Belgium. AIM To describe serotype's invasive disease potential and the detailed evolution of serotype distribution and antimicrobial susceptibility of pneumococcal isolates (carriage and IPD) in children up to 30 months of age over a period during and after the vaccine switch (2015-2018). METHODS S. pneumoniae strains isolated from the nasopharynx of healthy children attending day-care centres (DCCs) and strains from normally sterile sites of children with IPD were serotyped (Quellung-reaction) and antimicrobial susceptibility testing was performed. Invasive disease potential was defined as the serotype-specific odds ratio (OR). RESULTS The highly invasive (OR > 1) serotypes 12F, 1, 3, 24A/B/F, 33F, 19A, and 9N were not frequently carried (<7.5% of carriage strains). Different serotypes dominated in carriage (23B, 23A, 11A, 15B) versus IPD (12F, 19A, 10A, 33F). PCV13 vaccine serotypes increased in carriage (5.4% (25/463) in period 1 vs 10.3% (69/668) in period 3) and in IPD (7.3% (8/110 in period 1 vs 23.9% (34/142) in period 3) due to an increase (p < 0.01) in serotype 19A. The penicillin non-susceptibility of 19A was lower (p = 0.02) in carriage (6.8%) than in IPD (23.5%). Erythromycin and tetracycline non-susceptibility were more frequent (p < 0.01) in IPD (26.0%; 23.0%) compared to carriage strains (18.2%; 14.5%) and penicillin non-susceptibility increased over the three year study period (carriage: 13.4%, 19.8%, 18.5%, p = 0.05; IPD: 11.8%, 15.0%, 20.4%, p = 0.02). CONCLUSION Only some of the serotypes with high invasive disease potential (serotype 1, 3, 19A) in Belgium are included in PCV10 and/or PCV13. This reinforces the need for continuous monitoring, both in healthy children as in children with IPD, to better understand the dynamics of pneumococcal disease, to optimise the composition and implementation of PCVs.
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Affiliation(s)
- Stefanie Desmet
- Reference Centre for Pneumococci, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium; Department of Microbiology, Immunology and Transplantation, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Ine Wouters
- Centre for the Evaluation of Vaccination, Vaccine and Infectious Disease Institute, University of Antwerp, Campus Drie Eiken, Universiteitsplein 1, 2610 Wilrijk, Belgium
| | - Liesbet Van Heirstraeten
- Laboratory of Medical Microbiology, Vaccine and Infectious Disease Institute, University of Antwerp, Campus Drie Eiken, Universiteitsplein 1, 2610 Wilrijk, Belgium
| | - Philippe Beutels
- Centre for Health Economics Research and Modelling Infectious Diseases, University of Antwerp, Campus Drie Eiken, Universiteitsplein 1, 2610 Wilrijk, Belgium
| | - Pierre Van Damme
- Centre for the Evaluation of Vaccination, Vaccine and Infectious Disease Institute, University of Antwerp, Campus Drie Eiken, Universiteitsplein 1, 2610 Wilrijk, Belgium
| | - Surbhi Malhotra-Kumar
- Laboratory of Medical Microbiology, Vaccine and Infectious Disease Institute, University of Antwerp, Campus Drie Eiken, Universiteitsplein 1, 2610 Wilrijk, Belgium
| | - Piet Maes
- Reference Centre for Pneumococci, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium; Department of Microbiology, Immunology and Transplantation, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Jan Verhaegen
- Reference Centre for Pneumococci, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium; Department of Microbiology, Immunology and Transplantation, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Willy E Peetermans
- Reference Centre for Pneumococci, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium; Department of Microbiology, Immunology and Transplantation, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Katrien Lagrou
- Reference Centre for Pneumococci, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium; Department of Microbiology, Immunology and Transplantation, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Heidi Theeten
- Centre for the Evaluation of Vaccination, Vaccine and Infectious Disease Institute, University of Antwerp, Campus Drie Eiken, Universiteitsplein 1, 2610 Wilrijk, Belgium
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18
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Lee J, Kim KH, Jo DS, Ma SH, Kim JH, Kim CS, Kim HM, Kang JH. A longitudinal hospital-based epidemiology study to assess acute otitis media incidence and nasopharyngeal carriage in Korean children up to 24 months. Hum Vaccin Immunother 2020; 16:3090-3097. [PMID: 32330397 DOI: 10.1080/21645515.2020.1748978] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
This study was conducted to assess the nasopharyngeal (NP) carriage and acute otitis media (AOM) occurrence in Korean children who received pneumococcal conjugate vaccines (PCVs). The longitudinal study was conducted through four consecutive visits. At each visit, NP aspirates were obtained and subjects were asked to visit if AOM occurred. A total of 305 subjects were enrolled and received PCV13 (n = 182) or PCV10 (n = 123). In the PCV13 group, the NP carriage of Streptococcus pneumoniae at each visit was 2.7%, 14.8%, 18.7%, and 15.9%, respectively. Non-typeable Haemophilus influenzae (NTHi) was 3.3%, 2.7%, 2.7%, and 5.5%, and that of Moraxella catarrhalis was 1.1%, 9.3%, 4.9%, and 0.5%. In the PCV10 group, the NP carriage of S. pneumoniae at each visit was 3.3%, 7.3%, 6.5%, and 4.1%, respectively. That of NTHi was 2.4%, 4.1%, 1.6%, and 0.8%, and that of M. catarrhalis was 4.1%, 0.8%, 0.8%, and 0.0%. AOM occurrence in the PCV13 group observed after the primary dose and before booster dose was 20.9%, occurrence after booster dose was 11.0%, and the incidence of two or more AOM was 11.0%. In the PCV10 group, AOM occurrence was 9.8%, 7.3%, respectively, and the incidence of two or more AOM was 2.4%. The predominant S. pneumoniae isolated were non-vaccine type (10A, 15A, and 15B). In this study, AOM occurrence was lower in the PCV10 group than in the PCV13 group. This seems to be related to ecological changes that lead to differences in NP carriage, especially S. pneumoniae and NTHi.
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Affiliation(s)
- Jin Lee
- Department of Pediatrics, Hanil General Hospital , Seoul, Republic of Korea
| | - Ki Hwan Kim
- Department of Pediatrics, Incheon St. Mary's Hospital, The Catholic University of Korea , Incheon, Republic of Korea
| | - Dae Sun Jo
- Department of Pediatrics, Chonbuk National University Children's Hospital , Jeonju, Republic of Korea
| | - Sang Hyuk Ma
- Department of Pediatrics, Changwon Fatima Hospital , Changwon, Republic of Korea
| | - Jong-Hyun Kim
- Department of Pediatrics, St. Vincent's Hospital, the Catholic University of Korea , Suwon, Republic of Korea
| | - Chun Soo Kim
- Department of Pediatrics, Dongsan Medical Center, Keimyung University School of Medicine , Daegu, Republic of Korea
| | - Hwang Min Kim
- Department of Pediatrics, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine , Wonju, Republic of Korea
| | - Jin Han Kang
- Department of Pediatrics, Seoul St. Mary's Hospital, The Catholic University of Korea , Seoul, Republic of Korea
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19
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Phillips M, Finelli L, Saiman L, Wang C, Choi Y, Patel J. Respiratory Syncytial Virus-associated Acute Otitis Media in Infants and Children. J Pediatric Infect Dis Soc 2020; 9:544-550. [PMID: 32886769 DOI: 10.1093/jpids/piaa094] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 08/10/2020] [Indexed: 12/14/2022]
Abstract
Despite recent declines in the incidence of acute otitis media (AOM), more than 5 million cases and 5-6 million primary AOM visits still occur in young children in the United States, resulting in $4.4 billion direct medical costs annually. Our aims in this review are to describe the role of respiratory syncytial virus (RSV) in the etiology of AOM, discuss the prospect of prevention of RSV-associated AOM through immunization, and suggest future research strategies to assess the impact of immunization on RSV-associated AOM.
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Affiliation(s)
- Matthew Phillips
- Center for Observational and Real-World Evidence, Merck & Co, Inc, Kenilworth, New Jersey, USA
| | - Lyn Finelli
- Center for Observational and Real-World Evidence, Merck & Co, Inc, Kenilworth, New Jersey, USA
| | - Lisa Saiman
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York, USA.,Department of Infection Prevention & Control, New York-Presbyterian Hospital, New York, New York, USA
| | - Chengbin Wang
- Center for Observational and Real-World Evidence, Merck & Co, Inc, Kenilworth, New Jersey, USA
| | - Yoonyoung Choi
- Center for Observational and Real-World Evidence, Merck & Co, Inc, Kenilworth, New Jersey, USA
| | - Janak Patel
- Department of Pediatrics, University of Texas Medical Branch at Galveston, Galveston, Texas, USA
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20
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Ben-Shimol S, Givon-Lavi N, Greenberg D, van der Beek BA, Leibovitz E, Dagan R. Substantial reduction of antibiotic-non-susceptible pneumococcal otitis media following PCV7/PCV13 sequential introduction. J Antimicrob Chemother 2020; 75:3038-3045. [PMID: 32946586 DOI: 10.1093/jac/dkaa263] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 05/11/2020] [Accepted: 05/14/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND In the pre-pneumococcal conjugated vaccines (PCVs) era, serotypes included in the 7/13-valent PCVs (PCV7/PCV13) caused most pneumococcal otitis media (OM) and antibiotic-non-susceptible pneumococcal OM (ANSP-OM) episodes. In southern Israel, sequential PCV7/PCV13 introduction resulted in >90% reduction of vaccine-serotype OM. OBJECTIVES We assessed the dynamics of ANSP-OM necessitating middle ear fluid culture following PCV7/PCV13 sequential introduction in young children. METHODS This was a prospective, population-based, active surveillance. All episodes in children <3 years old, during 2004-16, were included. Two subperiods were defined: (i) pre-PCV: 2004-08; and (ii) PCV13: 2014-16. ANSP was defined for the following antibiotics: penicillin (MIC ≥0.1 mg/L and ≥1.0 mg/L), macrolide, tetracycline, clindamycin, ceftriaxone, trimethoprim/sulfamethoxazole and chloramphenicol. MDR was defined as ANSP for ≥3 classes. RESULTS Overall, 2270 pneumococcal OM episodes were identified. Annual overall pneumococcal, PCV13 and non-PCV13 serotype OM incidence declined by 86%, 97% and 33%, respectively, comparing pre-PCV with the PCV13 period. During 2004-08, 95% of ANSP was observed in vaccine serotypes. Incidence of penicillin (MIC ≥0.1 mg/L and ≥1.0 mg/L), macrolide, tetracycline, clindamycin, ceftriaxone and multidrug ANSP-OM declined by >90% in the PCV13 period. Rates of trimethoprim/sulfamethoxazole and chloramphenicol ANSP-OM declined by 85% and 79%, respectively. The proportions of ANSP of all pneumococcal isolates declined by ∼70% for penicillin, ceftriaxone and erythromycin; 53% for tetracycline; and 55% for MDR, versus no significant reductions observed for chloramphenicol, trimethoprim/sulfamethoxazole and clindamycin. CONCLUSIONS PCV7/PCV13 sequential introduction resulted in rapid and substantial ANSP-OM reduction, in parallel with the near disappearance of PCV13-serotype OM and no increase in replacement disease.
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Affiliation(s)
- Shalom Ben-Shimol
- The Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Noga Givon-Lavi
- The Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - David Greenberg
- The Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | | | - Eugene Leibovitz
- The Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Ron Dagan
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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21
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Danino D, Givon-Lavi N, Ben-Shimol S, Greenberg D, Dagan R. Understanding the Evolution of Antibiotic-nonsusceptible Pneumococcal Nasopharyngeal Colonization Following Pneumococcal Conjugate Vaccine Implementation in Young Children. Clin Infect Dis 2020; 69:648-656. [PMID: 30371763 DOI: 10.1093/cid/ciy926] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Accepted: 10/28/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Four main processes determine pneumococcal conjugate vaccine (PCV) antibiotic-nonsusceptible Streptococcus pneumoniae (ANSP) carriage: reduction of PCV serotypes, increase of non-PCV serotypes, potential overall reduction in carriage, and within-serotype nonsusceptibility resulting from continuous antibiotic pressure. The post-PCV implementation dynamics of these components were examined in young children from 2 distinct ethnic populations: Jewish and Bedouin. METHODS We performed ongoing, prospective, population-based, active surveillance initiated at the time of 7- and 13-valent PCVs (PCV7; PCV13) implementation. Nasopharyngeal cultures for S. pneumoniae were obtained daily from children aged <5 years who visited the only pediatric emergency room in the district during a 6-year period (2009 to 2015). RESULTS Of 8446 nasopharyngeal samples, 48.3% were positive (42.0% and 52.8% for Jewish and Bedouin children, respectively; P < .001). Nonsusceptibility was significantly more frequent among PCV serotypes than among non-PCV serotypes and among Bedouin children than among Jewish children. PCV serotype carriage declined by 80%, while that of non-PCV serotypes increased by 140%. The overall (all serotypes) pneumococcal carriage significantly declined (33% and 11% in Bedouin and Jewish children, respectively). Among non-PCV isolates, the proportion of ANSP significantly increased with time in both populations. As a summation of all 4 processes, ANSP carriage significantly decreased among both Bedouin and Jewish children. CONCLUSIONS PCV impact on ANSP nasopharyngeal carriage is a dynamic, multicomponent process, highly dependent on antibiotic consumption in the community, which may result in a continuous increase in antibiotic resistance in the replacing serotypes.
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Affiliation(s)
- Dana Danino
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.,Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva, Israel
| | - Noga Givon-Lavi
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.,Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva, Israel
| | - Shalom Ben-Shimol
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.,Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva, Israel
| | - David Greenberg
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.,Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva, Israel
| | - Ron Dagan
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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22
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Lapidot R, Shea KM, Yildirim I, Cabral HJ, Pelton SI. Characteristics of Serotype 3 Invasive Pneumococcal Disease before and after Universal Childhood Immunization with PCV13 in Massachusetts. Pathogens 2020; 9:E396. [PMID: 32455770 PMCID: PMC7281000 DOI: 10.3390/pathogens9050396] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 05/05/2020] [Accepted: 05/18/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Although a substantial decline in vaccine-serotype invasive pneumococcal disease (IPD) incidence was observed following the introduction of pneumococcal conjugate vaccines (PCV), the estimated range of thirteen-valent conjugate vaccine (PCV13) effectiveness for serotype 3 disease is wide and includes zero. We assessed the impact of PCV13 on serotype 3 IPD incidence and disease characteristics in Massachusetts' children. METHODS Serotype 3 IPD cases in children <18 years old were identified via enhanced passive surveillance system in Massachusetts. We compared incidence rates and characteristics of IPD cases before and after PCV13. RESULTS A total of 47 serotype 3 IPD cases were identified from 2002 to 2017; incidence of serotype 3 IPD in the years following PCV13 was 0.19 per 100,000 children compared to 0.21 before PCV 13, incidence rate ratio (IRR) = 0.86 (95% CI 0.47-1.57). The majority (78%) of post-PCV13 serotype 3 IPD cases occurred among fully vaccinated children. Age distribution, clinical syndrome and presence of comorbidities among serotype 3 IPD cases were similar before and after PCV13 introduction. There was no association between the date of the last PCV13 dose and time to IPD to suggest waning of immunity. CONCLUSIONS seven years following PCV 13 we found no significant changes in serotype 3 IPD incidence or disease characteristics in children in Massachusetts.
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Affiliation(s)
- Rotem Lapidot
- Division of Pediatric Infectious Diseases, Boston Medical Center, Boston, MA 02118, USA;
- Boston University Schools of Medicine, Boston, MA 02118, USA
| | - Kimberly M. Shea
- Boston University School of Public Health, Boston Medical Center, Boston, MA 02118, USA;
| | - Inci Yildirim
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA 30322, USA;
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA
| | - Howard J. Cabral
- Department of Biostatistics, Boston University School of Public Health, Boston, MA 02118, USA;
| | - Stephen I. Pelton
- Division of Pediatric Infectious Diseases, Boston Medical Center, Boston, MA 02118, USA;
- Boston University Schools of Medicine, Boston, MA 02118, USA
- Boston University School of Public Health, Boston Medical Center, Boston, MA 02118, USA;
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23
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Tin Tin Htar M, Sings HL, Syrochkina M, Taysi B, Hilton B, Schmitt HJ, Gessner BD, Jodar L. The impact of pneumococcal conjugate vaccines on serotype 19A nasopharyngeal carriage. Expert Rev Vaccines 2019; 18:1243-1270. [DOI: 10.1080/14760584.2019.1675521] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
| | - Heather L. Sings
- Vaccines Medical Development and Scientific and Clinical Affairs, Pfizer Inc, Collegeville, PA, USA
| | - Maria Syrochkina
- Vaccines Medical Development and Scientific and Clinical Affairs, Pfizer Inc, Moscow, Russia
| | - Bulent Taysi
- Vaccines Medical Development and Scientific and Clinical Affairs, Pfizer Inc, Istanbul, Turkey
| | - Betsy Hilton
- Vaccines Medical Development and Scientific and Clinical Affairs, Pfizer Inc, Collegeville, PA, USA
| | - Heinz-Josef Schmitt
- Vaccines Medical Development and Scientific and Clinical Affairs, Pfizer Inc, Collegeville, PA, USA
| | - Bradford D. Gessner
- Vaccines Medical Development and Scientific and Clinical Affairs, Pfizer Inc, Collegeville, PA, USA
| | - Luis Jodar
- Vaccines Medical Development and Scientific and Clinical Affairs, Pfizer Inc, Collegeville, PA, USA
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24
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Dilagui I, Moussair F, Loqman S, Diawara I, Zerouali K, Belabbes H, Zouhair S, Bourouss M, Bouskraoui M, Soraa N. Streptococcus pneumoniae carriage among febrile children at the time of PCV-10 immunization in pediatric emergencies at Mohammed VI University Hospital Centre in Marrakesh (Morocco). Arch Pediatr 2019; 26:453-458. [DOI: 10.1016/j.arcped.2019.08.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 07/17/2019] [Accepted: 08/26/2019] [Indexed: 11/29/2022]
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25
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Tin Tin Htar M, van Den Biggelaar AHJ, Sings H, Ferreira G, Moffatt M, Hall-Murray C, Verstraeten T, Gessner BD, Schmitt HJ, Jodar L. The impact of routine childhood immunization with higher-valent pneumococcal conjugate vaccines on antimicrobial-resistant pneumococcal diseases and carriage: a systematic literature review. Expert Rev Vaccines 2019; 18:1069-1089. [PMID: 31585049 DOI: 10.1080/14760584.2019.1676155] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Introduction: The introduction of 7-valent pneumococcal conjugate vaccine (PCV7) in childhood immunization programs reduced antimicrobial-resistant pneumococcal infections by vaccine serotypes. However, emerging antimicrobial-resistant non-vaccine serotypes, particularly serotype 19A, attenuated the overall effect. In 2010, higher-valent PCVs became available containing serotypes that are prone to become antimicrobial-resistant, like serotype 7F in PCV10 and PCV13, and serotype 19A in PCV13.Areas covered: This review evaluated literature published between June 1, 2008 and June 1, 2017 reporting on the effect of PCV10 or PCV13 implementation in routine infant immunization schedules on antimicrobial-resistant invasive pneumococcal disease (IPD), otitis media (OM), and nasopharyngeal carriage (NPC) in children and adults.Expert opinion: In countries with relatively high prior pneumococcal antimicrobial resistance (AMR), PCV13 childhood vaccination programs have reduced antimicrobial-resistant IPD, OM, and NPC in children and IPD in adults. The effectiveness of PCV13 against serotype 19A is likely an important contributing factor. Only few studies have documented the impact of PCV10 on AMR. Multiple factors may influence observed decreases in pneumococcal AMR including antimicrobial stewardship, case definition, time since PCV10/13 introduction, and pre-PCV10/13 AMR levels. This review emphasizes the importance of including impact on AMR when evaluating the full public health of pneumococcal vaccination programs.
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Affiliation(s)
| | | | - Heather Sings
- Vaccines Medical Development & Scientific/Clinical Affairs, Pfizer Inc, Collegeville, PA, USA
| | - Germano Ferreira
- Department of Epidemiology, P95 Epidemiology and Pharmacovigilance, Leuven, Belgium
| | - Margaret Moffatt
- Department of Health Economic & Outcomes Research, Pfizer Inc, New York, NY, USA
| | - Cassandra Hall-Murray
- Vaccines Medical Development & Scientific/Clinical Affairs, Pfizer Inc, Collegeville, PA, USA
| | - Thomas Verstraeten
- Department of Epidemiology, P95 Epidemiology and Pharmacovigilance, Leuven, Belgium
| | - Bradford D Gessner
- Vaccines Medical Development & Scientific/Clinical Affairs, Pfizer Inc, Collegeville, PA, USA
| | - Heinz-Josef Schmitt
- Vaccines Medical Development & Scientific/Clinical Affairs, Pfizer Inc, Paris, France
| | - Luis Jodar
- Vaccines Medical Development & Scientific/Clinical Affairs, Pfizer Inc, Collegeville, PA, USA
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26
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Novel insights into pneumococcal lineages in the vaccine era. THE LANCET. INFECTIOUS DISEASES 2019; 19:679-681. [DOI: 10.1016/s1473-3099(19)30292-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 05/31/2019] [Indexed: 11/18/2022]
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27
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Dagan R. Relationship between immune response to pneumococcal conjugate vaccines in infants and indirect protection after vaccine implementation. Expert Rev Vaccines 2019; 18:641-661. [PMID: 31230486 DOI: 10.1080/14760584.2019.1627207] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Introduction: Streptococcus pneumoniae is a leading cause of morbidity and mortality worldwide. Widespread infant vaccination with pneumococcal conjugate vaccines (PCVs) substantially reduced vaccine-serotype pneumococcal disease by direct protection of immunized children and indirect protection of the community via decreased nasopharyngeal carriage and transmission. Essential to grasping the public health implications of pediatric PCV immunization is an understanding of how PCV formulations impact carriage. Areas covered: Using clinical evidence, this review examines how the immune response to PCVs is associated with subsequent nasopharyngeal carriage reduction in vaccinated infants and toddlers. By combining direct and indirect protection, carriage reduction results in a reduced spread of vaccine serotypes, and eventually, a decrease in vaccine serotype disease incidence in community members of all ages. Expert opinion: The current review presents some of the aspects that influence the overall impact of PCVs on vaccine-serotype carriage, and thus, spread. The link between reduction of vaccine-serotype carriage and the eventual reduction of vaccine-serotype disease in the wider community is described by comparing data from current PCVs, specifically with respect to their ability to reduce carriage of some cross-reacting serotypes (i.e. 6A versus 6B and 19A versus 19F).
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Affiliation(s)
- Ron Dagan
- a The Faculty of Health Sciences , Ben-Gurion University of the Negev , Beer-Sheva , Israel
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28
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Abstract
Community-acquired pneumonia (CAP) is a leading cause of morbidity and mortality worldwide. Despite broad literature including basic and translational scientific studies, many gaps in our understanding of host-pathogen interactions remain. In this review, pathogen virulence factors that drive lung infection and injury are discussed in relation to their associated host immune pathways. CAP epidemiology is considered, with a focus on Staphylococcus aureus and Streptococcus pneumoniae as primary pathogens. Bacterial factors involved in nasal colonization and subsequent virulence are illuminated. A particular emphasis is placed on bacterial pore-forming toxins, host cell death, and inflammasome activation. Identified host-pathogen interactions are then examined by linking pathogen factors to aberrant host response pathways in the context of acute lung injury in both primary and secondary infection. While much is known regarding bacterial virulence and host immune responses, CAP management is still limited to mostly supportive care. It is likely that improvements in therapy will be derived from combinatorial targeting of both pathogen virulence factors and host immunomodulation.
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29
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Park SB, Kim HJ, Cheong HJ. Environmental factors which can affect the burden of pneumococcal disease and the immune response to pneumococcal vaccines: the need for more precisely delineated vaccine recommendations. Expert Rev Vaccines 2019; 18:587-596. [PMID: 30998430 DOI: 10.1080/14760584.2019.1607303] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Introduction: Precision medicine describes the customization of healthcare tailored to the individual patient. Generally, vaccines are considered as public health tools rather than from the individual patient perspective. However, adult vaccination programs in particular should consider many different factors, at the individual level and also from societal, cultural and country-specific perspectives. Currently, most immunization programs, including those for pneumococcal vaccines, have only been adopted on the basis of age or medical risk. Areas covered: Based on a broad literature search, this review addresses possible environmental factors which can affect the burden of pneumococcal disease and the immune response to pneumococcal vaccines. Expert opinion: Factors which influence the incidence of pneumococcal disease and the reaction against pneumococcal vaccination, including personal conditions, geographic/ethnic factors and social risks, are diverse. To maximize the effects of pneumococcal vaccination, not only for public health but also to induce optimal effects at the individual level, vaccines need to be verified under diverse situations and with collaboration among relevant medical societies, governments, and the pharmaceutical industry. Whereas vaccines are generally considered only from the public health perspective, flexible, comprehensive and tailored pneumococcal immunization programs, with appropriate policy support, can generate a greater positive impact on public health.
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Affiliation(s)
- Seong-Beom Park
- a Pfizer Pharmaceuticals Korea Ltd ., Seoul , Republic of Korea
| | - Hyun-Jin Kim
- a Pfizer Pharmaceuticals Korea Ltd ., Seoul , Republic of Korea
| | - Hee-Jin Cheong
- b Division of Infectious Diseases, Department of Internal Medicine , Guro Hospital, Korea University College of Medicine , Seoul , Republic of Korea
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30
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Levy C, Varon E, Ouldali N, Béchet S, Bonacorsi S, Cohen R. Changes in Invasive Pneumococcal Disease Spectrum After 13-Valent Pneumococcal Conjugate Vaccine Implementation. Clin Infect Dis 2019; 70:446-454. [DOI: 10.1093/cid/ciz221] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 03/13/2019] [Indexed: 01/28/2023] Open
Affiliation(s)
- Corinne Levy
- Association Clinique et Thérapeutique Infantile du Val-de-Marne, Saint Maur-des-Fossés
- Groupe de Pathologie Infectieuse Pédiatrique, Paris
- Université Paris Est, Institut Mondor de Recherche Biomédicale - Groupe de Recherche Clinique, Groupe d’Etude des Maladies Infectieuses Néonatales et Infantiles, Créteil
- Clinical Research Center, Créteil
| | - Emmanuelle Varon
- National Reference Center for Pneumococci, Centre Hospitalier Intercommunal de Créteil
| | - Naim Ouldali
- Association Clinique et Thérapeutique Infantile du Val-de-Marne, Saint Maur-des-Fossés
- Groupe de Pathologie Infectieuse Pédiatrique, Paris
- Unité d’épidémiologie clinique, Assistance Publique–Hôpitaux de Paris (AP-HP), Hôpital Robert Debré, Epidémiologie Clinique et Evaluation Economique Appliquée aux Populations Vulnérables Institut National de la Santé et de la Recherche Médicale Unité Mixte de Recherche, Paris
- Urgences pédiatriques, Hôpital Necker Enfants Malades, Université Paris Descartes
| | - Stéphane Béchet
- Association Clinique et Thérapeutique Infantile du Val-de-Marne, Saint Maur-des-Fossés
- Université Paris Est, Institut Mondor de Recherche Biomédicale - Groupe de Recherche Clinique, Groupe d’Etude des Maladies Infectieuses Néonatales et Infantiles, Créteil
- Clinical Research Center, Créteil
| | - Stéphane Bonacorsi
- Université Paris Diderot, Sorbonne Paris Citépital Robert-Debré, Paris
- Service de Microbiologie, AP-HP, Hôpital Robert-Debré, Paris
| | - Robert Cohen
- Association Clinique et Thérapeutique Infantile du Val-de-Marne, Saint Maur-des-Fossés
- Groupe de Pathologie Infectieuse Pédiatrique, Paris
- Université Paris Est, Institut Mondor de Recherche Biomédicale - Groupe de Recherche Clinique, Groupe d’Etude des Maladies Infectieuses Néonatales et Infantiles, Créteil
- Clinical Research Center, Créteil
- Unité Court Séjour, Petits nourrissons, Service de Néonatalogie, Centre Hospitalier Intercommunal de Créteil, France
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31
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Fu J, Li L, Liang Z, Xu S, Lin N, Qin P, Ye X, McGrath E. Etiology of acute otitis media and phenotypic-molecular characterization of Streptococcus pneumoniae isolated from children in Liuzhou, China. BMC Infect Dis 2019; 19:168. [PMID: 30770718 PMCID: PMC6377742 DOI: 10.1186/s12879-019-3795-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 02/08/2019] [Indexed: 11/24/2022] Open
Abstract
Background The etiology and epidemiology of acute otitis media (AOM) are poorly understood in China. This study aimed to describe the etiology of AOM and the phenotypic and molecular characteristics of AOM-causing Streptococcus pneumoniae (S.pneumoniae) recovered from Chinese children. Methods A retrospective study was conducted to enrol patients younger than 18 years diagnosed as AOM. Middle ear fluid specimens were collected then cultured for bacterial pathogens. All S.pneumoniae isolates were tested for antibiotic susceptibility, serotypes, virulence genes, antibiotic resistant determinants and sequence types. Results The dominant otopathogen among AOM children was S.pneumoniae (54.4%). Among S.pneumoniae isolates, there were 97.3, 97.3 and 75.7% isolates resistant to erythromycin, tetracycline and trimethoprim-sulfamethoxazole, respectively. There was 72.8% S.pneumoniae with multidrug resistance. The dominant sequence types (STs) were ST271 and ST320, whereas the prevailing serotypes were 19F and 19A. The 7-valent and 13-valent pneumococcal conjugate vaccine (PCV) coverage among AOM children were 73.0 and 94.6%, respectively. Additionally, we found that CC271 expressed more of mef(A/E) (P < 0.001), pspA (P = 0.022) and sipA (P < 0.001) than non-CC271 isolates. Conclusion The high prevalence of international multidrug-resistant clone (Taiwan19F-14) in China necessitates continued dedication to expand PCV13 immunization and better control of antibiotic use in China.
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Affiliation(s)
- Jinjian Fu
- Department of Laboratory, Liuzhou Maternity and Child Healthcare Hospital, Liuzhou, China
| | - Ling Li
- School of Public Health, Guangdong Pharmaceutical University, 283# Jianghai Dadao, Haizhu District, Guangzhou, 510310, China
| | - Zhuoxin Liang
- Department of Pediatric, Liuzhou Maternity and Child Health Care Hospital, Liuzhou, Guangxi, China
| | - Shaolin Xu
- Department of Laboratory, Liuzhou Maternity and Child Healthcare Hospital, Liuzhou, China
| | - Nan Lin
- Department of Otolaryngology, Liuzhou Maternity and Child Health Care Hospital, Liuzhou, Guangxi, China
| | - Peixu Qin
- Department of Laboratory, Liuzhou Maternity and Child Healthcare Hospital, Liuzhou, China
| | - Xiaohua Ye
- School of Public Health, Guangdong Pharmaceutical University, 283# Jianghai Dadao, Haizhu District, Guangzhou, 510310, China.
| | - Eric McGrath
- Children's Hospital of Michigan, Detroit, MI, USA.,Wayne State University School of Medicine, Detroit, MI, USA
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Should Pneumococcal Serotype 3 Be Included in Serotype-Specific Immunoassays? Vaccines (Basel) 2019; 7:vaccines7010004. [PMID: 30609868 PMCID: PMC6466091 DOI: 10.3390/vaccines7010004] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 12/21/2018] [Accepted: 01/02/2019] [Indexed: 12/21/2022] Open
Abstract
Since the introduction of the 13-valent pneumococcal conjugate vaccine, a number of studies have demonstrated the limited efficacy of the pneumococcal serotype 3 component of this vaccine. Evidence from seven countries (Denmark, France, Greece, Portugal, Sweden, UK, US) shows limited or no effectiveness of the 13-valent pneumococcal conjugate vaccine against serotype 3 invasive pneumococcal disease and carriage. The serotype 3 capsule has some unique characteristics that may serve to explain this lack of efficacy—capsular polysaccharide is abundantly expressed, leading to a greater thickness of capsule, and free capsular polysaccharide may be released during growth. The serotype 3 component of the Luminex multiplex assay demonstrates inferior inter-laboratory reproducibility than other components and results may not be reliable. This communication outlines this evidence and discusses whether it is necessary to include serotype 3 in the assay in the future.
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Wald ER, DeMuri GP. Antibiotic Recommendations for Acute Otitis Media and Acute Bacterial Sinusitis: Conundrum No More. Pediatr Infect Dis J 2018; 37:1255-1257. [PMID: 29570583 PMCID: PMC6151174 DOI: 10.1097/inf.0000000000002009] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
There has been a substantial change in the prevalence and microbiologic characteristics of cases of acute otitis media secondary to the widespread use of pneumococcal conjugate vaccines. Current trends in nasopharyngeal colonization and the microbiology of acute otitis media support a change in the recommendation for antibiotic management of acute otitis media and acute bacterial sinusitis in children.
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Affiliation(s)
- Ellen R. Wald
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health
| | - Gregory P. DeMuri
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health
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Pichichero M, Kaur R, Scott DA, Gruber WC, Trammel J, Almudevar A, Center KJ. Effectiveness of 13-valent pneumococcal conjugate vaccination for protection against acute otitis media caused by Streptococcus pneumoniae in healthy young children: a prospective observational study. THE LANCET CHILD & ADOLESCENT HEALTH 2018; 2:561-568. [PMID: 30119715 DOI: 10.1016/s2352-4642(18)30168-8] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 05/04/2018] [Accepted: 05/09/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND With wide use of the seven-valent pneumococcal conjugate vaccine (PCV7) for protection against acute otitis media caused by Streptococcus pneumoniae serotypes included in the vaccine, efficacy testing for the 13-valent vaccine (PCV13) was not feasible. We aimed to assess the effectiveness of PCV13 in preventing acute otitis media caused by the six serotypes in PCV13 that were not in PCV7. METHODS We did a longitudinal observational study in healthy children seen as outpatients in a private paediatric practice in Rochester, NY, USA. Children aged up to 30 months who had received the full primary series of PCV13 with other recommended vaccines were eligible to participate and were followed up to age 30-36 months to identify episodes of acute otitis media, during which we collected middle-ear fluid (MEF) by tympanocentesis. We assessed MEF for the serotypes common to PCV7 and PCV13 (4, 6B, 9V, 14, 18C, 19F, and 23F) and the six additional serotypes specific to PCV13 (1, 3, 5, 6A, 7F, and 19A). As controls, we included children enrolled in a longitudinal study in the study centre from Oct 1, 2007, to Sept 30, 2009, who had been vaccinated with PCV7, had MEF prospectively collected at the onset of acute otitis media, and been followed up until age 30 months. The primary outcome was the effectiveness of PCV13 to prevent acute otitis media caused by pneumococci expressing the six capsular serotypes not included in PCV7 (1, 3, 5, 6A, 7F, and 19A). This study is registered with ClinicalTrials.gov, number NCT01199016. FINDINGS From Sept 28, 2010, to Sept 30, 2013, we enrolled 239 children (123 [51%] boys and 116 [49%] girls; median age 6·3 months [IQR 6·1-8·6]) in the PCV13 cohort, and 162 completed the study. Of 348 children (184 [53%] boys and 164 [47%] girls; 6·5 months [6·1-9·1]) included in the PCV7 cohort, 248 completed follow-up. 223 MEF samples were obtained at onset of acute otitis media from 90 children in the PCV13 cohort. 53 (24%) of 223 samples were culture positive for S pneumoniae, compared with 89 (31%) of 284 samples in the PCV7 cohort (p=0·06). Four (8%) of 53 samples in the PCV13 cohort contained pneumococci expressing one of the additional PCV13 capsular serotypes, compared with 46 (52%) of 89 samples in the PCV7 cohort, giving a relative reduction of 86% (95% CI 61-94, p=0·0010). The greatest reduction in MEF samples was in serotype 19A (two [4%] in the PCV13 cohort vs 46 [52%] in the PCV7 cohort; relative reduction 91% [58-97, p=0·0010]). INTERPRETATION PCV13 prevents acute otitis media caused by S pneumoniae expressing serotypes included in the vaccine. FUNDING Pfizer.
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Affiliation(s)
- Michael Pichichero
- Center for Infectious Diseases and Immunology, Rochester General Hospital Research Institute, Rochester, NY, USA.
| | - Ravinder Kaur
- Center for Infectious Diseases and Immunology, Rochester General Hospital Research Institute, Rochester, NY, USA
| | - Daniel A Scott
- Pfizer Vaccines Clinical Research and Development, Collegeville, PA, USA
| | - William C Gruber
- Pfizer Vaccines Clinical Research and Development, Pearl River, NY, USA
| | | | - Anthony Almudevar
- Department of Biostatistics and Computational Biology, University of Rochester, Rochester, NY, USA
| | - Kimberly J Center
- Pfizer Vaccines Clinical Research and Development, Collegeville, PA, USA
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Protasova IN, Wan TW, Bakhareva NV, Hung WC, Higuchi W, Iwao Y, Yelistratova TA, Ilyenkova NA, Sokolovskaya YS, Martynova GP, Reva IV, Reva GV, Sidorenko SV, Teng LJ, Peryanova OV, Salmina AB, Yamamoto T. Molecular characterization of Streptococcus pneumoniae, particularly serotype19A/ST320, which emerged in Krasnoyarsk, Russia. Microbiol Immunol 2018; 61:359-370. [PMID: 28736993 PMCID: PMC5639370 DOI: 10.1111/1348-0421.12503] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 06/30/2017] [Accepted: 07/17/2017] [Indexed: 12/18/2022]
Abstract
Streptococcus pneumoniae, a common human pathogen, colonizes the nasopharynx and causes diseases including acute otitis media (AOM). Herein, pneumococcal serotype distributions in children before and after PCV7 vaccination and in patients with pneumococcal disease in Siberian Russia (Krasnoyarsk) are reported. Analyses included antimicrobial susceptibility testing, sequence typing (ST), pulsed field gel electrophoresis, virulence‐related surface protein gene (VSG) typing with novel primers and structural analysis by scanning electron microscopy. In healthy children (HC) prior to administration of PCV7, drug‐susceptible serotype23F/ST1500 was a major pneumococcal genotype. In the PCV7 trial, multidrug‐resistant serotype19A/ST320 emerged in vaccinees after PCV7, exhibiting a PCV7‐induced serotype replacement. Multidrug‐resistant serotype19A/ST320 was evident in patients with AOM. Community‐acquired pneumonia (CAP) isolates showed genetic similarities to the AOM (ST320) genotype, constituting a common non‐invasive AOM–CAP group. In contrast, meningitis isolates were more divergent. Overall, 25 ST types were identified; five (20%) of which were Krasnoyarsk‐native. Regarding VSGs, PI‐1 (rlrA/rrgB), PI‐2 (pitA/B), psrP and cbpA were present at 54.3%, 38.6%, 48.6%, and 95.7%, respectively, with two major VSG content types, PI‐1−/PI‐2−/psrP+/cbpA+ and PI‐1+/PI‐2+/psrP‐/cbpA+, being found for HC and non‐invasive diseases, respectively. A major clone of serotype19A/ST320 (PI‐1+/PI‐2+) produced the longest pneumococcal wire (pilus) structures in colonies. ST1016 (PI‐1−/PI‐2−) in HC had HEp‐2 cell‐adherent pili. These results suggest that serotype19A/ST320 and related genotypes, with the VSG content type PI‐1+/PI‐2+/psrP−/cbpA+, emerged in vaccinees after PCV7 in Siberia, accompanying diseases in non‐vaccinated children, and that some genotypes (serotypes19A/ST320 and 18/ST1016) produced novel pneumococcal structures, predicting their roles in colony formation and adherence.
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Affiliation(s)
- Irina N Protasova
- Russia-Japan Center of Microbiology, Metagenomics and Infectious Diseases, Krasnoyarsk, Russia.,Department of Microbiology Krasnoyarsk State Medical University, Krasnoyarsk, Russia.,Department of Epidemiology, Genomics, and Evolution, International Medical Education and Research, Center Niigata, Japan
| | - Tsai-Wen Wan
- Department of Epidemiology, Genomics, and Evolution, International Medical Education and Research, Center Niigata, Japan.,Department of Clinical Laboratory Sciences and Medical Biotechnology, National Taiwan University College of Medicine, Taipei, Taiwan
| | | | - Wei-Chun Hung
- Department of Epidemiology, Genomics, and Evolution, International Medical Education and Research, Center Niigata, Japan.,Department of Microbiology and Immunology, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Wataru Higuchi
- Division of Bacteriology, Department of Infectious Disease Control and International Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Yasuhisa Iwao
- Department of Epidemiology, Genomics, and Evolution, International Medical Education and Research, Center Niigata, Japan
| | | | | | | | - Galina P Martynova
- Department of Children Infectious Diseases, Krasnoyarsk State Medical University, Krasnoyarsk, Russia
| | - Ivan V Reva
- Department of Epidemiology, Genomics, and Evolution, International Medical Education and Research, Center Niigata, Japan.,Department of Clinical and Fundamental Medicine, Far Eastern Federal University School of Biomedicine, Vladivostok, Russia
| | - Galina V Reva
- Department of Clinical and Fundamental Medicine, Far Eastern Federal University School of Biomedicine, Vladivostok, Russia
| | - Sergey V Sidorenko
- Research Institute of Children Infections of Federal State Medical and Biological Agency of Russia, Saint Petersburg
| | - Lee-Jene Teng
- Department of Clinical Laboratory Sciences and Medical Biotechnology, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Olga V Peryanova
- Russia-Japan Center of Microbiology, Metagenomics and Infectious Diseases, Krasnoyarsk, Russia.,Department of Microbiology Krasnoyarsk State Medical University, Krasnoyarsk, Russia
| | - Alla B Salmina
- Research Institute of Molecular Medicine and Pathobiochemistry, Krasnoyarsk State Medical University, Krasnoyarsk, Russia
| | - Tatsuo Yamamoto
- Russia-Japan Center of Microbiology, Metagenomics and Infectious Diseases, Krasnoyarsk, Russia.,Department of Epidemiology, Genomics, and Evolution, International Medical Education and Research, Center Niigata, Japan
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Tong S, Amand C, Kieffer A, Kyaw MH. Trends in healthcare utilization and costs associated with acute otitis media in the United States during 2008-2014. BMC Health Serv Res 2018; 18:318. [PMID: 29720156 PMCID: PMC5932897 DOI: 10.1186/s12913-018-3139-1] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 04/22/2018] [Indexed: 11/23/2022] Open
Abstract
Background Acute otitis media (AOM) is the most common cause of pediatric medical visits and antibiotic prescriptions worldwide, but its current impact on the US healthcare system is not clear. The aim of this study was to investigate changes in the incidence of AOM from 2008, just before 13-valent pneumococcal conjugate vaccine was introduced, to 2014 using US insurance records in the Truven MarketScan® database. The study also examined the costs associated with index AOM events during the two most recent years for which data were available (2013–2014). Methods AOM cases in the MarketScan database during 2008–2014 were identified using ICD9 diagnosis codes 381.xx and 382.xx. Incidence rates of healthcare utilization related to the index AOM episode were calculated using the annual number of enrolled person-years as the denominator and the number of individuals with AOM as the numerator. AOM-associated costs were calculated as the mean payment per episode during the 2 years from 2013 to 2014. Results The overall annual rate of AOM-related healthcare utilization was 60.5 per 1000 person-years and changed little from 2008 to 2014 (range, 58.4–62.6). Most of this was due to office/outpatient visits (55.7 [range, 52.0–58.8] per 1000 person-years). Emergency department/urgent care visits (4.7 [range 3.7–6.3] per 1000 person-years) and hospitalization (0.0 [range, 0.0–0.1] per 1000 person-years) contributed little. The rate of AOM-related healthcare utilization per 1000 person-years was highest in the youngest children and declined with age (474.3 for < 1 year, 503.9 for 1 year, 316.3 for 2–4 years, 94.9 for 5–17 years, 33.1 for 18–49 years, 28.6 for 50–64 years, 23.7 for 65–74 years, 20.2 for 75–84 years, and 16.1 for ≥85 years). The mean cost per AOM episode in 2013–2014 (95% confidence interval) was $199.0 (198.4–199.6) for office or outpatient visits, $329.6 (328.2–331.0) for emergency department/urgent care visits, and $1592.9 (1422.0–1763.8) for hospitalization. Conclusions In the US, AOM-associated healthcare utilization and costs remain substantial. More effective preventive measures such as new vaccines are needed to reduce the burden of AOM.
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Affiliation(s)
- Sabine Tong
- IVIDATA Stats, 79 Rue Baudin, 92300, Levallois-Perret, France
| | - Caroline Amand
- Sanofi, 1 Avenue Pierre Brossolette, 91380, Chilly-Mazarin, France
| | - Alexia Kieffer
- Sanofi Pasteur, 14 Espace Henry Vallée, 69007, Lyon, France
| | - Moe H Kyaw
- Sanofi Pasteur, 1 Discovery Drive, Swiftwater, PA, 18370, USA.
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Decreased Acute Otitis Media With Treatment Failure After Introduction of the Ten-valent Pneumococcal Haemophilus influenzae Protein D Conjugate Vaccine. Pediatr Infect Dis J 2018; 37:361-366. [PMID: 29278616 DOI: 10.1097/inf.0000000000001870] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Acute otitis media (AOM) nonresponsive to antibiotics is most commonly caused by antibiotic-resistant Streptococcus pneumoniae and Haemophilus influenzae. A strategy for treating these infections with parenteral ceftriaxone was adopted at the Children's Hospital Iceland. The 10-valent pneumococcal H. influenzae protein D-conjugate vaccine was introduced into the vaccination program in Iceland in 2011. The aim was to study its effect on the incidence of AOM with treatment failure. METHODS This retrospective observational study included children who visited the Children's Hospital Iceland because of AOM or received ceftriaxone, regardless of indication from 2008-2015. Incidence rate was calculated for prevaccine (2008-2011) and postvaccine (2012-2015) periods using person-years at risk within the hospital's referral region. Incidence rate ratio of ceftriaxone treatment episodes of AOM was calculated using the Mantel-Haenzel method adjusting for age. Incidence risk ratio of ceftriaxone treatment if presenting to the hospital with AOM was calculated to adjust for rate of AOM visits. RESULTS Visits for AOM decreased from 47.5 to 33.9 visits per 1000 person-years, incidence rate ratio (IRR) 0.86 (95% confidence interval [CI]: 0.81-0.91), P < 0.001. Fewer AOM episodes were treated with ceftriaxone, decreasing from 6.49 to 2.96 treatment episodes per 1000 person-years, with an overall Mantel-Haenzel adjusted IRR 0.45 (95% CI: 0.37-0.54; P < 0.001). This remained significant after adjusting for the decrease in AOM visits, IRR 0.53 (95% CI: 0.44-0.63; P < 0.001). CONCLUSIONS Visits for AOM and ceftriaxone use decreased significantly after H. influenzae protein D-conjugate vaccine introduction. The observed decrease in ceftriaxone use is presumed to represent a decline in AOM with treatment failure, secondary to a decrease in resistant infections.
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Levy C, Vie le Sage F, Varon E, Chalumeau M, Grimprel E, Cohen R. Pediatric Ambulatory and Hospital Networks for Surveillance and Clinical Epidemiology of Community-Acquired Infections. J Pediatr 2018; 194:269-270.e2. [PMID: 29637893 DOI: 10.1016/j.jpeds.2017.11.050] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 11/22/2017] [Indexed: 01/01/2023]
Affiliation(s)
- Corinne Levy
- University Paris Est, IMRB- GRC GEMINI, Créteil, France; ACTIV, Pediatric Clinical and Therapeutical Association of the Val de Marne, Saint-Maur des Fossés, France; Clinical Research Center (CRC), Centre Hospitalier Intercommunal de Créteil, France; GPIP, Pediatric Infectious Disease Group, France; AFPA, French Association of Ambulatory Pediatricians, Saint-Germain-en-Laye, France
| | - François Vie le Sage
- GPIP, Pediatric Infectious Disease Group, France; AFPA, French Association of Ambulatory Pediatricians, Saint-Germain-en-Laye, France
| | - Emmanuelle Varon
- National Reference Center for Pneumococci, Microbiology Laboratory, Assistance Publique-Hôpitaux de Paris, Hospital Georges-Pompidou, Paris, France
| | - Martin Chalumeau
- GPIP, Pediatric Infectious Disease Group, France; Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité (CRESS-INSERM U1153), Paris Descartes University, Paris, France; Department of General Pediatrics and Pediatric Infectious Diseases, Necker hospital for Sick Children, Assistance Publique-Hôpitaux de Paris, Paris Descartes University, Paris, France
| | - Emmanuel Grimprel
- GPIP, Pediatric Infectious Disease Group, France; Department of General Pediatrics, Hospital Trousseau, AP-HP, University Pierre et Marie Curie, Paris, France
| | - Robert Cohen
- University Paris Est, IMRB- GRC GEMINI, Créteil, France; ACTIV, Pediatric Clinical and Therapeutical Association of the Val de Marne, Saint-Maur des Fossés, France; Clinical Research Center (CRC), Centre Hospitalier Intercommunal de Créteil, France; GPIP, Pediatric Infectious Disease Group, France; AFPA, French Association of Ambulatory Pediatricians, Saint-Germain-en-Laye, France; Unité Court Séjour, Petits Nourrissons, Neonatology Department, Centre Hospitalier Intercommunal de Créteil, France
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Internetbasierte Erfassung und Bearbeitung von Forschungsdaten zur Kindergesundheit. Monatsschr Kinderheilkd 2018. [DOI: 10.1007/s00112-018-0453-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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40
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Opatowski L, Baguelin M, Eggo RM. Influenza interaction with cocirculating pathogens and its impact on surveillance, pathogenesis, and epidemic profile: A key role for mathematical modelling. PLoS Pathog 2018; 14:e1006770. [PMID: 29447284 PMCID: PMC5814058 DOI: 10.1371/journal.ppat.1006770] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Evidence is mounting that influenza virus interacts with other pathogens colonising or infecting the human respiratory tract. Taking into account interactions with other pathogens may be critical to determining the real influenza burden and the full impact of public health policies targeting influenza. This is particularly true for mathematical modelling studies, which have become critical in public health decision-making. Yet models usually focus on influenza virus acquisition and infection alone, thereby making broad oversimplifications of pathogen ecology. Herein, we report evidence of influenza virus interactions with bacteria and viruses and systematically review the modelling studies that have incorporated interactions. Despite the many studies examining possible associations between influenza and Streptococcus pneumoniae, Staphylococcus aureus, Haemophilus influenzae, Neisseria meningitidis, respiratory syncytial virus (RSV), human rhinoviruses, human parainfluenza viruses, etc., very few mathematical models have integrated other pathogens alongside influenza. The notable exception is the pneumococcus-influenza interaction, for which several recent modelling studies demonstrate the power of dynamic modelling as an approach to test biological hypotheses on interaction mechanisms and estimate the strength of those interactions. We explore how different interference mechanisms may lead to unexpected incidence trends and possible misinterpretation, and we illustrate the impact of interactions on public health surveillance using simple transmission models. We demonstrate that the development of multipathogen models is essential to assessing the true public health burden of influenza and that it is needed to help improve planning and evaluation of control measures. Finally, we identify the public health, surveillance, modelling, and biological challenges and propose avenues of research for the coming years.
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Affiliation(s)
- Lulla Opatowski
- Université de Versailles Saint Quentin, Institut Pasteur, Inserm, Paris, France
| | - Marc Baguelin
- London School of Hygiene & Tropical Medicine, London, United Kingdom
- Public Health England, London, United Kingdom
| | - Rosalind M. Eggo
- London School of Hygiene & Tropical Medicine, London, United Kingdom
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Talathi S, Gupta N, Sethuram S, Khanna S, Sitnitskaya Y. Otitis Media in Fully Vaccinated Preschool Children in the Pneumococcal Conjugate Vaccine Era. Glob Pediatr Health 2018; 4:2333794X17749668. [PMID: 29308427 PMCID: PMC5751904 DOI: 10.1177/2333794x17749668] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 11/08/2017] [Indexed: 11/17/2022] Open
Abstract
Objectives. To evaluate the effect of pneumococcal conjugate vaccine (PCV13) on the burden of acute otitis media (AOM) and to evaluate the characteristics of AOM versus otitis media with effusion (OME) in the 2 PCV periods. Methods. A cohort of fully vaccinated children aged 18 to 60 months diagnosed with AOM from 2006 to 2015 was identified. Patients with otorrhea/bulging tympanic membrane were considered as true AOM, while those without bulging/otorrhea were considered to have OME. Burden of true AOM in the PCV7 and PCV13 periods and clinical features of true AOM versus OME were compared. Results. Of 393 episodes in our cohort, 50.8% occurred in PCV7 period. Burden of true AOM in the 2 PCV groups was similar: 26% in PCV7 versus 26.4% in PCV13 (odds ratio [OR] = 1.02, 95% confidence interval [CI] = 0.65-1.60). Factors significantly associated with OME were cold season (OR = 1.54, 95% CI = 1.04-2.4), fever (OR = 2.05, 95% CI = 1.29-3.3), and recurrence (OR = 2.24, 95% CI = 1.22-4.09). No complications of AOM were identified. Majority episodes were treated with antibiotics. Conclusion. Unlike the role of PCV13 in reducing invasive pneumococcal disease, its effect on reducing the burden of AOM is minimal as compared with PCV7. With regard to characteristics of AOM versus OME, findings of tympanic membrane should be used to suggest a diagnosis of AOM, instead of occurrence of fever or recurrence of AOM episodes. Using this approach would help in guiding the use of antibiotics appropriately.
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Arfi A, Cohen R, Varon E, Béchet S, Bonacorsi S, Levy C. Case-control study shows that neonatal pneumococcal meningitis cannot be distinguished from group B Streptococcus cases. Acta Paediatr 2017; 106:1915-1918. [PMID: 28508419 DOI: 10.1111/apa.13919] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 04/14/2017] [Accepted: 05/11/2017] [Indexed: 11/30/2022]
Abstract
AIM Streptococcus pneumoniae (S. pneumoniae) is sometimes implicated in neonatal bacterial meningitis. This study described the demographic, clinical and biological features of neonatal S. pneumoniae meningitis and compared pneumococcal and group B streptococcal (GBS) neonatal meningitis. METHODS We conducted a case-control study that compared neonates, aged one to 28 days with S. pneumoniae meningitis or GBS meningitis. Each case with S. pneumoniae was randomly matched to four control patients with GBS by age group and study year. RESULTS From 2001 to 2013, the national French paediatric network, which comprises 227 paediatric wards, recorded 831 neonatal cases of meningitis. S. pneumoniae (n = 18, 2.2%) was the fifth infection cause after GBS (n = 464, 55.8%), Escherichia coli (n = 232, 27.9%), Neisseria meningitidis (n = 23, 2.8%) and Listeria monocytogenes (n = 20, 2.4%). Neonatal pneumococcal and GBS meningitis did not differ in demographic data or clinical and biological characteristics. All S. pneumoniae strains were fully susceptible to cefotaxime, and we observed a decrease of 13-valent pneumococcal conjugate vaccine (PCV13) serotypes (88.9%-20.0%) after PCV13 implementation. CONCLUSION Clinically and biologically, neonatal pneumococcal meningitis could not be distinguished from GBS cases. A herd effect of PCV13 implementation was suggested by the decrease in the prevalence of vaccine serotypes.
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Affiliation(s)
- Alexandra Arfi
- Hôpital Intercommunal de Créteil; Service de Gynécologie Obstétrique; Université Paris Est, Paris XII; Créteil France
| | - Robert Cohen
- ACTIV - Association Clinique et Thérapeutique Infantile du Val de Marne; Saint-Maur-des-Fossés France
- Université Paris Est, IMRB - GRC GEMINI; Créteil France
- Clinical Research Center (CRC); Centre Hospitalier Intercommunal de Créteil; Créteil France
- Groupe de Pathologie Infectieuse Pédiatrique (GPIP); Paris France
- Unité Court Séjour, Petits Nourrissons, Service de Néonatologie; Centre Hospitalier Intercommunal de Créteil; Créteil France
| | - Emmanuelle Varon
- National Reference Center for Pneumococci; Laboratoire de Microbiologie; Assistance Publique-Hôpitaux de Paris; Hopital Européen Georges-Pompidou; Paris France
| | - Stéphane Béchet
- ACTIV - Association Clinique et Thérapeutique Infantile du Val de Marne; Saint-Maur-des-Fossés France
- Université Paris Est, IMRB - GRC GEMINI; Créteil France
| | - Stéphane Bonacorsi
- Sorbonne Paris Cité; Université Denis Diderot; Paris France
- Service de Microbiologie; Hôpital Robert-Debré, AP-HP; Paris France
| | - Corinne Levy
- ACTIV - Association Clinique et Thérapeutique Infantile du Val de Marne; Saint-Maur-des-Fossés France
- Université Paris Est, IMRB - GRC GEMINI; Créteil France
- Clinical Research Center (CRC); Centre Hospitalier Intercommunal de Créteil; Créteil France
- Groupe de Pathologie Infectieuse Pédiatrique (GPIP); Paris France
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Wouters I, Van Heirstraeten L, Desmet S, Blaizot S, Verhaegen J, Goossens H, Van Damme P, Malhotra-Kumar S, Theeten H. Nasopharyngeal s. pneumoniae carriage and density in Belgian infants after 9 years of pneumococcal conjugate vaccine programme. Vaccine 2017; 36:15-22. [PMID: 29180027 DOI: 10.1016/j.vaccine.2017.11.052] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 11/06/2017] [Accepted: 11/15/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND In Belgium, the infant pneumococcal conjugate vaccine (PCV) programme changed from PCV7 (2007-2011) to PCV13 (2011-2015) and to PCV10 (2015-2016). A 3-year nasopharyngeal carriage study was initiated during the programme switch in 2016. Main objective of the year 1 assessment was to obtain a baseline measurement of pneumococcal carriage prevalence, carriage density, serotype distribution and antibiotic resistance. MATERIALS/METHODS Two infant populations aged 6-30 months and without use of antibiotics in the seven days prior to sampling were approached: (1) attending one of 85 randomly selected day-care centres (DCC); (2) presenting with AOM at study-trained general practitioners and paediatricians. Demographic and clinical characteristics were documented and a single nasopharyngeal swab was taken. S. pneumoniae were cultured, screened for antibiotic resistance and serotyped, and quantitative Taqman real-time PCR (qRT-PCR) targeting LytA was performed. RESULTS Culture-based (DCC: 462/760; 60.8% - AOM: 27/39; 69.2%) and LytA-based (DCC: 603/753; 80.1% - AOM: 32/39; 82.1%) carriage prevalence was high. Average pneumococcal DNA load in LytA-positive day-care samples was 6.5 × 106 copies/µl (95%CI = 3.9-9.2 × 106, median = 3.5 × 105); DNA load was positively associated with signs of common cold and negatively with previous antibiotic use. Culture-based frequency of 13 pneumococcal vaccine (PCV) serotypes was 5.4% in DCC and 7.7% in AOM, with 19F and 14 being most frequent, and frequencies below 0.5% for serotypes 3, 6A, 19A in both populations. Predominant non-PCV serotypes were 23B and 23A in day-care and 11A in infants with AOM. In day-care, resistance to penicillin was rare (<0.5%) and absent against levofloxacin; 32.7% and 16.9% isolates were cotrimoxazole- and erythromycin-resistant respectively. CONCLUSION Four years after PCV13 introduction in the vaccination programme, PCV13 serotype carriage was rare in infants throughout Belgium and penicillin resistance was rare. Continued surveillance in the context of a PCV programme switch is necessary.
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Affiliation(s)
- Ine Wouters
- Centre for the Evaluation of Vaccination, Vaccine and Infectious Disease Institute, University of Antwerp, Campus Drie Eiken, Universiteitsplein 1, 2610 Wilrijk, Belgium.
| | - Liesbet Van Heirstraeten
- Laboratory of Medical Microbiology, Vaccine and Infectious Disease Institute, University of Antwerp, Campus Drie Eiken, Universiteitsplein 1, 2610 Wilrijk, Belgium
| | - Stefanie Desmet
- Reference Centre for Pneumococci, University Hospitals Leuven, Campus Gasthuisberg, Herestraat 49, 3000 Leuven, Belgium
| | - Stéphanie Blaizot
- Centre for Health Economics Research and Modelling Infectious Diseases, University of Antwerp, Campus Drie Eiken, Universiteitsplein 1, 2610 Wilrijk, Belgium
| | - Jan Verhaegen
- Reference Centre for Pneumococci, University Hospitals Leuven, Campus Gasthuisberg, Herestraat 49, 3000 Leuven, Belgium
| | - Herman Goossens
- Laboratory of Medical Microbiology, Vaccine and Infectious Disease Institute, University of Antwerp, Campus Drie Eiken, Universiteitsplein 1, 2610 Wilrijk, Belgium
| | - Pierre Van Damme
- Centre for the Evaluation of Vaccination, Vaccine and Infectious Disease Institute, University of Antwerp, Campus Drie Eiken, Universiteitsplein 1, 2610 Wilrijk, Belgium
| | - Surbhi Malhotra-Kumar
- Laboratory of Medical Microbiology, Vaccine and Infectious Disease Institute, University of Antwerp, Campus Drie Eiken, Universiteitsplein 1, 2610 Wilrijk, Belgium
| | - Heidi Theeten
- Centre for the Evaluation of Vaccination, Vaccine and Infectious Disease Institute, University of Antwerp, Campus Drie Eiken, Universiteitsplein 1, 2610 Wilrijk, Belgium
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A nationwide study on the impact of pneumococcal conjugate vaccination on antibiotic use and ventilation tube insertion in Denmark 2000-2014. Vaccine 2017; 35:5858-5863. [PMID: 28928078 DOI: 10.1016/j.vaccine.2017.09.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2016] [Revised: 08/31/2017] [Accepted: 09/01/2017] [Indexed: 11/20/2022]
Abstract
Introduction of Pneumococcal Conjugated Vaccines (PCV) in national immunization programs have been successful in reducing the number of invasive and lower respiratory pneumococcal infections. The impact of the vaccines on upper respiratory infections caused by pneumococci is less clear although these account for most pneumococcal infections. In this study, we used likely proxies for respiratory infections in children, such as antibiotic use and ventilation tube insertions (VTI), to estimate the impact of the vaccine on a national level. The study was designed as a population-based retrospective observational study, comparing trends in the incidence rate of antibiotic prescriptions and VTIs in the period 2000-2014, where PCV7 was introduced in 2007 and PCV13 in 2010. The introduction of PCV7 and PCV13 correlated with changes in the incidence rate from an almost steady increase in prescription of antibiotics in the pre-PCV period to a decreasing incidence for all children age 0-15years. The 2.4 DDD per person year in 2014 was at almost the same level of antibiotic use as in 2000 at 2.3 DDD per person year. Similar patterns were observed in the mostly vaccinated age groups below 5years of age. For VTI we observed a decreasing incidence rate in the years following introduction of PCV13 ending with a slightly higher incidence at 35 per 1000 person years in 2014 compared to 31 in year 2000. We conclude that the steady increase in antibiotic use and VTI in the pre-PCV period have been partially reversed to near year 2000 levels after the introduction of PCV. This indicates that implementation of pneumococcal vaccines in the Childhood Vaccination Programme has likely reduced the incidence of upper respiratory diseases due to pneumococci in Denmark.
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Isturiz R, Sings HL, Hilton B, Arguedas A, Reinert RR, Jodar L. Streptococcus pneumoniae serotype 19A: worldwide epidemiology. Expert Rev Vaccines 2017; 16:1007-1027. [DOI: 10.1080/14760584.2017.1362339] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Impact of PCV13 on community-acquired pneumonia by C-reactive protein and procalcitonin levels in children. Vaccine 2017; 35:5058-5064. [PMID: 28778617 DOI: 10.1016/j.vaccine.2017.06.057] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 06/19/2017] [Accepted: 06/20/2017] [Indexed: 01/17/2023]
Abstract
BACKGROUND Many countries have observed an early and strong impact of implementation of the 13-valent pneumococcal conjugate vaccine (PCV13) on community-acquired pneumonia (CAP). High levels of C-reactive protein (CRP) and procalcitonin (PCT) are considered biomarkers of bacterial infection (particularly infection due to pneumococcus); therefore, PCV13 implementation should have different effectiveness on CAP depending on the levels of these two biomarkers. To demonstrate this assumption, we analyzed the evolution of number of CAP cases seen in pediatric emergency departments in France after PCV13 implementation (in 2010) by levels of these two biomarkers. METHODS From June 2009 to May 2015, 8 pediatric emergency units prospectively enrolled all children (1month to 15years) with radiologically confirmed CAP. RESULTS A cohort of 9586 children with CAP was enrolled (median age 3years). CAP with pleural effusion (PE-CAP) and proven pneumococcal pneumonia (PP-CAP) accounted for 5.5% and 2.0% of cases. During the study period, the number of cases of overall CAP decreased by 25.4%, hospitalized CAP by 30.5%, PE-CAP by 63.4%, CAP with CRP level≥100mg/L by 50.9%, CAP with PCT level≥4ng/L by 60.4% and PP-CAP by 86.4%. We found no change in number of cases of CAP with low levels of CRP (<20 or <40mg/L) or PCT (<0.5ng/mL). The number of cases of CAP overall increased (20.0%) in the last year of the study as compared with the preceeding year but not cases with CRP level≥100mg/L and/or PCT level≥4ng/mL. CONCLUSION PCV13 implementation has had a strong impact on number of CAP cases with high levels of CRP and/or PCT in children but no impact on that with low levels of these two biomarkers. Five years after PCV13 implementation, a sustained reduction in CAP cases is observed.
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Geno KA, Saad JS, Nahm MH. Discovery of Novel Pneumococcal Serotype 35D, a Natural WciG-Deficient Variant of Serotype 35B. J Clin Microbiol 2017; 55:1416-1425. [PMID: 28202800 PMCID: PMC5405259 DOI: 10.1128/jcm.00054-17] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 02/09/2017] [Indexed: 11/20/2022] Open
Abstract
Pneumococcus (Streptococcus pneumoniae) remains a significant cause of morbidity and mortality, especially among those at the extremes of age. Its capsular polysaccharide is essential for systemic virulence. Over 90 serologically distinct pneumococcal capsular polysaccharides (serotypes) are recognized, but they are unequal in prevalence. Because antibodies against the capsule are protective, polysaccharide conjugate vaccines, which are constructed against the most prevalent serotypes, have caused great reductions in pneumococcal disease caused by these serotypes. In response, however, the relative prevalences of serotypes have shifted. Certain previously rare serotypes, such as serotype 35B, are increasing in prevalence. Serotype 35B is thus a likely future vaccine candidate, but due to their previous rarity, serotype 35B strains have not been scrutinized for underlying heterogeneity. We studied putative serotype 35B clinical isolates to assess the uniformity of their serological reactions. While most isolates exhibited the accepted serology of serotype 35B, one isolate failed to bind to critical serotyping reagents. We determined that the genetic basis for this aberrant serology was the presence of inactivating mutations in the O-acetyltransferase gene wciG Complementation studies in a wciG deletion strain verified that the mutant WciG was nonfunctional, and the serology of the mutant could be restored through complementation with a construct encoding a functional WciG. Nuclear magnetic resonance studies confirmed that the capsule of the WciG-deficient isolate lacked O-acetylation but was otherwise identical to serotype 35B. As this isolate expresses a unique serology with unique biochemistry and a stable genetic basis, we named its novel capsule serotype 35D.
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Affiliation(s)
- K Aaron Geno
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jamil S Saad
- Department of Microbiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Moon H Nahm
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Department of Microbiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Cohen R, Cohen JF, Chalumeau M, Levy C. Impact of pneumococcal conjugate vaccines for children in high- and non–high-income countries. Expert Rev Vaccines 2017; 16:625-640. [DOI: 10.1080/14760584.2017.1320221] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Robert Cohen
- Université Paris Est, IMRB-GRC GEMINI, Créteil, France
- ACTIV, Association Clinique et Thérapeutique Infantile du Val de Marne, Saint-Maur des Fossés, France
- Clinical Research Center (CRC), Centre Hospitalier Intercommunal Créteil, France
- Unité Court Séjour, Petits Nourrissons, Service de Néonatologie, Centre Hospitalier Intercommunal Créteil, France
| | - Jérémie François Cohen
- Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Paris Descartes University, INSERM U1153, Paris, France
- Service de Pédiatrie Générale, Hôpital Necker-Enfants Malades; AP-HP; Université Paris Descartes, Paris, France
| | - Martin Chalumeau
- Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Paris Descartes University, INSERM U1153, Paris, France
- Service de Pédiatrie Générale, Hôpital Necker-Enfants Malades; AP-HP; Université Paris Descartes, Paris, France
| | - Corinne Levy
- Université Paris Est, IMRB-GRC GEMINI, Créteil, France
- ACTIV, Association Clinique et Thérapeutique Infantile du Val de Marne, Saint-Maur des Fossés, France
- Clinical Research Center (CRC), Centre Hospitalier Intercommunal Créteil, France
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Allemann A, Frey PM, Brugger SD, Hilty M. Pneumococcal carriage and serotype variation before and after introduction of pneumococcal conjugate vaccines in patients with acute otitis media in Switzerland. Vaccine 2017; 35:1946-1953. [PMID: 28279564 DOI: 10.1016/j.vaccine.2017.02.010] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 01/26/2017] [Accepted: 02/02/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND Acute otitis media (AOM) is an important cause for antibiotic prescription within the paediatric population and Streptococcus pneumoniae is a major pathogen associated with AOM episodes. This study aimed at analysing the influence of the heptavalent and 13-valent pneumococcal conjugate vaccines (PCV7 and PCV13) on pneumococcal carriage and serotype distribution in AOM. METHODS Nasopharyngeal swabs (NPS) and middle ear fluid (MEF) were collected within a Swiss surveillance study of outpatients from all ages with AOM between 2004 and 2015, covering three vaccination eras (pre-PCV7, PCV7 and PCV13). Samples were cultured for pneumococcal identification, and the association of vaccine era with pneumococcal carriage was investigated by logistic regression analysis adjusting for sociodemographic factors. FINDINGS In total, 3300 NPS and 620 MEF were included in this study. The number of samples from patients with AOM dropped over vaccination eras and S. pneumoniae was less frequently isolated in the PCV13 era as compared to the other two eras. The latest (PCV13) vaccination era was independently associated with a reduced pneumococcal carriage within NPS (adjusted odds ratio 0.65, 95%-CI 0.45-0.94). Investigating serotype epidemiology, vaccine serotypes decreased significantly after the conjugate vaccine introductions with the exception of serotype 3. Within the non-PCV13 serotypes, a particular increase of serogroups 11, 15 and 23 was observed in both NPS and MEF. CONCLUSION A substantial change in pneumococcal carriage and serotype epidemiology suggests an impact of the conjugate vaccines on pneumococcal AOM in Switzerland.
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Affiliation(s)
- Aurélie Allemann
- Institute for Infectious Diseases, University of Bern, Bern, Switzerland; Graduate School for Cellular and Biomedical Sciences, University of Bern, Bern, Switzerland
| | - Pascal M Frey
- Institute for Infectious Diseases, University of Bern, Bern, Switzerland; Department of Microbiology, The Forsyth Institute, Cambridge, MA, USA; Department of General Internal Medicine, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Silvio D Brugger
- Institute for Infectious Diseases, University of Bern, Bern, Switzerland; Department of Microbiology, The Forsyth Institute, Cambridge, MA, USA; Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Boston, MA, USA
| | - Markus Hilty
- Institute for Infectious Diseases, University of Bern, Bern, Switzerland; Department of Infectious Diseases, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland.
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50
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Cohen R, Levy C. 13-valent pneumococcal conjugate vaccine in Africa. LANCET GLOBAL HEALTH 2017; 5:e244-e245. [DOI: 10.1016/s2214-109x(17)30044-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 01/04/2017] [Indexed: 10/20/2022]
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