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Opavski N, Jovićević M, Kabić J, Kekić D, Gajić I. Effect of Childhood Pneumococcal Conjugate Vaccination on Invasive Disease Serotypes in Serbia. Vaccines (Basel) 2024; 12:940. [PMID: 39204064 PMCID: PMC11359874 DOI: 10.3390/vaccines12080940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2024] [Revised: 08/16/2024] [Accepted: 08/19/2024] [Indexed: 09/03/2024] Open
Abstract
In Serbia, PCV10 was introduced into the routine immunization for children under 2 in 2018 and replaced by PCV13 in 2022. We evaluated their impact on the distribution of invasive pneumococcal disease (IPD) serotypes across all age groups. Overall, 756 isolates were obtained from patients with IPD between 2010 and 2023 through laboratory surveillance. In the post-vaccination period, serotypes 14, 19F, 23F, and 6A significantly declined, while 3 and 19A considerably increased. This was especially evident in the ≤2 years group, making these serotypes the most prevalent among them. Serotype 3 dominated, representing 19.1% of all invasive isolates prior to 2018 and 33.1% thereafter. While serotype coverage of PCV10 has significantly decreased in the ≤2 years group (from 74.2% before 2018 to 29.5% after 2018), PCV13 coverage was 63.9% after 2018. In the post-PCV period, non-PCV13 serotypes, such as 9N, 10A, 15A, 15B, 15C, 22F, 6C, 6D, and 7C, increased across all isolates. Antibiotic non-susceptibility considerably decreased after 2018. MLST analysis showed shifts in sequence type prevalence, with pre-PCV lineages replaced and ongoing serotype 3 persistence, alongside potential capsule-switching events. These findings emphasize a noticeable shift in the distribution of serotypes and adaptability of pneumococcal populations, highlighting the importance of ongoing surveillance and the requirement for the urgent introduction of higher valent vaccines into the National Immunization Program.
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Affiliation(s)
| | | | | | | | - Ina Gajić
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (M.J.); (D.K.)
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Park JJ, Tiefenbach J, Anwar MM, Narayanan S, Ope B, Bin Han SS, Ale BM, Adeloye D, Rudan I. Estimating the Global and Regional Burden of Streptococcus pneumoniae Meningitis in Children: Protocol for a Systematic Review and Meta-Analysis. JMIR Res Protoc 2024; 13:e50678. [PMID: 39012685 PMCID: PMC11289570 DOI: 10.2196/50678] [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: 07/09/2023] [Revised: 04/09/2024] [Accepted: 06/12/2024] [Indexed: 07/17/2024] Open
Abstract
BACKGROUND Streptococcus pneumoniae (Spn) has been a leading cause of bacterial meningitis in children. The most recent estimation of the global burden of Spn meningitis indicates a positive trajectory in eliminating Spn through the implementation of pneumococcal conjugate vaccines. However, continuous monitoring and assessment of the disease burden are necessary due to the evidence of serotype replacement, antibiotic resistance, and the impact of the recent COVID-19 pandemic. OBJECTIVE The aim of this systematic review is to provide an updated and focused assessment of the global and regional burden of Spn meningitis in children, which can guide policies and strategies to reduce the disease burden. METHODS Population-based studies published from January 1, 2000, to January 1, 2022, were preliminarily searched from the electronic databases PubMed, Embase, Global Health (CABI), and CINAHL Plus without any language restrictions. Studies were included if they reported the incidence, prevalence, mortality, or case-fatality ratio (CFR) for Spn meningitis in children aged 0-4 years; meningitis was confirmed by cerebrospinal fluid culture; the study period was a minimum of 1 year; the number of reported cases was at least 10; and the study had no methodological ambiguities. The article screening process follows the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines. Characteristics including study period, setting, World Health Organization region, income level, vaccination information, and participant data (age, number of cases, deaths, sequelae, and risk factors) will be extracted from the included studies. Search results will be updated and incorporated into our review prior to finalizing the extraction of data. Generalized linear mixed models meta-analysis will be performed to estimate the pooled incidence and CFR. We will further assess the risk of bias and heterogeneity, and will perform subgroup and sensitivity analyses to provide a meaningful interpretation of the current burden and literature for pneumococcal meningitis. RESULTS Our preliminary search in December 2021 yielded 9295 articles. Out of 275 studies that were assessed with our eligibility criteria, 117 articles were included. Data extraction and analysis are expected to be complete by January 2025. We plan to publish the results from the full study, including an updated search in 2024, by March 2025. CONCLUSIONS Given that the major burden of Spn meningitis affects children under the age of 5 years, this systematic review will provide a thorough understanding of the global burden of Spn meningitis in this vulnerable population over a span of 2 decades. Insights into incidence trends, geospatial distribution, risk factors, and sequelae will be valuable for stakeholders, policy makers, and the academic community. This information will aid in the ongoing monitoring of the disease and in enhancing targeted vaccine programs to further mitigate the impact of the disease on children worldwide. TRIAL REGISTRATION PROSPERO CRD42021293110; https://tinyurl.com/kc3j5k4m. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/50678.
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Affiliation(s)
- Jay J Park
- Edinburgh Medical School, University of Edinburgh, Edinburgh, United Kingdom
- Edinburgh Global Health Interest Group, Edinburgh, United Kingdom
| | - Jakov Tiefenbach
- Edinburgh Global Health Interest Group, Edinburgh, United Kingdom
- Neurological Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Mohammed Ma'arij Anwar
- Edinburgh Medical School, University of Edinburgh, Edinburgh, United Kingdom
- Department of Bioengineering, Imperial College London, London, United Kingdom
| | - Sandhya Narayanan
- Edinburgh Global Health Interest Group, Edinburgh, United Kingdom
- Barnardo's, Barkingside, United Kingdom
| | - Beatrice Ope
- Association for Reproductive and Family Health, Abuja, Nigeria
| | | | - Boni Maxime Ale
- Edinburgh Global Health Interest Group, Edinburgh, United Kingdom
- Holo Healthcare Limited, Nairobi, Kenya
| | - Davies Adeloye
- School of Health and Life Sciences, Teesside University, Middlesbrough, United Kingdom
| | - Igor Rudan
- Edinburgh Medical School, University of Edinburgh, Edinburgh, United Kingdom
- Edinburgh Global Health Interest Group, Edinburgh, United Kingdom
- Centre of Global Health, Edinburgh Medical School, Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
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Fletcher MA, Daigle D, Siapka M, Baay M, Hanquet G, del Carmen Morales G. Serotype distribution of invasive pneumococcal disease from countries of the WHO Africa, Americas, Eastern Mediterranean, South-East Asia, and Western Pacific regions: a systematic literature review from 2010 to 2021. Front Public Health 2024; 12:1402795. [PMID: 39050608 PMCID: PMC11266301 DOI: 10.3389/fpubh.2024.1402795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 06/20/2024] [Indexed: 07/27/2024] Open
Abstract
Background Most publications on invasive pneumococcal disease (IPD) serotype distribution are from about 20 countries (Australia, Canada, China, European Union members, Japan, New Zealand, South Korea, and USA). Here, we reviewed the literature among underrepresented countries in the Americas (AMRO), Africa (AFRO), Eastern Mediterranean (EMRO), South-East Asia (SEARO), and Western Pacific (WPRO) WHO regions. Methods We performed a systematic review of the most recent IPD serotype surveillance publications (from 01/01/2010 to 31/12/2021, Medline/Embase) in those WHO regions. Selection criteria were delineated by contemporality, within-country geographical scope, and number of samples. Reported serotype distributions for each country were stratified by age group, pneumococcal conjugate vaccine (PCV) serotype category (considering undifferentiated serotypes), and PCV program period (pre-PCV, intermediate, or PCVhv [higher valency PCV formulation]). Pre-PCV period pooled data estimated PCV serotype category distribution by age group across WHO regions, while for the PCVhv period, country-level dataset tables were prepared. Results Of 2,793 publications screened, 107 were included (58 pediatric, 11 adult, 37 all ages, and one comprising every age group). One-third of eligible countries (51/135) published serotype distribution, ranging from 30 to 43% by WHO region. Considering number of samples per WHO region, a few countries prevailed: AMRO (Brazil), AFRO (South Africa, Malawi, and Burkina Faso), and WPRO (Taiwan). In the pre-PCV period, PCV13 formulation serotypes predominated: ranging from 74 to 85% in children and 58-86% in adults in the different WHO regions. The PCVhv period represented half of the most recent IPD surveillance by countries (26/51). Undifferentiated serotypes represented >20% of IPD from most countries (34/51). Conclusion Ubiquity of undifferentiated serotypes among the publications could constrain estimates of PCV program impact and of serotype coverage for newer PCVhv formulations; consequently, we recommend that countries favor techniques that identify serotypes specifically and, rather than reporting PCV formulation serotype distributions, provide serotype results individually. Systematic review registration The protocol has been prospectively registered at PROSPERO, identifier: CRD42021278501. https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=278501.
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Affiliation(s)
- Mark A. Fletcher
- Pfizer Vaccines Emerging Markets, Medical Affairs, Paris, France
| | - Derek Daigle
- Pfizer Vaccines Emerging Markets, Medical Affairs, New York, NY, United States
| | | | - Marc Baay
- P95 Epidemiology & Pharmacovigilance, Leuven, Belgium
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Almeida SCG, de Lemos APS, Bierrenbach AL, de Moraes JC, Brandileone MCDC. Serotype Distribution and Antimicrobial Susceptibility Pattern of Streptococcus pneumoniae in COVID-19 Pandemic Era in Brazil. Microorganisms 2024; 12:401. [PMID: 38399805 PMCID: PMC10893029 DOI: 10.3390/microorganisms12020401] [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: 01/09/2024] [Revised: 02/13/2024] [Accepted: 02/15/2024] [Indexed: 02/25/2024] Open
Abstract
Despite the introduction of the pneumococcal vaccine, Streptococcus pneumoniae remains a cause of invasive diseases in Brazil. This study provides the distribution of serotypes and antimicrobial susceptibility patterns for pneumococcal isolates before and during the years of the COVID-19 pandemic in two age groups, <5 and ≥50 years. This is a national laboratory-based surveillance study that uses data from the Brazilian national laboratory for invasive S. pneumoniae from the pre-COVID-19 (January 2016 to January 2020) and COVID-19 (February 2020 to May 2022) periods. Antimicrobial resistance was evaluated by disk diffusion and minimum inhibitory concentration. The year 2020 was marked by a 44.6% reduction in isolates received and was followed by an upward trend from 2021 onwards, which became evident in 2022. No differences were observed in serotypes distribution between the studied periods. The COVID-19 period was marked by the high prevalence of serotypes 19A, 3, and 6C in both age groups. Serotypes 19A and 6C were related to non-antimicrobial susceptibility. We observed a reduction in S. pneumoniae, without changes in serotypes distribution and epidemiological capsular switch during the COVID-19 period. We observed elevated resistance rates, mainly to penicillin and ceftriaxone for non-meningitis cases in children under 5 years of age.
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Affiliation(s)
- Samanta C. G. Almeida
- Center of Bacteriology, National Laboratory for Meningitis and Invasive Pneumococcal Infections, Institute Adolfo Lutz, São Paulo 01246-902, Brazil; (A.P.S.d.L.); (M.C.d.C.B.)
| | - Ana Paula S. de Lemos
- Center of Bacteriology, National Laboratory for Meningitis and Invasive Pneumococcal Infections, Institute Adolfo Lutz, São Paulo 01246-902, Brazil; (A.P.S.d.L.); (M.C.d.C.B.)
| | - Ana Luiza Bierrenbach
- Hospital Sírio-Libanês, Institute of Education and Researcher, São Paulo 01308-060, Brazil;
| | | | - Maria Cristina de Cunto Brandileone
- Center of Bacteriology, National Laboratory for Meningitis and Invasive Pneumococcal Infections, Institute Adolfo Lutz, São Paulo 01246-902, Brazil; (A.P.S.d.L.); (M.C.d.C.B.)
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Reis JN, Azevedo J, de Oliveira AML, Menezes APDO, Pedrosa M, Dos Santos MS, Ribeiro LC, Freitas HFD, Gouveia EL, Teles MB, Carvalho MDG, Reis MG, Nascimento-Carvalho C, Verani JR. Long-term surveillance of invasive pneumococcal disease: The impact of 10-valent pneumococcal conjugate vaccine in the metropolitan region of Salvador, Brazil. Vaccine 2024; 42:591-597. [PMID: 38184393 PMCID: PMC10872423 DOI: 10.1016/j.vaccine.2023.12.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 12/18/2023] [Accepted: 12/19/2023] [Indexed: 01/08/2024]
Abstract
BACKGROUND In 2010, Brazil introduced the ten-valent pneumococcal conjugate vaccine (PCV10) in the national infant immunization program. Limited data on the long-term impact of PCV10 are available from lower-middle-income settings. We examined invasive pneumococcal disease (IPD) in Salvador, Bahia, over 11 years. METHODS Prospective laboratory-based surveillance for IPD was carried out in 9 hospitals in the metropolitan region of Salvador from 2008 to 2018. IPD was defined as Streptococcus pneumoniae cultured from a normally sterile site. Serotype was determined by multiplex polymerase chain reaction and/or Quellung reaction. Incidence rates per 100,000 inhabitants were calculated for overall, vaccine-type, and non-vaccine-type IPD using census data as the denominator. Incidence rate ratios (IRRs) were calculated to compare rates during the early (2010-2012), intermediate (2013-2015), and late (2016-2018) post-PCV10 periods in comparison to the pre-PCV10 period (2008-2009). RESULTS Pre-PCV10, overall IPD incidence among all ages was 2.48/100,000. After PCV10 introduction, incidence initially increased (early post-PCV10 IRR 3.80, 95% CI 1.18-1.99) and then declined to 0.38/100,000 late post-PCV10 (IRR 0.15; 95% CI 0.09-0.26). The greatest reductions in the late post-PCV10 period were observed in children aged ≤2 years, with no cases (IRR not calculated) and those ≥60 years (IRR 0.11, 95% CI 0.03-0.48). Late post-PCV10, significant reductions were observed for both PCV10 serotypes (IRR 0.02; 95% CI 0.0-0.15) and non-PCV10 serotypes (IRR 0.27; 95%CI 0.14-0.53). Non-PCV10 serotypes 15B, 12F, 3, 17F, and 19A became predominant late post-PCV10 without a significant increase in serotype-specific IPD incidence compared to pre-PCV10. CONCLUSION Significant declines in IPD, including among adults not eligible for vaccination, suggest direct and indirect protection up to nine years after PCV10 introduction, without evidence of significant replacement disease. Continued surveillance is needed to monitor changes in non-vaccine serotypes and inform decisions about introducing higher valent PCVs.
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Affiliation(s)
- Joice Neves Reis
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz/Ministério da Saúde, Salvador, Bahia 40296-710, Brazil; Faculdade de Farmácia, Universidade Federal da Bahia, Salvador, Bahia 40170-115, Brazil.
| | - Jailton Azevedo
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz/Ministério da Saúde, Salvador, Bahia 40296-710, Brazil
| | | | | | - Mayara Pedrosa
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz/Ministério da Saúde, Salvador, Bahia 40296-710, Brazil
| | - Milena Soares Dos Santos
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz/Ministério da Saúde, Salvador, Bahia 40296-710, Brazil; Instituto Multidisciplinar em Saúde, Campus Anísio Teixeira, Universidade Federal da Bahia, Vitória da Conquista, Bahia 45029-094, Brazil
| | | | | | | | | | | | - Mitermayer Galvão Reis
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz/Ministério da Saúde, Salvador, Bahia 40296-710, Brazil; Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Bahia 40025-010, Brazil; Department of Epidemiology of Microbial Diseases, School of Public Health, Yale School of Public Health, Yale University, New Haven, CT, USA
| | | | - Jennifer R Verani
- Centers for Disease Control and Prevention, Division of Bacterial Diseases, Atlanta 30329, USA
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Duarte C, Agudelo CI, Castañeda-Orjuela C, Moreno J, Sanabria OM, Bautista A, Castañeda E. Indirect impact of PCV10 children vaccination on the serotype distribution and antimicrobial resistance of Streptococcus pneumoniae causing invasive disease in adults over 50 in Colombia, 2005-2019: Observational analysis. ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA (ENGLISH ED.) 2023:S2529-993X(23)00259-9. [PMID: 37945464 DOI: 10.1016/j.eimce.2023.07.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 07/09/2023] [Indexed: 11/12/2023]
Abstract
INTRODUCTION The introduction of pneumococcal conjugate vaccine (PCV) into childhood vaccination programmes has reduced the prevalence of vaccine serotypes (VTs) that cause invasive pneumococcal disease (IPD) in children. In the elderly population, an impact has also been seen through indirect protection (herd effect). The aim of this study was to estimate the changes in serotype distribution and antimicrobial susceptibility of Streptococcus pneumoniae isolates recovered from adult IPD and to evaluate the indirect effect of immunization with PCV10 based on laboratory records by analyzing the period from 2005 to 2019 for six years before and eight years after the universal PCV10 administration to Colombian children. METHODS A total of 2204 S. pneumoniae isolates from adults (≥50 years) with IPD were analyzed. The analysis examined the percentage changes in proportions (prevalence) and percentage variations in population rates (annual reported rates - ARR) of VTs between the pre-PCV10 (2005-2009) and post-PCV10 (2015-2019) periods. RESULTS The findings were (1) evidence of a significant percentage decrease of pneumococcal VT10 causing IPD in adults (50% pre-PCV10 and 16% post-PCV10); (2) significant increase of serotype 19A (from 1.6% to 14.8%) and less important increase of serotype 3 (from 10.5% to 14.5%) and non-vaccine serotypes (NVT) (from 21.4% to 38.4%) non-significant; and (3) meningitis and non-meningitis multidrug resistant isolates associated with serotype 19A. An improvement in the surveillance system is associated with the immunization of children, as noted by the increased ARRs across the analysis period. CONCLUSIONS Our results show the indirect impact of PCV10 vaccination in children on the VT10 distribution and antimicrobial resistance of S. pneumoniae causing IPD in Colombian adults over 50 when comparing the pre-PCV10 (2005-2009) and post-PCV10 (2015-2019) periods.
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Affiliation(s)
- Carolina Duarte
- Grupo de Microbiología, Instituto Nacional de Salud (INS), Bogotá, Colombia.
| | - Clara Inés Agudelo
- Grupo de Microbiología, Instituto Nacional de Salud (INS), Bogotá, Colombia
| | | | - Jaime Moreno
- Grupo de Microbiología, Instituto Nacional de Salud (INS), Bogotá, Colombia
| | | | - Adriana Bautista
- Grupo de Microbiología, Instituto Nacional de Salud (INS), Bogotá, Colombia
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Hagedoorn NN, Anglemyer A, Gilkison C, Hartley M, Walls T. Comparison of the epidemiology of invasive pneumococcal disease between Australia and New Zealand in 2017-2021: an observational study based on surveillance data. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2023; 36:100764. [PMID: 37547043 PMCID: PMC10398586 DOI: 10.1016/j.lanwpc.2023.100764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 03/04/2023] [Accepted: 03/24/2023] [Indexed: 08/08/2023]
Abstract
Background The Australian immunisation schedule uses 13-valent pneumococcal conjugate vaccine (PCV13), while New Zealand (NZ) changed from PCV13 to 10-valent PCV (PCV10) in 2017. In NZ, cases of serotype 19A (not in PCV10) have been increasing since 2017. We compared invasive pneumococcal disease (IPD) epidemiology between Australia and NZ in 2017-2021. Methods We collated IPD notification data from national surveillance systems. Between Australia and NZ, we compared IPD incidence rates and assessed the proportion of serotype 19A, and stratified for ethnicity and age. Findings Between 2017 and 2021, the crude IPD incidence per 100,000 in Australia ranged from 4.3 to 8.4, and ranged from 6.9 to 11.4 in NZ. The highest age-adjusted IPD rates were observed in Australian Indigenous people (range: 27.3-35.5) followed by NZ Māori/Pacific peoples (range 19.7-30.4). For children <2 years, ethnicity-adjusted IPD rates were similar between Australia and NZ in 2017-2020. In 2021, however, the ethnicity-adjusted incidence in children <2 years was higher in NZ (30.2; 95% CI 21.1-39.4) than in Australia (23.3 95% CI: 19.5-27.1) (p < 0.01). In Australia, the proportion of serotype 19A remained 5%, whereas in NZ serotype 19A increased from 11.5% to 29.5% with the largest increase in children <2 years and 2-4 years. Interpretation Despite higher risks in Indigenous populations in Australia compared to all other groups, the overall IPD rate in NZ is increasing, particularly among children. The numbers and proportions of IPD due to serotype 19A are increasing in NZ especially in children. These data support the NZ decision from December 2022 to change to PCV13. Funding This research received no specific funding.
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Affiliation(s)
- Nienke N. Hagedoorn
- Department of Paediatrics, University of Otago, Christchurch, New Zealand
- Department of General Paediatrics, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Andrew Anglemyer
- Health Intelligence Team, Institute of Environmental Science and Research, Wellington, New Zealand
- Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - Charlotte Gilkison
- Health Intelligence Team, Institute of Environmental Science and Research, Wellington, New Zealand
| | - Mica Hartley
- Communicable Diseases and Surveillance Section, Australian Government Department of Health, Canberra, Australia
| | - Tony Walls
- Department of Paediatrics, University of Otago, Christchurch, New Zealand
- Research for Children Aotearoa—Wellbeing, Whanau, Health, Christchurch, New Zealand
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Carneiro GB, Castro JT, Davi M, Miyaji EN, Ladant D, Oliveira MLS. Immune responses and protection against Streptococcus pneumoniae elicited by recombinant Bordetella pertussis adenylate cyclase (CyaA) carrying fragments of pneumococcal surface protein A, PspA. Vaccine 2023:S0264-410X(23)00570-4. [PMID: 37236818 DOI: 10.1016/j.vaccine.2023.05.031] [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: 03/15/2023] [Revised: 05/10/2023] [Accepted: 05/12/2023] [Indexed: 05/28/2023]
Abstract
Streptococcus pneumoniae is a common agent of important human diseases such as otitis media, pneumonia, meningitis and sepsis. Current available vaccines that target capsular polysaccharides induce protection against invasive disease and nasopharyngeal colonization in children, yet their efficacy is limited to the serotypes included in the formulations. The virulence factor Pneumococcal Surface Protein A (PspA) interacts with host immune system and helps the bacteria to evade phagocytosis. Due to its essential role in virulence, PspA is an important vaccine candidate. Here we have tested a delivery system based on the adenylate cyclase toxin of Bordetella pertussis (CyaA) to induce immune responses against PspA in mice. CyaA was engineered to express fragments of the N-terminal region of PspAs from clades 2 and 4 (A2 and A4) and the resulting proteins were used in immunization experiments in mice. The recombinant CyaA-A2 and CyaA-A4 proteins were able to induce high levels of anti-PspA antibodies that reacted with pneumococcal strains expressing either PspA2 or PspA4. Moreover, reactivity of the antibodies against pneumococcal strains that express PspAs from clades 3 and 5 (PspA3 and PspA5) was also observed. A formulation containing CyaA-A2 and CyaA-A4 was able to protect mice against invasive pneumococcal challenges with isolates that express PspA2, PspA4 or PspA5. Moreover, a CyaA-A2-A4 fusion protein induced antibodies at similar levels and with similar reactivity as the formulation containing both proteins, and protected mice against the invasive challenge. Our results indicate that CyaA-PspA proteins are good candidates to induce broad protection against pneumococcal isolates.
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Affiliation(s)
| | | | - Marilyne Davi
- Institut Pasteur, Université de Paris Cité, CNRS UMR 3528, Unité de Biochimie des Interactions Macromoléculaires, Paris, France
| | | | - Daniel Ladant
- Institut Pasteur, Université de Paris Cité, CNRS UMR 3528, Unité de Biochimie des Interactions Macromoléculaires, Paris, France.
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Adamu AL, Ojal J, Abubakar IA, Odeyemi KA, Bello MM, Okoromah CAN, Karia B, Karani A, Akech D, Inem V, Scott JAG, Adetifa IMO. The impact of introduction of the 10-valent pneumococcal conjugate vaccine on pneumococcal carriage in Nigeria. Nat Commun 2023; 14:2666. [PMID: 37160867 PMCID: PMC10169786 DOI: 10.1038/s41467-023-38277-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 04/24/2023] [Indexed: 05/11/2023] Open
Abstract
Pneumococcal conjugate vaccines (PCVs) protect against invasive pneumococcal disease (IPD) among vaccinees. However, at population level, this protection is driven by indirect effects. PCVs prevent nasopharyngeal acquisition of vaccine-serotype (VT) pneumococci, reducing onward transmission. Each disease episode is preceded by infection from a carrier, so vaccine impacts on carriage provide a minimum estimate of disease reduction in settings lacking expensive IPD surveillance. We documented carriage prevalence and vaccine coverage in two settings in Nigeria annually (2016-2020) following PCV10 introduction in 2016. Among 4,684 rural participants, VT carriage prevalence fell from 21 to 12% as childhood (<5 years) vaccine coverage rose from 7 to 84%. Among 2,135 urban participants, VT carriage prevalence fell from 16 to 9% as uptake rose from 15 to 94%. Within these ranges, carriage prevalence declined with uptake. Increasing PCV10 coverage reduced pneumococcal infection at all ages, implying at least a comparable reduction in IPD.
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Affiliation(s)
- Aishatu L Adamu
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya.
- Department of Infectious Diseases Epidemiology, London School of Hygiene & Tropical Medicine, London, UK.
- Department of Community Medicine, College of Health Sciences, Bayero University, Kano/Aminu Kano Teaching Hospital, Kano, Nigeria.
| | - J Ojal
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Department of Infectious Diseases Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Isa A Abubakar
- Department of Community Medicine, College of Health Sciences, Bayero University, Kano/Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Kofo A Odeyemi
- Department of Community Medicine and Primary Care, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Musa M Bello
- Department of Community Medicine, College of Health Sciences, Bayero University, Kano/Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Christy A N Okoromah
- Department of Paediatrics and Child Health, College of Medicine, University of Lagos, Lagos, Nigeria
| | | | - Angela Karani
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Donald Akech
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Victor Inem
- Department of Community Medicine and Primary Care, College of Medicine, University of Lagos, Lagos, Nigeria
| | - J Anthony G Scott
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Department of Infectious Diseases Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Ifedayo M O Adetifa
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Department of Infectious Diseases Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
- Department of Paediatrics and Child Health, College of Medicine, University of Lagos, Lagos, Nigeria
- Nigeria Centre for Disease Control, Abuja, Nigeria
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Leal JT, Primon-Barros M, de Carvalho Robaina A, Pizzutti K, Mott MP, Trentin DS, Dias CAG. Streptococcus pneumoniae serotype 19A from carriers and invasive disease: virulence gene profile and pathogenicity in a Galleria mellonella model. Eur J Clin Microbiol Infect Dis 2023; 42:399-411. [PMID: 36790530 DOI: 10.1007/s10096-023-04560-6] [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: 07/26/2022] [Accepted: 01/27/2023] [Indexed: 02/16/2023]
Abstract
PURPOSE This study aimed to evaluate and compare the presence of genes related to surface proteins between isolates of Streptococcus pneumoniae from healthy carriers (HC) and invasive pneumococcal disease (IPD) with a particular focus on serotype 19A. METHODS The presence of these genes was identified by real-time PCR. Subsequently, we employed the Galleria mellonella larval infection model to study their effect on pathogenicity in vivo. RESULTS The percentage of selected virulence genes was similar between the HC and IPD groups (p > 0.05), and the genes lytA, nanB, pavA, pcpA, phtA, phtB, phtE, rrgA, and sipA were all present in both groups. However, the virulence profile of the isolates differed individually between HC and IPD groups. The highest lethality in G. mellonella was for IPD isolates (p < 0.01), even when the virulence profile was the same as compared to the HC isolates or when the nanA, pspA, pspA-fam1, and pspC genes were not present. CONCLUSIONS The occurrence of the investigated virulence genes was similar between HC and IPD S. pneumoniae serotype 19A groups. However, the IPD isolates showed a higher lethality in the alternative G. mellonella model than the HC isolates, regardless of the virulence gene composition, indicating that other virulence factors may play a decisive role in virulence. Currently, this is the first report using the in vivo G. mellonella model to study the virulence of clinical isolates of S. pneumoniae.
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Affiliation(s)
- Josiane Trevisol Leal
- Laboratório de Microbiologia Molecular, Departamento de Ciências Básicas da Saúde, Programa de Pós-Graduação em Ciências da Saúde (PPGCS), Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Rio Grande Do Sul, Brasil
- Laboratório de Bacteriologia & Modelos Experimentais Alternativos, Departamento de Ciências Básicas da Saúde, Programa de Pós-Graduação em Biociências (PPGBIO), Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brasil
| | - Muriel Primon-Barros
- Laboratório de Microbiologia Molecular, Departamento de Ciências Básicas da Saúde, Programa de Pós-Graduação em Ciências da Saúde (PPGCS), Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Rio Grande Do Sul, Brasil
| | - Amanda de Carvalho Robaina
- Laboratório de Microbiologia Molecular, Departamento de Ciências Básicas da Saúde, Programa de Pós-Graduação em Ciências da Saúde (PPGCS), Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Rio Grande Do Sul, Brasil
| | - Kauana Pizzutti
- Laboratório de Microbiologia Molecular, Departamento de Ciências Básicas da Saúde, Programa de Pós-Graduação em Ciências da Saúde (PPGCS), Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Rio Grande Do Sul, Brasil
| | - Mariana Preussler Mott
- Laboratório de Microbiologia Molecular, Departamento de Ciências Básicas da Saúde, Programa de Pós-Graduação em Ciências da Saúde (PPGCS), Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Rio Grande Do Sul, Brasil
| | - Danielle Silva Trentin
- Laboratório de Bacteriologia & Modelos Experimentais Alternativos, Departamento de Ciências Básicas da Saúde, Programa de Pós-Graduação em Biociências (PPGBIO), Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brasil.
| | - Cícero Armídio Gomes Dias
- Laboratório de Microbiologia Molecular, Departamento de Ciências Básicas da Saúde, Programa de Pós-Graduação em Ciências da Saúde (PPGCS), Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Rio Grande Do Sul, Brasil
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11
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de Souza MB, de Carvalho E, Cergole-Novella MC, Molinari DA, Colpas DR, Dos Santos Carmo AM, Dos Santos Menezes Gaiotto Daros V, de Campos IB. Multiplex PCR to Streptococcus pneumoniae serotype identification directly in cerebrospinal fluid samples. Eur J Clin Microbiol Infect Dis 2023; 42:255-266. [PMID: 36662376 PMCID: PMC9854411 DOI: 10.1007/s10096-023-04547-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 01/11/2023] [Indexed: 01/21/2023]
Abstract
Streptococcus pneumoniae causes invasive diseases of significant public health concern, such as meningitis. The culture of cerebrospinal fluid (CSF) samples, the standard technique for meningitis diagnoses, is not always positive. Consequently, meaningful information about the etiological agent is lost, which can compromise effective epidemiological surveillance and the improvement of immunization policies. This study aims to standardize a method to genotype pneumococcus in the CSF samples which could mitigate the absence of isolated strains, and also evaluate the prediction of this assay. We applied eight multiplex PCR (mPCR) assays to CSF samples paired with the Quellung reaction applied to the isolated strains. We also compared different master mix kits in the mPCR. Moreover, a retrospective study was conducted with CSF samples considered pneumococcus positive due to the presence of the lytA gene. Results showed that genotyping by the mPCR correlated 100% with the Quellung reaction, and genotyping was dependent on the master mix applied. In the retrospective study (2014-2020), 73.4% were successfully genotyped. The analyses of the receiver operating characteristic curve showed that the cycle threshold (Ct value) around 30 for the lytA gene had a 75% positive chance of successful genotyping, whereas with a Ct value > 35, the chance was 12.5%. Finally, we observed that genotype 19A was prevalent in the period (12%), information unknown until now due to the lack of isolated strains. Therefore, the mPCR of CSF samples can efficiently predict S. pneumoniae serotypes, especially in the absence of isolated strains, which can be a great tool for pneumococcal serotype surveillance.
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Affiliation(s)
- Mariana Brena de Souza
- Adolfo Lutz Institute, Santo André Regional Center, Av. Ramiro Colleoni, 240 - Vila Dora, Santo André, SP, Zip Code: 09040-160, Brazil
| | - Eneas de Carvalho
- Butantan Institute, Bacteriology Laboratory, Av. Vital Brasil, 1500 - Butantã, São Paulo, SP, Zip Code: 05503-900, Brazil
| | - Maria Cecília Cergole-Novella
- Adolfo Lutz Institute, Santo André Regional Center, Av. Ramiro Colleoni, 240 - Vila Dora, Santo André, SP, Zip Code: 09040-160, Brazil
| | - Delma Aparecida Molinari
- Adolfo Lutz Institute, Santo André Regional Center, Av. Ramiro Colleoni, 240 - Vila Dora, Santo André, SP, Zip Code: 09040-160, Brazil
| | - Daniela Rodrigues Colpas
- Adolfo Lutz Institute, Santo André Regional Center, Av. Ramiro Colleoni, 240 - Vila Dora, Santo André, SP, Zip Code: 09040-160, Brazil
| | - Andréia Moreira Dos Santos Carmo
- Adolfo Lutz Institute, Santo André Regional Center, Av. Ramiro Colleoni, 240 - Vila Dora, Santo André, SP, Zip Code: 09040-160, Brazil
| | | | - Ivana Barros de Campos
- Adolfo Lutz Institute, Santo André Regional Center, Av. Ramiro Colleoni, 240 - Vila Dora, Santo André, SP, Zip Code: 09040-160, Brazil.
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12
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da Silva AB, Cardoso-Marques NT, Dolores ÍDM, Teixeira LM, Neves FPG. Carriage prevalence, serotype distribution, antimicrobial resistance, pspA typing and pilus islets of Streptococcus pneumoniae isolated from adults living in a Brazilian urban slum. Vaccine 2023; 41:1431-1437. [PMID: 36690557 DOI: 10.1016/j.vaccine.2023.01.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 01/10/2023] [Accepted: 01/16/2023] [Indexed: 01/22/2023]
Abstract
INTRODUCTION For Brazilian adults, pneumococcal vaccines have been usually taken only by those who are at higher risk for development of pneumococcal diseases. Since populations from lower socioeconomic status are at high risk of acquiring pneumococcal infections, we investigated the carriage prevalence, colonization risk factors, capsular and surface protein types, and antimicrobial resistance among pneumococcal isolates recovered from adults living in a Brazilian urban slum. METHODS Between September-December 2016, we conducted a cross-sectional study among individuals aged ≥ 18 years who attended a public primary clinic in Niterói/RJ, Brazil. Pneumococci were isolated by culture on sheep blood agar plates with and without gentamicin. Antimicrobial susceptibility was determined for all isolates. We used PCR to determine capsular types, PspA families (Fam) and pilus islets (PI). RESULTS Of 385 adults, 32 (8.3 %) were pneumococcal carriers. Three carriers had two different pneumococci, totaling 35 isolates. After multivariate analysis, smoking, previous hospitalization, alcohol consumption and co-habitation with children aged < 6 years increased the odds of pneumococcal carriage, but antibiotic use in the previous 2 weeks was found to be a protective factor. Fourteen different serogroups/serotypes were detected and the prevalent ones were 9 N/L, 10A, 15B/C and 35F/47F (n = 3; 8.6 % each). Non-typeable (NT) isolates made up 31.4 %. All isolates were susceptible to chloramphenicol, levofloxacin and vancomycin. We found eight (22.9 %) penicillin non-susceptible pneumococci (PNSP) with minimum inhibitory concentrations (MICs) of 0.38-1.5 μg/mL. The two (5.7 %) erythromycin-resistant isolates had MIC > 256 μg/mL, cMLSB phenotype and the erm(B) gene. Twelve (34.3 %) and 17 (48.6 %) isolates had PspA Fam1 and Fam2, respectively. Three (8.6 %) isolates had genes for pilitwo PI-1 and one PI-2. CONCLUSION We detected a low frequency of pneumococcal carriage among the adult population, but a high diversity of serotypes. Frequencies of PNSP and NT isolates resistant to antimicrobial agents are concerning.
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Affiliation(s)
- Amanda Beiral da Silva
- Department of Microbiology and Parasitology, Instituto Biomédico, Universidade Federal Fluminense, Niterói, RJ, Brazil
| | - Nayara Torres Cardoso-Marques
- Department of Microbiology and Parasitology, Instituto Biomédico, Universidade Federal Fluminense, Niterói, RJ, Brazil
| | - Ítalo de Moraes Dolores
- Department of Microbiology and Parasitology, Instituto Biomédico, Universidade Federal Fluminense, Niterói, RJ, Brazil
| | - Lúcia Martins Teixeira
- Department of Medical Microbiology, Instituto de Microbiologia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
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13
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Thindwa D, Clifford S, Kleynhans J, von Gottberg A, Walaza S, Meiring S, Swarthout TD, Miller E, McIntyre P, Andrews N, Amin-Chowdhury Z, Fry N, Jambo KC, French N, Almeida SCG, Ladhani SN, Heyderman RS, Cohen C, de Cunto Brandileone MC, Flasche S. Optimal age targeting for pneumococcal vaccination in older adults; a modelling study. Nat Commun 2023; 14:888. [PMID: 36797259 PMCID: PMC9935637 DOI: 10.1038/s41467-023-36624-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 02/09/2023] [Indexed: 02/18/2023] Open
Abstract
Invasive pneumococcal disease (IPD) risk increases with age for older adults whereas the population size benefiting from pneumococcal vaccines and robustness of immunogenic response to vaccination decline. We estimate how demographics, vaccine efficacy/effectiveness (VE), and waning VE impact on optimal age for a single-dose pneumococcal vaccination. Age- and vaccine-serotype-specific IPD cases from routine surveillance of adults ≥ 55 years old (y), ≥ 4-years after infant-pneumococcal vaccine introduction and before 2020, and VE data from prior studies were used to estimate IPD incidence and waning VE which were then combined in a cohort model of vaccine impact. In Brazil, Malawi, South Africa and England 51, 51, 54 and 39% of adults older than 55 y were younger than 65 years old, with a smaller share of annual IPD cases reported among < 65 years old in England (4,657; 20%) than Brazil (186; 45%), Malawi (4; 63%), or South Africa (134, 48%). Vaccination at 55 years in Brazil, Malawi, and South Africa, and at 70 years in England had the greatest potential for IPD prevention. Here, we show that in low/middle-income countries, pneumococcal vaccines may prevent a substantial proportion of residual IPD burden if administered earlier in adulthood than is typical in high-income countries.
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Affiliation(s)
- Deus Thindwa
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, UK.
- Department of Infectious Disease Epidemiology London School of Hygiene & Tropical Medicine, London, UK.
- Malawi Liverpool Wellcome Research Programme, Blantyre, Malawi.
| | - Samuel Clifford
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, UK
- Department of Infectious Disease Epidemiology London School of Hygiene & Tropical Medicine, London, UK
| | - Jackie Kleynhans
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Anne von Gottberg
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
- School of Pathology, University of the Witwatersrand, Johannesburg, South Africa
| | - Sibongile Walaza
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
| | - Susan Meiring
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
| | - Todd D Swarthout
- Malawi Liverpool Wellcome Research Programme, Blantyre, Malawi
- Division of Infection and Immunity, University College London, London, UK
- Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, Netherlands
| | - Elizabeth Miller
- Department of Infectious Disease Epidemiology London School of Hygiene & Tropical Medicine, London, UK
| | | | - Nick Andrews
- Immunisation and Countermeasures Division, UK Health Security Agency, London, UK
| | - Zahin Amin-Chowdhury
- Immunisation and Countermeasures Division, UK Health Security Agency, London, UK
| | - Norman Fry
- Immunisation and Countermeasures Division, UK Health Security Agency, London, UK
| | - Kondwani C Jambo
- Malawi Liverpool Wellcome Research Programme, Blantyre, Malawi
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Neil French
- Malawi Liverpool Wellcome Research Programme, Blantyre, Malawi
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
| | - Samanta Cristine Grassi Almeida
- National Laboratory for Meningitis and Pneumococcal Infections, Laboratory for Meningitis, Pneumonia and Pneumococcal Infection, Centre of Bacteriology, São Paulo, Brazil
| | - Shamez N Ladhani
- Immunisation and Countermeasures Division, UK Health Security Agency, London, UK
| | - Robert S Heyderman
- Malawi Liverpool Wellcome Research Programme, Blantyre, Malawi
- Division of Infection and Immunity, University College London, London, UK
| | - Cheryl Cohen
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Maria Cristina de Cunto Brandileone
- National Laboratory for Meningitis and Pneumococcal Infections, Laboratory for Meningitis, Pneumonia and Pneumococcal Infection, Centre of Bacteriology, São Paulo, Brazil
| | - Stefan Flasche
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, UK
- Department of Infectious Disease Epidemiology London School of Hygiene & Tropical Medicine, London, UK
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14
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Nasopharyngeal colonization by Streptococcus pneumoniae in children and adults before the introduction of the 10-valent conjugate vaccine, Paraguay. PLoS One 2023; 18:e0280722. [PMID: 36795644 PMCID: PMC9934358 DOI: 10.1371/journal.pone.0280722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 01/07/2023] [Indexed: 02/17/2023] Open
Abstract
Streptococcus pneumoniae is a cause of invasive diseases such as pneumonia, meningitis, and other serious infections among children and adults in Paraguay. This study was conducted to establish S. pneumoniae baseline prevalence, serotype distribution, and antibiotic resistance patterns in healthy children aged 2 to 59 months and adults ≥60 years of age prior to the introduction of PCV10 in the national childhood immunization program in Paraguay. Between April and July 2012, a total of 1444 nasopharyngeal swabs were collected, 718 from children aged 2 to 59 months and 726 from adults ≥60 years of age. The pneumococcal isolation, serotyping, and antibiotic susceptibility testing were performed using standard tests. Pneumococcal colonization prevalence was 34.1% (245/718) in children and 3.3% (24/726) in adults. The most frequent pneumococcal vaccine-types (VT) detected in the children were 6B (42/245), 19F (32/245), 14 (17/245), and 23F (20/245). Carriage prevalence with PCV10 serotypes was 50.6% (124/245) and PCV13 was 59.5% (146/245). Among colonized adults, prevalence of PCV10 and PCV13 serotypes were 29.1% (7/24) and 41.6% (10/24), respectively. Colonized children were more likely to share a bedroom, have a history of respiratory infection or pneumococcal infection compared to non-colonized children. no associations were found in adults. However, no significant associations were found in children and neither in adults. Vaccine-type pneumococcal colonization was highly prevalent in children and rare in adults in Paraguay prior to vaccine introduction, supporting the introduction of PCV10 in the country in 2012. These data will be useful to evaluate the impact of PCV introduction in the country.
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15
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Kfouri RA, Brandileone MCC, Sáfadi MAP, Richtmann R, Gilio AE, Rossi F, Guimarães T, Bierrenbach AL, Moraes JC. Chronic medical conditions associated with invasive pneumococcal diseases in inpatients in teaching hospitals in São Paulo city: Estimating antimicrobial susceptibility and serotype-coverage of pneumococcal vaccines. Braz J Infect Dis 2023; 27:102746. [PMID: 36758625 PMCID: PMC9943857 DOI: 10.1016/j.bjid.2023.102746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 12/30/2022] [Accepted: 01/13/2023] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Chronic conditions increase the risk of invasive pneumococcal diseases (IPD). Pneumococcal vaccination remarkably reduced IPD morbimortality in vulnerable populations. In Brazil, pneumococcal vaccines are included in the National Immunization Program (PNI): PCV10 for < 2 years-old, and PPV23 for high risk-patients aged ≥ 2 years and institutionalized ≥ 60 years. PCV13 is available in private clinics and recommended in the PNI for individuals with certain underlying conditions. METHODS A retrospective study was performed using clinical data from all inpatients from five hospitals with IPD from 2016 to 2018 and the corresponding data on serotype and antimicrobial-non-susceptibility of pneumococcus. Vaccine-serotype-coverage was estimated. Patients were classified according to presence of comorbidities: healthy, without comorbidities; at-risk, included immunocompetent persons with specific medical conditions; high-risk, with immunocompromising conditions and others RESULTS: 406 IPD cases were evaluated. Among 324 cases with information on medical conditions, children < 5 years were mostly healthy (55.9%), while presence of comorbidity prevailed in adults ≥ 18 years old (> 82.0%). Presence of ≥1 risk condition was reported in ≥ 34.8% of adults. High-risk conditions were more frequent than at-risk in all age groups. Among high-risk comorbidity (n = 211), cancer (28%), HIV/AIDS (25.7%) and hematological diseases (24.5%) were the most frequent. Among at-risk conditions (n = 89), asthma (16.5%) and diabetes (8.1%) were the most frequent. Among 404 isolates, 42.9% belonged to five serotypes: 19A (14.1%), 3 (8.7%), 6C (7.7%), 4 and 8 (6.2% each); 19A and 6C expressed antimicrobial-non-susceptibility. The vaccine-serotype-coverage was: PCV10, 19.1%, PCV13, 43.8%; PCV15, 47.8%; PCV20, 62.9%; PCV21, 65.8%, and PPV23, 67.3%. Information on hospital outcome was available for 283 patients, of which 28.6% died. Mortality was 54.2% for those with meningitis. CONCLUSION Vaccine with expanded valence of serotypes is necessary to offer broad prevention to IPD. The present data contribute to pneumococcal vaccination public health policies for vulnerable patients, mainly those with comorbidity and the elderly.
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Affiliation(s)
- Renato A. Kfouri
- Sociedade Brasileira de Imunizações (SBim), São Paulo, SP, Brazil,Corresponding author.
| | - Maria-Cristina C. Brandileone
- Centro de Bacteriologia, Laboratório Nacional de Meningite e Infecção Pneumocócica, Instituto Adolfo Lutz (IAL), São Paulo, SP, Brazil
| | | | - Rosana Richtmann
- Instituto de Infectologia Emílio Ribas (IIER), São Paulo, SP, Brazil
| | - Alfredo E. Gilio
- Hospital Universitário (HU) da Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | - Flavia Rossi
- Laboratório de Medicina Laboratorial (LIM/03), Hospital das Clínicas da Universidade de São Paulo (HCUSP), São Paulo, SP, Brazil
| | - Thais Guimarães
- Hospital do Servidor Público Estadual (HSPE), São Paulo, SP, Brazil
| | | | - José C. Moraes
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, SP, Brazil
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16
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Ordóñez JE, Ordóñez A. A cost-effectiveness analysis of pneumococcal conjugate vaccines in infants and herd protection in older adults in Colombia. Expert Rev Vaccines 2023; 22:216-225. [PMID: 36812426 DOI: 10.1080/14760584.2023.2184090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
BACKGROUND Pneumococcal diseases have a clinical and economic impact on the population. Until this year, a 10-valent pneumococcal vaccine (PCV10) used to be applied in Colombia, which does not contain serotypes 19A, 3, and 6A, the most prevalent in the country. Therefore, we aimed to assess the cost-effectiveness of the shift to the 13-valent pneumococcal vaccine (PCV13). RESEARCH DESIGN AND METHODS A decision model was used for newborns in Colombia between 2022-2025 and adults over 65 years. The time horizon was life expectancy. Outcomes are Invasive Pneumococcal Diseases (IPD), Community-Acquired Pneumonia (CAP), Acute Otitis Media (AOM), their sequelae, Life Gained Years (LYGs), and herd effect in older adults. RESULTS PCV10 covers 4.27% of serotypes in the country, while PCV13 covers 64.4%. PCV13 would avoid in children 796 cases of IPD, 19,365 of CAP, 1,399 deaths, and generate 44,204 additional LYGs, as well as 9,101 cases of AOM, 13 cases of neuromotor disability and 428 cochlear implants versus PCV10. In older adults, PCV13 would avoid 993 cases of IPD and 17,245 of CAP, versus PCV10. PCV13 saves $51.4 million. The decision model shows robustness in the sensitivity analysis. CONCLUSION PCV13 is a cost-saving strategy versus PCV10 to avoid pneumococcal diseases.
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Affiliation(s)
| | - Angélica Ordóñez
- Instituto de Evaluación Tecnológica en Salud, Bogotá, D.C, Colombia
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17
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Silva MEP, Oliveira JR, Carvalho AG, Santos DG, Lima NCS, Santos FAG, Taborda RLM, Rodrigues RS, Dall'Acqua DSV, Matos NB. Colonization by Streptococcus pneumoniae among children in Porto Velho, Rondônia, Western Brazilian Amazon. BRAZ J BIOL 2022; 82:e260617. [PMID: 35830013 DOI: 10.1590/1519-6984.260617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 05/26/2022] [Indexed: 11/22/2022] Open
Abstract
Streptococcus pneumoniae is one of the primary pathogens that are associated with acute respiratory infections (ARI) that cause high rates of morbidity and mortality among children under five years of age in developed and developing countries. This study aimed to determine the prevalence of nasopharyngeal colonization, the antimicrobial resistance profile, and the capacity for biofilm formation by S. pneumoniae isolated from children aged 0-6 years with ARI throughout the Porto Velho-RO. A total of 660 swabs were collected from children with ARI. Molecular and biochemical tests were performed to characterize the isolates. The disk-difusion method and the E-test were used for antimicrobial sensitivity testing (TSA). Biofilm formation capacity was assessed using microtiter plate assays, and serotype detection was acheived using polymerase chain reaction (PCR) analyses. The colonization rate for S. pneumoniae was 8.9% (59/660) and exhibited a high prevalence in children under 23 months of age 64.4% (38/59). The observed serotypes were 9V and 19F with frequencies of 1.7% (1/59) and 13.6% (8/59), respectively. The antimicrobial susceptibility test revealed 100% (59/59) sensitivity to vancomycin. In contrast, trimethoprim and oxacillin exhibited high resistance rates of 76.3% (45/59) and 52.5% (31/59), respectively. Of the biofilm-forming isolates, 54.8% (23/42) possessed resistance to some antimicrobials. In this study, S. pneumoniae showed high rates of antimicrobial resistance and the ability to form biofilms, as these are factors that favor bacterial persistence and can cause serious damage to the host.
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Affiliation(s)
- M E P Silva
- Fundação Oswaldo Cruz Rondônia - Fiocruz Rondônia, Laboratório de Microbiologia, Porto Velho, RO, Brasil.,Universidade Federal de Rondônia, Programa de Pós-graduação em Biologia Experimental, Porto Velho, RO, Brasil
| | - J R Oliveira
- Universidade Federal de Rondônia, Programa de Pós-graduação em Biologia Experimental, Porto Velho, RO, Brasil
| | - A G Carvalho
- Fundação Oswaldo Cruz Rondônia - Fiocruz Rondônia, Laboratório de Microbiologia, Porto Velho, RO, Brasil.,Universidade Federal de Rondônia, Programa de Pós-graduação em Biologia Experimental, Porto Velho, RO, Brasil
| | - D G Santos
- Fundação Oswaldo Cruz Rondônia - Fiocruz Rondônia, Laboratório de Microbiologia, Porto Velho, RO, Brasil
| | - N C S Lima
- Fundação Oswaldo Cruz Rondônia - Fiocruz Rondônia, Laboratório de Microbiologia, Porto Velho, RO, Brasil.,Centro de Pesquisa em Medicina Tropical - CEPEM, Porto Velho, RO, Brasil
| | - F A G Santos
- Universidade Federal de Rondônia, Programa de Pós-graduação em Biologia Experimental, Porto Velho, RO, Brasil.,Centro de Pesquisa em Medicina Tropical - CEPEM, Porto Velho, RO, Brasil
| | - R L M Taborda
- Fundação Oswaldo Cruz Rondônia - Fiocruz Rondônia, Laboratório de Microbiologia, Porto Velho, RO, Brasil.,Centro de Pesquisa em Medicina Tropical - CEPEM, Porto Velho, RO, Brasil
| | - R S Rodrigues
- Fundação Oswaldo Cruz Rondônia - Fiocruz Rondônia, Laboratório de Microbiologia, Porto Velho, RO, Brasil.,Centro de Pesquisa em Medicina Tropical - CEPEM, Porto Velho, RO, Brasil.,Instituto Oswaldo Cruz, Programa de Pós-graduação em Biologia Celular e Molecular, Rio de Janeiro, RJ, Brasil
| | - D S V Dall'Acqua
- Fundação Oswaldo Cruz Rondônia - Fiocruz Rondônia, Laboratório de Microbiologia, Porto Velho, RO, Brasil.,Universidade Federal de Rondônia, Programa de Pós-graduação em Biologia Experimental, Porto Velho, RO, Brasil.,Centro de Pesquisa em Medicina Tropical - CEPEM, Porto Velho, RO, Brasil
| | - N B Matos
- Fundação Oswaldo Cruz Rondônia - Fiocruz Rondônia, Laboratório de Microbiologia, Porto Velho, RO, Brasil.,Universidade Federal de Rondônia, Programa de Pós-graduação em Biologia Experimental, Porto Velho, RO, Brasil.,Centro de Pesquisa em Medicina Tropical - CEPEM, Porto Velho, RO, Brasil
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18
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Castro ALL, Camacho-Moreno G, Montañez-Ayala A, Varón-Vega F, Alvarez-Rodríguez JC, Valderrama-Beltrán S, Ariza BE, Pancha O, Santana AY, Flórez NS, Reyes P, Ruiz J, Beltran C, Prieto E, Rojas M, Urrego-Reyes J, Parellada CI. Invasive Pneumococcal Disease Characterization in Adults and Subgroups aged < 60 years and ≥ 60 years in Bogota, Colombia. IJID REGIONS 2022; 3:293-299. [PMID: 35774639 PMCID: PMC9231666 DOI: 10.1016/j.ijregi.2022.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 04/18/2022] [Accepted: 04/22/2022] [Indexed: 11/02/2022]
Abstract
The clinical burden of IPD is high in the elderly and adults with comorbidities IPD placed a high burden on healthcare resources in the adult population The most common types causing IPD in adults were similar to those found in children Policy makers should consider pneumococcal vaccination for populations at risk
Background Methods Results Conclusions
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19
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Duarte FG, Barberino MG, da Silva Moreira S, Reis JN, Spinardi JR, de Almeida RS, Allen KE, Alexander-Parrish R, Brim R, de Araújo Neto CA, Moreira ED. Incidence, aetiology and serotype coverage for pneumococcal vaccines of community-acquired pneumonia in adults: a population-based prospective active surveillance study in Brazil. BMJ Open 2022; 12:e059824. [PMID: 35428648 PMCID: PMC9014102 DOI: 10.1136/bmjopen-2021-059824] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 03/30/2022] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To determine the incidence, aetiology and pneumococcal serotype distribution of community-acquired pneumonia (CAP) in Brazilian adults during a 2-year period. DESIGN Prospective population-based surveillance study. SETTING Patients from two emergency hospitals in Brazil were consecutively included in this study. PARTICIPANTS A total of 111 adults aged 50 years and older with radiographically-confirmed CAP requiring an emergency department visit were prospectively enrolled between January 2018 and January 2020. MAIN OUTCOME MEASURES Incidence rates of CAP were calculated according to age and pathogen. Pathogens were identified by conventional microbiological methods. Additionally, a novel, Luminex-based serotype specific urinary antigen detection assay was used to detect serotypes included in pneumococcal vaccines. RESULTS Mean age of participants was 64 years and 31% were aged ≥70 years. Aetiology was established in 61 (57%) patients; among identified cases, the most common pathogens were Streptococcus pneumoniae (42/61, 69%) and influenza (4/61, 7%). Among serotypes identified from the 42 cases of pneumococcal CAP, estimated coverage ranged by pneumococcal vaccine formulations from 47.6% (13-valent), 59.5% (20-valent, licenced in the USA only) and 71.4% (23-valent). In patients with CAP, 20-valent pneumococcal vaccine serotypes were identified 2.5 times more frequently than 10-valent pneumococcal vaccine serotypes (22.5% vs 9.0%). The incidence rate for CAP in adults aged ≥50 years was 20.1 per 10 000 person-years. In general, the incidence of CAP increased consistently with age, reaching 54.4 (95% CI 36.8 to -76.6) per 10 000 in adults 80 years or older. CONCLUSIONS We observed a high burden of pneumococcal CAP among adults in Brazil. Despite the routine immunisation of children and high-risk adults against pneumococcal disease in the Brazilian national vaccination programme, a persistent burden of pneumococcal CAP caused by vaccine serotypes remains in this population.
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Affiliation(s)
- Fernanda Gross Duarte
- Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Brazilian Ministry of Health, Salvador, Bahia, Brazil
| | - Maria Goreth Barberino
- Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Brazilian Ministry of Health, Salvador, Bahia, Brazil
| | | | | | | | | | | | | | - Rosa Brim
- Federal University of Bahia, Salvador, Brazil
| | | | - Edson Duarte Moreira
- Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Brazilian Ministry of Health, Salvador, Bahia, Brazil
- Centro de Pesquisa Clínica (CPEC), Obras Sociais Irma Dulce, Salvador, Bahia, Brazil
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20
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Silveira MM, Conrad NL, Leivas Leite FP. Effect of COVID-19 on vaccination coverage in Brazil. J Med Microbiol 2021; 70. [PMID: 34845982 DOI: 10.1099/jmm.0.001466] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
During the COVID-19 pandemic, recommendations for maintaining physical distance, restricted mobility measures, as well as fear of mass transmission by going to health centers have significantly contributed to the general vaccination coverage, which by and large is decreasing worldwide; thus, favoring the potential re-emergence of vaccine-preventable diseases. In this study, we have used the existing data on vaccination coverage during the pre-pandemic (2019) as well as the pandemic (2020) period to evaluate the impact of coronavirus outbreaks during the vaccination drive in Brazil. Furthermore, we have accumulated data since 2015 among the different regions of the country to acquire more consistent information. The various vaccines analyzed in our study were meningococcal C conjugate, Triple antigen vaccine, 10-valent pneumococcal conjugate, and BCG; subsequently, the data were obtained from the National Disease Notification System. This study revealed that the ongoing immunization drive saw a steep decline of around 10 to 20% during the (2019-2020) pandemic period in Brazil. These results provide strong evidence towards the decreasing trends following the vaccination programs during the COVID-19 pandemic period in Brazil. Furthermore, our results also highlight the importance of adopting widespread multi-component interventions to improve vaccination uptake rates.
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Affiliation(s)
| | - Neida Lucia Conrad
- Biotechnology Unit, Technological Development Centre, Federal University of Pelotas, Pelotas, Brazil
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21
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Pneumococcal Vaccines: Past Findings, Present Work, and Future Strategies. Vaccines (Basel) 2021; 9:vaccines9111338. [PMID: 34835269 PMCID: PMC8620834 DOI: 10.3390/vaccines9111338] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 11/12/2021] [Accepted: 11/13/2021] [Indexed: 01/24/2023] Open
Abstract
The importance of Streptococcus pneumoniae has been well established. These bacteria can colonize infants and adults without symptoms, but in some cases can spread, invade other tissues and cause disease with high morbidity and mortality. The development of pneumococcal conjugate vaccines (PCV) caused an enormous impact in invasive pneumococcal disease and protected unvaccinated people by herd effect. However, serotype replacement is a well-known phenomenon that has occurred after the introduction of the 7-valent pneumococcal conjugate vaccine (PCV7) and has also been reported for other PCVs. Therefore, it is possible that serotype replacement will continue to occur even with higher valence formulations, but the development of serotype-independent vaccines might overcome this problem. Alternative vaccines are under development in order to improve cost effectiveness, either using proteins or the pneumococcal whole cell. These approaches can be used as a stand-alone strategy or together with polysaccharide vaccines. Looking ahead, the next generation of pneumococcal vaccines can be impacted by the new technologies recently approved for human use, such as mRNA vaccines and viral vectors. In this paper, we will review the advantages and disadvantages of the addition of new polysaccharides in the current PCVs, mainly for low- and middle-income countries, and we will also address future perspectives.
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22
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Almeida SCG, Lo SW, Hawkins PA, Gladstone RA, Cassiolato AP, Klugman KP, Breiman RF, Bentley SD, McGee L, Brandileone MCDC. Genomic surveillance of invasive Streptococcus pneumoniae isolates in the period pre-PCV10 and post-PCV10 introduction in Brazil. Microb Genom 2021; 7. [PMID: 34609274 PMCID: PMC8627213 DOI: 10.1099/mgen.0.000635] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
In 2010, Brazil introduced the 10-valent pneumococcal conjugate vaccine (PCV10) into the national children’s immunization programme. This study describes the genetic characteristics of invasive Streptococcus pneumoniae isolates before and after PCV10 introduction. A subset of 466 [pre-PCV10 (2008–2009): n=232, post-PCV10 (2012–2013): n=234;<5 years old: n=310, ≥5 years old: n=156] pneumococcal isolates, collected through national laboratory surveillance, were whole-genome sequenced (WGS) to determine serotype, pilus locus, antimicrobial resistance and genetic lineages. Following PCV10 introduction, in the <5 years age group, non-vaccine serotypes (NVT) serotype 3 and serotype 19A were the most frequent, and serotypes 12F, 8 and 9 N in the ≥5 years old group. The study identified 65 Global Pneumococcal Sequence Clusters (GPSCs): 49 (88 %) were GPSCs previously described and 16 (12 %) were Brazilian clusters. In total, 36 GPSCs (55 %) were NVT lineages, 18 (28 %) vaccine serotypes (VT) and 11 (17 %) were both VT and NVT lineages. In both sampling periods, the most frequent lineage was GPSC6 (CC156, serotypes 14/9V). In the <5 years old group, a decrease in penicillin (P=0.0123) and cotrimoxazole (P<0.0001) resistance and an increase in tetracycline (P=0.019) were observed. Penicillin nonsusceptibility was predicted in 40 % of the isolates; 127 PBP combinations were identified (51 predicted MIC≥0.125 mg l−1); cotrimoxazole (folA and/or folP alterations), macrolide (mef and/or ermB) and tetracycline (tetM, tetO or tetS/M) resistance were predicted in 63, 13 and 21.6 % of pneumococci studied, respectively. The main lineages associated with multidrug resistance in the post-PCV10 period were composed of NVT, GPSC1 (CC320, serotype 19A), and GPSC47 (ST386, serotype 6C). The study provides a baseline for future comparisons and identified important NVT lineages in the post-PCV10 period in Brazil.
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Affiliation(s)
- Samanta C. G. Almeida
- National Reference Laboratory for Meningitis and Pneumococcal Infections, Institute Adolfo Lutz, São Paulo, Brazil
- *Correspondence: Samanta C. G. Almeida,
| | - Stephanie W. Lo
- Parasites and Microbes Programme, Wellcome Sanger Institute, Hinxton, UK
| | - Paulina A. Hawkins
- Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, USA
| | | | - Ana Paula Cassiolato
- National Reference Laboratory for Meningitis and Pneumococcal Infections, Institute Adolfo Lutz, São Paulo, Brazil
| | - Keith P. Klugman
- Emeritus Professor of Global Health, Emory University, Atlanta, GA, USA
| | | | - Stephen D. Bentley
- Parasites and Microbes Programme, Wellcome Sanger Institute, Hinxton, UK
| | - Lesley McGee
- Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, USA
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23
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Decouttere C, De Boeck K, Vandaele N. Advancing sustainable development goals through immunization: a literature review. Global Health 2021; 17:95. [PMID: 34446050 PMCID: PMC8390056 DOI: 10.1186/s12992-021-00745-w] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 07/23/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Immunization directly impacts health (SDG3) and brings a contribution to 14 out of the 17 Sustainable Development Goals (SDGs), such as ending poverty, reducing hunger, and reducing inequalities. Therefore, immunization is recognized to play a central role in reaching the SDGs, especially in low- and middle-income countries (LMICs). Despite continuous interventions to strengthen immunization systems and to adequately respond to emergency immunization during epidemics, the immunization-related indicators for SDG3 lag behind in sub-Saharan Africa. Especially taking into account the current Covid19 pandemic, the current performance on the connected SDGs is both a cause and a result of this. METHODS We conduct a literature review through a keyword search strategy complemented with handpicking and snowballing from earlier reviews. After title and abstract screening, we conducted a qualitative analysis of key insights and categorized them according to showing the impact of immunization on SDGs, sustainability challenges, and model-based solutions to these challenges. RESULTS We reveal the leveraging mechanisms triggered by immunization and position them vis-à-vis the SDGs, within the framework of Public Health and Planetary Health. Several challenges for sustainable control of vaccine-preventable diseases are identified: access to immunization services, global vaccine availability to LMICs, context-dependent vaccine effectiveness, safe and affordable vaccines, local/regional vaccine production, public-private partnerships, and immunization capacity/capability building. Model-based approaches that support SDG-promoting interventions concerning immunization systems are analyzed in light of the strategic priorities of the Immunization Agenda 2030. CONCLUSIONS In general terms, it can be concluded that relevant future research requires (i) design for system resilience, (ii) transdisciplinary modeling, (iii) connecting interventions in immunization with SDG outcomes, (iv) designing interventions and their implementation simultaneously, (v) offering tailored solutions, and (vi) model coordination and integration of services and partnerships. The research and health community is called upon to join forces to activate existing knowledge, generate new insights and develop decision-supporting tools for Low-and Middle-Income Countries' health authorities and communities to leverage immunization in its transformational role toward successfully meeting the SDGs in 2030.
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Affiliation(s)
- Catherine Decouttere
- KU Leuven, Access-To-Medicines research Center, Naamsestraat 69, Leuven, Belgium
| | - Kim De Boeck
- KU Leuven, Access-To-Medicines research Center, Naamsestraat 69, Leuven, Belgium
| | - Nico Vandaele
- KU Leuven, Access-To-Medicines research Center, Naamsestraat 69, Leuven, Belgium
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24
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Bentley SD, Lo SW. Global genomic pathogen surveillance to inform vaccine strategies: a decade-long expedition in pneumococcal genomics. Genome Med 2021; 13:84. [PMID: 34001237 PMCID: PMC8130287 DOI: 10.1186/s13073-021-00901-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 04/30/2021] [Indexed: 11/10/2022] Open
Abstract
Vaccines are powerful agents in infectious disease prevention but often designed to protect against some strains that are most likely to spread and cause diseases. Most vaccines do not succeed in eradicating the pathogen and thus allow the potential emergence of vaccine evading strains. As with most evolutionary processes, being able to capture all variations across the entire genome gives us the best chance of monitoring and understanding the processes of vaccine evasion. Genomics is being widely adopted as the optimum approach for pathogen surveillance with the potential for early and precise identification of high-risk strains. Given sufficient longitudinal data, genomics also has the potential to forecast the emergence of such strains enabling immediate or pre-emptive intervention. In this review, we consider the strengths and challenges for pathogen genomic surveillance using the experience of the Global Pneumococcal Sequencing (GPS) project as an early example. We highlight the multifaceted nature of genome data and recent advances in genome-based tools to extract useful information relevant to inform vaccine strategies and treatment options. We conclude with future perspectives for genomic pathogen surveillance.
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Affiliation(s)
- Stephen D Bentley
- Parasites and Microbes, Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, UK.
| | - Stephanie W Lo
- Parasites and Microbes, Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, UK
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25
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Polkowska A, Rinta-Kokko H, Toropainen M, Palmu AA, Nuorti JP. Long-term population effects of infant 10-valent pneumococcal conjugate vaccination on pneumococcal meningitis in Finland. Vaccine 2021; 39:3216-3224. [PMID: 33934915 DOI: 10.1016/j.vaccine.2021.02.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 02/11/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND No previous studies have reported long-term follow-up of ten-valent pneumococcal conjugate vaccine (PCV10) program impact on pneumococcal meningitis (PM). We assessed the effects of infant PCV10 program on PM incidence, mortality and serotype distribution in children and adults during 7 years after introduction. METHODS We conducted a population-based observational study. A case of PM was defined as isolation of Streptococcus pneumoniae from cerebrospinal fluid or, a patient with S. pneumoniae isolated from blood and an ICD-10 hospital discharge diagnosis of bacterial meningitis within 30 days before or after positive culture date.We compared age- and serotype-specific incidence and associated 30-day mortality rates in 2011-2017 (PCV10 period) with those in 2004-2010 (pre-PCV10 baseline) by using Poisson regression models. Absolute rate differences and 95% confidence intervals (CIs) were calculated from the parameter estimates by using delta method. RESULTS During the PCV10 period, the overall incidence of PCV10 serotype meningitis decreased by 68% (95%CI 57%-77%), and the overall PM incidence by 27% (95%CI: 12%-39%). In age groups 0-4, 50-64, and ≥ 18 years, the overall PM incidence was reduced by 64%, 34% and 19%, respectively. In adults ≥ 65 years of age, a 69% reduction in PCV10 serotypes was offset by 157% (56%-342%) increase in non-PCV10 serotypes. The overall PM-related mortality rate decreased by 42% (95%CI 4%-65%). Overall case fatality proportion (CFP) was 16% in pre-PCV10 period and 12% in PCV10 period (p = 0.41); among persons 50-64 years the CFP decreased from 25% to 10% (p = 0.04). CONCLUSIONS We observed substantial impact and herd protection for vaccine-serotype PM and associated mortality after infant PCV10 introduction. However, in older adults ≥ 65 years of age, PM burden remains unchanged due to serotype replacement.
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Affiliation(s)
- Aleksandra Polkowska
- Health Sciences Unit, Faculty of Social Sciences, Tampere University, Arvo Ylpön katu 34, 33520 Tampere, Finland.
| | - Hanna Rinta-Kokko
- Public Health Evaluation and Projection Unit, Department of Public Health Solutions, Finnish Institute for Health and Welfare (THL), Mannerheimintie 166, Helsinki, Finland.
| | - Maija Toropainen
- Infectious Diseases and Vaccinations Unit, Department of Health Security, Finnish Institute for Health and Welfare (THL), Mannerheimintie 166, Helsinki, Finland.
| | - Arto A Palmu
- Public Health Evaluation and Projection Unit, Department of Public Health Solutions, Finnish Institute for Health and Welfare (THL), Mannerheimintie 166, Helsinki, Finland.
| | - J Pekka Nuorti
- Health Sciences Unit, Faculty of Social Sciences, Tampere University, Arvo Ylpön katu 34, 33520 Tampere, Finland; Infectious Diseases and Vaccinations Unit, Department of Health Security, Finnish Institute for Health and Welfare (THL), Mannerheimintie 166, Helsinki, Finland.
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26
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Constrained Optimization for Pneumococcal Vaccination in Brazil. Value Health Reg Issues 2021; 26:40-49. [PMID: 33848895 DOI: 10.1016/j.vhri.2020.11.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 10/02/2020] [Accepted: 11/12/2020] [Indexed: 01/17/2023]
Abstract
OBJECTIVES To identify the most cost-efficient combination of pneumococcal vaccines in infants and aging adults for a 10-year period in Brazil. METHODS Constrained optimization (CO) prioritized 9 pneumococcal vaccine regimens according to their gain in quality-adjusted life-years (QALYs) and their related costs over a prespecified time horizon with defined constraints for 2 age groups, infants and aging adults. The analysis starts from the current universal infant vaccination of pneumococcal non-typeable Haemophilus influenzae protein D conjugate vaccine (PHiD-CV), 2 primary and 1 booster dose at 2, 4, and 12 months, respectively. Key constraints are the fixed annual vaccine budget increase and the relative return on investment (ROIR) per regimen, which must be > 1, the reference intervention being the current vaccination strategy in infants and the most cost-efficient one in aging adults. RESULTS The CO analysis including all the constraints indicates that over 10 years the maximum extra health gain is 126 194 QALYs for an extra budget of $974 million Brazilian reals (ROIR = 1.15). Results could be improved with a higher proportion of the at-risk population in aging adults, less herd effect, and better QALY scores. CONCLUSION The study shows that with 4 constraints on budget, time horizon, vaccine coverage, and cost efficiency, a CO analysis could identify the most cost-efficient overall pneumococcal vaccination strategy for Brazil, allowing for limited vaccine budget increase while obtaining appropriate health gain.
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Wang BC, Chaiyakunapruk N, Zhu S, Babigumira JB, Furnback W, Chitale R, Gamil A, Zhao K, Wasserman M. A systematic literature review of economic evaluations of pneumococcal conjugate vaccines in east and southeast Asia (2006-2019). Expert Rev Vaccines 2021; 21:885-898. [PMID: 33682584 DOI: 10.1080/14760584.2021.1894933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Pneumococcal infections can lead to serious invasive diseases such as meningitis, septicemia and pneumonia, as well as milder but more common illnesses such as sinusitis and otitis media. The World Health Organization (WHO) recommends the inclusion of pneumococcal conjugate vaccines (PCVs) in infant National Immunization Program (NIP) programs worldwide. Decision-makers in Asian countries planning to introduce PCVs in their respective NIP will need a comprehensive evidence of effectiveness of PCVs at the population level and economic evidence including cost-effectiveness. AREAS COVERED A systematic literature review (from 1/1/2016 to 10/11/2019) of PCVs in East and Southeast Asia to understand (1) the contributing factors to cost-effectiveness results of PCVs and (2) whether gaps in evidence exist suggesting why the region may have yet to implement full NIPs. EXPERT OPINION In East and Southeast Asia, vaccination with PCVs was found to significantly reduce the mortality and morbidity of pneumococcal diseases and was cost-effective compared to no vaccination. Study assumptions, specifically vaccine local acquisition, the inclusion or exclusion of indirect effects (serotype replacement and herd effect), cross-protection, and protection against nontypeable haemophilus influenzae and serotype 3, were the main drivers of cost-effectiveness.
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Affiliation(s)
- Bruce Cm Wang
- Health Economics and Real World Evidence , Elysia Group, LLC, New York, NY, USA
| | | | - Shuiqing Zhu
- Health Economics and Outcomes Research, Pfizer Investment Co. Ltd, Shanghai, China
| | | | - Wesley Furnback
- Health Economics and Real World Evidence , Elysia Group, LLC, New York, NY, USA
| | - Ramaa Chitale
- Health Economics and Outcomes Research, Pfizer Inc, New York, NY, USA
| | - Amgad Gamil
- Medical and Scientific Affairs, Pfizer Inc, Singapore
| | - Kun Zhao
- Health Technology Assessment, China National Health Development Research Center, National Health Commission of the People's Republic of China
| | - Matt Wasserman
- Health Economics and Outcomes Research, Pfizer Inc, New York, NY, USA
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Guzman-Holst A, de Barros E, Rubio P, DeAntonio R, Cintra O, Abreu A. Impact after 10-year use of pneumococcal conjugate vaccine in the Brazilian national immunization program: an updated systematic literature review from 2015 to 2020. Hum Vaccin Immunother 2021; 18:1879578. [PMID: 33735585 PMCID: PMC8920160 DOI: 10.1080/21645515.2021.1879578] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
In 2010, a 10-valent pneumococcal non-typeable Haemophilus influenzae protein D conjugate vaccine (PHiD-CV) was introduced in the Brazilian national immunization program; the 3 + 1 dose schedule was replaced by a 2 + 1 dose schedule in 2016. This systematic review presents the latest published evidence (2015–2020) on the impact after 10-year use of PHiD-CV in Brazil from a total of 29 publications. Overall, the PHiD-CV program had a positive impact on the morbidity and mortality associated with invasive pneumococcal disease (IPD), pneumonia and acute otitis media (AOM) in children <5 years-old. A reduction in the vaccine-type invasive disease was observed in all-ages; suggesting indirect protection unvaccinated older children and adults. The occurrence of non-vaccine type disease was evidenced in some studies. Higher vaccination coverage is required at national and state level for sustained population impact. Given the change in the vaccination schedule and the dynamics of pneumococcal disease epidemiology, continuous surveillance is warranted. GSK Study identifier: HO-18-19438
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Affiliation(s)
| | | | | | - Rodrigo DeAntonio
- Centro de Vacunación Internacional S.A. CEVAXIN, Panama City, Panama
| | | | - Ariane Abreu
- Instituto Nacional de Cardiologia, Rio de Janeiro, Brasil
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Dynamics of antimicrobial resistance of Streptococcus pneumoniae following PCV10 introduction in Brazil: Nationwide surveillance from 2007 to 2019. Vaccine 2021; 39:3207-3215. [PMID: 33707062 DOI: 10.1016/j.vaccine.2021.02.063] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 02/22/2021] [Accepted: 02/25/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Brazil introduced 10-valent pneumococcal conjugate vaccine (PCV10) into its immunization program in 2010. We assessed antimicrobial susceptibility of Streptococcus pneumoniae (Spn) obtained from a national surveillance system for invasive pneumococcal diseases (IPD) before/after PCV10 introduction. METHODS Antimicrobial non-susceptible isolates were defined as intermediate or resistant. Minimum inhibitory concentrations (MICs) to penicillin and ceftriaxone were analyzed by year. Antimicrobial susceptibility rates were assessed for each three-year-period using the pre-PCV10-period as reference. Susceptibility of vaccine-types was evaluated for 2017-2019. RESULTS 11,380 isolates were studied. Spn with penicillin ≥ 0.125 mg/L and ceftriaxone ≥ 1.0 mg/L decreased in the three-years after PCV10 introduction (2011-2013: penicillin, 28.1-22.5%; ceftriaxone, 11.3%-7.6%) versus pre-PCV10-years (2007-2009: penicillin, 33.8-38.1%; ceftriaxone, 17.2%-15.6%). After 2013, the proportion of Spn with those MICs to penicillin and ceftriaxone increased to 39.4% and 19.7% in 2019, respectively. Non-susceptibility to penicillin and ceftriaxone increased in 2014-2016, and again in 2017-2019 especially among children < 5 years with meningitis (penicillin, 53.9%; ceftriaxone, 28.0%); multidrug-resistance reached 25% in 2017-2019. Serotypes 19A, 6C and 23A were most associated with antimicrobial non-susceptibility. CONCLUSIONS Antimicrobial non-susceptible Spn decreased in the three-years after vaccination but subsequently increased and was associated with non-PCV10-types. Antimicrobial susceptibility surveillance is fundamental for guiding antibiotic therapy policies.
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Severiche-Bueno DF, Severiche-Bueno DF, Bastidas A, Caceres EL, Silva E, Lozada J, Gomez S, Vargas H, Viasus D, Reyes LF. Burden of invasive pneumococcal disease (IPD) over a 10-year period in Bogotá, Colombia. Int J Infect Dis 2021; 105:32-39. [PMID: 33582374 DOI: 10.1016/j.ijid.2021.02.031] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 01/27/2021] [Accepted: 02/06/2021] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Invasive pneumococcal disease (IPD) is the leading cause of infectious death worldwide. This study aimed to describe the epidemiology of IPD and the impact of pneumococcal conjugate vaccine-10 (PCV-10) over a 10-year period in Bogotá, Colombia. METHODS This was a laboratory-based surveillance study of Streptococcus pneumoniae isolated from patients with IPD from 82 hospitals over 10 years in Bogotá, Colombia. Data were compared between two periods: 2007-2011 (before the introduction of PCV-10) and 2012-2017 (after the introduction of PCV-10). RESULTS In total, 1670 patients with IPD were included in the study between 2007 and 2017. Between 2007 and 2011, the most common serotypes were 14, 1, 6B, 6A and 3. Between 2012 and 2017, the most common serotypes were 19A, 3, 14 and 1. A decrease in the incidence of IPD, particularly in children aged 0-4 years, was noted after the introduction of PCV-10. Importantly, this reduction in incidence was not observed in patients aged ≥50 years. CONCLUSIONS The IPD burden in Bogotá remained stable between 2007 and 2017. The incidence of IPD decreased in children but not in older adults. The introduction of PCV-10 led to a change in the most prevalent serotypes to serotypes that are not included in PCV-10.
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Affiliation(s)
| | | | - Alirio Bastidas
- Universidad de la Sabana, Chía, Colombia; Clínica Universidad de La Sabana, Chía, Colombia
| | | | | | | | - Sandra Gomez
- Grupo Laboratorio de Salud Pública de Bogotá, Secretaria de Salud de Bogotá, Bogotá, Colombia
| | - Hernán Vargas
- Grupo Laboratorio de Salud Pública de Bogotá, Secretaria de Salud de Bogotá, Bogotá, Colombia
| | | | - Luis F Reyes
- Universidad de la Sabana, Chía, Colombia; Clínica Universidad de La Sabana, Chía, Colombia.
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Liu Y, Li W, Dong Q, Chen M, Li W, Wang X, Fu J, Ye X. Non-linear relationships between children age and pneumococcal vaccine coverage: Important implications for vaccine prevention strategies. Vaccine 2021; 39:1392-1401. [PMID: 33531198 DOI: 10.1016/j.vaccine.2021.01.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 01/04/2021] [Accepted: 01/20/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Streptococcus pneumoniae (S. pneumoniae) is an important pathogen causing both invasive and non-invasive infections in children, with significant morbidity and mortality worldwide. This study aimed to determine the potential relationships between age and vaccine coverage and between multiple phenotype-genotype characteristics of S. pneumoniae isolated from children. METHODS All S. pneumoniae isolates were tested for antimicrobial susceptibility, virulence genes, serotypes, and sequence types. The restricted cubic spline models were used to reveal potential relationships between children age and pneumococcal vaccine coverage. RESULTS For capsular-based vaccines, we observed a high coverage rate of 13-valent pneumococcal conjugate vaccine (PCV13, 85.8%) and a significantly non-linear relationship between children age and vaccine coverage (including PCV7, PCV10, and PCV13), with marked fluctuations in children aged < 2 years. For protein-based and pilus-based vaccine candidates, we demonstrated dynamic non-linear relationships between age and vaccine coverage, maintaining a stable and high coverage rate of ply and lytA for all age groups. Moreover, there were significantly high-dimensional corresponding relationships among multiple phenotype-genotype characteristics of S. pneumoniae isolates (such as ST271 associated with serotype 19F, PI-2, and extensively drug-resistance). CONCLUSIONS Our findings suggest that the age for high PCV coverage being children aged ≥ 2 years and also provide important evidence for supporting ply and lytA as priority candidate targets for the development of new-generation protein vaccines.
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Affiliation(s)
- Yanling Liu
- School of Public Health, Guangdong Pharmaceutical University, Guangzhou, China
| | - Wenhui Li
- School of Public Health, Guangdong Pharmaceutical University, Guangzhou, China
| | - Qian Dong
- School of Public Health, Guangdong Pharmaceutical University, Guangzhou, China
| | - Minqi Chen
- School of Public Health, Guangdong Pharmaceutical University, Guangzhou, China
| | - Wenyu Li
- School of Public Health, Guangdong Pharmaceutical University, Guangzhou, China
| | - Xulin Wang
- School of Public Health, Guangdong Pharmaceutical University, Guangzhou, China
| | - Jinjian Fu
- Department of Prevention and Health Care, Liuzhou Maternity and Child Health Care Hospital, Liuzhou, China.
| | - Xiaohua Ye
- School of Public Health, Guangdong Pharmaceutical University, Guangzhou, China.
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Agudelo CI, Castañeda-Orjuela C, Brandileone MCDC, Echániz-Aviles G, Almeida SCG, Carnalla-Barajas MN, Regueira M, Fossati S, Alarcón P, Araya P, Duarte C, Sánchez J, Novas M, Toraño-Peraza G, Rodríguez-Ortega M, Chamorro-Cortesi G, Kawabata A, García-Gabarrot G, Camou T, Spadola E, Payares D, Andrade AL, Di Fabio JL, Castañeda E. The direct effect of pneumococcal conjugate vaccines on invasive pneumococcal disease in children in the Latin American and Caribbean region (SIREVA 2006-17): a multicentre, retrospective observational study. THE LANCET. INFECTIOUS DISEASES 2020; 21:405-417. [PMID: 32986996 DOI: 10.1016/s1473-3099(20)30489-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 04/02/2020] [Accepted: 04/24/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Streptococcus pneumoniae isolated from patients with invasive pneumococcal disease has been subjected to laboratory-based surveillance in Latin American and Caribbean countries since 1993. Invasive pneumococcal diseases remain a major cause of death and disability worldwide, particularly in children. We therefore aimed to assess the direct effect of pneumococcal conjugate vaccines (PCVs) on the distribution of pneumococcal serotypes causing invasive pneumococcal disease in children younger than 5 years before and after PCV introduction. METHODS We did a multicentre, retrospective observational study in eight countries that had introduced PCV (ie, PCV countries) in the Latin American and Caribbean region: Argentina, Brazil, Chile, Colombia, Dominican Republic, Mexico, Paraguay, and Uruguay. Cuba and Venezuela were also included as non-PCV countries. Isolate data for Streptococcus pneumoniae were obtained between 2006 and 2017 from children younger than 5 years with an invasive pneumococcal disease from local laboratories or hospitals. Species' confirmation and capsular serotyping were done by the respective national reference laboratories. Databases from the Sistema Regional de Vacunas (SIREVA) participating countries were managed and cleaned in a unified database using Microsoft Excel 2016 and the program R (version 3.6.1). Analysis involved percentage change in vaccine serotypes between pre-PCV and post-PCV periods and the annual reporting rate of invasive pneumococcal diseases per 100 000 children younger than 5 years, which was used as a population reference to calculate percentage vaccine type reduction. FINDINGS Between 2006 and 2017, 12 269 isolates of invasive pneumococcal disease were collected from children younger than 5 years in the ten Latin American and Caribbean countries. The ten serotypes included in ten-valent pneumococcal conjugate vaccine (PCV10) decreased significantly (p<0·0001) after any PCV introduction, except for the Dominican Republic. The percentage change for the ten vaccine serotypes in PCV10 countries was -91·6% in Brazil (530 [72·9%] of 727 before, 27 [6·1%] of 441 after); -85·0% in Chile (613 [72·6%] of 844 before, 44 [10·9%] of 404] after); -84·7% in Colombia (231 [63·1%] of 366 before, 34 [9·7%] of 352 after); and -73·8% in Paraguay (127 [77·0%] of 165 before, 22 [20·2%] of 109 after). In the 13-valent pneumococcal conjugate vaccine (PCV13) countries, the percentage change for the 13 vaccine serotypes was -59·6% in Argentina (853 [85·0%] of 1003 before, 149 [34·3%] of 434 after); -16·5% in the Dominican Republic (95 [80·5%] of 118 before, 39 [67·2%] of 58 after); -43·7% in Mexico (202 [73·2%] of 276 before, 63 [41·2%] of 153 after); and -45·9% in Uruguay (138 [80·7%] of 171 before, 38 [43·7%] of 87 after). Annual reporting rates showed a reduction from -82·5% (6·21 before vs 1·09 after per 100 000, 95% CI -61·6 to -92·0) to -94·7% (1·15 vs 0·06 per 100 000, -89·7 to -97·3) for PCV10 countries, and -58·8% (2·98 vs 1·23 per 100 000, -21·4 to -78·4) to -82·9% (7·80 vs 1·33 per 100 000, -76·9 to -87·4) for PCV13 countries. An increase in the amount of non-vaccine types was observed in the eight countries after PCV introduction together with an increase in their percentage in relation to total invasive strains in the post-PCV period. INTERPRETATION SIREVA laboratory surveillance was able to confirm the effect of PCV vaccine on serotypes causing invasive pneumococcal disease in the eight PCV countries. Improved monitoring of the effect and trends in vaccine type as well as in non-vaccine type isolates is needed, as this information will be relevant for future decisions associated with new PCVs. FUNDING None. TRANSLATIONS For the Portuguese and Spanish translations of the abstract see Supplementary Materials section.
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Affiliation(s)
| | | | | | - Gabriela Echániz-Aviles
- Centro de Investigaciones Sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, Mexico
| | | | - María Noemí Carnalla-Barajas
- Centro de Investigaciones Sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, Mexico
| | - Mabel Regueira
- Departamento Bacteriología, INEI-ANLIS Dr Carlos G Malbrán, Buenos Aires, Argentina
| | - Sofia Fossati
- Departamento Bacteriología, INEI-ANLIS Dr Carlos G Malbrán, Buenos Aires, Argentina
| | - Pedro Alarcón
- Sección Bacteriología, Instituto de Salud Pública de Chile, Santiago, Chile
| | - Pamela Araya
- Sección Bacteriología, Instituto de Salud Pública de Chile, Santiago, Chile
| | - Carolina Duarte
- Grupo de Microbiología, Instituto Nacional de Salud, Bogotá, Colombia
| | - Jacqueline Sánchez
- Laboratorio de Microbiología-DEI, Hospital Infantil Dr Robert Reid Cabral, Santo Domingo, Dominican Republic
| | - Mirna Novas
- Laboratorio de Microbiología-DEI, Hospital Infantil Dr Robert Reid Cabral, Santo Domingo, Dominican Republic
| | - Gilda Toraño-Peraza
- Departamento de Bacteriología y Micología, Instituto Pedro Kouri, La Habana, Cuba
| | | | - Gustavo Chamorro-Cortesi
- Departamento de Bacteriología y Micología, Laboratorio Central de Salud Pública, Asunción, Paraguay
| | - Anibal Kawabata
- Departamento de Bacteriología y Micología, Laboratorio Central de Salud Pública, Asunción, Paraguay
| | | | - Teresa Camou
- Departamento de Laboratorios, Ministerio de Salud, Montevideo, Uruguay
| | - Enza Spadola
- Sección de Aislamiento e Identificación Bacteriana, Instituto Nacional de Higiene Rafael Rangel, Caracas, Venezuela
| | - Daisy Payares
- Sección de Aislamiento e Identificación Bacteriana, Instituto Nacional de Higiene Rafael Rangel, Caracas, Venezuela
| | - Ana Lucía Andrade
- Instituto de Patología Tropical e Saúde Pública, Universidade Federal de Goias, Goiania, Goias, Brazil
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Perdrizet J, Santana CFS, Senna T, Alexandre RF, Sini de Almeida R, Spinardi J, Wasserman M. Cost-effectiveness analysis of replacing the 10-valent pneumococcal conjugate vaccine (PCV10) with the 13-valent pneumococcal conjugate vaccine (PCV13) in Brazil infants. Hum Vaccin Immunother 2020; 17:1162-1172. [PMID: 32966176 PMCID: PMC8018448 DOI: 10.1080/21645515.2020.1809266] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Brazil currently has a 10-valent pneumococcal conjugate vaccine (PCV10) pediatric national immunization program (NIP). However, in recent years, there has been significant progressive increases in pneumococcal disease attributed to serotypes 3, 6A, and 19A, which are covered by the 13-valent PCV (PCV13). We sought to evaluate the cost-effectiveness and budget impact of switching from PCV10 to PCV13 for Brazilian infants from a payer perspective. A decision-analytic model was adapted to evaluate the clinical and economic outcomes of continuing PCV10 or switching to PCV13. The analysis estimated future costs ($BRL), quality-adjusted life-years (QALYs), and health outcomes for PCV10 and PCV13 over 5 y. Input parameters were from published sources. Future serotype dynamics were predicted using Brazilian and global historical trends. Over 5 y, PCV13 could prevent 12,342 bacteremia, 15,330 meningitis, 170,191 hospitalized pneumonia, and 25,872 otitis media cases, avert 13,709 pneumococcal disease deaths, gain 20,317 QALYs, and save 172 million direct costs compared with PCV10. The use of PCV13 in the Brazilian NIP could reduce pneumococcal disease, improve population health, and save substantial health-care costs. Results are reliable even when considering uncertainty for possible serotype dynamics with different underlying assumptions.
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Affiliation(s)
- Johnna Perdrizet
- Health Economics and Outcomes Research, Pfizer Inc, New York, NY, USA
| | | | - Thais Senna
- Health Economics and Outcomes Research, Pfizer Inc, Sao Paulo, Brazil
| | | | | | - Julia Spinardi
- Medical and Scientific Affairs, Pfizer Inc, Sao Paulo, Brazil
| | - Matt Wasserman
- Health Economics and Outcomes Research, Pfizer Inc, New York, NY, USA
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Camacho Moreno G, Imbachi LF, Leal AL, Moreno VM, Patiño JA, Gutiérrez IF, Beltrán S, Álvarez-Olmos MI, Mariño C, Barrero R, Espinosa F, Ramos N, Castellar LP, Sánchez N, Montañez A. Emergence of Streptococcus pneumoniae serotype 19A (Spn19A) in the pediatric population in Bogotá, Colombia as the main cause of invasive pneumococcal disease after the introduction of PCV10. Hum Vaccin Immunother 2020; 16:2300-2306. [PMID: 32078398 PMCID: PMC7553689 DOI: 10.1080/21645515.2019.1710411] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 12/08/2019] [Accepted: 12/24/2019] [Indexed: 11/25/2022] Open
Abstract
Introduction: With the use of pneumococcal conjugate vaccines(PCV), the behavior of invasive pneumococcal disease(IPD) has changed relative to serotype distribution. The introduction of these vaccines in national immunization programs has reduced the incidence of IPD, with a marked decrease in the circulation of the serotypes included in the vaccine used in each country. However, the subsequent emergence of other serotypes not included in the vaccine, such 19A in case of PCV7 and PCV10, has been documented. Materials and methods: This was case series study (2008-2017) in pediatric patients admitted to 10 hospitals in Bogota who were diagnosed with IPD. It was conducted during the transitional period of implementing the PCV10 vaccine in Colombia in 2012. Cases of bacteremic pneumococcal pneumonia, meningitis, primary bacteremia and osteoarticular infection were included. A descriptive analysis of the demographic, clinical and laboratory variables of patients with IPD by Spn19A, its trend over time, profiles of antimicrobial susceptibility and clinical outcomes was performed. Results: There were 463 cases of IPD, 315(68%) with known serotypes. The prevalence of IPD by Spn19A was 17.7%(56 cases), tending to increase over time. During 2008-2011, the prevalence was 4.4%, and during 2014-2017, it was 32.4%, The most frequent diagnosis was pneumonia(80.4%). In nonmeningeal isolates, 39.6% were not susceptible to penicillin. An increase in the resistance was observed over time. Conclusion: Spn19A is a prevalent cause of IPD in the pediatric population of the analyzed cohort, with an increasing trend of this serotype during the surveillance period after the introduction of PCV10, being the most common serotype identified in recent years.
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Affiliation(s)
- Germán Camacho Moreno
- Universidad Nacional de Colombia, Bogotá, Colombia
- Fundación HOMI – Hospital Pediátrico de la Misericordia, Bogotá, Colombia
- Red Neumocolombia, Bogotá, Colombia
- Hospital Universitario Infantil San José, Bogotá, Colombia
| | - Luisa F. Imbachi
- Universidad Nacional de Colombia, Bogotá, Colombia
- Red Neumocolombia, Bogotá, Colombia
| | - Aura L. Leal
- Universidad Nacional de Colombia, Bogotá, Colombia
- Red Neumocolombia, Bogotá, Colombia
| | | | | | - Iván F. Gutiérrez
- Red Neumocolombia, Bogotá, Colombia
- Clínica Infantil Colsubsidio, Bogotá, Colombia
| | - Sandra Beltrán
- Red Neumocolombia, Bogotá, Colombia
- Clínica Universitaria Colombia-Clínica Pediátrica Colsanitas, Bogotá, Colombia
| | | | - Cristina Mariño
- Red Neumocolombia, Bogotá, Colombia
- Hospital Militar Central, Bogotá, Colombia
| | - Rocío Barrero
- Red Neumocolombia, Bogotá, Colombia
- Hospital Universitario Clínica San Rafael, Bogotá, Colombia
- Unidad de Servicios de Salud Santa Clara, Subred Centro Oriente, Bogotá, Colombia
- Hospital el Tunal, Bogotá, Colombia
| | - Fabio Espinosa
- Red Neumocolombia, Bogotá, Colombia
- Hospital Universitario Infantil San José, Bogotá, Colombia
| | - Nicolás Ramos
- Red Neumocolombia, Bogotá, Colombia
- Clínica el Bosque, Bogotá, Colombia
| | - Liliana P. Castellar
- Fundación HOMI – Hospital Pediátrico de la Misericordia, Bogotá, Colombia
- Red Neumocolombia, Bogotá, Colombia
| | - Nella Sánchez
- Red Neumocolombia, Bogotá, Colombia
- Unidad de Servicios de Salud Santa Clara, Subred Centro Oriente, Bogotá, Colombia
| | - Anita Montañez
- Universidad Nacional de Colombia, Bogotá, Colombia
- Red Neumocolombia, Bogotá, Colombia
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Di Fabio JL, Agudelo CI, Castañeda E. [Regional System for Vaccines (SIREVA), laboratory surveillance and vaccine development for Streptococcus pneumoniae: bibliometric analysis, 1993-2019]. Rev Panam Salud Publica 2020; 44:e80. [PMID: 32774349 PMCID: PMC7406127 DOI: 10.26633/rpsp.2020.80] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 05/14/2020] [Indexed: 01/30/2023] Open
Abstract
Objetivo. Medir a través del análisis bibliométrico la productividad, la visibilidad y el impacto del Sistema Regional de Vacunas (SIREVA, un proyecto de la Organización Panamericana de la Salud) en sus dos componentes, la vigilancia por laboratorio y el desarrollo de vacunas. Métodos. Se recuperaron de Scopus las publicaciones correspondientes a vigilancia por laboratorio y desarrollo de vacunas con sus referencias y citas y se aplicó la herramienta para obtener los indicadores bibliométricos. Se utilizó VOSviewer® 1.6.13 para visualizar las redes de coautoría por país y autores, y para realizar un análisis de coocurrencia de términos incluidos en los títulos y resúmenes de las publicaciones. Resultados. Cumplieron los criterios establecidos para vigilancia por laboratorio y desarrollo de vacunas 173 y 128 publicaciones, respectivamente. Diez países de la Región fueron responsables de 90,8% de las publicaciones sobre vigilancia por laboratorio y 8 países de todas las publicaciones sobre desarrollo de vacunas. Las diez publicaciones más citadas sobre vigilancia por laboratorio y sobre desarrollo de vacunas estaban incluidas en 855 y 503 artículos, respectivamente; los principales autores se encontraban en Alemania, Australia, Bélgica, Brasil, China, Estados Unidos de América y el Reino Unido. La construcción y visualización de redes por coautorías de autores y países, y la coocurrencia de términos mostraron el trabajo en red y la colaboración intrarregional, así como permitieron hacer seguimiento a las diversas áreas de estudio y su evolución en el tiempo. Conclusiones. El análisis bibliométrico permitió documentar de manera objetiva la productividad y visibilidad del Sistema Regional de Vacunas para Streptococcus pneumoniae en la Región.
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Affiliation(s)
- José Luis Di Fabio
- Consultor independiente Washington D.C. Estados Unidos de América Consultor independiente, Washington D.C., Estados Unidos de América
| | - Clara Inés Agudelo
- Instituto Nacional de Salud Bogotá Colombia Instituto Nacional de Salud, Bogotá, Colombia
| | - Elizabeth Castañeda
- Instituto Nacional de Salud Bogotá Colombia Instituto Nacional de Salud, Bogotá, Colombia
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Abstract
PURPOSE OF REVIEW This review highlights the recent impacts of vaccines against the major bacterial causes of meningitis in children, and the challenges for further prevention of bacterial meningitis, with a focus on Streptococcus pneumoniae, Neisseria meningitidis and group B Streptococcus. RECENT FINDINGS Conjugate vaccines against S. pneumoniae and N. meningitidis have resulted in dramatic reductions in bacterial meningitis globally where they have been used. Recent licensure and use of capsular group B meningococcal protein vaccines have further reduced meningococcal meningitis in infants, young children and adolescents for countries with endemic disease and during outbreaks. SUMMARY Existing vaccines to prevent bacterial meningitis in children should be utilized in countries with significant numbers of cases of pneumococcal and/or meningococcal meningitis. Vaccines, which are able to protect against more than 13 serotypes of S. pneumoniae are in clinical trials and should be able to further reduce pneumococcal meningitis cases. Cost effective meningococcal vaccines against non-A capsular groups are needed for low-resource countries. There remains an urgent need for a vaccine against group B Streptococcus, which is a major cause of neonatal meningitis globally and for which no vaccine currently exists.
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Desmet S, Lagrou K, Wyndham-Thomas C, Braeye T, Verhaegen J, Maes P, Fieuws S, Peetermans WE, Blumental S. Dynamic changes in paediatric invasive pneumococcal disease after sequential switches of conjugate vaccine in Belgium: a national retrospective observational study. THE LANCET. INFECTIOUS DISEASES 2020; 21:127-136. [PMID: 32702303 DOI: 10.1016/s1473-3099(20)30173-0] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 02/16/2020] [Accepted: 03/04/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Ten-valent and 13-valent pneumococcal conjugate vaccines (PCVs) have shown important benefits by decreasing invasive pneumococcal disease caused by vaccine serotypes. Belgium had an uncommon situation with sequential use of PCV7, PCV13, and PCV10 in the childhood vaccination programmes between 2007 and 2018. We aimed to analyse the changes in incidence of invasive pneumococcal disease and serotype distribution in children throughout this period. METHODS Streptococcus pneumoniae isolates were obtained from patients with invasive pneumococcal disease in Belgium between 2007 and 2018 by the national laboratory-based surveillance. Paediatric invasive pneumococcal disease incidence, serotype distribution, and antimicrobial susceptibility were analysed in periods during which PCV7 (2009-10), PCV13 (2013-14), both PCV13 and PCV10 (2015-16), and PCV10 (2017-18) were used. Incidence rates and trends were compared. Vaccination status was collected. For a subset of serotype 19A isolates, multilocus sequence type was identified. FINDINGS After a decrease in PCV7 serotype invasive pneumococcal disease was observed during the PCV7 period, total paediatric invasive pneumococcal disease incidence significantly declined during the PCV13 period (-2·6% monthly, p<0·0001). During the PCV13-PCV10 period (2015-16), the lowest mean in paediatric invasive pneumococcal disease incidence was achieved, but the incidence increased again during the PCV10 period (2017-18), especially in children younger than 2 years (+1·7% monthly; p=0·028). This increase was mainly due to a significant rise in serotype 19A invasive pneumococcal disease incidence in the PCV10 period compared with the PCV13 period (p<0·0001), making serotype 19A the predominant serotype in paediatric invasive pneumococcal disease in the PCV10 period. Genetic diversity within the 2017-18 serotype 19A collection was seen, with two predominant clones, ST416 and ST994, that were infrequently observed before PCV10 introduction. In 2018, among children younger than 5 years with invasive pneumococcal disease who were correctly vaccinated, 37% (37 of 100) had PCV13 serotype invasive pneumococcal disease, all caused by serotype 19A and serotype 3. INTERPRETATION After a significant decrease during the PCV13 period, paediatric invasive pneumococcal disease incidence increased again during the PCV10 period. This observation mainly resulted from a significant increase of serotype 19A cases. During the PCV10 period, dominant serotype 19A clones differed from those detected during previous vaccine periods. Whether changes in epidemiology resulted from the vaccine switch or also from natural evolution remains to be further elucidated. FUNDING The Belgian National Reference is funded by the Belgian National Institute for Health and Disability Insurance and the whole genome sequencing by an investigator-initiated research grant from Pfizer.
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Affiliation(s)
- Stefanie Desmet
- National Reference Centre for Streptococcus pneumoniae, University Hospitals Leuven, Leuven, Belgium; Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium.
| | - Katrien Lagrou
- National Reference Centre for Streptococcus pneumoniae, University Hospitals Leuven, Leuven, Belgium; Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
| | | | - Toon Braeye
- Department Epidemiology of Infectious Diseases, Sciensano, Brussels, Belgium; Interuniversity Institute for Biostatistics and Statistical Bioinformatics, Hasselt University, Hasselt, Belgium
| | - Jan Verhaegen
- National Reference Centre for Streptococcus pneumoniae, University Hospitals Leuven, Leuven, Belgium; Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
| | - Piet Maes
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
| | - Steffen Fieuws
- Interuniversity Institute for Biostatistics and Statistical Bioinformatics, KU Leuven, University of Leuven and Universiteit Hasselt, Leuven, Belgium
| | - Willy E Peetermans
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
| | - Sophie Blumental
- Hôpital Universitaire des Enfants Reine Fabiola, Unité de Maladies Infectieuses Pédiatriques, Université Libre de Bruxelles, Brussels, Belgium
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Pugh S, Wasserman M, Moffatt M, Marques S, Reyes JM, Prieto VA, Reijnders D, Rozenbaum MH, Laine J, Åhman H, Farkouh R. Estimating the Impact of Switching from a Lower to Higher Valent Pneumococcal Conjugate Vaccine in Colombia, Finland, and The Netherlands: A Cost-Effectiveness Analysis. Infect Dis Ther 2020; 9:305-324. [PMID: 32096144 PMCID: PMC7237584 DOI: 10.1007/s40121-020-00287-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Widespread use of ten-valent (Synflorix™, GSK) or 13-valent (Prevenar 13™; Pfizer) conjugate vaccination programs has effectively reduced invasive pneumococcal disease (IPD) globally. However, IPD caused by serotypes not contained within the respective vaccines continues to increase, notably serotypes 3, 6A, and 19A in countries using lower-valent vaccines. Our objective was to estimate the clinical and economic benefit of replacing PCV10 with PCV13 in Colombia, Finland, and The Netherlands. METHODS Country-specific databases, supplemented with published and unpublished data, informed the historical incidence of pneumococcal disease as well as direct and indirect medical costs. A decision-analytic forecasting model was applied, and both costs and outcomes were discounted. The observed invasive pneumococcal disease (IPD) trends from each country were used to forecast the future number of IPD cases given a PCV13 or PCV10 program. RESULTS Over a 5-year time horizon, a switch to a PCV13 program was estimated to reduce overall IPD among 0-2 year olds by an incremental - 37.6% in Colombia, - 32.9% in Finland, and - 26% in The Netherlands, respectively, over PCV10. Adults > 65 years experienced a comparable incremental decrease in overall IPD in Colombia (- 32.2%), Finland (- 15%), and The Netherlands (- 3.7%). Serotypes 3, 6A, and 19A drove the incremental decrease in disease for PCV13 over PCV10 in both age groups. A PCV13 program was dominant in Colombia and Finland and cost-effective in The Netherlands at 1 × GDP per capita (€34,054/QALY). CONCLUSION In Colombia, Finland, and The Netherlands, countries with diverse epidemiologic and population distributions, switching from a PCV10 to PCV13 program would significantly reduce the burden of IPD in all three countries in as few as 5 years.
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Vyse A, Theilacker C, Sings H, Fletcher M. Pneumococcal immunization with conjugate vaccines – are 10-valent and 13-valent vaccines similar? Future Microbiol 2020; 15:575-577. [DOI: 10.2217/fmb-2019-0310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Andrew Vyse
- Vaccines Medical, Pfizer Limited, Walton Oaks, Surrey, UK
| | - Christian Theilacker
- Vaccines Medical Development & Scientific & Clinical Affairs, Pfizer Inc, Collegeville, PA 19426, USA
| | - Heather Sings
- Vaccines Medical Development & Scientific & Clinical Affairs, Pfizer Inc, Collegeville, PA 19426, USA
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Abstract
BACKGROUND Polysaccharide conjugate vaccines (PCVs) target the pneumococcal capsular types that most commonly cause fatal pneumonia and sepsis. Because these types were eliminated by the vaccines, it became apparent that in immunized populations, most invasive pneumococcal diseases, including bacteremia, sepsis and complicated pneumonia, were greatly reduced. However, the protective effects of PCVs against another invasive disease, meningitis, has shown much less or no decrease in disease incidence. METHODS References were identified through searches of PubMed for articles published from January 1930 to the present by use of specific search terms. Relevant articles were also identified through searches in Google and Google Scholar. Relevant references cited in those articles were also reviewed. RESULTS Even in the presence of the PCVs, meningitis rates in children have been reported globally to be as high as 13 per 100,000 annually. Widespread use of vaccines resulted in the emergence of a broad diversity of replacement non-PCV type strains. These strains generally failed to cause sepsis, but caused meningitis of comparable severity and levels similar to, or in excess of, prior pneumococcal meningitis rates. This is probably because these non-PCV type strains do not survive well in the blood, therefore possibly entering the brain through nonhematogenous routes. CONCLUSIONS Because virtually all cases of pneumococcal meningitis lead to either permanent neurologic sequelae or death, it would be well worth the effort to develop a new vaccine capable of preventing pneumococcal meningitis regardless of capsular type. Such a vaccine would need to protect against colonization with most, if not all, pneumococci.
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Affiliation(s)
| | - David E Briles
- Department of Microbiology and Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama
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Lower respiratory infections mortality among Brazilians under-five before and after national pneumococcal conjugate vaccine implementation. Vaccine 2020; 38:2559-2565. [DOI: 10.1016/j.vaccine.2020.01.084] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 01/23/2020] [Accepted: 01/28/2020] [Indexed: 11/17/2022]
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Berezin EN, Jarovsky D, Cardoso MRA, Mantese OC. Invasive pneumococcal disease among hospitalized children in Brazil before and after the introduction of a pneumococcal conjugate vaccine. Vaccine 2019; 38:1740-1745. [PMID: 31874778 DOI: 10.1016/j.vaccine.2019.12.038] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Revised: 09/10/2019] [Accepted: 12/16/2019] [Indexed: 01/23/2023]
Abstract
BACKGROUND Most of the available data on invasive pneumococcal disease in Latin America are derived from laboratory-based surveillance systems. There is a lack of epidemiological data on the disease severity and mortality from hospitalized patients with pneumococcal infection. METHODS In this hospital-based retrospective historical series of hospitalized children with laboratory-confirmed IPD, we evaluated changes in disease episodes, in-hospital fatality rates, and need for intensive care unit admission after the inclusion of PCV10 in the Brazilian vaccination schedule. Invasive pneumococcal strains isolated by culture were serotyped. Changes over time were assessed, and pre-vaccination (2005-2009) to post-vaccination (2011-2015) disease rates and serotypes were compared. RESULTS 260 patients with IPD and positive pneumococcal isolates were identified (198 during the pre-PCV10 period). When comparing both periods, hospitalizations were reduced from 20 cases to 5 cases per 10,000 pediatric admissions (p < 0.0001). Likewise, fatalities reduced from 6.6 to 2.0 cases per 10,000 pediatric admissions (p < 0.0001). Pneumonia was the most frequent clinical diagnosis (58%) - of which 49.6% had pleural effusion - followed by meningitis (22%) and bacteremia (15.9%). Overall 30% of cases were sent to ICU, with no percentual changes after PCV10. Additional PCV13 serotypes increased from 7% before vaccine introduction to 21% after PCV10 use. Similarly, serotypes not included in PCV13 increased from 11% to 29%. CONCLUSIONS There was a significant reduction in the hospitalizations rates, ICU admissions, and fatalities due to IPD after PCV10 introduction in Brazil. Cases due to PCV10 serotypes were reduced, while infections rates caused by non-PCV10 serotypes increased.
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Affiliation(s)
- Eitan Naaman Berezin
- Pediatric Infectious Diseases Unit, Santa Casa de São Paulo, Rua Dr. Cesário Mota Júnior 112, São Paulo, SP 01221-020, Brazil.
| | - Daniel Jarovsky
- Pediatric Infectious Diseases Unit, Santa Casa de São Paulo, Rua Dr. Cesário Mota Júnior 112, São Paulo, SP 01221-020, Brazil.
| | - Maria Regina Alves Cardoso
- Department of Epidemiology, School of Public Health, University of São Paulo, Avenida Dr. Arnaldo 715, São Paulo, SP 01246-904, Brazil.
| | - Orlando Cesar Mantese
- Department of Pediatrics, Universidade Federal de Uberlândia, Avenida Pará 1720, Uberlândia, MG 38405-320, Brazil
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Rivero-Calle I, Pardo Seco J, Raguindin PF, Alvez F, Gómez-Rial J, Salas A, Martinón Sanchez J, Martinón-Torres F. Routine infant vaccination of pneumococcal conjugate vaccines has decreased pneumonia across all age groups in Northern Spain. Hum Vaccin Immunother 2019; 16:1446-1453. [PMID: 31851569 DOI: 10.1080/21645515.2019.1690884] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Since the early 2000s, pneumococcal conjugate vaccines (PCVs) have been shown to be effective in the prevention of pneumonia and invasive pneumococcal diseases. In 2011, the Galician region incorporated PCV in the routine infant immunization, the very first stable program in Spain. We aim to assess direct and indirect benefits of PCV vaccination on all-cause pneumonia in the region across different age groups using an ecological study design. For this, we calculated the annual hospitalization rates using a hospital-based disease registry. We identified all-cause pneumonia, pneumococcal pneumonia and pneumococcal invasive diseases within the registry. Hospitalization rates were computed and compared across three study periods: pre-vaccination (1998-2003), early-vaccination (2005-2009) and routine-vaccination (2011-2015). Across Northern Spain, we identified 114,873 all-cause pneumonia hospitalizations, of which 24,808 were further diagnosed with pneumococcal pneumonia. The majority were elderly > 64 years (67.3%). Hospitalizations from all-cause pneumonia had a net increase from 20.6 (pre-PCV) and 21.4/10,000 (early) to 28.4/10,000 (routine) (+32.7%, p < .0001), this is attributed to the huge number of cases in the elderly age group. In contrast, a net reduction of incidence of hospitalized pneumococcal pneumonia was observed from 6.3/10,000 (pre-PCV) and 5.7/10,000 (early) to 2.4/10,000 (routine) cases (-57.9%, p < .0001). Thus, routine infant vaccination may have resulted to an overall decline of pneumococcal pneumonia in infants, as well as in elderly age groups. However, a paradoxical increase on all-cause pneumonia was observed in Galicia, mostly attributed to the growing number of cases in the elderly population.
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Affiliation(s)
- I Rivero-Calle
- Genetics, Vaccines and Pediatric Infectious Diseases Research Group (GENVIP), Hospital Clínico Universitario and Universidad de Santiago de Compostela (USC) , Galicia, Spain.,Translational Pediatrics and Infectious Diseases, Department of Pediatrics, Hospital Clínico Universitario de Santiago de Compostela , Galicia, Spain
| | - J Pardo Seco
- Genetics, Vaccines and Pediatric Infectious Diseases Research Group (GENVIP), Hospital Clínico Universitario and Universidad de Santiago de Compostela (USC) , Galicia, Spain
| | - P F Raguindin
- Genetics, Vaccines and Pediatric Infectious Diseases Research Group (GENVIP), Hospital Clínico Universitario and Universidad de Santiago de Compostela (USC) , Galicia, Spain
| | - F Alvez
- Genetics, Vaccines and Pediatric Infectious Diseases Research Group (GENVIP), Hospital Clínico Universitario and Universidad de Santiago de Compostela (USC) , Galicia, Spain
| | - J Gómez-Rial
- Genetics, Vaccines and Pediatric Infectious Diseases Research Group (GENVIP), Hospital Clínico Universitario and Universidad de Santiago de Compostela (USC) , Galicia, Spain
| | - A Salas
- Genetics, Vaccines and Pediatric Infectious Diseases Research Group (GENVIP), Hospital Clínico Universitario and Universidad de Santiago de Compostela (USC) , Galicia, Spain.,Unidad de Genética, Departamento de Anatomía Patológica y Ciencias Forenses, Instituto de Ciencias Forenses, Facultad de Medicina, Universidad de Santiago de Compostela, and GENPOB, Research Group, Instituto de Investigaciones Sanitarias (IDIS), Hospital Clínico Universitario de Santiago , Galicia, Spain
| | - J Martinón Sanchez
- Genetics, Vaccines and Pediatric Infectious Diseases Research Group (GENVIP), Hospital Clínico Universitario and Universidad de Santiago de Compostela (USC) , Galicia, Spain.,Translational Pediatrics and Infectious Diseases, Department of Pediatrics, Hospital Clínico Universitario de Santiago de Compostela , Galicia, Spain
| | - F Martinón-Torres
- Genetics, Vaccines and Pediatric Infectious Diseases Research Group (GENVIP), Hospital Clínico Universitario and Universidad de Santiago de Compostela (USC) , Galicia, Spain.,Translational Pediatrics and Infectious Diseases, Department of Pediatrics, Hospital Clínico Universitario de Santiago de Compostela , Galicia, Spain
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Immunization with proline rich region of pneumococcal surface protein A has no role in protection against Streptococcus pneumoniae serotype 19F. Microb Pathog 2019; 138:103761. [PMID: 31560974 DOI: 10.1016/j.micpath.2019.103761] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 09/21/2019] [Accepted: 09/24/2019] [Indexed: 11/20/2022]
Abstract
Pneumococcal surface protein A (PspA) is one of the major virulence factors expressed by almost all pneumococcal serotypes and was suggested to be a promising universal vaccine candidate for all pneumococcal sero-groups. Here, we expressed and purified the proline-rich region (PR) of PspA and tested it as a recombinant vaccine against infection caused by a clinical isolate (SP19) of Streptococcus pneumoniae serotype 19F. Our results showed that BALB/c mice immunized with recombinant proline-rich (rPR) region showed a significant higher antibody titre against rPR region compared to control non-immunized group. However, immunized mice or mice recived polyclonal antibodies against rPR region challenged via the intra-peritoneal route with a lethal dose of SP19 isolate showed no significant difference in survival compared to control non-immunized group. These results suggested that, immunization of BALB/c mice with rPR region of PspA is not protective against infection caused by serotype 19F in a mouse model.
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Zanella RC, Brandileone MCDC, Almeida SCG, de Lemos APS, Sacchi CT, Gonçalves CR, Gonçalves MG, Fukasawa LO, Saraiva MD, Rangel LF, Cunha JLL, Rotta TCA, Douradinho C, Jacob-Filho W, Minamisava R, Andrade AL. Nasopharyngeal carriage of Streptococcus pneumoniae, Haemophilus influenzae, and Staphylococcus aureus in a Brazilian elderly cohort. PLoS One 2019; 14:e0221525. [PMID: 31437226 PMCID: PMC6705818 DOI: 10.1371/journal.pone.0221525] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 08/08/2019] [Indexed: 11/19/2022] Open
Abstract
We aimed to investigate the nasopharyngeal colonization (NPC) by Streptococcus pneumoniae, Haemophilus influenzae, and Staphylococcus aureus in the elderly population and to assess the demographic factors associated with NPC. This was an observational cohort study in which outpatients aged ≥60 years were enrolled from April to August 2017, with a follow-up visit from September through December 2017. Nasopharyngeal (NP) swabs were collected, bacteria were detected and isolated, and isolates were subjected to phenotypic and molecular characterization using standard microbiological techniques. At enrolment, the rates of S. aureus, methicillin-resistant S. aureus (MRSA), H. influenzae, and S. pneumoniae among 776 elderly outpatients were 15.9%, 2.3%, 2.5%, and 2.2%, respectively. Toxin production was detected in 21.1% of methicillin-susceptible S. aureus, and three SCCmec types were identified: II/IIb, IVa, and VI. At the follow-up visit, all carriage rates were similar (p > 0.05) to the rates at enrolment. Most of S. pneumoniae serotypes were not included in pneumococcal conjugate vaccines (PCVs), except for 7F, 3, and 19A. All strains of H. influenzae were non-typeable. Previous use of antibiotics and 23-valent pneumococcal polysaccharide vaccination (p < 0.05) were risk factors for S. aureus and MRSA carriage; S. aureus colonization was also associated with chronic kidney disease (p = 0.021). S. pneumoniae carriage was associated with male gender (p = 0.032) and an absence of diabetes (p = 0.034), while not receiving an influenza vaccine (p = 0.049) and chronic obstructive pulmonary disease (p = 0.031) were risk factors for H. influenzae colonization. The frailty of study participants was not associated with colonization status. We found a higher S. aureus carriage rate compared with the S. pneumoniae- and H. influenzae-carriage rates in a well-attended population in a geriatric outpatient clinic. This is one of the few studies conducted in Brazil that can support future colonization studies among elderly individuals.
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Affiliation(s)
- Rosemeire Cobo Zanella
- National Laboratory for Meningitis and Pneumococcal Infections, Centre of Bacteriology, Institute Adolfo Lutz (IAL), São Paulo, Brazil
- * E-mail:
| | | | - Samanta Cristine Grassi Almeida
- National Laboratory for Meningitis and Pneumococcal Infections, Centre of Bacteriology, Institute Adolfo Lutz (IAL), São Paulo, Brazil
| | - Ana Paula Silva de Lemos
- National Laboratory for Meningitis and Pneumococcal Infections, Centre of Bacteriology, Institute Adolfo Lutz (IAL), São Paulo, Brazil
| | | | | | | | | | - Marcos Daniel Saraiva
- Medical Research Laboratory in Aging (LIM 66) of Geriatrics Division of the Clinics Hospital of the University of São Paulo Medical School (GDCH-USPMS), São Paulo, Brazil
| | - Luís Fernando Rangel
- Medical Research Laboratory in Aging (LIM 66) of Geriatrics Division of the Clinics Hospital of the University of São Paulo Medical School (GDCH-USPMS), São Paulo, Brazil
| | - Julia Lusis Lassance Cunha
- Medical Research Laboratory in Aging (LIM 66) of Geriatrics Division of the Clinics Hospital of the University of São Paulo Medical School (GDCH-USPMS), São Paulo, Brazil
| | - Thereza Cristina Ariza Rotta
- Medical Research Laboratory in Aging (LIM 66) of Geriatrics Division of the Clinics Hospital of the University of São Paulo Medical School (GDCH-USPMS), São Paulo, Brazil
| | - Christian Douradinho
- Medical Research Laboratory in Aging (LIM 66) of Geriatrics Division of the Clinics Hospital of the University of São Paulo Medical School (GDCH-USPMS), São Paulo, Brazil
| | - Wilson Jacob-Filho
- Medical Research Laboratory in Aging (LIM 66) of Geriatrics Division of the Clinics Hospital of the University of São Paulo Medical School (GDCH-USPMS), São Paulo, Brazil
| | - Ruth Minamisava
- School of Nursing, Federal University of Goiás, Goiânia, Brazil
| | - Ana Lúcia Andrade
- Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiânia, Brazil
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[Immunisation schedule of the Spanish Association of Paediatrics: 2019 recommendations]. An Pediatr (Barc) 2019; 90:56.e1-56.e9. [PMID: 30609975 DOI: 10.1016/j.anpedi.2018.10.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Revised: 10/10/2018] [Accepted: 10/10/2018] [Indexed: 11/21/2022] Open
Abstract
The Advisory Committee on Vaccines of the Spanish Association of Paediatrics annually publishes the immunisation schedule considered optimal for children resident in Spain, according to available evidence on current vaccines. As regards funded immunisations, the 2+1 strategy (2, 4, 11 months) with hexavalent (DTPa-IPV-Hib-HB) and 13-valent pneumococcal vaccines are recommended. Administration of the 6-year booster dose with DTPa is recommended, with a poliomyelitis dose for children who had received the 2+1 scheme, as well as Tdap vaccine for adolescents and pregnant women in every pregnancy between 27 and 32 weeks gestation. The 2-dose scheme should be used for MMR (12 months and 3-4 years) and varicella (15 months and 3-4 years). MMRV vaccine could be applied as the second dose. Vaccination against HPV is recommended in both genders, preferably at 12 years of age. A stronger effort should be made to improve vaccination coverage. The new 9-valent vaccine is now available, expanding the coverage for both genders. Tetravalent meningococcal vaccine (MenACWY) is recommended at 12 months and 12-14 years, with a catch-up up at 19 years of age. It is also recommended in infants older than 6 weeks of age with risk factors, or travellers to countries with high incidence of ACWY meningococcal serogroups. As regards non-funded immunisations, it is recommended meningococcal B vaccination, with a 2+1 schedule, and requests that it be included in the National Immunisation Program. Vaccination against rotavirus is recommended in all infants.
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Brandileone MCDC, Zanella RC, Almeida SC, Cassiolato AP, Lemos APSD, Salgado MM, Higa FT, Minamisava R, Andrade AL. Long-term effect of 10-valent pneumococcal conjugate vaccine on nasopharyngeal carriage of Streptococcus pneumoniae in children in Brazil. Vaccine 2019; 37:5357-5363. [DOI: 10.1016/j.vaccine.2019.07.043] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 07/04/2019] [Accepted: 07/10/2019] [Indexed: 12/19/2022]
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Neves FPG, Cardoso NT, Cardoso CAA, Teixeira LM, Riley LW. Direct effect of the 13-valent pneumococcal conjugate vaccine use on pneumococcal colonization among children in Brazil. Vaccine 2019; 37:5265-5269. [PMID: 31337592 DOI: 10.1016/j.vaccine.2019.07.056] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 07/09/2019] [Accepted: 07/16/2019] [Indexed: 01/17/2023]
Abstract
BACKGROUND The 13-valent pneumococcal conjugate vaccine (PCV13) has been commercially available in Brazil since 2010. We investigated the carriage prevalence, capsular types, and antimicrobial resistance among pneumococci isolated from children immunized with PCV13 in Brazil. METHODS We analyzed 500 children < 6 years old attending public (n = 270) and private (n = 230) clinics in Niterói/RJ, Brazil, in 2014. We determined the antimicrobial susceptibility and capsular types for all isolates. RESULTS Thirty-eight (7.6%) of 500 children had received at least one PCV13 dose. Since only two (0.7%) of 270 children at the public clinic were vaccinated with PCV13, major analyses focused on 36 (15.7%) of 230 children attending private clinics. Nine (25%) of 36 children were pneumococcal carriers. Characteristics associated with carriage were age ≥ 2 years, cough/expectoration, and childcare center attendance (p ≤ 0.01). The capsular types found were 15B/C (n = 2), 6C, 11A/D, 16F, 23A, and 23F. Two isolates were non-typeable (NT). Three (33.3%) isolates were multidrug resistant. We found four (44.4%) penicillin non-susceptible pneumococci, with penicillin and ceftriaxone MICs ranging from 0.12 to 4.0 µg/ml and 0.023-0.5 µg/ml, respectively. We also detected two (22.2%) erythromycin-resistant isolates (MICs of 3.0 and 256 µg/ml). CONCLUSIONS Colonization with PCV13 serotype was rare among the vaccinated children. Increasing PCV13 coverage might help reduce the frequency of major serotypes currently associated with invasive pneumococcal diseases in Brazil, such as 3 and 19A. The isolation of multidrug-resistant serotype 6C and NT isolates in carriage, however, requires close monitoring.
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Affiliation(s)
- Felipe P G Neves
- Instituto Biomédico, Universidade Federal Fluminense, Rua Professor Hernani Melo, 101. São Domingos, Niterói, RJ 24210-130, Brazil.
| | - Nayara T Cardoso
- Instituto Biomédico, Universidade Federal Fluminense, Rua Professor Hernani Melo, 101. São Domingos, Niterói, RJ 24210-130, Brazil
| | - Claudete A A Cardoso
- Faculdade de Medicina, Universidade Federal Fluminense, Av. Marquês do Paraná, 303. Centro, Niterói, RJ 24033-900, Brazil.
| | - Lúcia M Teixeira
- Instituto de Microbiologia Paulo de Góes, Universidade Federal do Rio de Janeiro, Av. Carlos Chagas Filho, 373 - bloco I, Cidade Universitária, Ilha do Fundão, Rio de Janeiro, RJ 21941-902, Brazil.
| | - Lee W Riley
- Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, 530E Li Ka Shing Center, Berkeley, CA 94720, USA.
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Mrkvan T, Pelton SI, Ruiz-Guiñazú J, Palmu AA, Borys D. Effectiveness and impact of the 10-valent pneumococcal conjugate vaccine, PHiD-CV: review of clinical trials and post-marketing experience. Expert Rev Vaccines 2019; 17:797-818. [PMID: 30185083 DOI: 10.1080/14760584.2018.1516551] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
INTRODUCTION Pneumococcal diseases (including septicemia, meningitis, pneumonia, and upper respiratory infections) constitute a major public health problem. The World Health Organization recommends pneumococcal conjugate vaccine immunization of young children worldwide. AREAS COVERED We reviewed evidence on the effects of the 10-valent pneumococcal non-typeable Haemophilus influenzae protein D conjugate vaccine (PHiD-CV), which is used in childhood immunization programs in over 45 countries or regions. The effectiveness of PHiD-CV against invasive pneumococcal disease (IPD), pneumonia, and acute otitis media was assessed. We also present its effect on pneumococcal nasopharyngeal carriage (NPC) and indirect effects (herd protection) among unvaccinated individuals. EXPERT COMMENTARY Results from randomized, double-blind trials and post-marketing studies in various countries provide evidence of the protective efficacy, effectiveness, and impact of PHiD-CV against pneumococcal diseases. Data from different geographic locations also show reductions in NPC of vaccine pneumococcal serotypes, laying the foundation for indirect protection against pneumococcal disease. In countries where PHiD-CV is included in childhood immunization programs, there are signs of herd protection for vaccine serotypes among unvaccinated individuals. Although increases in non-vaccine serotype IPD and NPC rates were observed, there was an overall reduction of pneumococcal disease.
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Affiliation(s)
| | - Stephen I Pelton
- b Maxwell Finland Laboratory for Infectious Diseases , Boston University , Boston , MA , USA
| | | | - Arto A Palmu
- c Department of Public Health Solutions , National Institute for Health and Welfare , Tampere , Finland
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Follow-up of serotype distribution and antimicrobial susceptibility of Streptococcus pneumoniae in child carriage after a PCV13-to-PCV10 vaccine switch in Belgium. Vaccine 2019; 37:1080-1086. [PMID: 30665775 DOI: 10.1016/j.vaccine.2018.12.068] [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] [Received: 06/06/2018] [Revised: 12/19/2018] [Accepted: 12/30/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND A three year pneumococcal carriage study was set up in Belgium when the vaccination programme switched from a 13-valent (PCV13) to a 10-valent (PCV10) vaccine. We compared the first follow-up period (October 2016 - June 2017, year 2, Y2) for nasopharyngeal carriage, serotype distribution and antimicrobial susceptibility of S. pneumoniae with the baseline (January-July 2016, year 1, Y1). MATERIALS/METHODS A single nasopharyngeal swab was taken in children (6-30 months), either attending one of the 112 day-care centres (DCCs), or visiting one of the 21 physicians for an acute otitis media (AOM). S. pneumoniae were cultured, screened for antimicrobial susceptibility, and serotyped. RESULTS In Y2, 1218 samples were collected. The majority of the Y2-children (>85%) was vaccinated appropriately for their age. Children in Y2 received either PCV13 only (DCC: 23.5%; AOM: 24.6%), PCV10 only (DCC: 29.8%; AOM: 37.7%), or a mix of both vaccines (DCC: 31.9%; AOM: 25.4%). Pneumococcal carriage rates were high (Y2, DCC: 68.2%; AOM: 64.8%). Among carriers, prevalence of PCV13 serotypes was low (Y2 vs Y1, DCC: 3.5% vs 5.4%; AOM: 7.6% vs 7.7%). Although prevalence of PCV13-non-PCV10 serotypes did not increase significantly compared to Y1 (Y2 vs Y1, DCC: 1.6% vs 0.9%; Y2 vs Y1, AOM: 5.1% vs 0.0%), the proportion of serotypes 3, 6A, 19A among PCV13 serotype carriers in DCC was significantly higher in Y2 (46.2% vs Y1: 16.0%, p-value = 0.034). Serotypes 23B and 15B were the predominant non-vaccine serotypes (Y2). Among detected strains, non-susceptibility to at least one of five antibiotics tested (penicillin, tetracycline, erythromycin, levofloxacin, cotrimoxazole) was comparable to Y1 (Y2 vs Y1, DCC: 41.3% vs 42.4%; AOM: 49.4% vs 48.1%). CONCLUSION After completion of the PCV13-to-PCV10 vaccine switch in Belgium, the proportion of PCV13-non-PCV10 serotypes (mainly 19A) significantly increased among PCV13 serotype carriers in DCC, stressing the need for strengthened surveillance as the PCV10-vaccinated population grows.
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