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Elias C, Nunes MC, Saadatian-Elahi M. Epidemiology of community-acquired pneumonia caused by S treptococcus pneumoniae in older adults: a narrative review. Curr Opin Infect Dis 2024; 37:144-153. [PMID: 38323404 DOI: 10.1097/qco.0000000000001005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
PURPOSE OF REVIEW This review covers updated perspectives on different aspects of pneumococcal community-acquired pneumonia (pCAP), including the epidemiology, clinical presentation, risk factors, antibiotic treatment, and existing preventive strategies in older adults. RECENT FINDINGS pCAP remains the most prevalent condition among lower respiratory tract infections in the older adults according to Global Burden of Diseases 2019. Older adults can display atypical symptoms such as confusion, general clinical deterioration, new onset of and exacerbation of underlying illness that might trigger clinical suspicion of pCAP. Older adults with pCAP often experience increased disease severity and a higher risk of pulmonary complications compared with younger individuals, owing to age-related changes in immunity and a higher prevalence of comorbidities. Vaccination stands fundamental for prevention, emphasizing the need for effective immunization strategies, specifically tailored for older adults. There is a pressing need to reinforce efforts aimed at boosting pneumococcal vaccination rates. SUMMARY Despite a high morbidity and mortality, the burden of pCAP, in particular hospital admission and occurrence of invasive infections, among the elderly population is not sufficiently documented. This review findings emphasize the substantial burden of pCAP in this vulnerable population, driven by factors such as advancing age and underlying comorbidities. The emergence of antibiotic-resistant pneumococcal strains further complicates treatment decisions and highlights the importance of tailored approaches for managing pCAP in older adults.
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Affiliation(s)
- Christelle Elias
- Service d'Hygiène, Epidémiologie, Infectiovigilance et Prévention, Hospices Civils de Lyon
- Équipe Santé Publique, Epidémiologie et Eco-évolution des Maladies Infectieuses (PHE ID), Centre International de Recherche en Infectiologie (CIRI), Université de Lyon, Inserm, U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, ENS de Lyon
| | - Marta C Nunes
- Équipe Santé Publique, Epidémiologie et Eco-évolution des Maladies Infectieuses (PHE ID), Centre International de Recherche en Infectiologie (CIRI), Université de Lyon, Inserm, U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, ENS de Lyon
- Center of Excellence in Respiratory Pathogens (CERP), Hospices Civils de Lyon, Lyon, France
- South African Medical Research Council, Vaccines & Infectious Diseases Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Mitra Saadatian-Elahi
- Service d'Hygiène, Epidémiologie, Infectiovigilance et Prévention, Hospices Civils de Lyon
- Équipe Santé Publique, Epidémiologie et Eco-évolution des Maladies Infectieuses (PHE ID), Centre International de Recherche en Infectiologie (CIRI), Université de Lyon, Inserm, U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, ENS de Lyon
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Grant LR, Begier E, Theilacker C, Barry R, Hall-Murray C, Yan Q, Pope V, Pride MW, Jodar L, Gessner BD. Multicountry Review of Streptococcus pneumoniae Serotype Distribution Among Adults With Community-Acquired Pneumonia. J Infect Dis 2024; 229:282-293. [PMID: 37665210 PMCID: PMC10786249 DOI: 10.1093/infdis/jiad379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 07/24/2023] [Accepted: 08/31/2023] [Indexed: 09/05/2023] Open
Abstract
BACKGROUND Nonbacteremic community-acquired pneumonia (CAP) is a leading presentation of severe pneumococcal disease in adults. Serotype-specific urinary antigen detection (UAD) assay can detect serotypes causing pneumococcal CAP, including nonbacteremic cases, and guide recommendations for use of higher valency pneumococcal conjugate vaccines (PCVs). METHODS Adult CAP serotype distribution studies that used both Pfizer UADs (UAD1, detects PCV13 serotypes; UAD2, detects PCV20 non-PCV13 serotypes plus 2, 9N, 17F, and 20) were identified by review of an internal study database and included if results were published. The percentages of all-cause radiologically confirmed CAP (RAD + CAP) due to individual or grouped (PCV13, PCV15, and PCV20) serotypes as detected from culture or UAD were reported. RESULTS Six studies (n = 2, United States; n = 1 each, Germany, Sweden, Spain, and Greece) were included. The percentage of RAD + CAP among adults ≥18 years with PCV13 serotypes equaled 4.6% to 12.9%, with PCV15 serotypes 5.9% to 14.5%, and with PCV20 serotypes 7.8% to 23.8%. The percentage of RAD + CAP due to PCV15 and PCV20 serotypes was 1.1-1.3 and 1.3-1.8 times higher than PCV13 serotypes, respectively. CONCLUSIONS PCV13 serotypes remain a cause of RAD + CAP among adults even in settings with pediatric PCV use. Higher valency PCVs among adults could address an important proportion of RAD + CAP in this population.
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Affiliation(s)
- Lindsay R Grant
- Vaccines, Antivirals, and Evidence Generation, Pfizer Biopharma Group, Collegeville, Pennsylvania, USA
| | - Elizabeth Begier
- Vaccines, Antivirals, and Evidence Generation, Pfizer Biopharma Group, Dublin, Ireland
| | - Christian Theilacker
- Vaccines, Antivirals, and Evidence Generation, Pfizer Pharma GmbH, Berlin, Germany
| | - Rachid Barry
- Vaccines, Antivirals, and Evidence Generation, Pfizer Biopharma Group, Collegeville, Pennsylvania, USA
| | - Cassandra Hall-Murray
- Vaccines, Antivirals, and Evidence Generation, Pfizer Biopharma Group, Collegeville, Pennsylvania, USA
| | - Qi Yan
- Vaccines, Antivirals, and Evidence Generation, Pfizer Biopharma Group, Collegeville, Pennsylvania, USA
| | - Veneta Pope
- Vaccines, Antivirals, and Evidence Generation, Pfizer Biopharma Group, Collegeville, Pennsylvania, USA
| | - Michael W Pride
- Vaccine Research and Development, Pfizer Vaccines, Pearl River, New York, USA
| | - Luis Jodar
- Vaccines, Antivirals, and Evidence Generation, Pfizer Biopharma Group, Collegeville, Pennsylvania, USA
| | - Bradford D Gessner
- Vaccines, Antivirals, and Evidence Generation, Pfizer Biopharma Group, Collegeville, Pennsylvania, USA
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Grant LR, Slack MPE, Theilacker C, Vojicic J, Dion S, Reinert RR, Jodar L, Gessner BD. Distribution of serotypes causing invasive pneumococcal disease in older adults from high-income countries and impact of pediatric and adult vaccination policies. Vaccine 2023; 41:5662-5669. [PMID: 37544825 DOI: 10.1016/j.vaccine.2023.08.001] [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: 01/18/2023] [Revised: 07/31/2023] [Accepted: 08/01/2023] [Indexed: 08/08/2023]
Abstract
BACKGROUND Neither indirect protection through use of 13-valent and 10-valent pneumococcal conjugate vaccines (PCV13 and PCV10) in pediatric National Immunization Programs (NIPs) nor direct vaccination with the 23-valent polysaccharide vaccine have eliminated vaccine serotype invasive pneumococcal disease (IPD) in older adults. Vaccinating older adults with higher-valency PCV15 and PCV20 could address remaining IPD due to pediatric PCV serotypes plus additional IPD due to serotypes included in these vaccines. METHODS We collected serotype-specific IPD data in older adults (≥65 years in most countries), from national or regional surveillance systems or hospital networks of 33 high-income countries. Data were from official government websites, online databases, surveillance system reports, published literature, and personal communication with in-country investigators. Average percentages of IPD serotypes were calculated. RESULTS Among 52,905 cases of IPD with a serotype identified, PCV13 serotypes accounted for 33.7% of IPD (55.8% and 30.6% for countries with PCV10 and PCV13 in the pediatric NIP), most commonly serotypes 3 (14.9%) and 19A (7.0%). PCV15 and PCV20 would cover an additional 10.4% and 32.9% of older adult IPD beyond PCV13 serotypes (PCV10 countries: 7.7% and 23.3%; PCV13 countries: 10.6% and 34.6%). The most common of these additional serotypes were 8 (9.9%), 22F (7.9%), 12F (4.6%), and 11A (3.3%). PPSV23 policies for older adults were not correlated with lower IPD percentages due to PPSV23 serotypes. CONCLUSIONS Vaccinating older adults with higher-valency PCVs, especially PCV20, could substantially reduce the remaining IPD burden in high-income countries, regardless of current PCV use in pediatric NIPs and adult PPSV23 policies.
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Affiliation(s)
| | - Mary P E Slack
- School of Medicine & Dentistry, Griffith University, Gold Coast Campus, Queensland, Australia
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4
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Invasive pneumococcal surveillance to assess the potential benefits of extended spectrum conjugate vaccines (PCV15/PCV20) in older adults. Epidemiol Infect 2023; 151:e27. [PMID: 36700424 PMCID: PMC9990380 DOI: 10.1017/s0950268823000110] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
The introduction of pneumococcal conjugate vaccines (PCV) into the childhood vaccination programme has reduced invasive pneumococcal disease (IPD). Although anticipated from data elsewhere, surveillance in Ireland has confirmed reductions in IPD amongst those ⩾65 years of age due to a decline of PCV serotypes in this age group. Currently, direct protection against IPD in the elderly is focused on immunisation with the 23-valent pneumococcal polysaccharide vaccine (PPV23). However, immunity may not be as effective as with PCV and, furthermore, PPV23 uptake is poor in Ireland. Hence, consideration should be given to providing a PCV to this age group.
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5
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Hansen K, Rünow E, Torisson G, Theilacker C, Palmborg A, Pan K, Jiang Q, Southern J, Beavon R, Gessner BD, Riesbeck K, Ahl J. Radiographically confirmed community-acquired pneumonia in hospitalized adults due to pneumococcal vaccine serotypes in Sweden, 2016-2018-The ECAPS study. Front Public Health 2023; 11:1086648. [PMID: 36875379 PMCID: PMC9981934 DOI: 10.3389/fpubh.2023.1086648] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 01/24/2023] [Indexed: 02/19/2023] Open
Abstract
Objectives In Sweden, pneumococcal serotype distribution in adults with community-acquired pneumonia (CAP) and potential coverage of currently licensed pneumococcal conjugate vaccines (PCVs) is unknown. Methods During 2016-2018, patients aged ≥18 years hospitalized with radiologically confirmed (RAD+) CAP were enrolled at Skåne University Hospital in a study on the etiology of CAP in Sweden (ECAPS). Urine samples and blood cultures were collected per-protocol. Streptococcus pneumoniae (Spn) culture isolates were serotyped and urine samples tested for the pan-pneumococcal urinary antigen (PUAT) and multiplex urine antigen detection (UAD) assay, detecting 24 serotypes. Results Analyses included 518 participants with RAD+CAP; 67.4% were ≥65 years of age, 73.4% were either immunocompromised or had an underlying chronic medical condition. The proportion of CAP due to Spn identified by any method was 24.3% of which 9.3% was detected by UAD alone. The most frequently identified serotypes were 3 (26 cases, 5.0% of all CAP), and 8, 11A and 19A (10 cases each, 1.9%). In individuals aged 18-64 and ≥65 years, respectively, PCV20 serotypes contributed to 35 of 169 (20.7%) and 53 of 349 cases of all CAP (15.2%), and PCV13 serotypes caused 21 of 169 (12.4%) and 35 of 349 (10.0%) cases. PCV15 coverage was 23 of 169 (13.6%) and 42 of 349 (12.0%) in individuals aged 18-64 and ≥65 years, respectively. Overall, PCV20 increases the coverage of all CAP from 10.8% (PCV13) to 17.0%. Conclusion Compared to earlier pneumococcal vaccines, PCV20 expands the coverage of all-cause CAP. Routine diagnostic tests underestimate the proportion of CAP caused by Spn.
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Affiliation(s)
- Karin Hansen
- Section of Infectious Diseases, Department Translational Medicine, Faculty of Medicine, Lund University, Malmö, Sweden.,Section of Clinical Microbiology, Department Translational Medicine, Faculty of Medicine, Lund University, Malmö, Sweden
| | - Elisabeth Rünow
- Section of Infectious Diseases, Department Translational Medicine, Faculty of Medicine, Lund University, Malmö, Sweden.,Section of Clinical Microbiology, Department Translational Medicine, Faculty of Medicine, Lund University, Malmö, Sweden
| | - Gustav Torisson
- Section of Infectious Diseases, Department Translational Medicine, Faculty of Medicine, Lund University, Malmö, Sweden
| | - Christian Theilacker
- Vaccines Global Medical Development, Scientific and Clinical Affairs, Pfizer, Collegeville, PA, United States
| | - Andreas Palmborg
- Pfizer Vaccines, Medical Development, Scientific and Clinical Affairs, Stockholm, Sweden
| | - Kaijie Pan
- Vaccines Global Medical Development, Scientific and Clinical Affairs, Pfizer, Collegeville, PA, United States
| | - Qin Jiang
- Vaccines Global Medical Development, Scientific and Clinical Affairs, Pfizer, Collegeville, PA, United States
| | - Jo Southern
- Vaccines Global Medical Development, Scientific and Clinical Affairs, Pfizer, Collegeville, PA, United States
| | - Rohini Beavon
- Vaccines Global Medical Development, Scientific and Clinical Affairs, Pfizer, Collegeville, PA, United States
| | - Bradford D Gessner
- Vaccines Global Medical Development, Scientific and Clinical Affairs, Pfizer, Collegeville, PA, United States
| | - Kristian Riesbeck
- Section of Clinical Microbiology, Department Translational Medicine, Faculty of Medicine, Lund University, Malmö, Sweden
| | - Jonas Ahl
- Section of Infectious Diseases, Department Translational Medicine, Faculty of Medicine, Lund University, Malmö, Sweden.,Section of Clinical Microbiology, Department Translational Medicine, Faculty of Medicine, Lund University, Malmö, Sweden
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Campling J, Vyse A, Liu HH, Wright H, Slack M, Reinert RR, Drayson M, Richter A, Singh D, Barlow G, Kassianos G, Ellsbury G. A review of evidence for pneumococcal vaccination in adults at increased risk of pneumococcal disease: risk group definitions and optimization of vaccination coverage in the United Kingdom. Expert Rev Vaccines 2023; 22:785-800. [PMID: 37694398 DOI: 10.1080/14760584.2023.2256394] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 09/02/2023] [Accepted: 09/04/2023] [Indexed: 09/12/2023]
Abstract
INTRODUCTION Pneumococcal disease (PD) significantly contributes to morbidity and mortality, carrying substantial economic and public health burden. This article is a targeted review of evidence for pneumococcal vaccination in the UK, the definitions of groups at particular risk of PD and vaccine effectiveness. AREAS COVERED Relevant evidence focusing on UK data from surveillance systems, randomized controlled trials, observational studies and publicly available government documents is collated and reviewed. Selected global data are included where appropriate. EXPERT OPINION National vaccination programs have reduced the incidence of vaccine-type PD, despite the rising prominence of non-vaccine serotypes in the UK. The introduction of higher-valency conjugate vaccines provides an opportunity to improve protection against PD for adults in risk groups. Several incentives are in place to encourage general practitioners to vaccinate risk groups, but uptake is low-suboptimal particularly among at-risk individuals. Wider awareness and understanding among the public and healthcare professionals may increase vaccination uptake and coverage. National strategies targeting organizational factors are urgently needed to achieve optimal access to vaccines. Finally, identifying new risk factors and approaches to risk assessment for PD are crucial to ensure those at risk of PD can benefit from pneumococcal vaccination.
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Affiliation(s)
| | - Andrew Vyse
- Medical Affairs, Pfizer Ltd, Walton Oaks, UK
| | | | | | - Mary Slack
- School of Medicine & Dentistry, Griffith University, Southport, Queensland, Australia
| | | | - Mark Drayson
- Institute of Immunology and Immunotherapy, Medical School, University of Birmingham, Edgbaston, Birmingham, UK
| | - Alex Richter
- Institute of Immunology and Immunotherapy, Medical School, University of Birmingham, Edgbaston, Birmingham, UK
| | - Dave Singh
- Division of Immunology, Immunity to Infection and Respiratory Medicine, University of Manchester, Manchester, UK
| | - Gavin Barlow
- Hull York Medical School, University of York, York, UK
| | - George Kassianos
- Royal College of General Practitioners, London, UK
- British Global & Travel Health Association, Bath, UK
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7
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Robinson RE, Mitsi E, Nikolaou E, Pojar S, Chen T, Reiné J, Nyazika TK, Court J, Davies K, Farrar M, Gonzalez-Dias P, Hamilton J, Hill H, Hitchins L, Howard A, Hyder-Wright A, Lesosky M, Liatsikos K, Matope A, McLenaghan D, Myerscough C, Murphy A, Solórzano C, Wang D, Burhan H, Gautam M, Begier E, Theilacker C, Beavon R, Anderson AS, Gessner BD, Gordon SB, Collins AM, Ferreira DM. Human Infection Challenge with Serotype 3 Pneumococcus. Am J Respir Crit Care Med 2022; 206:1379-1392. [PMID: 35802840 DOI: 10.1164/rccm.202112-2700oc] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Rationale: Streptococcus pneumoniae serotype 3 (SPN3) is a cause of invasive pneumococcal disease and associated with low carriage rates. Following the introduction of pediatric 13-valent pneumococcal conjugate vaccine (PCV13) programs, SPN3 declines are less than other vaccine serotypes and incidence has increased in some populations coincident with a shift in predominant circulating SPN3 clade, from I to II. A human challenge model provides an effective means for assessing the impact of PCV13 on SPN3 in the upper airway. Objectives: To establish SPN3's ability to colonize the nasopharynx using different inoculum clades and doses, and the safety of an SPN3 challenge model. Methods: In a human challenge study involving three well-characterized and antibiotic-sensitive SPN3 isolates (PFESP306 [clade Ia], PFESP231 [no clade], and PFESP505 [clade II]), inoculum doses (10,000, 20,000, 80,000, and 160,000 cfu/100 μl) were escalated until maximal colonization rates were achieved, with concurrent acceptable safety. Measurement and Main Results: Presence and density of experimental SPN3 nasopharyngeal colonization in nasal wash samples, assessed using microbiological culture and molecular methods, on Days 2, 7, and 14 postinoculation. A total of 96 healthy participants (median age 21, interquartile range 19-25) were inoculated (n = 6-10 per dose group, 10 groups). Colonization rates ranged from 30.0-70.0% varying with dose and isolate. 30.0% (29/96) reported mild symptoms (82.8% [24/29] developed a sore throat); one developed otitis media requiring antibiotics. No serious adverse events occurred. Conclusions: An SPN3 human challenge model is feasible and safe with comparable carriage rates to an established Serotype 6B human challenge model. SPN3 carriage may cause mild upper respiratory symptoms.
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Affiliation(s)
- Ryan E Robinson
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, UK.,Respiratory Research Group, Liverpool University Hospitals Foundation Trust, Liverpool, UK
| | - Elena Mitsi
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Elissavet Nikolaou
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Sherin Pojar
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Tao Chen
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Jesús Reiné
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Tinashe K Nyazika
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, UK
| | - James Court
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Kelly Davies
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Madlen Farrar
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, UK
| | | | - Josh Hamilton
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Helen Hill
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Lisa Hitchins
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Ashleigh Howard
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Angela Hyder-Wright
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, UK.,Respiratory Research Group, Liverpool University Hospitals Foundation Trust, Liverpool, UK
| | - Maia Lesosky
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, UK
| | | | - Agnes Matope
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Daniella McLenaghan
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, UK
| | | | - Annabel Murphy
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Carla Solórzano
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Duolao Wang
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Hassan Burhan
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, UK.,Respiratory Research Group, Liverpool University Hospitals Foundation Trust, Liverpool, UK
| | - Manish Gautam
- Respiratory Research Group, Liverpool University Hospitals Foundation Trust, Liverpool, UK
| | | | | | | | | | | | - Stephen B Gordon
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, UK.,Malawi Liverpool Wellcome Research Programme, Blantyre, Malawi
| | - Andrea M Collins
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, UK.,Respiratory Research Group, Liverpool University Hospitals Foundation Trust, Liverpool, UK
| | - Daniela M Ferreira
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, UK
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8
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Mendes D, Averin A, Atwood M, Sato R, Vyse A, Campling J, Weycker D, Slack M, Ellsbury G, Mugwagwa T. Cost-effectiveness of using a 20-valent pneumococcal conjugate vaccine to directly protect adults in England at elevated risk of pneumococcal disease. Expert Rev Pharmacoecon Outcomes Res 2022; 22:1285-1295. [PMID: 36225103 DOI: 10.1080/14737167.2022.2134120] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Despite the current pneumococcal vaccination program in England for older adults and adults with underlying conditions, disease burden remains high. We evaluated cost-effectiveness of 20-valent pneumococcal conjugate vaccine (PCV20) compared to current pneumococcal recommendations for adults in England. METHODS Lifetime outcomes/costs of invasive pneumococcal disease (IPD) and community-acquired pneumonia (CAP) among adults aged 65-99 years and adults aged 18-64 years with underlying conditions in England were projected using a probabilistic cohort model. Vaccination with PCV20 was compared with 23-valent pneumococcal polysaccharide vaccine (PPV23) from the National Health Service perspective. RESULTS PCV20 was cost saving compared with PPV23 in base case and most sensitivity analyses. In the base case, replacing PPV23 with PCV20 prevented 7,789 and 140,046 cases of IPD and hospitalized CAP, respectively, and 22,199 associated deaths, resulting in incremental gain of 91,375 quality-adjusted life-years (QALYs) and incremental savings of £160M. In probabilistic sensitivity analyses, PCV20 (vs. PPV23) was cost saving in 85% of simulations; incremental cost per QALY was below £30,000 in 99% of simulations. CONCLUSIONS PCV20 vaccination in adults aged 65-99 years and those aged 18-64 years with underlying comorbidities in England is expected to prevent more hospitalizations, save more lives, and yield lower overall costs than current recommendations for PPV23.
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Affiliation(s)
| | | | - Mark Atwood
- Policy Analysis Inc. (PAI), Chestnut Hill, MA
| | | | | | | | | | - Mary Slack
- School of Medicine & Dentistry, Griffith University, Gold Coast Campus, Queensland 4222, Australia
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9
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Egorova E, Kumar N, Gladstone RA, Urban Y, Voropaeva E, Chaplin A, Rumiantseva E, Svistunova TS, Hawkins PA, Klugman KP, Breiman RF, McGee L, Bentley SD, Lo SW. Key features of pneumococcal isolates recovered in Central and Northwestern Russia in 2011–2018 determined through whole-genome sequencing. Microb Genom 2022; 8. [PMID: 36112007 PMCID: PMC9676041 DOI: 10.1099/mgen.0.000851] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Invasive pneumococcal disease remains one of the leading causes of morbidity and mortality worldwide. In Russia, 13- valent pneumococcal conjugate vaccine (PCV13) was introduced into the childhood immunization programme nationwide in 2014. As part of the Global Pneumococcal Sequencing Project (GPS), we used genome data to characterize 179 pneumococcal isolates collected from Russia in 2011–2018 to investigate the circulating pneumococcal strains using a standardized genomic definition of pneumococcal lineages (global pneumococcal sequence clusters, GPSCs), prevalent serotypes and antimicrobial resistance profiles. We observed high serotype and lineage diversity among the 179 isolates recovered from cerebrospinal fluid (n=77), nasopharyngeal swabs (n=99) and other non-sterile site swabs (n=3). Overall, 60 GPSCs were identified, including 48 clonal complexes (CCs) and 14 singletons, and expressed 42 serotypes (including non-typable). Among PCV13 serotypes, 19F, 6B and 23F were the top three serotypes while 11A, 15B/C and 8 were the top three among non-PCV13 serotypes in the collection. Two lineages (GPSC6 and GPSC47) expressed both PCV13 and non-PCV13 serotypes that caused invasive disease, and were penicillin- and multidrug-resistant (MDR), highlighting their potential to adapt and continue to cause infections under vaccine and antibiotic selective pressure. PCV13 serotypes comprised 92 % (11/12) of the CSF isolates from the children aged below 5 years; however, the prevalence of PCV13 serotype isolates dropped to 53 % (31/58) among the nasopharyngeal isolates. Our analysis showed that 59 % (105/179) of the isolates were predicted to be non-susceptible to at least one class of antibiotics and 26 % (46/179) were MDR. Four MDR lineages (GPSC1, GPSC6, GPSC10 and GPSC47) accounted for 65 % (30/46) of the MDR isolates and expressed PCV13 serotypes (93 %, 28/30). This study provides evidence of high genetic and serotype diversity contributed by a mix of globally spreading and regionally circulating lineages in Russia. The observations suggest that the PCV13 vaccine could be important in reducing both invasive disease and antimicrobial resistance. We also identify potential lineages (GPSC6 and GPSC47) that may evade the vaccine.
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Affiliation(s)
- Ekaterina Egorova
- G. N. Gabrichevsky Research Institute for Epidemiology and Microbiology, Moscow, Russia
| | - Narender Kumar
- Parasites and Microbes, Wellcome Sanger Institute, Hinxton, UK
| | - Rebecca A. Gladstone
- Department of Biostatistics, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Oslo, Norway
- Parasites and Microbes, Wellcome Sanger Institute, Hinxton, UK
| | - Yulia Urban
- G. N. Gabrichevsky Research Institute for Epidemiology and Microbiology, Moscow, Russia
| | - Elena Voropaeva
- G. N. Gabrichevsky Research Institute for Epidemiology and Microbiology, Moscow, Russia
| | - A.V. Chaplin
- G. N. Gabrichevsky Research Institute for Epidemiology and Microbiology, Moscow, Russia
| | | | | | | | - Keith P. Klugman
- Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | | | - Lesley McGee
- Centers for Disease Control and Prevention, Atlanta, USA
| | - Stephen D. Bentley
- Department of Pathology, University of Cambridge, Cambridge, UK
- Parasites and Microbes, Wellcome Sanger Institute, Hinxton, UK
| | - Stephanie W. Lo
- Parasites and Microbes, Wellcome Sanger Institute, Hinxton, UK
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10
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Liatsikos K, Hyder-Wright A, Pojar S, Chen T, Wang D, Davies K, Myerscough C, Reine J, Robinson RE, Urban B, Mitsi E, Solorzano C, Gordon SB, Quinn A, Pan K, Anderson AS, Theilacker C, Begier E, Gessner BD, Collins A, Ferreira DM. Protocol for a phase IV double-blind randomised controlled trial to investigate the effect of the 13-valent pneumococcal conjugate vaccine and the 23-valent pneumococcal polysaccharide vaccine on pneumococcal colonisation using the experimental human pneumococcal challenge model in healthy adults (PREVENTING PNEUMO 2). BMJ Open 2022; 12:e062109. [PMID: 35798520 PMCID: PMC9263934 DOI: 10.1136/bmjopen-2022-062109] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 02/21/2022] [Accepted: 05/30/2022] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Despite widely available vaccinations, Streptococcus pneumoniae (SPN) remains a major cause of morbidity and mortality worldwide, causing community-acquired pneumonia, meningitis, otitis media, sinusitis and bacteraemia. Here, we summarise an ethically approved protocol for a double-blind, randomised controlled trial investigating the effect of the 13-valent pneumococcal conjugate vaccine (PCV13) and the 23-valent pneumococcal polysaccharide vaccine (PPV23) on pneumococcal nasopharyngeal colonisation acquisition, density and duration using experimental human pneumococcal challenge (EHPC). METHODS AND ANALYSIS Healthy adult participants aged 18-50 years will be randomised to receive PCV13, PPV23 or placebo and then undergo one or two EHPCs involving intranasal administration of SPN at 1-month post-vaccination with serotype 3 (SPN3) and 6 months with serotype 6B (SPN6B). Participants randomised to PCV13 and placebo will also be randomised to one of two clinically relevant SPN3 strains from distinct lineages within clonal complex 180, clades Ia and II, creating five study groups. Following inoculation, participants will be seen on days 2, 7, 14 and 23. During the follow-up period, we will monitor safety, colonisation status, density and duration, immune responses and antigenuria. The primary outcome of the study is comparing the rate of SPN3 acquisition between the vaccinated (PCV13 or PPV23) and unvaccinated (placebo) groups as defined by classical culture. Density and duration of colonisation, comparison of acquisition rates using molecular methods and evaluation of the above measurements for individual SPN3 clades and SPN6B form the secondary objectives. Furthermore, we will explore the immune responses associated with these vaccines, their effect on colonisation and the relationship between colonisation and urinary pneumococcal antigen detection. ETHICS AND DISSEMINATION The study is approved by the NHS Research and Ethics Committee (Reference: 20/NW/0097) and by the Medicines and Healthcare products Regulatory Agency (Reference: CTA 25753/0001/001-0001). Findings will be published in peer-reviewed journals. TRIAL REGISTRATION NUMBER ISRCTN15728847, NCT04974294.
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Affiliation(s)
| | - Angela Hyder-Wright
- Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
- Respiratory Research Group, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Sherin Pojar
- Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Tao Chen
- Global Health Trials Unit, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Duolao Wang
- Global Health Trials Unit, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Kelly Davies
- Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | | | - Jesus Reine
- Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Ryan E Robinson
- Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
- Respiratory Research Group, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Britta Urban
- Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Elena Mitsi
- Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Carla Solorzano
- Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Stephen B Gordon
- Malawi Liverpool Wellcome Trust Clinical Research Programme, Liverpool School of Tropical Medicine, Blantyre, Malawi
| | - Angela Quinn
- Pfizer Vaccines, Pfizer Inc, Collegeville, Pennsylvania, USA
| | - Kaijie Pan
- Pfizer Vaccines, Pfizer Inc, Collegeville, Pennsylvania, USA
| | | | | | | | | | - Andrea Collins
- Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
- Respiratory Research Group, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
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11
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Liapikou A, Konstantinidis A, Kossyvaki V, Skiadas J, Menegas D, Méndez C, Beavon R, Begier E, Gessner BD, Milionis H, Tsimihodimos V, Baxevanos G, Argiriadou T, Terrovitou C, Toumbis M, Study Group TE, Moses E, Angelos L, Ilias T, Aikaterini P, Valentina S, Iro R, Konstantinos E, Konstantina G, Christos K, Elias L, Thomas T, Georgios D, Evaggelia C, Nikolaos Z, Lampros P, Vasilios I, Elisavet F, Daniil D, Ioanna K, Anastasia C, Eleni T. Pneumococcal serotypes in adults hospitalized with community-acquired pneumonia in Greece using urinary antigen detection tests: the EGNATIA study, November 2017 - April 2019. Hum Vaccin Immunother 2022; 18:2079923. [PMID: 35703733 DOI: 10.1080/21645515.2022.2079923] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Greece introduced a 13-valent pneumococcal conjugate vaccine (PCV13) into the infant national immunization program in 2010 (3 + 1 schedule until June 2019). Since 2015, PCV13 has been recommended for adults aged 19-64 years with comorbidities and adults ≥65 years sequentially with 23-valent pneumococcal polysaccharide vaccine (PPSV23). We examined pneumococcal serotype distribution among Greek adults aged ≥19 years hospitalized with community-acquired pneumonia (CAP) during November 2017-April 2019. This was an interim analysis of EGNATIA, a prospective study of adult hospitalized CAP in the cities of Ioannina and Kavala. Pneumococcus was identified using cultures, BinaxNow®, serotype-specific urinary antigen detection assays (UAD-1/2). Our analysis included overall 482 hospitalized CAP patients (mean age: 70.5 years; 56.4% male). 53.53% of patients belonged to the highest pneumonia severity index (PSI) classes (IV-V). Pneumococcus was detected in 65 (13.5%) patients, with more than half (57%) of cases detected only by UAD. Approximately two-thirds of pneumococcal CAP occurred in those aged ≥65 years (n = 40, 8.3% of CAP). More than half of pneumococcal CAP (n = 35, 53.8%) was caused by PCV13 serotypes. Most frequently detected PCV13 serotypes were 3, 19A, 23F, collectively accounting for 83% of PCV13 vaccine-type (VT) CAP and 6% of all-cause CAP. Overall, 82.9% of PCV13 VT CAP occurred among persons with an indication (age/risk-based) for PCV13 vaccination. Even with a mature PCV13 childhood immunization program, a persistent burden of PCV13 VT CAP exists in Greek adults. Strategies to increase PCV13 (and higher-valency PCVs, when licensed) coverage in adults should be implemented to reduce the disease burden.
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Affiliation(s)
- Adamantia Liapikou
- Hellenic Thoracic Society (HTS), Infectious Diseases Working Group, Athens, Greece.,6th Respiratory Medicine Department, "Sotiria" Hospital of Chest Diseases, Athens, Greece
| | | | | | | | | | | | - Rohini Beavon
- Pfizer Ltd, Global Vaccines, Medical Development and Scientific/Clinical Affairs (MDSCA), London, United Kingdo
| | - Elizabeth Begier
- Pfizer Inc., Global Vaccines, Collegeville, Pennsylvania, United States of America
| | - Bradford D Gessner
- Pfizer Inc., Global Vaccines, Collegeville, Pennsylvania, United States of America
| | - Haralampos Milionis
- 1st Internal Medicine Department, University Hospital of Ioannina, Loannina, Greece
| | | | - Gerasimos Baxevanos
- Internal Medicine Department, General Hospital of Ioannina G. Hatzikosta, Loannina, Greece
| | - Theodora Argiriadou
- 1st Respiratory Medicine Department, General Hospital of Kavala, Kavala, Greece
| | | | - Michael Toumbis
- Hellenic Thoracic Society (HTS), Infectious Diseases Working Group, Athens, Greece
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12
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Fulop T, Larbi A, Pawelec G, Cohen AA, Provost G, Khalil A, Lacombe G, Rodrigues S, Desroches M, Hirokawa K, Franceschi C, Witkowski JM. Immunosenescence and Altered Vaccine Efficiency in Older Subjects: A Myth Difficult to Change. Vaccines (Basel) 2022; 10:vaccines10040607. [PMID: 35455356 PMCID: PMC9030923 DOI: 10.3390/vaccines10040607] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 04/05/2022] [Accepted: 04/08/2022] [Indexed: 12/14/2022] Open
Abstract
Organismal ageing is associated with many physiological changes, including differences in the immune system of most animals. These differences are often considered to be a key cause of age-associated diseases as well as decreased vaccine responses in humans. The most often cited vaccine failure is seasonal influenza, but, while it is usually the case that the efficiency of this vaccine is lower in older than younger adults, this is not always true, and the reasons for the differential responses are manifold. Undoubtedly, changes in the innate and adaptive immune response with ageing are associated with failure to respond to the influenza vaccine, but the cause is unclear. Moreover, recent advances in vaccine formulations and adjuvants, as well as in our understanding of immune changes with ageing, have contributed to the development of vaccines, such as those against herpes zoster and SARS-CoV-2, that can protect against serious disease in older adults just as well as in younger people. In the present article, we discuss the reasons why it is a myth that vaccines inevitably protect less well in older individuals, and that vaccines represent one of the most powerful means to protect the health and ensure the quality of life of older adults.
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Affiliation(s)
- Tamas Fulop
- Research Center on Aging, Geriatric Division, Department of Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC J1H 5N4, Canada; (A.K.); (G.L.)
- Correspondence: (T.F.); (S.R.)
| | - Anis Larbi
- Singapore Immunology Network (SIgN), Agency for Science Technology and Research (A*STAR), Immunos Building, Singapore 138648, Singapore;
| | - Graham Pawelec
- Department of Immunology, University of Tübingen, 72072 Tübingen, Germany;
- Health Sciences North Research Institute, Sudbury, ON P3E 2H2, Canada
| | - Alan A. Cohen
- Groupe de Recherche PRIMUS, Department of Family Medicine, University of Sherbrooke, 3001 12e Ave N, Sherbrooke, QC J1H 5N4, Canada;
| | | | - Abedelouahed Khalil
- Research Center on Aging, Geriatric Division, Department of Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC J1H 5N4, Canada; (A.K.); (G.L.)
| | - Guy Lacombe
- Research Center on Aging, Geriatric Division, Department of Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC J1H 5N4, Canada; (A.K.); (G.L.)
| | - Serafim Rodrigues
- Ikerbasque, The Basque Foundation for Science, 48009 Bilbao, Spain;
- BCAM—The Basque Center for Applied Mathematics, 48009 Bilbao, Spain
- Correspondence: (T.F.); (S.R.)
| | - Mathieu Desroches
- MathNeuro Team, Inria Sophia Antipolis Méditerranée, CEDEX, 06902 Sophia Antipolis, France;
- The Jean Alexandre Dieudonné Laboratory, Université Côte d’Azur, CEDEX 2, 06108 Nice, France
| | - Katsuiku Hirokawa
- Institute of Health and Life Science, Tokyo Medical and Dental University, Tokyo 113-8510, Japan;
| | - Claudio Franceschi
- IRCCS Institute of Neurological Sciences of Bologna, Alma Mater Studiorum University of Bologna, 40126 Bologna, Italy;
- Department of Applied Mathematics and Laboratory of Systems Biology of Healthy Aging, Lobachevsky State University, 603000 Nizhny Novgorod, Russia
| | - Jacek M. Witkowski
- Department of Pathophysiology, Medical University of Gdansk, 80-210 Gdansk, Poland;
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13
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Recalibrated estimates of non-bacteremic and bacteremic pneumococcal community acquired pneumonia in hospitalized Canadian adults from 2010 to 2017 with addition of an extended spectrum serotype-specific urine antigen detection assay. Vaccine 2022; 40:2635-2646. [DOI: 10.1016/j.vaccine.2022.02.081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 02/10/2022] [Accepted: 02/24/2022] [Indexed: 12/26/2022]
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14
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Theilacker C, Fletcher MA, Jodar L, Gessner BD. PCV13 Vaccination of Adults against Pneumococcal Disease: What We Have Learned from the Community-Acquired Pneumonia Immunization Trial in Adults (CAPiTA). Microorganisms 2022; 10:microorganisms10010127. [PMID: 35056576 PMCID: PMC8778913 DOI: 10.3390/microorganisms10010127] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 12/23/2021] [Accepted: 12/30/2021] [Indexed: 02/04/2023] Open
Abstract
The Community-Acquired Pneumonia immunization Trial in Adults (CAPiTA) evaluated older adult pneumococcal vaccination and was one of the largest vaccine clinical trials ever conducted. Among older adults aged ≥65 years, the trial established 13-valent pneumococcal conjugate vaccine (PCV13) efficacy in preventing first episodes of bacteremic and nonbacteremic pneumococcal vaccine serotype (VT) community acquired pneumonia (CAP), and of vaccine serotype invasive pneumococcal disease (VT-IPD). Since the publication of the original trial results, 15 additional publications have extended the analyses. In this review, we summarize and integrate the full body of evidence generated by these studies, contextualize the results in light of their public health relevance, and discuss their implications for the assessment of current and future adult pneumococcal vaccination. This accumulating evidence has helped to better understand PCV13 efficacy, serotype-specific efficacy, efficacy in subgroups, the interpretation of immunogenicity data, and the public health value of adult PCV vaccination.
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Affiliation(s)
- Christian Theilacker
- Pfizer Vaccines, 500 Arcola Rd., Collegeville, PA 19426, USA; (L.J.); (B.D.G.)
- Correspondence: ; Tel.: +49-175-810-9049
| | - Mark A. Fletcher
- Pfizer Emerging Markets, 23-25 Avenue du Docteur Lannelongue, 75014 Paris, France;
| | - Luis Jodar
- Pfizer Vaccines, 500 Arcola Rd., Collegeville, PA 19426, USA; (L.J.); (B.D.G.)
| | - Bradford D. Gessner
- Pfizer Vaccines, 500 Arcola Rd., Collegeville, PA 19426, USA; (L.J.); (B.D.G.)
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15
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Torres A, Menéndez R, España PP, Fernández-Villar JA, Marimón JM, Cilloniz C, Méndez R, Egurrola M, Botana-Rial M, Ercibengoa M, Méndez C, Cifuentes I, Gessner BD. The Evolution and Distribution of Pneumococcal Serotypes in Adults Hospitalized With Community-Acquired Pneumonia in Spain Using a Serotype-Specific Urinary Antigen Detection Test: The CAPA Study, 2011-2018. Clin Infect Dis 2021; 73:1075-1085. [PMID: 33851220 PMCID: PMC8442776 DOI: 10.1093/cid/ciab307] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 04/09/2021] [Indexed: 11/12/2022] Open
Abstract
Background Spain introduced the 13-valent pneumococcal conjugate vaccine (PCV13) in the childhood National Immunization Program in 2015–2016 with coverage of 3 doses of 94.8% in 2018. We assessed the evolution of all pneumococcal, PCV13 vaccine type (VT), and experimental PCV20-VT (PCV13 + serotypes 8, 10A, 11A, 12F, 15B, 22F, 33F) hospitalized community-acquired pneumonia (CAP) in adults in Spain from 2011–2018. Methods A prospective observational study of immunocompetent adults (≥18 years) admitted to 4 Spanish hospitals with chest X-ray–confirmed CAP between November 2011 and November 2018. Microbiological confirmation was obtained using the Pfizer serotype-specific urinary antigen detection tests (UAD1/UAD2), BinaxNow test for urine, and conventional cultures of blood, pleural fluid, and high-quality sputum. Results Of 3107 adults hospitalized with CAP, 1943 were ≥65 years. Underlying conditions were present in 87% (n = 2704) of the participants. Among all patients, 895 (28.8%) had pneumococcal CAP and 439 (14.1%) had PCV13-VT CAP, decreasing from 17.9% (n = 77) to 13.2% (n = 68) from 2011–2012 to 2017–2018 (P = .049). PCV20-VT CAP occurred in 243 (23.8%) of those included in 2016–2018. The most identified serotypes were 3 and 8. Serotype 3 accounted for 6.9% (n = 215) of CAP cases, remaining stable during the study period, and was associated with disease severity. Conclusions PCV13-VT caused a substantial proportion of CAP in Spanish immunocompetent adults 8 years after introduction of childhood PCV13 immunization. Improving direct PCV13 coverage of targeted adult populations could further reduce PCV13-VT burden, a benefit that could be increased further if PCV20 is licensed and implemented.
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Affiliation(s)
- Antoni Torres
- Hospital Clinic, Barcelona, Spain.,Biomedical Research Center Network for Respiratory Diseases (CIBERES), Madrid, Spain
| | - Rosario Menéndez
- Biomedical Research Center Network for Respiratory Diseases (CIBERES), Madrid, Spain.,Hospital Universitario y Politécnico la Fe, Valencia, Spain
| | | | | | | | | | - Raúl Méndez
- Hospital Universitario y Politécnico la Fe, Valencia, Spain
| | | | | | - María Ercibengoa
- Biodonostia, Hospital Universitario Donostia, San Sebastian, Spain
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16
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Chan J, Gidding HF, Blyth CC, Fathima P, Jayasinghe S, McIntyre PB, Moore HC, Mulholland K, Nguyen CD, Andrews R, Russell FM. Levels of pneumococcal conjugate vaccine coverage and indirect protection against invasive pneumococcal disease and pneumonia hospitalisations in Australia: An observational study. PLoS Med 2021; 18:e1003733. [PMID: 34343186 PMCID: PMC8376256 DOI: 10.1371/journal.pmed.1003733] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 08/19/2021] [Accepted: 07/13/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND There is limited empiric evidence on the coverage of pneumococcal conjugate vaccines (PCVs) required to generate substantial indirect protection. We investigate the association between population PCV coverage and indirect protection against invasive pneumococcal disease (IPD) and pneumonia hospitalisations among undervaccinated Australian children. METHODS AND FINDINGS Birth and vaccination records, IPD notifications, and hospitalisations were individually linked for children aged <5 years, born between 2001 and 2012 in 2 Australian states (New South Wales and Western Australia; 1.37 million children). Using Poisson regression models, we examined the association between PCV coverage, in small geographical units, and the incidence of (1) 7-valent PCV (PCV7)-type IPD; (2) all-cause pneumonia; and (3) pneumococcal and lobar pneumonia hospitalisation in undervaccinated children. Undervaccinated children received <2 doses of PCV at <12 months of age and no doses at ≥12 months of age. Potential confounding variables were selected for adjustment a priori with the assistance of a directed acyclic graph. There were strong inverse associations between PCV coverage and the incidence of PCV7-type IPD (adjusted incidence rate ratio [aIRR] 0.967, 95% confidence interval [CI] 0.958 to 0.975, p-value < 0.001), and pneumonia hospitalisations (all-cause pneumonia: aIRR 0.991 95% CI 0.990 to 0.994, p-value < 0.001) among undervaccinated children. Subgroup analyses for children <4 months old, urban, rural, and Indigenous populations showed similar trends, although effects were smaller for rural and Indigenous populations. Approximately 50% coverage of PCV7 among children <5 years of age was estimated to prevent up to 72.5% (95% CI 51.6 to 84.4) of PCV7-type IPD among undervaccinated children, while 90% coverage was estimated to prevent 95.2% (95% CI 89.4 to 97.8). The main limitations of this study include the potential for differential loss to follow-up, geographical misclassification of children (based on residential address at birth only), and unmeasured confounders. CONCLUSIONS In this study, we observed substantial indirect protection at lower levels of PCV coverage than previously described-challenging assumptions that high levels of PCV coverage (i.e., greater than 90%) are required. Understanding the association between PCV coverage and indirect protection is a priority since the control of vaccine-type pneumococcal disease is a prerequisite for reducing the number of PCV doses (from 3 to 2). Reduced dose schedules have the potential to substantially reduce program costs while maintaining vaccine impact.
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Affiliation(s)
- Jocelyn Chan
- Asia-Pacific Health Research Group, Murdoch Children’s Research Institute, Melbourne, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia
- * E-mail:
| | - Heather F. Gidding
- Northern Clinical School, The University of Sydney, Sydney Australia
- Women and Babies Health Research, Kolling Institute, Northern Sydney Local Health District, Sydney Australia
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, The Children’s Hospital at Westmead, Sydney, Australia
| | | | - Parveen Fathima
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Australia
| | - Sanjay Jayasinghe
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, The Children’s Hospital at Westmead, Sydney, Australia
- Children’s Hospital at Westmead Clinical School, Faculty of Medicine, University of Sydney, Sydney, Australia
| | - Peter B. McIntyre
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, The Children’s Hospital at Westmead, Sydney, Australia
| | - Hannah C. Moore
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Australia
| | - Kim Mulholland
- Asia-Pacific Health Research Group, Murdoch Children’s Research Institute, Melbourne, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Cattram D. Nguyen
- Asia-Pacific Health Research Group, Murdoch Children’s Research Institute, Melbourne, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia
| | - Ross Andrews
- Global & Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia
- National Centre for Epidemiology & Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Fiona M. Russell
- Asia-Pacific Health Research Group, Murdoch Children’s Research Institute, Melbourne, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia
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Grant LR, Slack MPE, Yan Q, Trzciński K, Barratt J, Sobczyk E, Appleby J, Cané A, Jodar L, Isturiz RE, Gessner BD. The epidemiologic and biologic basis for classifying older age as a high-risk, immunocompromising condition for pneumococcal vaccine policy. Expert Rev Vaccines 2021; 20:691-705. [PMID: 34233558 DOI: 10.1080/14760584.2021.1921579] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Immunosenescence is a normal biologic process involving deterioration of protective immune responses. Consequently, older adults experience increased risk of infectious diseases, particularly pneumonia, and its leading bacterial cause, Streptococcus pneumoniae. Pneumococcal vaccine recommendations are often limited to adults with specific medical conditions despite similar disease risks among older adults due to immunosenescence. AREAS COVERED This article reviews epidemiologic, biologic, and clinical evidence supporting the consideration of older age due to immunosenescence as an immunocompromising condition for the purpose of pneumococcal vaccine policy and the role vaccination can play in healthy aging. EXPERT OPINION Epidemiologic and biologic evidence suggest that pneumococcal disease risk increases with age and is comparable for healthy older adults and younger adults with immunocompromising conditions. Because immunocompromising conditions are already indicated for pneumococcal conjugate vaccines (PCVs), a comprehensive public health strategy would also recognize immunosenescence. Moreover, older persons should be vaccinated before reaching the highest risk ages, consistent with the approach for other immunocompromising conditions. To facilitate PCV use among older adults, vaccine technical committees (VTCs) could classify older age as an immunocompromising condition based on the process of immunosenescence. With global aging, VTCs will need to consider immunosenescence and vaccine use during healthy aging.
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Affiliation(s)
- Lindsay R Grant
- Vaccines Medical Development & Scientific/Clinical Affairs, Pfizer Inc, Collegeville, PA, USA
| | - Mary P E Slack
- School of Medicine, Griffith University Gold Coast Campus, Australia
| | - Qi Yan
- Vaccines Medical Development & Scientific/Clinical Affairs, Pfizer Inc, Collegeville, PA, USA
| | - Krzysztof Trzciński
- Department of Pediatric Immunology and Infectious Diseases, Wilhelmina's Children Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Jane Barratt
- International Federation on Ageing, Toronto, Ontario, Canada
| | | | - James Appleby
- The Gerontological Society of America, Washington, D.C., USA
| | - Alejandro Cané
- Vaccines Medical Development & Scientific/Clinical Affairs, Pfizer Inc, Collegeville, PA, USA
| | - Luis Jodar
- Vaccines Medical Development & Scientific/Clinical Affairs, Pfizer Inc, Collegeville, PA, USA
| | - Raul E Isturiz
- Vaccines Medical Development & Scientific/Clinical Affairs, Pfizer Inc, Collegeville, PA, USA
| | - Bradford D Gessner
- Vaccines Medical Development & Scientific/Clinical Affairs, Pfizer Inc, Collegeville, PA, USA
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18
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Gessner BD, Isturiz R, Snow V, Grant LR, Theilacker C, Jodar L. The rationale for use of clinically defined outcomes in assessing the impact of pneumococcal conjugate vaccines against pneumonia. Expert Rev Vaccines 2021; 20:269-280. [PMID: 33602035 DOI: 10.1080/14760584.2021.1889376] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Introduction: When evaluating the public health value of adult pneumococcal conjugate vaccine (PCV) for pneumonia, regulatory agencies and vaccine technical committees (VTCs) emphasize vaccine serotype (VT), radiologically confirmed community-acquired pneumonia (CAP) to the exclusion of clinically defined pneumonia and thus may underestimate PCV's public health value.Areas covered: We review the critiques that have been raised to using clinically defined pneumonia as a complement to VT-CAP in evaluating the public health value of adult PCVs.Expert opinion: PCV13 efficacies for preventing hospitalized CAP ranged from 6% to 11% and for a combination of primary and secondary care from 4% to 12%, with relatively high associated rate reductions. These efficacy values are larger than estimated from multiplying PCV13 efficacy against vaccine-type CAP by the proportion of CAP identified as vaccine-type through tests, such as a serotype-specific urinary antigen detection assay. Current understanding of pneumococcal epidemiology and limitations of diagnostic tests suggest the efficacy values for clinically defined outcomes are plausible and potentially generalizable. Regulatory agencies and VTCs have accepted clinically defined outcomes for assessing pediatric vaccines and - while additional studies assessing adult clinical CAP VE are needed - they might consider existing data when evaluating adult PCV use.
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Abstract
The proportion of the global population aged 65 and older is rapidly increasing. Infections in this age group, most recently with SARS-CoV-2, cause substantial morbidity and mortality. Major improvements have been made in vaccines for older people, either through the addition of novel adjuvants-as in the new recombinant zoster vaccine and an adjuvanted influenza vaccine-or by increasing antigen concentration, as in influenza vaccines. In this article we review improvements in immunization for the three most important vaccine preventable diseases of aging. The recombinant zoster vaccine has an efficacy of 90% that is minimally affected by the age of the person being vaccinated and persists for more than four years. Increasing antigen dose or inclusion of adjuvant has improved the immunogenicity of influenza vaccines in older adults, although the relative effectiveness of the enhanced influenza vaccines and the durability of the immune response are the focus of ongoing clinical trials. Conjugate and polysaccharide pneumococcal vaccines have similar efficacy against invasive pneumococcal disease and pneumococcal pneumonia caused by vaccine serotypes in older adults. Their relative value varies by setting, depending on the prevalence of vaccine serotypes, largely related to conjugate vaccine coverage in children. Improved efficacy will increase public confidence and uptake of these vaccines. Co-administration of these vaccines is feasible and important for maximal uptake in older people. Development of new vaccine platforms has accelerated following the arrival of SARS-CoV-2, and will likely result in new vaccines against other pathogens in the future.
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Affiliation(s)
- Anthony L Cunningham
- Centre for Virus Research, The Westmead Institute for Medical Research, Faculty of Medicine and Health, University of Sydney, Australia
| | - Peter McIntyre
- Women's and Children's Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Kanta Subbarao
- WHO CollaboratingCentre for Reference and Research on Influenza and Department of Microbiology and Immunology, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Robert Booy
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, The Children's Hospital at Westmead, New South Wales, Australia
- Marie Bashir Institute for Infectious Diseases and Biosecurity, School of Biological Sciences and Sydney Medical School, University of Sydney, Australia
| | - Myron J Levin
- Departments of Pediatrics and Medicine, University of Colorado School of Medicine Anschutz Medical Campus, Aurora, Colorado, USA
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Pneumococcal Conjugate Vaccine Impact on Serotype 3: A Review of Surveillance Data. Infect Dis Ther 2021; 10:521-539. [PMID: 33587245 PMCID: PMC7954992 DOI: 10.1007/s40121-021-00406-w] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 01/20/2021] [Indexed: 11/24/2022] Open
Abstract
Introduction Limited changes in serotype 3 invasive pneumococcal disease (IPD) incidence rates after a decade of 13-valent pneumococcal conjugate vaccine (PCV13) introduction into several national immunization programs (NIP) have raised questions about PCV13's effectiveness against this serotype. Methods We analyzed the impact of pediatric PCV programs on serotype 3 IPD with two approaches. First, we reviewed the publicly available surveillance data from countries identified in two recently published reviews to describe the population impact of pediatric PCV13 or PCV10 vaccination programs on serotype 3 IPD. We then compared the observed trends in PCV10 and PCV13 countries to a previously described dynamic transmission model that simulates the spread of pneumococcal carriage and development of IPD in a population over time. Results When serotype 3 disease rates are compared from countries that have introduced either a 10-valent (PCV10) vaccine that does not contain serotype 3 in its formulation or PCV13 in their pediatric NIP, over time, serotype 3 incidence rate trends are markedly different. Countries with a PCV10 NIP showed a substantial linear increase in serotype 3 pneumococcal disease among all age groups since the time of PCV10 introduction, whereas countries with a PCV13 NIP experienced a modest decline during the 3–4 years after vaccine introduction followed by an inflection upward in subsequent years. Conclusion These data suggest that PCV13 provides a certain degree of direct and indirect protection against serotype 3 at the population level and direct adult vaccination with a serotype 3-containing vaccine is likely to provide substantial benefit in the context of a pediatric PCV NIP. Further research around serotype 3 transmission patterns and epidemiology is nonetheless warranted. Supplementary Information The online version contains supplementary material available at 10.1007/s40121-021-00406-w.
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21
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The proportion of contemporary invasive pneumococcal disease and pneumococcal pneumonia in UK adults reflected by serotypes included in the 13-valent pneumococcal conjugate vaccine and next generation higher valency pneumococcal conjugate vaccines in development. Vaccine 2020; 38:8068-8070. [PMID: 33190949 DOI: 10.1016/j.vaccine.2020.10.090] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 10/27/2020] [Accepted: 10/29/2020] [Indexed: 11/22/2022]
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22
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Suaya JA, Mendes RE, Sings HL, Arguedas A, Reinert RR, Jodar L, Isturiz RE, Gessner BD. Streptococcus pneumoniae serotype distribution and antimicrobial nonsusceptibility trends among adults with pneumonia in the United States, 2009‒2017. J Infect 2020; 81:557-566. [DOI: 10.1016/j.jinf.2020.07.035] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 07/15/2020] [Accepted: 07/28/2020] [Indexed: 10/23/2022]
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23
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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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24
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LeBlanc J, ElSherif M, Ye L, MacKinnon-Cameron D, Ambrose A, Hatchette TF, Lang AL, Gillis HD, Martin I, Demczuk WH, LaFerriere C, Andrew MK, Boivin G, Bowie W, Green K, Johnstone J, Loeb M, McCarthy A, McGeer A, Semret M, Trottier S, Valiquette L, Webster D, McNeil SA. Age-stratified burden of pneumococcal community acquired pneumonia in hospitalised Canadian adults from 2010 to 2015. BMJ Open Respir Res 2020; 7:e000550. [PMID: 32188585 PMCID: PMC7078693 DOI: 10.1136/bmjresp-2019-000550] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 02/25/2020] [Accepted: 02/26/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND In Canada, 13-valent pneumococcal conjugate vaccine (PCV13) is recommended in childhood, in individuals at high risk of invasive pneumococcal disease (IPD) and in healthy adults aged ≥65 years for protection against vaccine-type IPD and pneumococcal community-acquired pneumonia (pCAP). Since vaccine recommendations in Canada include both age-based and risk-based guidance, this study aimed to describe the burden of vaccine-preventable pCAP in hospitalised adults by age. METHODS Surveillance for community-acquired pneumonia (CAP) in hospitalised adults was performed prospectively from 2010 to 2015. CAP was radiologically confirmed, and pCAP was identified using blood and sputum culture and urine antigen testing. Patient demographics and outcomes were stratified by age (16-49, 50-64, ≥65 and ≥50 years). RESULTS Of 6666/8802 CAP cases tested, 830 (12.5%) had pCAP, and 418 (6.3%) were attributed to a PCV13 serotype. Of PCV13 pCAP, 41% and 74% were in adults aged ≥65 and ≥50 years, respectively. Compared with non-pCAP controls, pCAP cases aged ≥50 years were more likely to be admitted to intensive care units (ICUs) and to require mechanical ventilation. Older adults with pCAP were less likely to be admitted to ICU or required mechanical ventilation, given their higher mortality and goals of care. Of pCAP deaths, 67% and 90% were in the ≥65 and ≥50 age cohorts, respectively. CONCLUSIONS Adults hospitalised with pCAP in the age cohort of 50-64 years contribute significantly to the burden of illness, suggesting that an age-based recommendation for adults aged ≥50 years should be considered in order to optimise the impact of pneumococcal vaccination programmes in Canada.
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Affiliation(s)
- Jason LeBlanc
- Canadian Center for Vaccinology (CCfV), Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - May ElSherif
- Canadian Center for Vaccinology (CCfV), Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Lingyun Ye
- Canadian Center for Vaccinology (CCfV), Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Donna MacKinnon-Cameron
- Canadian Center for Vaccinology (CCfV), Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Ardith Ambrose
- Canadian Center for Vaccinology (CCfV), Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Todd F Hatchette
- Canadian Center for Vaccinology (CCfV), Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Amanda Ls Lang
- Canadian Center for Vaccinology (CCfV), Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Hayley D Gillis
- Canadian Center for Vaccinology (CCfV), Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Irene Martin
- Streptocococcus & STI Unit, National Microbiology Laboratory (NML), Public Health Agency of Canada (PHAC), Winnipeg, Manitoba, Canada
| | - Walter H Demczuk
- Streptocococcus & STI Unit, National Microbiology Laboratory (NML), Public Health Agency of Canada (PHAC), Winnipeg, Manitoba, Canada
| | | | - Melissa K Andrew
- Canadian Center for Vaccinology (CCfV), Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Guy Boivin
- Department of Microbiology-Immunology and Infectious Diseases, Centre Hospitalier Universitaire de Québec, Quebec City, Quebec, Canada
| | - William Bowie
- Department of Medicine, Vancouver General Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | - Karen Green
- Department of Microbiology, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Jennie Johnstone
- Department of Medicine, Public Health Ontario and University of Toronto, Toronto, Ontario, Canada
| | - Mark Loeb
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Anne McCarthy
- Division of Infectious Diseases, Ottawa Hospital General Campus and University of Ottawa, Hamilton, Ontario, Canada
| | - Allison McGeer
- Department of Microbiology, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Makeda Semret
- Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
| | - Sylvie Trottier
- Department of Microbiology-Immunology and Infectious Diseases, Centre Hospitalier Universitaire de Québec, Quebec City, Quebec, Canada
| | - Louis Valiquette
- Department of Microbiology and Infectiology, Centre Intégré Universitaire de Santé et de Services Sociaux de l'Estrie - Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Québec, Canada
| | - Duncan Webster
- Department of Medicine, Saint John Regional Hospital, Saint John, New Brunswick, Canada
| | - Shelly A McNeil
- Canadian Center for Vaccinology (CCfV), Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
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Arguedas A, Gessner BD, Williams S, Fletcher MA, Isturiz R, Reinert R, Jodar L. Letter to the editor. Vaccine 2019; 37:7530-7531. [PMID: 31783978 DOI: 10.1016/j.vaccine.2019.09.107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 08/16/2019] [Accepted: 09/30/2019] [Indexed: 11/27/2022]
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26
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Affiliation(s)
- David Goldblatt
- Great Ormond Street Institute of Child Health Biomedical Research Centre, University College London, London, UK
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27
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Gessner BD, Sings HL, Jodar L. Efficacy and effectiveness of ten-valent versus 13-valent pneumococcal conjugate vaccines. THE LANCET. INFECTIOUS DISEASES 2019; 19:692-693. [PMID: 31250816 DOI: 10.1016/s1473-3099(19)30270-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 05/15/2019] [Indexed: 06/09/2023]
Affiliation(s)
| | | | - Luis Jodar
- Pfizer Vaccines, Collegeville, PA19426, USA
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