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Grant LR, Apodaca K, Deshpande L, Kimbrough JH, Hayford K, Yan Q, Mendes R, Cané A, Gessner BD, Arguedas A. Characterization of Streptococcus pneumoniae isolates obtained from the middle ear fluid of US children, 2011-2021. Front Pediatr 2024; 12:1383748. [PMID: 39077066 PMCID: PMC11284096 DOI: 10.3389/fped.2024.1383748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 06/17/2024] [Indexed: 07/31/2024] Open
Abstract
Introduction Pneumococcal conjugate vaccines (PCVs), including higher valency vaccines such as PCV20, have the potential to reduce pediatric otitis media. We assessed serotype distribution, potential PCV coverage, and antimicrobial susceptibility of Streptococcus pneumoniae isolates cultured from middle ear fluid (MEF) of US children age ≤5 years. Methods S. pneumoniae isolates identified from US hospitals participating in the SENTRY Antimicrobial Surveillance program from 2011 to 2021 were included. Serotypes were determined by in silico analysis based on Pneumococcal Capsular Typing methodology. The percentage of isolates belonging to serotypes included in PCV13 (serotypes 1, 3, 4, 5, 6A, 6B, 7F, 9V, 14, 18C, 19A, 19F, 23F), PCV15 (PCV13 plus 22F, 33F), and PCV20 (PCV13 plus, 8, 10A, 11A, 12F, 15B, 22F and 33F) was calculated. Antimicrobial susceptibility testing was performed by broth microdilution and interpreted using CLSI criteria. Nonsusceptibility was defined as isolates that were intermediate or resistant to a selected antimicrobial. Results Among the 199 S. pneumoniae isolates that were identified, 56.8% were from children age <2 years. Six serotypes accounted for around 60% of isolates: 35B (16.6%), 15B (14.6%), 15A (7.5%), 19A (7.5%), 19F (7.5%), and 3 (7.0%). Serotypes included in PCV13, PCV15, and PCV20 accounted for 23.1%, 30.2%, and 54.8% of isolates, respectively. Overall, 45.2% of isolates were penicillin non-susceptible, and 13.6% were MDR, of which 48% were serotype 19A. Seven serotypes (19A, 15A, 15B, 15C, 23A, 33F, and 35B) accounted for the majority of non-susceptible isolates. Discussion PCVs, particularly PCV20, may prevent a substantial fraction of S. pneumoniae otitis media (OM), including OM due to non-susceptible serotypes. The addition of serotypes 15A, 23A, and 35B would improve coverage against susceptible and non-susceptible pneumococcal OM.
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Affiliation(s)
- Lindsay R. Grant
- Vaccines and Antivirals, Pfizer Inc., Collegeville, PA, United States
| | - Kevin Apodaca
- Vaccines and Antivirals, Pfizer Inc., Collegeville, PA, United States
| | | | | | - Kyla Hayford
- Vaccines and Antivirals, Pfizer Inc., Collegeville, PA, United States
| | - Qi Yan
- Vaccines and Antivirals, Pfizer Inc., Collegeville, PA, United States
| | | | - Alejandro Cané
- Vaccines and Antivirals, Pfizer Inc., Collegeville, PA, United States
| | | | - Adriano Arguedas
- Vaccines and Antivirals, Pfizer Inc., Collegeville, PA, United States
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Andrejko KL, Gierke R, Rowlands JV, Rosen JB, Thomas A, Landis ZQ, Rosales M, Petit S, Schaffner W, Holtzman C, Barnes M, Farley MM, Harrison LH, McGee L, Chochua S, Verani JR, Cohen AL, Pilishvili T, Kobayashi M. Effectiveness of 13-valent pneumococcal conjugate vaccine for prevention of invasive pneumococcal disease among children in the United States between 2010 and 2019: An indirect cohort study. Vaccine 2024; 42:3555-3563. [PMID: 38704263 DOI: 10.1016/j.vaccine.2024.04.061] [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: 02/23/2024] [Revised: 04/09/2024] [Accepted: 04/21/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUND A U.S. case-control study (2010-2014) demonstrated vaccine effectiveness (VE) for ≥ 1 dose of the thirteen-valent pneumococcal conjugate vaccine (PCV13) against vaccine-type (VT) invasive pneumococcal disease (IPD) at 86 %; however, it lacked statistical power to examine VE by number of doses and against individual serotypes. METHODS We used the indirect cohort method to estimate PCV13 VE against VT-IPD among children aged < 5 years in the United States from May 1, 2010 through December 31, 2019 using cases from CDC's Active Bacterial Core surveillance, including cases enrolled in a matched case-control study (2010-2014). Cases and controls were defined as individuals with VT-IPD and non-PCV13-type-IPD (NVT-IPD), respectively. We estimated absolute VE using the adjusted odds ratio of prior PCV13 receipt (1-aOR x 100 %). RESULTS Among 1,161 IPD cases, 223 (19.2 %) were VT cases and 938 (80.8 %) were NVT controls. Of those, 108 cases (48.4 %; 108/223) and 600 controls (64.0 %; 600/938) had received > 3 PCV13 doses; 23 cases (17.6 %) and 15 controls (2.4 %) had received no PCV doses. VE ≥ 3 PCV13 doses against VT-IPD was 90.2 % (95 % Confidence Interval75.4-96.1 %), respectively. Among the most commonly circulating VT-IPD serotypes, VE of ≥ 3 PCV13 doses was 86.8 % (73.7-93.3 %), 50.2 % (28.4-80.5 %), and 93.8 % (69.8-98.8 %) against serotypes 19A, 3, and 19F, respectively. CONCLUSIONS At least three doses of PCV13 continue to be effective in preventing VT-IPD among children aged < 5 years in the US. PCV13 was protective against serotypes 19A and 19F IPD; protection against serotype 3 IPD did not reach statistical significance.
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Affiliation(s)
- Kristin L Andrejko
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Ryan Gierke
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Jennifer B Rosen
- Bureau of Immunization, New York City Department of Health and Mental Hygiene, New York, NY, USA
| | - Ann Thomas
- Oregon Public Health Division, Portland, OR, USA
| | | | - Maria Rosales
- California Emerging Infections Program, Richmond, CA, USA
| | - Sue Petit
- Connecticut Department of Public Health, Hartford, CT, USA
| | - William Schaffner
- Department of Health Policy, Vanderbilt University School of Medicine, Nashville, TN, USA
| | | | - Meghan Barnes
- Colorado Department of Public Health and Environment, Denver, CO, USA
| | - Monica M Farley
- Department of Medicine, Emory University School of Medicine and Atlanta VA Medical Center, Atlanta, GA, USA
| | - Lee H Harrison
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Lesley McGee
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Sopio Chochua
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jennifer R Verani
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Adam L Cohen
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Tamara Pilishvili
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Miwako Kobayashi
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Feemster K, Buchwald UK, Banniettis N, Joyce JG, Velentgas P, Chapman TJ, Yildirim I. Immunogenicity of Current and Next-Generation Pneumococcal Conjugate Vaccines in Children: Current Challenges and Upcoming Opportunities. Open Forum Infect Dis 2024; 11:ofae220. [PMID: 38770212 PMCID: PMC11103622 DOI: 10.1093/ofid/ofae220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Indexed: 05/22/2024] Open
Abstract
Global use of pneumococcal conjugate vaccines (PCVs) with increasingly broader serotype coverage has helped to reduce the burden of pneumococcal disease in children and adults. In clinical studies comparing PCVs, higher-valency PCVs have met noninferiority criteria (based on immunoglobulin G geometric mean concentrations and response rates) for most shared serotypes. A numeric trend of declining immunogenicity against shared serotypes with higher-valency PCVs has also been observed; however, the clinical relevance is uncertain, warranting additional research to evaluate the effectiveness of new vaccines. Novel conjugation processes, carriers, adjuvants, and vaccine platforms are approaches that could help maintain or improve immunogenicity and subsequent vaccine effectiveness while achieving broader protection with increasing valency in pneumococcal vaccines.
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Affiliation(s)
- Kristen Feemster
- Merck Research Laboratories, Merck & Co, Inc., Rahway, New Jersey, USA
| | - Ulrike K Buchwald
- Merck Research Laboratories, Merck & Co, Inc., Rahway, New Jersey, USA
| | | | - Joseph G Joyce
- Merck Research Laboratories, Merck & Co, Inc., Rahway, New Jersey, USA
| | | | - Timothy J Chapman
- Merck Research Laboratories, Merck & Co, Inc., Rahway, New Jersey, USA
| | - Inci Yildirim
- Department of Pediatrics, School of Medicine, Yale University, New Haven, Connecticut, USA
- Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, USA
- Yale Institute for Global Health, Yale University, New Haven, Connecticut, USA
- Yale Center for Infection and Immunity, Yale University School of Medicine, New Haven, Connecticut, USA
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Lv M, Du J, Xie MZ, Zhou Y, Yang G, Wang J, Zhang WX, Yang H, Zhang SS, Cui F, Lu QB, Wu J. Protective effect of PCV13 against all-cause hospitalized pneumonia in children in Beijing, China: real-world evidence. Vaccine 2024; 42:3091-3098. [PMID: 38594120 DOI: 10.1016/j.vaccine.2024.04.015] [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: 02/01/2024] [Revised: 03/12/2024] [Accepted: 04/04/2024] [Indexed: 04/11/2024]
Abstract
BACKGROUND The study evaluated the protective effect of 13-valent pneumococcal polysaccharide conjugate vaccine (PCV13) against all-cause hospitalized pneumonia in children in Beijing. METHODS Based on the vaccination record and inpatient medical record database of Beijing, children born in 2017 in Beijing, matched by age, gender, and district of the children with the ratio of 1:4, were selected as the vaccinated and unvaccinated groups according whether if vaccinated with PCV13. The incidence rate and 95 % confidence interval (95 %CI), vaccine effectiveness (VE) and direct medical costs of all-cause hospitalized pneumonia were calculated and compared within the same period of 12 months, 18 months, 24 months and 30 months after the birth of the child. RESULTS The decreased incidence rates of all-cause hospitalized pneumonia were observed at the four points in the PCV13 vaccinated group compared to the unvaccinated group, which were significant at the points of 12 months (0.42 % vs. 0.72 %, P = 0.001), 18 months (0.90 % vs. 1.26 %, P = 0.002) and 24 months (1.37 % vs. 1.65 %, P = 0.046). The VE of PCV13 against all-cause hospitalized pneumonia within 12 months was the highest as 41.9 % (95 % CI 19.6 %, 58.0 %), followed by 29.3 % (95 % CI 11.4 %, 43.5 %) within 18 months, 17.1 % (95 % CI 0.3 %, 31.1 %) within 24 months and it almost disappeared within 30 months. The VE of 4-dose vaccination within 18 months and 24 months were 39.9 % (95 % CI 20.3 %, 54.7 %) and 27.2 % (95 % CI 8.6 %, 42.0 %), respectively. The median hospitalization cost of the children in the vaccinated group was higher at the four points but without significance. CONCLUSIONS PCV13 had a certain protective effect on all-cause hospitalized pneumonia, and the booster immunization strategy had the best protective effect with great public health significance to enter the immunization program.
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Affiliation(s)
- Min Lv
- Institute for Immunization and Prevention, Beijing Center for Disease Prevention and Control, Beijing 100013, China
| | - Juan Du
- Department of Laboratorial Science and Technology & Vaccine Research Center, School of Public Health, Peking University, Beijing 100191, China; Center for Infectious Disease and Policy Research & Global Health and Infectious Diseases Group, Peking University, Beijing 100191, China
| | - Ming-Zhu Xie
- Department of Laboratorial Science and Technology & Vaccine Research Center, School of Public Health, Peking University, Beijing 100191, China; Center for Infectious Disease and Policy Research & Global Health and Infectious Diseases Group, Peking University, Beijing 100191, China
| | - Yiguo Zhou
- Center for Infectious Disease and Policy Research & Global Health and Infectious Diseases Group, Peking University, Beijing 100191, China; Department of Health Policy and Management, School of Public Health, Peking University, Beijing 100191, China; Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing 100191, China
| | - Guangzhao Yang
- Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne 3052, Australia
| | - Jian Wang
- Institute for Immunization and Prevention, Beijing Center for Disease Prevention and Control, Beijing 100013, China
| | - Wan-Xue Zhang
- Department of Laboratorial Science and Technology & Vaccine Research Center, School of Public Health, Peking University, Beijing 100191, China; Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing 100191, China
| | - Han Yang
- Department of Laboratorial Science and Technology & Vaccine Research Center, School of Public Health, Peking University, Beijing 100191, China; Center for Infectious Disease and Policy Research & Global Health and Infectious Diseases Group, Peking University, Beijing 100191, China
| | - Shan-Shan Zhang
- Department of Laboratorial Science and Technology & Vaccine Research Center, School of Public Health, Peking University, Beijing 100191, China; Center for Infectious Disease and Policy Research & Global Health and Infectious Diseases Group, Peking University, Beijing 100191, China
| | - Fuqiang Cui
- Department of Laboratorial Science and Technology & Vaccine Research Center, School of Public Health, Peking University, Beijing 100191, China; Center for Infectious Disease and Policy Research & Global Health and Infectious Diseases Group, Peking University, Beijing 100191, China; Department of Health Policy and Management, School of Public Health, Peking University, Beijing 100191, China; Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing 100191, China
| | - Qing-Bin Lu
- Department of Laboratorial Science and Technology & Vaccine Research Center, School of Public Health, Peking University, Beijing 100191, China; Center for Infectious Disease and Policy Research & Global Health and Infectious Diseases Group, Peking University, Beijing 100191, China; Department of Health Policy and Management, School of Public Health, Peking University, Beijing 100191, China; Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing 100191, China.
| | - Jiang Wu
- Institute for Immunization and Prevention, Beijing Center for Disease Prevention and Control, Beijing 100013, China.
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Grant LR, Hanquet G, Sepúlveda-Pachón IT, Theilacker C, Baay M, Slack MPE, Jodar L, Gessner BD. Effects of PCV10 and PCV13 on pneumococcal serotype 6C disease, carriage, and antimicrobial resistance. Vaccine 2024; 42:2983-2993. [PMID: 38553292 DOI: 10.1016/j.vaccine.2024.03.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 02/26/2024] [Accepted: 03/24/2024] [Indexed: 04/22/2024]
Abstract
BACKGROUND The cross-protection of pneumococcal conjugate vaccines (PCV) against serotype 6C is not clearly documented, although 6C represents a substantial burden of pneumococcal disease in recent years. A systematic review by the World Health Organization that covered studies through 2016 concluded that available data were insufficient to determine if either PCV10 (which contains serotype 6B but not 6A) or PCV13 (containing serotype 6A and 6B) conferred protection against 6C. METHODS We performed a systematic review of randomized controlled trials and observational studies published between January 2010 - August 2022 (Medline/Embase), covering the direct, indirect, and overall effect of PCV10 and PCV13 against 6C invasive pneumococcal disease (IPD), non-IPD, nasopharyngeal carriage (NPC), and antimicrobial resistance (AMR). RESULTS Of 2548 publications identified, 112 were included. Direct vaccine effectiveness against 6C IPD in children ranged between 70 and 85 % for ≥ 1 dose PCV13 (n = 3 studies), was 94 % in fully PCV13 vaccinated children (n = 2), and -14 % for ≥ 1 dose of PCV10 (n = 1). Compared to PCV7, PCV13 efficacy against 6C NPC in children was 66 % (n = 1). Serotype 6C IPD rates or NPC prevalence declined post-PCV13 in most studies in children (n = 5/6) and almost half of studies in adults (n = 5/11), while it increased post-PCV10 for IPD and non-IPD in all studies (n = 6/6). Changes in AMR prevalence were inconsistent. CONCLUSIONS In contrast to PCV10, PCV13 vaccination consistently protected against 6C IPD and NPC in children, and provided some level of indirect protection to adults, supporting that serotype 6A but not 6B provides cross-protection to 6C. Vaccine policy makers and regulators should consider the effects of serotype 6A-containing PCVs against serotype 6C disease in their decisions.
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Affiliation(s)
- Lindsay R Grant
- Medical Development and Scientific Clinical Affairs, Pfizer Vaccines, 500 Arcola Road, Collegeville, PA 19426, USA.
| | - Germaine Hanquet
- P95 Epidemiology & Pharmacovigilance, Koning Leopold III-laan 1, 3001 Leuven, Belgium.
| | | | - Christian Theilacker
- Medical Development and Scientific Clinical Affairs, Pfizer Pharma GmbH, Berlin, Germany.
| | - Marc Baay
- P95 Epidemiology & Pharmacovigilance, Koning Leopold III-laan 1, 3001 Leuven, Belgium.
| | - Mary P E Slack
- School of Medicine & Dentistry, Griffith University Gold Coast Campus, Parklands Drive, Southport, Queensland, QLD 4222, Australia.
| | - Luis Jodar
- Medical Development and Scientific Clinical Affairs, Pfizer Vaccines, 500 Arcola Road, Collegeville, PA 19426, USA.
| | - Bradford D Gessner
- Medical Development and Scientific Clinical Affairs, Pfizer Vaccines, 500 Arcola Road, Collegeville, PA 19426, USA.
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Qiu X, McGee L, Hammitt LL, Grant LR, O’Brien KL, Hanage WP, Lipsitch M. Prediction of post-PCV13 pneumococcal evolution using invasive disease data enhanced by inverse-invasiveness weighting. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.12.10.23299786. [PMID: 38168234 PMCID: PMC10760274 DOI: 10.1101/2023.12.10.23299786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
Background After introduction of pneumococcal conjugate vaccines (PCVs), serotype replacement occurred in the population of Streptococcus pneumoniae. Predicting which pneumococcal clones and serotypes will become more common in carriage after vaccination can enhance vaccine design and public health interventions, while also improving our understanding of pneumococcal evolution. We sought to use invasive disease data to assess how well negative frequency-dependent selection (NFDS) models could explain pneumococcal carriage population evolution in the post-PCV13 epoch by weighting invasive data to approximate strain proportions in the carriage population. Methods Invasive pneumococcal isolates were collected and sequenced during 1998-2018 by the Active Bacterial Core surveillance (ABCs) from the Centers for Disease Control and Prevention (CDC). To predict the post-PCV13 population dynamics in the carriage population using a NFDS model, all genomic data were processed under a bioinformatic pipeline of assembly, annotation, and pangenome analysis to define genetically similar sequence clusters (i.e., strains) and a set of accessory genes present in 5% to 95% of the isolates. The NFDS model predicted the strain proportion by calculating the post-vaccine strain composition in the weighted invasive disease population that would best match pre-vaccine accessory gene frequencies. To overcome the biases of invasive disease data, serotype-specific inverse-invasiveness weights were defined as the ratio of the proportion of the serotype in the carriage data to the proportion in the invasive data, using data from 1998-2001 in the United States, before conjugate vaccine introduction. The weights were applied to adjust both the observed strain proportion and the accessory gene frequencies. Results Inverse-invasiveness weighting increased the correlation of accessory gene frequencies between invasive and carriage data with reduced residuals in linear or logit scale for pre-vaccine, post-PCV7, and post-PCV13. Similarly, weighting increased the correlation of accessory gene frequencies between different time periods in the invasive data. By weighting the invasive data, we were able to use the NFDS model to predict strain proportions in the carriage population in the post-PCV13 epoch, with the adjusted R-squared between predicted and observed strain proportions increasing from 0.176 to 0.544 after weighting. Conclusions The weighting system adjusted the invasive disease surveillance data to better represent the carriage population of S. pneumoniae. The NFDS mechanism predicted the strain proportions in the projected carriage population as estimated from the weighted invasive disease frequencies in the post-PCV13 epoch. Our methods enrich the value of genomic sequences from invasive disease surveillance, which is readily available, easy to collect, and of direct interest to public health.
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Affiliation(s)
- Xueting Qiu
- Center for Communicable Disease Dynamics, Department of Epidemiology, T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
| | - Lesley McGee
- Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Laura L Hammitt
- Center for Indigenous Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Lindsay R Grant
- Center for Indigenous Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Katherine L O’Brien
- Center for Indigenous Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - William P Hanage
- Center for Communicable Disease Dynamics, Department of Epidemiology, T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
| | - Marc Lipsitch
- Center for Communicable Disease Dynamics, Department of Epidemiology, T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
- Department of Immunology and Infectious Diseases, T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
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Tian J, Zheng B, Yang L, Guan Y, Xu C, Wang W. Effectiveness of 13-valent pneumococcal conjugate vaccine on all-cause pneumonia in children under 5 years in Shanghai, China: An observational study. Vaccine 2023; 41:5979-5986. [PMID: 37620204 PMCID: PMC10549215 DOI: 10.1016/j.vaccine.2023.08.041] [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: 11/08/2022] [Revised: 07/28/2023] [Accepted: 08/15/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND Streptococcus pneumoniae (Spn) is a common respiratory pathogen and the main cause of bacterial pneumonia, meningitis, and bacteremia, acute otitis media. Imported 13-valent pneumococcal conjugate vaccine (PCV13) was licensed in China and introduced in Shanghai in 2017. We aim to describe PCV13 vaccination trends and pneumonia incidence of children under 5 from 2017 to 2020, then estimate the effectiveness of PCV13 against community-acquired pneumonia (CAP) in children under 5 in Shanghai, China. METHODS By calculating propensity scores with logistic regression, a comparison group was formed by frequency matching one unvaccinated child to one vaccinated child. For matching, we used the nearest-neighbor matching algorithm and exact matching, and then created distinct matched analysis sets for two cohorts. A Kaplan-Meier analysis was conducted to measure the cumulative incidence of all-cause pneumonia in both groups and used the log-rank test to assess the differences between the two cumulative incidence curves. Cox proportional hazards regression was used to compare the adjusted hazard ratios (HR) of differences in all-cause pneumonia between the two groups. RESULTS Children received three or more doses PCV13 accounted for 85.7% of all vaccinated children. The incidence of pneumonia in Shanghai's Songjiang district decreased rapidly from 2017, when PCV13 vaccination presented an overall increasing trend. The estimated vaccine effectiveness against visits for all-cause pneumonia was 19% (95% CI: 3 to 32) after the first dose in children vaccinated with at least one dose of PCV13. The protective effectiveness of PCV13 was found to be higher for hospitalized pneumonia (30%, 95% CI: 5% to 49%) than for outpatient pneumonia (19%, 95% CI: 4% to 32%). CONCLUSIONS PCV13 vaccination among children aged 0-5 years substantially reduced the incidence of all-cause pneumonia. Direct immunization of children under 5 years is an effective strategy to combat outpatient pneumonia, and hospitalized pneumonia.
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Affiliation(s)
- Jie Tian
- School of Public Health, Shanghai Institute of Infectious Disease and Biosecurity, Fudan University, Shanghai 200032, China
| | - Bo Zheng
- School of Public Health, Shanghai Institute of Infectious Disease and Biosecurity, Fudan University, Shanghai 200032, China
| | - Laibao Yang
- Department of Immunization, Pudong New Area Center for Disease Control and Prevention, Shanghai 200136, China
| | - Ying Guan
- Department of Health Information, Songjiang Center for Disease Control and Prevention, Shanghai 201620, China
| | - Chunze Xu
- Department of Health Information, Songjiang Center for Disease Control and Prevention, Shanghai 201620, China
| | - Weibing Wang
- School of Public Health, Shanghai Institute of Infectious Disease and Biosecurity, Fudan University, Shanghai 200032, China; Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, 138 Yi Xue Yuan Road, Shanghai 200032, China.
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8
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Deceuninck G, Brousseau N, Lefebvre B, Quach C, Tapiero B, Bui YG, Desjardins M, De Wals P. Effectiveness of thirteen-valent pneumococcal conjugate vaccine to prevent serotype 3 invasive pneumococcal disease in Quebec in children, Canada. Vaccine 2023; 41:5486-5489. [PMID: 37524629 DOI: 10.1016/j.vaccine.2023.07.049] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 07/04/2023] [Accepted: 07/24/2023] [Indexed: 08/02/2023]
Abstract
In the province of Quebec, Canada, a 2 + 1 dose pneumococcal conjugate vaccine (PCV) program for children was implemented in 2004. PCV7 was replaced by PCV10 in 2009, by PCV13 in 2011 and by PCV10 in 2018, without catch-up in all instances. The objective was to estimate PCV13 effectiveness to prevent serotype 3 invasive pneumococcal disease in children aged less than 5 years, using 2010-2018 mandatory notification and laboratory surveillance data, an indirect cohort design and multivariate logistic regression models. A total of 29 cases of serotype 3 and 290 non-vaccine serotype cases as controls were analysed. Overall vaccine effectiveness (≥1 dose) was estimated at 59% [-39% to 88%]. During the first year after the last dose effectivness was 88% [47% to 97%] whereas no protection was observed thereafter. There was no trend towards increased effectiveness with the number of doses. PCV13 protection against serotype 3 IPD seems to be short-lived.
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Affiliation(s)
- Geneviève Deceuninck
- Centre de recherche du Centre hospitalier universitaire de Québec, Équipe de recherche en vaccination, Québec, QC, Canada; Institut National de Santé Publique du Québec, Direction des risques biologiques, Québec, QC, Canada.
| | - Nicholas Brousseau
- Centre de recherche du Centre hospitalier universitaire de Québec, Équipe de recherche en vaccination, Québec, QC, Canada; Institut National de Santé Publique du Québec, Direction des risques biologiques, Québec, QC, Canada
| | - Brigitte Lefebvre
- Institut national de santé publique du Québec, Laboratoire de santé publique du Québec, Sainte-Anne-de-Bellevue, QC, Canada
| | - Caroline Quach
- Department of Microbiology, Infectious Diseases and Immunology, University of Montreal, Montreal, QC, Canada; Division of Medical microbiology, Clinical Department of Laboratory Medicine, CHU Sainte-Justine, Montreal, QC, Canada
| | - Bruce Tapiero
- Service des maladies infectieuses, CHU Sainte-Justine, Montréal, QC, Canada
| | - Yen-Giang Bui
- Institut National de Santé Publique du Québec, Direction des risques biologiques, Québec, QC, Canada
| | - Michaël Desjardins
- Department of Microbiology, Infectious Diseases and Immunology, University of Montreal, Montreal, QC, Canada; Division of Infectious Diseases, Centre hospitalier de l'Université de Montréal, Qc, Canada
| | - Philippe De Wals
- Centre de recherche du Centre hospitalier universitaire de Québec, Équipe de recherche en vaccination, Québec, QC, Canada; Institut National de Santé Publique du Québec, Direction des risques biologiques, Québec, QC, Canada; Département de Médecine Sociale et Préventive, Université Laval, Québec, QC, Canada; Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec, Québec, QC, Canada
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Wilson M, Lucas A, Mendes D, Vyse A, Mikudina B, Czudek C, Ellsbury GF, Perdrizet J. Estimating the Cost-Effectiveness of Switching to Higher-Valency Pediatric Pneumococcal Conjugate Vaccines in the United Kingdom. Vaccines (Basel) 2023; 11:1168. [PMID: 37514984 PMCID: PMC10386052 DOI: 10.3390/vaccines11071168] [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: 05/23/2023] [Revised: 06/14/2023] [Accepted: 06/26/2023] [Indexed: 07/30/2023] Open
Abstract
Currently, the 13-valent pneumococcal conjugate vaccine (PCV13) is administered under a 1+1 (1 primary dose) pediatric schedule in the United Kingdom (UK). Higher-valency PCVs, 15-valent PCV (PCV15), or 20-valent PCV (PCV20) might be considered to expand serotype coverage. We evaluated the cost-effectiveness of PCV20 or PCV15 using either a 2+1 (2 primary doses) or 1+1 schedule for pediatric immunization in the UK. Using a dynamic transmission model, we simulated future disease incidence and costs under PCV13 1+1, PCV20 2+1, PCV20 1+1, PCV15 2+1, and PCV15 1+1 schedules from the UK National Health Service perspective. We prospectively estimated disease cases, direct costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratio. Scenario analyses were performed to estimate the impact of model assumptions and parameter uncertainty. Over a five-year period, PCV20 2+1 averted the most disease cases and gained the most additional QALYs. PCV20 2+1 and 1+1 were dominant (cost-saving and more QALYs gained) compared with PCV15 (2+1 or 1+1) and PCV13 1+1. PCV20 2+1 was cost-effective (GBP 8110/QALY) compared with PCV20 1+1. PCV20 was found cost-saving compared with PCV13 1+1, and PCV20 2+1 was cost-effective compared with PCV20 1+1. Policymakers should consider the reduction in disease cases with PCV20, which may offset vaccination costs.
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Affiliation(s)
- Michele Wilson
- RTI Health Solutions, 3040 East Cornwallis Road, P.O. Box 12194, Research Triangle Park, Morrisville, NC 27709, USA
| | - Aaron Lucas
- RTI Health Solutions, 3040 East Cornwallis Road, P.O. Box 12194, Research Triangle Park, Morrisville, NC 27709, USA
| | - Diana Mendes
- Pfizer Ltd., Walton Oaks, Dorking Road, Surrey, Tadworth KT20 7NS, UK
| | - Andrew Vyse
- Pfizer Ltd., Walton Oaks, Dorking Road, Surrey, Tadworth KT20 7NS, UK
| | - Boglarka Mikudina
- Pfizer Ltd., Walton Oaks, Dorking Road, Surrey, Tadworth KT20 7NS, UK
| | - Carole Czudek
- Pfizer Ltd., Walton Oaks, Dorking Road, Surrey, Tadworth KT20 7NS, UK
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10
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Vojicic J, Grajales AG, Cane A. Vaccine effectiveness of the 7-valent and 13-valent pneumococcal conjugate vaccines in Canada: An IMPACT study. Vaccine 2023; 41:3949-3950. [PMID: 36797099 DOI: 10.1016/j.vaccine.2023.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 10/03/2022] [Accepted: 02/03/2023] [Indexed: 02/16/2023]
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11
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Liu L, Zhang Z, Zhang X, Xu C, Song Y, Li L, Ye J, Wang Z, Liang H, Zhang W, Lin L, Li N, Zhang S, Ma Q, Du W, Jiao Y, Cao L, Qi Q, Cao L, Yu W. Coverage of 13-Valent Pneumococcal Conjugate Vaccine Among Children 0-15 Months of Age - 9 Provinces, China, 2019-2021. China CDC Wkly 2023; 5:379-384. [PMID: 37197448 PMCID: PMC10184383 DOI: 10.46234/ccdcw2023.072] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Accepted: 04/24/2023] [Indexed: 05/19/2023] Open
Abstract
What is already known on this topic? Limited data exist regarding the coverage of the 13-valent pneumococcal conjugate vaccine (PCV13) in China. A lack of official statistics, coupled with an insufficient body of published literature, hinders the accurate depiction of the current situation. What is added by this report? This study investigated the utilization of PCV13 and estimated its coverage in nine provinces across eastern, central, and western China between 2019 and 2021. Despite an annual increase in PCV13 usage during this period, the overall coverage remained suboptimal. What are the implications for public health practice? Consideration should be given to incorporating vaccines into the Expanded Program of Immunization, reducing vaccine prices, and addressing the vaccination coverage gap between eastern and western regions when there is an adequate supply of PCV13, particularly with domestic vaccines.
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Affiliation(s)
- Lijun Liu
- Sichuan Center for Disease Control and Prevention, Chengdu City, Sichuan Province, China
| | - Zhaonan Zhang
- National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Xixi Zhang
- National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Changsha Xu
- Suqian Center for Disease Control and Prevention, Suqian City, Jiangsu Province, China
| | - Yifan Song
- National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Li Li
- National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jiakai Ye
- National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Zhiguo Wang
- Jiangsu Center for Disease Control and Prevention, Nanjing City, Jiangsu Province, China
| | - Hui Liang
- Zhejiang Center for Disease Control and Prevention, Hangzhou City, Zhejiang Province, China
| | - Weiyan Zhang
- Shandong Center for Disease Control and Prevention, Jinan City, Shandong Province, China
| | - Ling Lin
- Anhui Center for Disease Control and Prevention, Hefei City, Anhui Province, China
| | - Ning Li
- Hubei Center for Disease Control and Prevention, Wuhan City, Hubei Province, China
| | - Shujun Zhang
- Hunan Center for Disease Control and Prevention, Changsha City, Hunan Province, China
| | - Qianli Ma
- Sichuan Center for Disease Control and Prevention, Chengdu City, Sichuan Province, China
| | - Wen Du
- Guizhou Center for Disease Control and Prevention, Guiyang City, Guizhou Province, China
| | - Yongzhuo Jiao
- Gansu Center for Disease Control and Prevention, Lanzhou City, Gansu Province, China
| | - Lingsheng Cao
- National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Qi Qi
- Sichuan Center for Disease Control and Prevention, Chengdu City, Sichuan Province, China
| | - Lei Cao
- National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Wenzhou Yu
- National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing, China
- Yu Wenzhou,
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12
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Goldblatt D, Andrews NJ, Sheppard CL, Rose S, Aley PK, Roalfe L, Southern J, Robinson H, Pearce E, Plested E, Johnson M, Litt DJ, Fry NK, Waight P, Snape MD, Miller E. Pneumococcal carriage following PCV13 delivered as one primary and one booster dose (1 + 1) compared to two primary doses and a booster (2 + 1) in UK infants. Vaccine 2023; 41:3019-3023. [PMID: 37045683 DOI: 10.1016/j.vaccine.2023.04.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 03/29/2023] [Accepted: 04/04/2023] [Indexed: 04/14/2023]
Abstract
In January 2020 the UK changed from a 2 + 1 schedule for 13-valent pneumococcal conjugate vaccine (PCV13) to a 1 + 1 schedule (doses at 3 and 12 months) based on a randomized immunogenicity trial comparing the two schedules. Carriage prevalence measured at the time of booster and 6 months later in 191 of the 213 study infants was 57 % (109/191) and 60 % (114/190) respectively. There were eight episodes of vaccine-type (VT) or vaccine-related 6C carriage in the 2 + 1 and six in the 1 + 1 group; ≥4-fold rises in serotype-specific IgG in 71 children with paired post-booster and follow up blood samples at 21-33 months of age were found in 20 % (7/35) of the 2 + 1 and 15 % (6/41) of the 1 + 1 group. VTs identified in carriage and inferred from serology were similar comprising 3, 19A and 19F. Dropping a priming dose from the 2 + 1 PCV 13 schedule did not increase VT carriage in the study cohort. Ongoing population level carriage studies will be important to confirm this.
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Affiliation(s)
- David Goldblatt
- Infection, Immunity and Inflammation Department, UCL Great Ormond Street Institute of Child Health Biomedical Research Centre, London, United Kingdom.
| | - Nick J Andrews
- Immunisation and Vaccine Preventable Diseases, UK Health Security Agency, United Kingdom
| | - Carmen L Sheppard
- Respiratory and Vaccine Preventable Bacteria Reference Unit, UK Health Security Agency, London Vaccine Preventable Bacteria Section, National Infection Service Public Health England Colindale, United Kingdom
| | - Samuel Rose
- Respiratory and Vaccine Preventable Bacteria Reference Unit, UK Health Security Agency, London Vaccine Preventable Bacteria Section, National Infection Service Public Health England Colindale, United Kingdom
| | - Parvinder K Aley
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom and NIHR Oxford Biomedical Research Centre, United Kingdom
| | - Lucy Roalfe
- Infection, Immunity and Inflammation Department, UCL Great Ormond Street Institute of Child Health Biomedical Research Centre, London, United Kingdom
| | - Jo Southern
- Immunisation and Vaccine Preventable Diseases, UK Health Security Agency, United Kingdom
| | - Hannah Robinson
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom and NIHR Oxford Biomedical Research Centre, United Kingdom
| | - Emma Pearce
- Infection, Immunity and Inflammation Department, UCL Great Ormond Street Institute of Child Health Biomedical Research Centre, London, United Kingdom
| | - Emma Plested
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom and NIHR Oxford Biomedical Research Centre, United Kingdom
| | - Marina Johnson
- Infection, Immunity and Inflammation Department, UCL Great Ormond Street Institute of Child Health Biomedical Research Centre, London, United Kingdom
| | - David J Litt
- Respiratory and Vaccine Preventable Bacteria Reference Unit, UK Health Security Agency, London Vaccine Preventable Bacteria Section, National Infection Service Public Health England Colindale, United Kingdom
| | - Norman K Fry
- Immunisation and Vaccine Preventable Diseases, UK Health Security Agency, United Kingdom
| | - Pauline Waight
- Infection, Immunity and Inflammation Department, UCL Great Ormond Street Institute of Child Health Biomedical Research Centre, London, United Kingdom
| | - Matthew D Snape
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom and NIHR Oxford Biomedical Research Centre, United Kingdom
| | - Elizabeth Miller
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, United Kingdom
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13
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Mathematical modeling of pneumococcal transmission dynamics in response to PCV13 infant vaccination in Germany predicts increasing IPD burden due to serotypes included in next-generation PCVs. PLoS One 2023; 18:e0281261. [PMID: 36791091 PMCID: PMC9931105 DOI: 10.1371/journal.pone.0281261] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 01/18/2023] [Indexed: 02/16/2023] Open
Abstract
INTRODUCTION Two next-generation pneumococcal conjugate vaccines (PCVs), a 15- and a 20-valent PCV (PCV15 and PCV20), have recently been licensed for use in adults, and PCV15 has also been licensed in children. We developed a dynamic transmission model specific for Germany, with the aim to predict carriage prevalence and invasive pneumococcal disease (IPD) burden for serotypes included in these vaccines. METHODS The model allows to follow serotype distributions longitudinally both in the absence and presence of PCV vaccinations. We considered eight age cohorts and seven serotype groups according to the composition of different pneumococcal vaccines. This comprises the additional serotypes contained in PCV15 and PCV20 but not in PCV13. RESULTS The model predicted that by continuing the current vaccine policy (standard vaccination with PCV13 in children and with PPSV23 in adults) until 2031, IPD case counts due to any serotype in children <2 years of age will remain unchanged. There will be a continuous decrease of IPD cases in adults aged 16-59y, but a 20% increase in adults ≥60y. Furthermore, there will be a steady decrease of the proportion of carriage and IPD due to serotypes included in PCV7 and PCV13 over the model horizon and a steady rise of non-PCV13 serotypes in carriage and IPD. The highest increase for both pneumococcal carriage and absolute IPD case counts was predicted for serotypes 22F and 33F (included in both PCV15 and PCV20) and serotypes 8, 10A, 11A, 12F, and 15B (included in PCV20 only), particularly in older adults. Between 2022 and 2031, serotypes included in PCV20 only are expected to cause 19.7-25.3% of IPD cases in adults ≥60y. CONCLUSIONS We conclude that introduction of next-generation PCVs for adults may prevent a substantial and increasing proportion of adult IPDs, with PCV20 having the potential to provide the broadest protection against pneumococcal disease.
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14
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Adigweme I, Futa A, Saidy-Jah E, Edem B, Akpalu E, Dibbasey T, Sethna V, Dhere R, Kampmann B, Bengt C, Sirr J, Hosken N, Goldblatt D, Antony K, Alderson MR, Lamola S, Clarke E. Immunogenicity and safety of a 10-valent pneumococcal conjugate vaccine administered as a 2 + 1 schedule to healthy infants in The Gambia: a single-centre, double-blind, active-controlled, randomised, phase 3 trial. THE LANCET. INFECTIOUS DISEASES 2023; 23:609-620. [PMID: 36638819 DOI: 10.1016/s1473-3099(22)00734-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 09/18/2022] [Accepted: 10/28/2022] [Indexed: 01/12/2023]
Abstract
BACKGROUND Three pneumococcal conjugate vaccines (PCVs) are currently licensed and WHO prequalified for supply by UN agencies. Here, we aimed to investigate the safety and immunogenicity of SIIPL-PCV compared with PHiD-CV and PCV13, when administered to infants according to a 2 + 1 schedule. METHODS This single-centre, double-blind, active-controlled, randomised, phase 3 trial was done in Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine clinical trial facilities within two government health centres in the western region of The Gambia. Healthy, PCV-naive infants aged 6-8 weeks were enrolled if they weighed at least 3·5 kg and had no clinically significant health complaints, as determined by history and clinical examination. Eligible infants were randomly assigned (1:1:1) to receive either SIIPL-PCV, PHiD-CV, or PCV13 using permuted blocks of variable size. Parents and the trial staff assessing all study outcomes were masked to vaccine group. The first PCV vaccine was given with other routine Expanded Programme on Immunization vaccines when infants were aged 6-8 weeks (visit 1). At visit 2, routine vaccines alone (without a PCV) were administered. At visit 3, the second dose of the PCV was administered alongside other routine vaccines. At visit 4, a blood sample was collected. Visits 1-4 took place at intervals of 4 weeks. The booster PCV was administered at age 9-18 months (visit 5), with final follow-up 4 weeks after the booster (visit 6). The primary immunogenicity outcome compared the serotype-specific IgG geometric mean concentrations (GMCs) generated by SIIPL-PCV with those generated by PHiD-CV and PCV13, 4 weeks after the booster. We used descriptive 95% CIs without adjustment for multiplicity. Immunogenicity analyses were done in the per protocol population (defined as all children who received all the assigned study vaccines, who had an immunogenicity measurement available, and who had no protocol deviations that might interfere with the immunogenicity assessment). This trial was registered with the Pan African Clinical Trials Registry, PACTR201907754270299, and ClinicalTrials.gov, NCT03896477. FINDINGS Between July 18 and Nov 14, 2019, 745 infants were assessed for study eligibility. Of these, 85 infants (11%) were ineligible and 660 (89%) were enrolled and randomly assigned to receive SIIPL-PCV (n=220), PHiD-CV (n=220), or PCV13 (n=220). 602 infants (91%) were included in the per protocol immunogenicity population. The median age at vaccination was 46 days (range 42-56). 342 infants (52%) were female and 318 (48%) were male. Post-booster serotype-specific IgG GMCs generated by SIIPL-PCV ranged from 1·54 μg/mL (95% CI 1·38-1·73) for serotype 5 to 12·46 μg/mL (11·07-14·01) for serotype 6B. Post-booster GMCs against shared serotypes generated by PHiD-CV ranged from 0·80 μg/mL (0·72-0·88) for serotype 5 to 17·31 μg/mL (14·83-20·20) for serotype 19F. Post-booster GMCs generated by PCV13 ranged from 2·04 μg/mL (1·86-2·24) for serotype 5 to 15·54 μg/mL (13·71-17·60) for serotype 6B. Post-booster IgG GMCs generated by SIIPL-PCV were higher than those generated by PHiD-CV for seven of the eight shared serotypes (1, 5, 6B, 7F, 9V, 14, and 23F). The GMC generated by serotype 19F was higher after PHiD-CV. The SIIPL-PCV to PHiD-CV GMC ratios for shared serotypes ranged from 0·64 (95% CI 0·52-0·79) for serotype 19F to 2·91 (2·47-3·44) for serotype 1. The serotype 1 GMC generated by SIIPL-PCV was higher than that generated by PCV13, whereas serotype 5, 6A, 19A, and 19F GMCs were higher after PCV13. The SIIPL-PCV to PCV13 GMC ratios ranged from 0·72 (0·60-0·87) for serotype 19A to 1·44 (1·23-1·69) for serotype 1. INTERPRETATION SIIPL-PCV was safe and immunogenic when given to infants in The Gambia according to a 2 + 1 schedule. This PCV is expected to provide similar protection against invasive and mucosal pneumococcal disease to the protection provided by PCV13 and PHiD-CV, for which effectiveness data are available. Generating post-implementation data on the impact of SIIPL-PCV on pneumococcal disease endpoints remains important. FUNDING Bill & Melinda Gates Foundation.
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Affiliation(s)
- Ikechukwu Adigweme
- Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - Ahmed Futa
- Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - Ebrima Saidy-Jah
- Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - Bassey Edem
- Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - Edem Akpalu
- Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - Tida Dibbasey
- Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | | | | | - Beate Kampmann
- Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia; The Vaccine Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Christopher Bengt
- Great Ormond Street Institute of Child Health Biomedical Research Centre, University College London, London, UK
| | - Jake Sirr
- Great Ormond Street Institute of Child Health Biomedical Research Centre, University College London, London, UK
| | | | - David Goldblatt
- Great Ormond Street Institute of Child Health Biomedical Research Centre, University College London, London, UK
| | | | | | | | - Ed Clarke
- Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia; The Vaccine Centre, London School of Hygiene & Tropical Medicine, London, UK.
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15
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Henriques-Normark B, Narciso AR. An Experimental Human Colonization Model with Pneumococcal Serotype 3 has the Potential to be Used for Vaccine Studies. Am J Respir Crit Care Med 2022; 206:1312-1314. [PMID: 35856830 PMCID: PMC9746867 DOI: 10.1164/rccm.202207-1342ed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
- Birgitta Henriques-Normark
- Department of Microbiology, Tumor and Cell Biology,Department of Clinical MicrobiologyKarolinska University HospitalStockholm, Sweden
| | - Ana Rita Narciso
- Department of Microbiology, Tumor and Cell Biology,Department of Clinical MicrobiologyKarolinska University HospitalStockholm, Sweden
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16
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Savulescu C, Krizova P, Valentiner-Branth P, Ladhani S, Rinta-Kokko H, Levy C, Mereckiene J, Knol M, Winje BA, Ciruela P, de Miguel S, Guevara M, MacDonald L, Kozakova J, Slotved HC, Fry NK, Pekka Nuorti J, Danis K, Corcoran M, van der Ende A, Vestrheim DF, Munoz-Almagro C, Sanz JC, Castilla J, Smith A, Colzani E, Pastore Celentano L, Hanquet G. Effectiveness of 10 and 13-valent pneumococcal conjugate vaccines against invasive pneumococcal disease in European children: SpIDnet observational multicentre study. Vaccine 2022; 40:3963-3974. [PMID: 35637067 DOI: 10.1016/j.vaccine.2022.05.011] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 04/19/2022] [Accepted: 05/04/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Pneumococcal conjugate vaccines covering 10 (PCV10) and 13 (PCV13) serotypes have been introduced in the infant immunization schedule of most European countries in 2010-11. To provide additional real-life data, we measured the effectiveness of PCV10 and PCV13 against invasive pneumococcal disease (IPD) in children of 12 European sites (SpIDnet). METHODS We compared the vaccination status of PCV10 and PCV13 serotype IPD (cases) to that of nonPCV13 serotype IPD (controls) reported in 2012-2018. We calculated pooled effectiveness as (1-vaccination odds ratio)*100, and measured effectiveness over time since booster dose. RESULTS The PCV13 and PCV10 studies included 2522 IPD cases from ten sites and 486 cases from four sites, respectively. The effectiveness of ≥ 1 PCV13 dose was 84.2% (95 %CI: 79.0-88.1) against PCV13 serotypes (n = 2353) and decreased from 93.1% (87.8-96.1) < 12 months to 85.1% (72.0-92.1) ≥ 24 months after booster dose. PCV13 effectiveness of ≥ 1 dose was 84.7% (55.7-94.7) against fatal PCV13 IPD, 64.5% (43.7-77.6), 83.2% (73.7-89.3) and 85.1% (67.6-93.1) against top serotypes 3, 19A and 1, respectively, and 85.4% (62.3-94.4) against 6C. Serotype 3 and 19A effectiveness declined more rapidly. PCV10 effectiveness of ≥ 1 dose was 84.8% (69.4-92.5) against PCV10 serotypes (n = 370), 27.2% (-187.6 to 81.6) and 85.3% (35.2-96.7) against top serotypes 1 and 7F, 32.5% (-28.3 to 64.5) and -14.4% (-526.5 to 79.1) against vaccine-related serotypes 19A and 6C, respectively. CONCLUSIONS PCV10 and PCV13 provide similar protection against IPD due to the respective vaccine serotype groups but serotype-specific effectiveness varies by serotype and vaccine. PCV13 provided individual protection against serotype 3 and vaccine-related serotype 6C IPD. PCV10 effectiveness was not significant against vaccine-related serotypes 19A and 6C. PCV13 effectiveness declined with time after booster vaccination. This multinational study enabled measuring serotype-specific vaccine effectiveness with a precision rarely possible at the national level. Such large networks are crucial for the post-licensure evaluation of vaccines.
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Affiliation(s)
| | - Pavla Krizova
- National Institute of Public Health, Prague, Czech Republic
| | | | | | | | | | | | - Mirjam Knol
- National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | | | - Pilar Ciruela
- Health Agency of Catalunya, Barcelona, Spain; CIBER Epidemiología y Salud Pública, Madrid, Spain
| | | | - Marcela Guevara
- Public Health Institute of Navarra - IdiSNA, Pamplona, Spain; CIBER Epidemiología y Salud Pública, Madrid, Spain
| | | | - Jana Kozakova
- National Institute of Public Health, Prague, Czech Republic
| | | | | | - J Pekka Nuorti
- National Institute for Health and Welfare, Helsinki, Finland; Tampere University, Tampere, Finland
| | - Kostas Danis
- Santé publique France, the National Public Health Institute, Saint-Maurice, France
| | - Mary Corcoran
- Temple Street Children's University Hospital, Irish Pneumococcal Reference Laboratory, Dublin, Ireland
| | - Arie van der Ende
- Academic Medical Centre, National Reference Laboratory for Bacterial Meningitis, Amsterdam, the Netherlands
| | | | - Carmen Munoz-Almagro
- Hospital Sant Joan de Déu, and International University of Catalunya, Barcelona, Spain; CIBER Epidemiología y Salud Pública, Madrid, Spain
| | | | - Jesus Castilla
- Public Health Institute of Navarra - IdiSNA, Pamplona, Spain; CIBER Epidemiología y Salud Pública, Madrid, Spain
| | - Andrew Smith
- Bacterial Respiratory Infection Service, Scottish Microbiology Reference Laboratory, Glasgow Royal Infirmary & MVLS, University of Glasgow, Glasgow, Scotland, UK
| | - Edoardo Colzani
- European Centre for Disease Prevention and Control, Stockholm, Sweden
| | | | - Germaine Hanquet
- Epiconcept, Paris, France; Antwerp university, Antwerp, Belgium.
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Kobayashi M, Matanock A, Xing W, Adih WK, Li J, Gierke R, Almendares O, Reingold A, Alden N, Petit S, Farley MM, Harrison LH, Holtzman C, Baumbach J, Thomas A, Schaffner W, McGee L, Pilishvili T. Impact of 13-Valent Pneumococcal Conjugate Vaccine on Invasive Pneumococcal Disease Among Adults With HIV-United States, 2008-2018. J Acquir Immune Defic Syndr 2022; 90:6-14. [PMID: 35384920 PMCID: PMC9009407 DOI: 10.1097/qai.0000000000002916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 01/04/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND People with HIV (PWH) are at increased risk for invasive pneumococcal disease (IPD). Thirteen-valent pneumococcal conjugate vaccine (PCV13) was recommended for use in US children in 2010 and for PWH aged 19 years or older in 2012. We evaluated the population-level impact of PCV13 on IPD among PWH and non-PWH aged 19 years or older. METHODS We identified IPD cases from 2008 to 2018 through the Active Bacterial Core surveillance platform. We estimated IPD incidence using the National HIV Surveillance System and US Census Bureau data. We measured percent changes in IPD incidence from 2008 to 2009 to 2017-2018 by HIV status, age group, and vaccine serotype group, including serotypes in recently licensed 15-valent (PCV15) and 20-valent (PCV20) PCVs. RESULTS In 2008-2009 and 2017-2018, 8.4% (552/6548) and 8.0% (416/5169) of adult IPD cases were among PWH, respectively. Compared with non-PWH, a larger proportion of IPD cases among PWH were in adults aged 19-64 years (94.7%-97.4% vs. 56.0%-60.1%) and non-Hispanic Black people (62.5%-73.0% vs. 16.7%-19.2%). Overall and PCV13-type IPD incidence in PWH declined by 40.3% (95% confidence interval: -47.7 to -32.3) and 72.5% (95% confidence interval: -78.8 to -65.6), respectively. In 2017-2018, IPD incidence was 16.8 (overall) and 12.6 (PCV13 type) times higher in PWH compared with non-PWH; PCV13, PCV15/non-PCV13, and PCV20/non-PCV15 serotypes comprised 21.5%, 11.2%, and 16.5% of IPD in PWH, respectively. CONCLUSIONS Despite reductions post-PCV13 introduction, IPD incidence among PWH remained substantially higher than among non-PWH. Higher-valent PCVs provide opportunities to reduce remaining IPD burden in PWH.
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Affiliation(s)
- Miwako Kobayashi
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | - Almea Matanock
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | - Wei Xing
- Weems Design Studio Inc, Decatur, GA
| | - William K Adih
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - Jianmin Li
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - Ryan Gierke
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | - Olivia Almendares
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | - Arthur Reingold
- Berkeley School of Public Health, University of California, Berkeley, CA
| | - Nisha Alden
- Colorado Department of Public Health and Environment, Denver, CO
| | - Susan Petit
- Connecticut Department of Public Health, Hartford, CT
| | - Monica M Farley
- Department of Medicine, Emory University School of Medicine and the Atlanta VA Medical Center, GA
| | - Lee H Harrison
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | | | | | - Ann Thomas
- Oregon Department of Human Services, Portland, OR; and
| | - William Schaffner
- Department of Health Policy, Vanderbilt University School of Medicine, Nashville, TN
| | - Lesley McGee
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | - Tamara Pilishvili
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA
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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: 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: 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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Hanquet G, Krizova P, Dalby T, Ladhani SN, Nuorti JP, Danis K, Mereckiene J, Knol MJ, Winje BA, Ciruela P, de Miguel S, Portillo ME, MacDonald L, Morfeldt E, Kozakova J, Valentiner-Branth P, Fry NK, Rinta-Kokko H, Varon E, Corcoran M, van der Ende A, Vestrheim DF, Munoz-Almagro C, Sanz JC, Castilla J, Smith A, Henriques-Normark B, Colzani E, Pastore-Celentano L, Savulescu C. Serotype Replacement after Introduction of 10-Valent and 13-Valent Pneumococcal Conjugate Vaccines in 10 Countries, Europe. Emerg Infect Dis 2022; 28:137-138. [PMID: 34932457 PMCID: PMC8714201 DOI: 10.3201/eid2801.210734] [Citation(s) in RCA: 45] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
We evaluated invasive pneumococcal disease (IPD) during 8 years of infant pneumococcal conjugate vaccine (PCV) programs using 10-valent (PCV10) and 13-valent (PCV13) vaccines in 10 countries in Europe. IPD incidence declined during 2011-2014 but increased during 2015-2018 in all age groups. From the 7-valent PCV period to 2018, IPD incidence declined by 42% in children <5 years of age, 32% in persons 5-64 years of age, and 7% in persons >65 years of age; non-PCV13 serotype incidence increased by 111%, 63%, and 84%, respectively, for these groups. Trends were similar in countries using PCV13 or PCV10, despite different serotype distribution. In 2018, serotypes in the 15-valent and 20-valent PCVs represented one third of cases in children <5 years of age and two thirds of cases in persons >65 years of age. Non-PCV13 serotype increases reduced the overall effect of childhood PCV10/PCV13 programs on IPD. New vaccines providing broader serotype protection are needed.
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Mungall BA, Hoet B, Nieto Guevara J, Soumahoro L. A systematic review of invasive pneumococcal disease vaccine failures and breakthrough with higher-valency pneumococcal conjugate vaccines in children. Expert Rev Vaccines 2021; 21:201-214. [PMID: 34882050 DOI: 10.1080/14760584.2022.2012455] [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] [Indexed: 01/22/2023]
Abstract
INTRODUCTION : The pneumococcal non-typeable Haemophilus influenzae protein D-conjugate vaccine (PHiD-CV or PCV10) and 13-valent pneumococcal conjugate vaccine (PCV13) protect against vaccine-serotype invasive pneumococcal disease (VT IPD). However, VT IPD can still occur in fully or partially vaccinated children (vaccine failure or breakthrough). We performed a systematic review of vaccine failures and breakthrough IPD with PCV10 and PCV13 in ≤5-year-olds. AREAS COVERED : We searched Scopus/Medline/EMBASE to retrieve articles/abstracts published between 1/2008-7/2019. We excluded reports from studies only including data from adults or children ≥6 years, exclusively assessing PCV7-vaccinated children or children with underlying comorbidities. Twenty-six reports (20 PCV13, 1 PCV10, 5 both), covering studies with various designs in six continents, using different schedules, were included. Collectively, these studies reported 469 VT IPD cases classified as vaccine failures and 403 as breakthrough. Vaccine failure and breakthrough rates were low: 8.4% and 9.3%, respectively, of all IPD in vaccinated children, consistent with the vaccines' high effectiveness. The main serotypes associated with vaccine failure or breakthrough were 19A, 3 and 19F in PCV13 studies and 14, 6B and vaccine-related 19A and 6A in PCV10 studies. EXPERT OPINION : As we move to vaccines with more serotypes, it is not only important to consider which serotypes are added, but also to monitor and address incomplete protection against specific serotypes.
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Horn EK, Wasserman MD, Hall-Murray C, Sings HL, Chapman R, Farkouh RA. Public health impact of pneumococcal conjugate vaccination: a review of measurement challenges. Expert Rev Vaccines 2021; 20:1291-1309. [PMID: 34424123 DOI: 10.1080/14760584.2021.1971521] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Modeling analyses have attempted to quantify the global impact of pneumococcal conjugate vaccines (PCVs) on pneumococcal disease (PD), however these pediatric models face several challenges in obtaining comprehensive impact measurements. AREAS COVERED We present several measurement challenges and discuss examples from recently published pediatric modeling evaluations. Challenges include estimating the number of infants fully or partially vaccinated with PCVs, inclusion of indirect effects of vaccination, accounting for various dosing schedules, capturing effect of PCVs on nonspecific, noninvasive PD, and inclusion of adult PCV use. EXPERT OPINION The true impact of PCVs has been consistently underestimated in published analyses due to multiple measurement challenges. Nearly 100 million adults are estimated to have received PCV13 over the last decade globally, potentially preventing up to 662 thousand cases of PD. Approximately 4.1 million cases of invasive PD alone may have been averted through indirect protection. Estimates of PCV impact on noninvasive PD remain a challenge due to altered epidemiology. Program switches, incomplete vaccination, and private market uptake among children also confound PD impact estimates. Taken together, the number of averted PD cases from PCV use in the last ten years may be up to three times higher than estimated in previous studies.
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Affiliation(s)
- Emily K Horn
- Health Economics and Outcomes Research, Pfizer Inc, New York, NY, USA
| | - Matt D Wasserman
- Health Economics and Outcomes Research, Pfizer Inc, New York, NY, USA
| | - Cassandra Hall-Murray
- Vaccines Medical Development and Scientific and Clinical Affairs Pfizer, Inc, Collegeville, PA, USA
| | - Heather L Sings
- Vaccines Medical Development and Scientific and Clinical Affairs Pfizer, Inc, Collegeville, PA, USA
| | | | - Raymond A Farkouh
- Health Economics and Outcomes Research, Pfizer Inc, New York, NY, USA
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Chien YC, Lee YL, Liu PY, Lu MC, Shao PL, Lu PL, Cheng SH, Lin CY, Wu TS, Yen MY, Wang LS, Liu CP, Lee WS, Shi ZY, Chen YS, Wang FD, Tseng SH, Chen YH, Sheng WH, Lee CM, Chen YH, Ko WC, Hsueh PR. National surveillance of antimicrobial susceptibilities to dalbavancin, telavancin, tedizolid, eravacycline, omadacycline and other comparator antibiotics and serotype distribution of invasive Streptococcus pneumoniae isolates in adults: results from the Surveillance of Multicenter Antimicrobial Resistance in Taiwan (SMART) programme in 2017-2020. J Glob Antimicrob Resist 2021; 26:308-316. [PMID: 34289409 PMCID: PMC8437679 DOI: 10.1016/j.jgar.2021.07.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 06/27/2021] [Accepted: 07/07/2021] [Indexed: 11/20/2022] Open
Abstract
Objectives The aim of this study was to investigate the trends in serotypes and in vitro antimicrobial susceptibility of Streptococcus pneumoniae causing adult invasive pneumococcal disease (IPD) to dalbavancin, telavancin, tedizolid, eravacycline, omadacycline and other comparator antibiotics from 2017–2020 following implementation of the 13-valent pneumococcal conjugate vaccine (PCV-13) and during the COVID-19 (coronavirus disease 2019) pandemic. Methods During the study period, 237 S. pneumoniae isolates were collected from non-duplicate patients, covering 15.0% of IPD cases in Taiwan. Antimicrobial susceptibility testing was performed using a Sensititre® system. A latex agglutination method (ImmuLex™ Pneumotest Kit) was used to determine serotypes. Results Susceptibility rates were high for vancomycin (100%), teicoplanin (100%) and linezolid (100%), followed by ceftaroline (non-meningitis) (98.3%), moxifloxacin (94.9%) and quinupristin/dalfopristin (89.9%). MIC50 and MIC90 values of dalbavancin, telavancin, tedizolid, eravacycline and omadacycline were generally low. Non-vaccine serotype 23A was the leading cause of IPD across the adult age range. Isolates of serotype 15B were slightly fewer than those of PCV-13 serotypes in patients aged ≥65 years. The overall case fatality rate was 15.2% (36/237) but was especially high for non-PCV-13 serotype 15B (21.4%; 3/14). Vaccine coverage was 44.7% for PCV-13 and 49.4% for the 23-valent pneumococcal polysaccharide vaccine (PPSV-23), but was 57% for both PCV-13 and PPSV-23. Conclusion The incidence of IPD was stationary after PCV-13 introduction and only dramatically decreased in the COVID-19 pandemic in 2020. The MIC50 and MIC90 values of dalbavancin, telavancin, tedizolid, eravacycline, omadacycline were generally low for S. pneumoniae causing adult IPD.
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Affiliation(s)
- Ying-Chun Chien
- Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yu-Lin Lee
- Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan, and Institute of Genomics and Bioinformatics, National Chung Hsing University, Taichung, Taiwan
| | - Po-Yu Liu
- Division of Infectious Diseases, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Min-Chi Lu
- Department of Microbiology and Immunology, School of Medicine, China Medical University, Taichung, Taiwan
| | - Pei-Lan Shao
- Department of Pediatrics, Hsin-Chu Branch, National Taiwan University Hospital, Hsin-Chu, Taiwan
| | - Po-Liang Lu
- Department of Internal Medicine, Kaohsiung Medical University Hospital, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Shu-Hsing Cheng
- Department of Internal Medicine, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan, and School of Public Health, College of Public Health and Nutrition, Taipei Medical University, Taipei, Taiwan
| | - Chi-Ying Lin
- Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin, Taiwan
| | - Ting-Shu Wu
- Division of Infectious Diseases, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Muh-Yong Yen
- Division of Infectious Diseases, Taipei City Hospital, and National Yang-Ming University, School of Medicine, Taipei, Taiwan
| | - Lih-Shinn Wang
- Division of Infectious Diseases, Department of Internal Medicine, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan
| | - Chang-Pan Liu
- Division of Infectious Diseases, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan, and MacKay Medical College, New Taipei City, Taiwan
| | - Wen-Sen Lee
- Division of Infectious Diseases, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, and Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Zhi-Yuan Shi
- Division of Infectious Diseases, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Yao-Shen Chen
- Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, and School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Fu-Der Wang
- Division of Infectious Diseases, Department of Medicine, Taipei Veterans General Hospital, and School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Shu-Hui Tseng
- Center for Disease Control and Prevention, Ministry of Health and Welfare, Taiwan
| | - Yu-Hui Chen
- Infection Control Center, Chi Mei Hospital, Liouying, Taiwan
| | - Wang-Huei Sheng
- Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chun-Ming Lee
- Department of Internal Medicine, St Joseph's Hospital, Yunlin County, Taiwan; MacKay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan
| | - Yen-Hsu Chen
- Department of Internal Medicine, Kaohsiung Medical University Hospital, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Wen-Chien Ko
- Department of Internal Medicine, National Cheng Kung University Medical College and Hospital, Tainan, Taiwan
| | - Po-Ren Hsueh
- Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan; Department of Laboratory Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan; Departments of Laboratory Medicine and Internal Medicine, China Medical University Hospital, School of Medicine, China Medical University, Taichung, Taiwan.
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Coronas E, Martinot A, Varon E, Wallet F, Dubos F. Stable Incidence of Invasive Pneumococcal Disease in Children in Northern France From 2014 Through 2018. Pediatr Infect Dis J 2021; 40:688-693. [PMID: 34097661 DOI: 10.1097/inf.0000000000003095] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The 13-valent pneumococcal conjugate vaccine (PCV13) has been recommended in France since June 2010. The aim of this study was to evaluate the trends in the incidence of invasive pneumococcal disease (IPD) resulting in hospitalization of children younger than 18 years of age, to identify the vaccination status of these patients and to analyze the serotypic evolution of the pneumococci involved in the various types of IPD. METHODS This multicenter retrospective study reviewed all admissions of children younger than 18 years of age for IPD from 2014 through 2018 in all hospitals with a pediatric or neonatal unit in northern France. Data completeness was obtained by matching 3 independent databases. The incidence of IPD resulting in hospitalization was calculated per age group. The clinical course and the vaccine and nonvaccine types were described overall and by the IPD type. RESULTS One hundred thirty cases of IPD were identified: 51 with bacteremia, 45 meningitis, 28 pneumonia or pleuropneumonia and 6 arthritis. The IPD incidence ranged from 2.4 to 3.0/100,000 in children under 18 years of age (95% confidence intervals, 1.4-3.3 and 1.9-4.1, respectively), and from 9.5 to 15.9/100,000 in children under 2 years of age, with no significant differences over time. Nonvaccine types were predominant (81%), mainly 24F, 23B and 10A. Vaccine serotype 3 was involved in 10 cases of IPD, 2 of which were in correctly vaccinated children. Two cases of IPD could have been prevented by vaccination. Neurologic sequelae affected 26% of these children (62% of those with meningitis). Six children died from IPD (5%). CONCLUSION The incidence of IPD resulting in hospitalization remained stable in northern France during the study period, with no significant increase in nonvaccine types. Further surveillance is needed to adjust the vaccination strategy if necessary.
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Affiliation(s)
- Emilie Coronas
- From the CHU Lille, Pediatric Emergency Unit and Infectious Diseases
| | - Alain Martinot
- From the CHU Lille, Pediatric Emergency Unit and Infectious Diseases
- University of Lille, ULR 2694-METRICS: Evaluation des technologies de Santé et des pratiques médicales, Lille
| | - Emmanuelle Varon
- Centre National de Référence du Pneumocoque, Centre Hospitalier Intercommunal de Créteil
| | - Frédéric Wallet
- CHU Lille, Laboratory of bacteriology, Pathology-Biology Center, Lille, France
| | - François Dubos
- From the CHU Lille, Pediatric Emergency Unit and Infectious Diseases
- University of Lille, ULR 2694-METRICS: Evaluation des technologies de Santé et des pratiques médicales, Lille
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Hernández S, Moraga-Llop F, Díaz A, de Sevilla MF, Ciruela P, Muñoz-Almagro C, Codina G, Campins M, García-García JJ, Esteva C, Izquierdo C, González-Peris S, Martínez-Osorio J, Uriona S, Salleras L, Domínguez Á. Failures of 13-Valent Conjugated Pneumococcal Vaccine in Age-Appropriately Vaccinated Children 2-59 Months of Age, Spain. Emerg Infect Dis 2021; 26:1147-1155. [PMID: 32441620 PMCID: PMC7258469 DOI: 10.3201/eid2606.190951] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Vaccination with the 13-valent conjugated pneumococcal disease (PCV13) has reduced invasive pneumococcal disease (IPD), but there have been reports of vaccine failures. We performed a prospective study in children aged 2–59 months who received diagnoses of IPD during January 2012–June 2016 in 3 pediatric hospitals in Catalonia, Spain, a region with a PCV13 vaccination coverage of 63%. We analyzed patients who had been age-appropriately vaccinated but who developed IPD caused by PCV13 serotypes. We detected 24 vaccine failure cases. The serotypes involved were 3 (16 cases); 19A (5 cases); and 1, 6B, and 14 (1 case each). Cases were associated with children without underlying conditions, with complicated pneumonia (OR 6.65, 95% CI 1.91–23.21), and with diagnosis by PCR (OR 5.18, 95% CI 1.84–14.59). Vaccination coverage should be increased to reduce the circulation of vaccine serotypes. Continuous surveillance of cases of IPD using both culture and PCR to characterize vaccine failures is necessary.
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Esposito S, Dal Canto G, Caramia MR, Fainardi V, Pisi G, Principi N. Complications in community acquired pneumonia: magnitude of problem, risk factors, and management in pediatric age. Expert Rev Anti Infect Ther 2021; 20:45-51. [PMID: 33971782 DOI: 10.1080/14787210.2021.1927710] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Introduction: In the last decades, the large use of several effective vaccines has dramatically reduced the incidence of community acquired pneumonia (CAP) in infants and children. Moreover, the availability of new antibiotics effective against emerging resistant strains of bacteria has greatly improved the early and long-term prognosis of this disease.Areas covered: The aim of this manuscript is to evaluate the burden of complicated CAP in pediatric age and to discuss its appropriate management.Expert opinion: Complicated CAP remains a problem for children in industrialized and developing countries. A larger use of lung ultrasonography (US) as first diagnostic approach could significantly improve early identification of cases at higher risk of complications. Difficult to solve, is the problem of the use of an antibiotic therapy able to assure adequate control in all the CAP cases, including those at high risk of or with already established complications. All these findings reveal that control of the incidence of complicated CAP remains difficult and will not be significantly changed in the next few years. Any attempt to improve complicated CAP management must be made. Consensus documents on better definition of the use of corticosteroids, fibrinolytic agents, and interventional procedures (including surgery) can allow us to reach this goal.
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Affiliation(s)
- Susanna Esposito
- Pediatric Clinic, Pietro Barilla Children's Hospital, University of Parma, Parma, Italy
| | - Giulia Dal Canto
- Pediatric Clinic, Pietro Barilla Children's Hospital, University of Parma, Parma, Italy
| | - Maria Rosaria Caramia
- Pediatric Clinic, Pietro Barilla Children's Hospital, University of Parma, Parma, Italy
| | - Valentina Fainardi
- Pediatric Clinic, Pietro Barilla Children's Hospital, University of Parma, Parma, Italy
| | - Giovanna Pisi
- Pediatric Clinic, Pietro Barilla Children's Hospital, University of Parma, Parma, Italy
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Principi N, Esposito S. Pneumococcal Disease Prevention: Are We on the Right Track? Vaccines (Basel) 2021; 9:vaccines9040305. [PMID: 33804822 PMCID: PMC8063798 DOI: 10.3390/vaccines9040305] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 03/19/2021] [Accepted: 03/22/2021] [Indexed: 12/12/2022] Open
Abstract
The history of Streptococcus pneumoniae diseases dramatically changed with the introduction into the immunization schedule of infants and children of the first pneumococcal conjugate vaccine, the one containing 7 (PCV7) of the most common pneumococcal serotypes (STs) causing invasive pneumococcal diseases (IPDs). Where PCV7 was largely used, incidence of both IPDs and non-invasive pneumococcal diseases (nIPDs) in vaccinated children and in unvaccinated subjects of any age, mainly the elderly, significantly decreased. Unfortunately, the impact of PCV7 administration was slightly lower than expected, as the reduction in infections due to vaccine serotypes (STs) was accompanied by a significant increase in the number of IPDs and nIPDs due to STs not included in the vaccine. To overcome this problem, two PCVs containing 10 (PCV10) and 13 (PCV13) STs, chosen among those emerging, were developed and licensed. However, ST replacement occurred again. Moreover, the new PCVs showed little effectiveness in the prevention of infection due to non-encapsulated STs and to ST3. Next-generation S. pneumoniae vaccines able to prevent pneumococcal infections regardless of infecting ST are urgently needed. For the moment, the use of available PCVs remains fundamental because their benefits far outweigh any concerns for emerging STs.
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Affiliation(s)
| | - Susanna Esposito
- Pediatric Clinic, Pietro Barilla Children’s Hospital, University of Parma, 43126 Parma, Italy
- Correspondence: ; Tel.: +39-0521-903524
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Amin-Chowdhury Z, Groves N, Sheppard CL, Litt D, Fry NK, Andrews N, Ladhani SN. Invasive pneumococcal disease due to 22F and 33F in England: A tail of two serotypes. Vaccine 2021; 39:1997-2004. [PMID: 33715901 DOI: 10.1016/j.vaccine.2021.02.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 02/07/2021] [Accepted: 02/10/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND A 15-valent pneumococcal conjugate vaccine (PCV15) aims to protect against serotype 22F and 33F in addition to the serotypes within the 13-valent PCV (PCV13) which was introduced to the UK childhood immunisation programme in April 2010. Little is known about the specific epidemiology, clinical features or outcomes of invasive pneumococcal disease (IPD) due to these two serotypes. METHODS Public Health England (PHE) conducts enhanced IPD surveillance in England. Hospital laboratories routinely submit invasive pneumococcal isolates to PHE for serotyping and enhanced clinical information is collected through questionnaires sent to general practitioners. IPD due to serotypes 22F and 33F diagnosed during 2014/15-2018/19 were compared with IPD due to PCV13 serotypes and remaining serotypes. RESULTS In total, 25,415 isolates (93.4%) were serotyped and questionnaires were completed for 22,097 (86.9%) cases. Serotype 22F was responsible for 1,788 (7.0%) and serotype 33F for 893 (3.5%) cases compared to 19.9% (n = 5,047) for PCV13 and 69.6% (n = 17,687) for the remaining serotypes. IPD incidence increased for both serotypes since 2005/06, especially in older adults, but plateaued after PCV13 introduction. Comorbidity prevalence was 68.7% (n = 1,037) for serotype 22F and 67.2% (n = 505) for serotype 33F, with invasive pneumonia being the most common clinical presentation 1,067/1,482; 72.0%, and 514/755; 68.1%, respectively. There were 3,617 deaths within 30 days of disease onset, including 236 (CFR, 15.4%) among 22F, 128 (CFR, 16.5%) among 33F and 21.3% (925/4,350) among PCV13-type IPD cases. When compared with PCV13-type IPD, serotype 22F (aOR 0.58, 95%CI 0.49-0.68, p < 0.001) and 33F (aOR 0.73, 95%CI 0.59-0.91, p = 0.004) were independently associated with lower odds of death. The major circulating sequence types (STs) in 22F (ST 433, ST698) and 33F (ST717, ST100, ST673) were not associated with an increased risk of death compared to the other STs. CONCLUSIONS Serotype 22F and 33F-type IPD are associated with a lower risk of death compared to PCV13-type, with those presenting with septicaemia more likely to have a fatal outcome compared to pneumonia. PCV15 has the potential to prevent up to an additional 10% of IPD cases in England.
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Affiliation(s)
- Zahin Amin-Chowdhury
- Immunisation and Countermeasures Division, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK.
| | - Natalie Groves
- Respiratory and Vaccine Preventable Bacterial Reference Unit, Public Health England, London, UK
| | - Carmen L Sheppard
- Respiratory and Vaccine Preventable Bacterial Reference Unit, Public Health England, London, UK
| | - David Litt
- Respiratory and Vaccine Preventable Bacterial Reference Unit, Public Health England, London, UK
| | - Norman K Fry
- Immunisation and Countermeasures Division, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK; Respiratory and Vaccine Preventable Bacterial Reference Unit, Public Health England, London, UK
| | - Nick Andrews
- Immunisation and Countermeasures Division, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK; Statistics, Modelling and Economics Department, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Shamez N Ladhani
- Immunisation and Countermeasures Division, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK; Paediatric Infectious Diseases Research Group, St. George's University of London, Cranmer Terrace, London SW17 0RE, UK.
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Cripps AW, Folaranmi T, Johnson KD, Musey L, Niederman MS, Buchwald UK. Immunogenicity following revaccination or sequential vaccination with 23-valent pneumococcal polysaccharide vaccine (PPSV23) in older adults and those at increased risk of pneumococcal disease: a review of the literature. Expert Rev Vaccines 2021; 20:257-267. [PMID: 33567914 DOI: 10.1080/14760584.2021.1889374] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Introduction: Immunogenicity studies evaluating sequential administration of pneumococcal conjugate vaccine (PCV) followed by 23-valent pneumococcal polysaccharide vaccine (PPSV23) or revaccination with PPSV23 have raised concerns that PPSV23 may not elicit higher antibody levels than those measured following PCV or first PPSV23 dose.Areas covered: Recent literature was evaluated for evidence of blunted immune response (hyporesponsiveness), focusing on studies using adequate intervals between doses in accordance with vaccination recommendations. In eight of nine studies that evaluated revaccination with PPSV23 at an interval of ≥5 years after the previous dose, immunoglobulin G geometric mean concentrations and/or opsonophagocytic assay geometric mean titers for most serotypes increased from pre- to post-repeat vaccination and were comparable between repeat and primary vaccination groups post-vaccination. In seven studies in which PPSV23 was administered after PCVs (8 weeks to 1 year apart), responses to PPSV23 were comparable to those seen after initial PCV dose for shared vaccine serotypes. Studies in which PCVs were administered after PPSV23 were not evaluated.Expert opinion: Published data suggest immune responses following repeat vaccination with PPSV23, or sequential PCV/PPSV23 vaccination, are robust, without evidence of hyporesponsiveness. PPSV23 vaccination of at-risk adults is essential to ensure broad protection against all 23 vaccine serotypes.
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Affiliation(s)
- Allan W Cripps
- Mucosal Immunology Research Group, Menzies Health Institute and School of Medicine, Griffith University, Gold Coast Campus, Southport QLD, Australia
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Impact of pneumococcal conjugate vaccine on invasive pneumococcal disease in children under 5 years of age in the Czech Republic. PLoS One 2021; 16:e0247862. [PMID: 33635933 PMCID: PMC7909631 DOI: 10.1371/journal.pone.0247862] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 02/15/2021] [Indexed: 11/26/2022] Open
Abstract
Introduction The aim of this study is to analyse the impact of vaccination of infants with pneumococcal conjugate vaccine (PCV) on the incidence of invasive pneumococcal disease (IPD) in children under 5 years of age in the Czech Republic. Material and methods The present study includes all IPD cases reported in children aged 0–4 years within the surveillance program in 2007–2017. The impact of PCV is analysed for five categories of IPD: cases caused by all serotypes, cases caused by PCV7 serotypes (4, 6B, 9V, 14, 18C, 19F, and 23F), cases caused by three additional PCV10 serotypes (1, 5, and 7F), cases caused by three additional PCV13 serotypes (3, 6A, and 19A), and cases caused by non-PCV serotypes. To assess the impact of PCV, the study period was divided into the pre-vaccination period 2007–2008 and post-vaccination period 2009–2017, which was divided into three three-year parts: 2009–2011, 2012–2014, and 2015–2017. Analysis of differences between periods was based on the Poisson regression model where the population numbers were handled as an offset. Results The annual incidence of IPD in children under 5 years of age caused by all serotypes has had a downward trend since 2007: it dropped from 8.52/100 000 in 2007 to 2.67/100 000 in 2017, with slight increases in 2010 and 2013. All three post-vaccination periods show significantly lower (p<0.001) incidences in comparison to the pre-vaccination period, but they do not statistically significantly differ from each other. Conclusions IPD surveillance data in the Czech Republic show that after the introduction of PCV vaccination of infants, there has been a significant decrease in the IPD incidence of children under 5 years of age. Continued IPD surveillance is essential to monitor for possible post-vaccination serotype replacement.
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Izurieta P, Nieto Guevara J. Exploring the evidence behind the comparable impact of the pneumococcal conjugate vaccines PHiD-CV and PCV13 on overall pneumococcal disease. Hum Vaccin Immunother 2021; 18:1872341. [PMID: 33605846 PMCID: PMC8920200 DOI: 10.1080/21645515.2021.1872341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The worldwide implementation of pneumococcal conjugate vaccines (PCVs) in children has reduced the overall pneumococcal disease burden. Two PCVs are widely available for infant vaccination: the pneumococcal non-typeable Haemophilus influenzae protein D conjugate vaccine (PHiD-CV) and the 13-valent PCV (PCV13). While these PCVs differ in serotype composition (PCV13 includes polysaccharides of serotypes 3, 6A and 19A; PHiD-CV does not), their impact on the overall pneumococcal disease burden in children is comparable. This commentary summarizes the evidence of comparability between PHiD-CV and PCV13 and explores why differences in serotype composition may not necessarily translate into a differential clinical impact. Both vaccines confer similarly high protection against disease caused by vaccine serotypes and lead to a partial replacement by non-vaccine serotypes. PHiD-CV does not protect against serotype 3 disease (not included in the vaccine) and PCV13’s effect on this serotype has been inconsistent. PHiD-CV provides some cross-protection against disease caused by vaccine-related serotype 19A but neither vaccine has fully controlled 19A disease. While protection against 19A is higher for PCV13 than PHiD-CV, replacement by non-PCV13 serotypes in settings with a PCV13 program appears to compensate for this difference. This results in a similar residual overall disease burden with both vaccines.
What is the context?
The pneumococcus bacterium can cause infections of the meninges, blood, lung, middle ear and sinuses. Two vaccins, Synflorix (GSK) and Prevnar 13 (Pfizer Inc.), are widely used to protect young children against these infections. The vaccines’ compositions differ: Synflorix includes antigens from 10 pneumococcus strains (or “serotypes”) and Prevnar 13 from 13 serotypes. However, both have a similar effect on the total pneumococcal disease burden in children.
What does this commentary highlight?
This commentary summarizes the evidence beihnd the two vaccines’ comparable impact on pneumococcal disase. It also looks at why the vaccines have a similar effect on the total pneumococcal disease burden despite their different compositions.
What is the impact on current thinking?
Given that Synflorix and Prevnar 13 have a comparable impact on pneumococcal disease, a country’s choice between the two vaccines will depend on vaccine supply, cost, logistical factors (e.g., transport, storage, training requirements of health workers) and the local pneumococcal epidemiology.
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Hu T, Weiss T, Bencina G, Owusu-Edusei K, Petigara T. Health and economic burden of invasive pneumococcal disease associated with 15-valent pneumococcal conjugate vaccine serotypes in children across eight European countries. J Med Econ 2021; 24:1098-1107. [PMID: 34461796 DOI: 10.1080/13696998.2021.1970975] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
AIMS V114, a 15-valent pneumococcal conjugate vaccine (PCV15) currently approved in adults in the US, contains the 13 S. pneumoniae serotypes in PCV13 and two additional serotypes, 22 F and 33 F, which are important contributors to residual PD. This study quantified the health and economic burden of pediatric invasive pneumococcal disease (IPD) associated with V114 serotypes in eight countries in Europe. MATERIALS AND METHODS A Markov model estimated V114-type IPD cases and costs in hypothetical unvaccinated birth cohorts from Denmark, France, Germany, Italy, Norway, Spain, Switzerland, and the UK over 20 years. Inputs were obtained from published literature. IPD cases and costs were calculated for three time periods using time-specific epidemiological data: (a) pre-PCV7; (b) pre-PCV13; and (c) post-PCV13. Costs were estimated from a societal perspective (2018 Euros) and discounted at 3%. RESULTS The model estimated that 4,649 IPD cases in the pre-PCV7 period, 3,248 cases in the pre-PCV13 period, and 958 cases in the post-PCV13 period were attributable to V114 serotypes. Total discounted costs associated with V114 serotypes were €109.1 million (pre-PCV7 period), €65.7 million (pre-PCV13 period), and €18.7 million (post-PCV13 period). LIMITATIONS Post-meningitis sequelae, acute otitis media, and non-bacteremic pneumonia were not considered. Direct non-medical costs were not included. Conclusions on effectiveness of V114 or added value over existing infant vaccination programs cannot be drawn. CONCLUSIONS IPD cases and costs were estimated in hypothetical birth cohorts in eight European countries followed for 20 years during three time periods. Serotypes included in V114 were associated with significant morbidity and costs in pre-PCV7, pre-PCV13, and post-PCV13 periods. Future pediatric pneumococcal vaccines should maintain protection against serotypes in licensed vaccines while extending coverage to additional serotypes to ensure reductions in IPD burden are maintained.
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Affiliation(s)
- Tianyan Hu
- Center for Observational and Real-World Evidence, Merck & Co., Inc., Kenilworth, NJ, USA
| | - Thomas Weiss
- Center for Observational and Real-World Evidence, Merck & Co., Inc., Kenilworth, NJ, USA
| | | | - Kwame Owusu-Edusei
- Center for Observational and Real-World Evidence, Merck & Co., Inc., Kenilworth, NJ, USA
| | - Tanaz Petigara
- Center for Observational and Real-World Evidence, Merck & Co., Inc., Kenilworth, NJ, USA
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Hu T, Weiss T, Owusu-Edusei K, Petigara T. Health and economic burden associated with 15-valent pneumococcal conjugate vaccine serotypes in children in the United States. J Med Econ 2020; 23:1653-1660. [PMID: 33084447 DOI: 10.1080/13696998.2020.1840216] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
AIMS V114 is an investigational 15-valent pneumococcal conjugate vaccine (PCV) containing the 13 Streptococcus pneumoniae serotypes in 13-valent PCV (PCV13) plus two additional serotypes. This study quantified the health and economic burden of invasive pneumococcal disease (IPD) and acute otitis media (AOM) caused by V114 types among children in the United States. MATERIALS AND METHODS A Markov model estimated the number of V114-type IPD and AOM cases and costs in a hypothetical, unvaccinated US birth cohort over 20 years. Three time periods were analyzed using time-specific epidemiological data to determine the number of IPD and AOM cases associated with all 15 serotypes in V114. The time periods were: (1) pre-PCV7 (1999); (2) pre-PCV13 (2009); (3) post-PCV13 (2017). Costs were estimated from a societal perspective (2018 US dollars) and discounted at 3%. RESULTS The model estimated 18,983 IPD cases and 5.4 million AOM cases associated with V114 serotypes pre-PCV7, 4,697 IPD cases and 3.0 million AOM cases pre-PCV13, and 948 IPD cases and 0.2 million AOM cases post-PCV13. Total discounted costs associated with V114 serotypes were $1.7 billion pre-PCV7, $730 million pre-PCV13, and $75 million US dollars post-PCV13. LIMITATIONS Post-meningitis sequelae, cases of non-bacteremic pneumonia, and direct non-medical costs were not included. CONCLUSIONS IPD and AOM cases and costs were estimated in a hypothetical US birth cohort followed for 20 years at three time periods. In all three periods, the serotypes targeted by V114 contributed to significant morbidity and costs. New pediatric pneumococcal vaccines must continue to retain serotypes in licensed vaccines to maintain disease reduction while extending coverage to non-vaccine serotypes.
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Affiliation(s)
- Tianyan Hu
- Center for Observational and Real-world Evidence, Merck & Co., Inc., Kenilworth, NJ, USA
| | - Thomas Weiss
- Center for Observational and Real-world Evidence, Merck & Co., Inc., Kenilworth, NJ, USA
| | - Kwame Owusu-Edusei
- Center for Observational and Real-world Evidence, Merck & Co., Inc., Kenilworth, NJ, USA
| | - Tanaz Petigara
- Center for Observational and Real-world Evidence, Merck & Co., Inc., Kenilworth, NJ, USA
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Peckeu L, van der Ende A, de Melker HE, Sanders EAM, Knol MJ. Impact and effectiveness of the 10-valent pneumococcal conjugate vaccine on invasive pneumococcal disease among children under 5 years of age in the Netherlands. Vaccine 2020; 39:431-437. [PMID: 33243632 DOI: 10.1016/j.vaccine.2020.11.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 11/03/2020] [Accepted: 11/05/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND In 2011, the 7-valent pneumococcal conjugate vaccine (PCV7) was replaced by the 10-valent vaccine (PCV10) in the Netherlands. We report on impact and effectiveness against invasive pneumococcal disease (IPD) in children aged under 5 years by switching from PCV7 to PCV10. METHOD We included IPD cases between 2004 and 2019 in children aged < 5 years reported via the national surveillance system. To assess the impact of the PCV10 vaccination program we compared IPD incidence 6-8 years after PCV10 introduction (2017-2019) to the two years just before the switch to PCV10 (2009-2011). We estimated vaccine effectiveness (VE) using the indirect cohort method, comparing vaccination status (at least two vaccine doses) in IPD-cases caused by PCV10 serotypes (cases) to non-PCV10 IPD cases (controls), in children eligible for PCV10. RESULTS The overall incidence decreased from 8.7 (n = 162) in 2009-2011 to 7.3 per 100.000 (n = 127) in 2017-2019 (Incidence rate ratio (IRR) 0.83, 95%CI: 0.66; 1.05). IPD caused by the additional serotypes included in PCV10 declined by 93% (IRR 0.07, 95%CI: 0.02; 0.23). Incidence of non-PCV10 IPD showed a non-significant increase (IRR 1.25, 95%CI: 0.96; 1.63). Among 231 IPD-cases eligible for PCV10, the overall VE was 91% (95%CI: 67; 97) and did not differ by sex or age at diagnosis. Effectiveness against non-PCV10 serotype 19A IPD was non-significant with an estimate of 28% (95%CI:-179; 81). CONCLUSION PCV10 is highly effective in protecting against IPD in Dutch children under 5 years with limited serotype replacement after switching from PCV7 to PCV10. We found no evidence for significant cross-protection of PCV10 against 19A serotype IPD.
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Affiliation(s)
- L Peckeu
- European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden; National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - A van der Ende
- Amsterdam UMC, University of Amsterdam, Medical Microbiology and Infection Prevention and the Netherlands Reference Laboratory of Bacterial Meningitis, Amsterdam, the Netherlands
| | - H E de Melker
- National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - E A M Sanders
- National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - M J Knol
- National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands.
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Ladhani SN, Andrews N, Ramsay ME. Summary of evidence to reduce the two-dose infant priming schedule to a single dose of the 13-valent pneumococcal conjugate vaccine in the national immunisation programme in the UK. THE LANCET. INFECTIOUS DISEASES 2020; 21:e93-e102. [PMID: 33129426 DOI: 10.1016/s1473-3099(20)30492-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 04/23/2020] [Accepted: 04/30/2020] [Indexed: 11/28/2022]
Abstract
Pneumococcal conjugate vaccines (PCVs) are highly effective in preventing invasive and non-invasive pneumococcal infections in all age groups through a combination of direct and indirect protection. In many industrialised countries with established PCV programmes, the maximum benefit of the PCV programme has already been achieved, with most cases now due to non-PCV serotypes. On Jan 1, 2020, the UK changed its childhood pneumococcal immunisation programme from a two-dose infant priming schedule with the 13-valent PCV at 8 and 16 weeks after birth, to a single priming dose at 12 weeks after birth, while retaining the 12-month booster. This decision was made after reviewing the evidence from surveillance data, clinical trials, epidemiological analyses, vaccine effectiveness estimates, and modelling studies to support the reduced schedule. In this Review, we summarise the epidemiology of pneumococcal disease in the UK, the evidence supporting the decision to implement a reduced schedule, and the national and global implications of the proposed schedule.
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Affiliation(s)
- Shamez N Ladhani
- Immunisation and Countermeasures Division, Public Health England, Colindale, London, UK; Paediatric Infectious Diseases Research Group, St George's University of London, Cranmer Terrace, London, UK.
| | - Nick Andrews
- Statistics, Modelling, and Economics Department, Public Health England, Colindale, London, UK
| | - Mary E Ramsay
- Immunisation and Countermeasures Division, Public Health England, Colindale, London, UK
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Chapman R, Sutton K, Dillon-Murphy D, Patel S, Hilton B, Farkouh R, Wasserman M. Ten year public health impact of 13-valent pneumococcal conjugate vaccination in infants: A modelling analysis. Vaccine 2020; 38:7138-7145. [PMID: 32912642 DOI: 10.1016/j.vaccine.2020.08.068] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 08/24/2020] [Accepted: 08/26/2020] [Indexed: 01/27/2023]
Abstract
Pneumococcal disease is a substantial contributor to illness and death in young children globally. The introduction of 7-valent pneumococcal conjugate vaccine (PCV7) in 2000 had a significant impact in preventing pneumococcal disease in both vaccinated children and unvaccinated individuals (through herd effect). A higher valent PCV13 replaced PCV7 in late 2009. This analysis was undertaken to assess how many cases and deaths have been averted over the last decade since PCV13 introduction. A model estimated the number of infants vaccinated annually with PCV13, as well as the number of cases and deaths of invasive pneumococcal disease, pneumococcal pneumonia, and acute otitis media cases averted. PCV13 vaccination was estimated to have prevented 175.2 million cases of all pneumococcal diseases and 624,904 deaths globally between 2010 and 2019. These results demonstrate the substantial public health impact of PCV13 and highlight the importance of increasing the global reach of PCV programs.
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Affiliation(s)
- Ruth Chapman
- Evidera, The Ark, 201 Talgarth Road, London W6 8BJ, United Kingdom.
| | - Kelly Sutton
- Evidera, The Ark, 201 Talgarth Road, London W6 8BJ, United Kingdom.
| | | | - Shreeya Patel
- Evidera, The Ark, 201 Talgarth Road, London W6 8BJ, United Kingdom.
| | - Betsy Hilton
- Pfizer Inc., 235 42nd Street, New York, NY 10017, United States.
| | - Ray Farkouh
- Pfizer Inc., 235 42nd Street, New York, NY 10017, United States.
| | - Matt Wasserman
- Pfizer Inc., 235 42nd Street, New York, NY 10017, United States.
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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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Bakare OO, Fadaka AO, Klein A, Keyster M, Pretorius A. Diagnostic approaches of pneumonia for commercial-scale biomedical applications: an overview. ALL LIFE 2020. [DOI: 10.1080/26895293.2020.1826363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- Olalekan Olanrewaju Bakare
- Bioinformatics Research Group, Department of Biotechnology, Faculty of Natural Sciences, University of the Western Cape, Bellville, South Africa
- Environmental Biotechnology Laboratory, Department of Biotechnology, Faculty of Natural Sciences, University of the Western Cape, Bellville, South Africa
| | - Adewale Oluwaseun Fadaka
- Bioinformatics Research Group, Department of Biotechnology, Faculty of Natural Sciences, University of the Western Cape, Bellville, South Africa
- Department of Science and Technology/Mintek Nanotechnology Innovation Centre, Bio-labels Node, Department of Biotechnology, Faculty of Natural Sciences, University of the Western Cape, Bellville, South Africa
| | - Ashwil Klein
- Environmental Biotechnology Laboratory, Department of Biotechnology, Faculty of Natural Sciences, University of the Western Cape, Bellville, South Africa
| | - Marshall Keyster
- Environmental Biotechnology Laboratory, Department of Biotechnology, Faculty of Natural Sciences, University of the Western Cape, Bellville, South Africa
| | - Ashley Pretorius
- Bioinformatics Research Group, Department of Biotechnology, Faculty of Natural Sciences, University of the Western Cape, Bellville, South Africa
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Forstner C, Kolditz M, Kesselmeier M, Ewig S, Rohde G, Barten-Neiner G, Rupp J, Witzenrath M, Welte T, Pletz MW. Pneumococcal conjugate serotype distribution and predominating role of serotype 3 in German adults with community-acquired pneumonia. Vaccine 2019; 38:1129-1136. [PMID: 31761500 DOI: 10.1016/j.vaccine.2019.11.026] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 11/07/2019] [Accepted: 11/11/2019] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Implementation of the 7-valent pneumococcal conjugate vaccine (PCV7) in infant vaccination programs has substantially reduced the burden of PCV7 serotypes also in adult community-acquired pneumonia (CAP). Currently, it is unclear, if this extensive herd protection effect can be extrapolated to the additional 6 serotypes included in the 13-valent pneumococcal conjugate vaccine (PCV13), which replaced PCV7 in Germany in 2010. OBJECTIVES We investigated changing trends for PCV13 serotypes in adult CAP patients between three to seven years after implementation of PCV13 infant immunization in Germany. METHODS Between December 2012 and January 2017, urine samples from German adult patients with radiologically confirmed CAP were prospectively collected by the multi-center cohort study CAPNETZ and analyzed by the serotype-specific multiplex urinary antigen detection assay (SSUAD) allowing for the detection of PCV13 serotypes. RESULTS PCV13 serotypes were found in 59 of 796 (7.4%) patients with all-cause CAP, most prevalent was serotype 3 (30 of 59 patients, 50.8%). All patients with serotype 3-CAP were admitted to hospital and the majority required oxygen at admission (83.3% of patients with serotype 3-CAP versus 50.9% of patients with pneumococcal CAP by other serotypes, p = 0.005). Compared to SSUAD testing, conventional microbiological workup missed 27 of 30 (90.0%) serotype 3-CAP cases. We could not observe a time trend in the proportions of PCV13 serotypes and serotype 3 in all-cause CAP between 2013 and 2016 (OR trend per year 0.84, 95% CI 0.64-1.11 for PCV13 serotypes and OR trend per year 0.95, 95% CI 0.70-1.28 for serotype 3). CONCLUSIONS Conventional methods underestimate serotype 3-CAP that can cause severe disease. Changes in overall PCV13 coverage were not detected during the years 2013 to 2016, mostly driven by a high proportion of serotype 3.
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Affiliation(s)
- Christina Forstner
- Institute of Infectious Diseases and Infection Control, Jena University Hospital, Jena, Germany; Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Vienna, Austria.
| | - Martin Kolditz
- Division of Pulmonology, Medical Department I, University Hospital Carl Gustav Carus, Dresden, Germany; CAPNETZ STIFTUNG, Hannover, Germany
| | - Miriam Kesselmeier
- Research Group Clinical Epidemiology, Center for Sepsis Control and Care (CSCC), Jena University Hospital, Jena, Germany
| | - Santiago Ewig
- CAPNETZ STIFTUNG, Hannover, Germany; Thorax Center in the Ruhr Area, Department of Respiratory Medicine and Infectious Diseases, Evangelikal Protestant Hospital in Herne and Augusta Hospital in Bochum, Bochum, Germany
| | - Gernot Rohde
- CAPNETZ STIFTUNG, Hannover, Germany; Medical Department I, Department of Respiratory Medicine, Goethe University Hospital, Frankfurt/Main, Germany; Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL), Germany
| | - Grit Barten-Neiner
- CAPNETZ STIFTUNG, Hannover, Germany; Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL), Germany
| | - Jan Rupp
- CAPNETZ STIFTUNG, Hannover, Germany; Department of Infectious Diseases and Microbiology, University Hospital Schleswig-Holstein, Lübeck, Germany; German Center for Infection Research (DZIF), Partner Site Hamburg-Lübeck-Borstel-Riems, Germany
| | - Martin Witzenrath
- CAPNETZ STIFTUNG, Hannover, Germany; Department of Infectious Diseases and Pulmonary Medicine, and Division of Pulmonary Inflammation, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Tobias Welte
- CAPNETZ STIFTUNG, Hannover, Germany; Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL), Germany; Department of Pneumology, Hannover Medical School, Hannover, Germany
| | - Mathias W Pletz
- Institute of Infectious Diseases and Infection Control, Jena University Hospital, Jena, Germany; CAPNETZ STIFTUNG, Hannover, Germany
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Groves N, Sheppard CL, Litt D, Rose S, Silva A, Njoku N, Rodrigues S, Amin-Chowdhury Z, Andrews N, Ladhani S, Fry NK. Evolution of Streptococcus pneumoniae Serotype 3 in England and Wales: A Major Vaccine Evader. Genes (Basel) 2019; 10:genes10110845. [PMID: 31731573 PMCID: PMC6896183 DOI: 10.3390/genes10110845] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 10/18/2019] [Accepted: 10/22/2019] [Indexed: 11/30/2022] Open
Abstract
Despite its inclusion in pneumococcal conjugate vaccine 13 (PCV13), Streptococcus pneumoniae serotype 3 remains a major cause of invasive pneumococcal disease in England and Wales. Previous studies have indicated that there are distinct lineages within serotype 3 clonal complex 180 and the clade distributions have shifted in recent years with the emergence of clade II. We undertook whole genome sequencing and genomic analysis of 616 serotype 3 isolates from England and Wales between 2003 and 2018, including invasive and carriage isolates. Our investigations showed that clade II has expanded since 2014 and now represents 50% of serotype 3 invasive pneumococcal disease (IPD) isolates in England and Wales. Genomic analysis of antibiotic resistance and protein antigen genes showed that distinct profiles are present within the clades which could account for the recent emergence of this clade. This investigation highlights the importance and utility of routine whole genome sequencing and its ability to identify new and emerging variation at the single nucleotide level which informs surveillance and will impact future vaccine development.
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Affiliation(s)
- Natalie Groves
- Vaccine Preventable Bacteria Section, Public Health England–National Infection Service, London NW9 5EQ, UK; (C.L.S.); (D.L.); (S.R.); (A.S.); (N.N.); (S.R.); (N.K.F.)
- Correspondence:
| | - Carmen L. Sheppard
- Vaccine Preventable Bacteria Section, Public Health England–National Infection Service, London NW9 5EQ, UK; (C.L.S.); (D.L.); (S.R.); (A.S.); (N.N.); (S.R.); (N.K.F.)
| | - David Litt
- Vaccine Preventable Bacteria Section, Public Health England–National Infection Service, London NW9 5EQ, UK; (C.L.S.); (D.L.); (S.R.); (A.S.); (N.N.); (S.R.); (N.K.F.)
| | - Samuel Rose
- Vaccine Preventable Bacteria Section, Public Health England–National Infection Service, London NW9 5EQ, UK; (C.L.S.); (D.L.); (S.R.); (A.S.); (N.N.); (S.R.); (N.K.F.)
| | - Ana Silva
- Vaccine Preventable Bacteria Section, Public Health England–National Infection Service, London NW9 5EQ, UK; (C.L.S.); (D.L.); (S.R.); (A.S.); (N.N.); (S.R.); (N.K.F.)
| | - Nina Njoku
- Vaccine Preventable Bacteria Section, Public Health England–National Infection Service, London NW9 5EQ, UK; (C.L.S.); (D.L.); (S.R.); (A.S.); (N.N.); (S.R.); (N.K.F.)
| | - Sofia Rodrigues
- Vaccine Preventable Bacteria Section, Public Health England–National Infection Service, London NW9 5EQ, UK; (C.L.S.); (D.L.); (S.R.); (A.S.); (N.N.); (S.R.); (N.K.F.)
| | - Zahin Amin-Chowdhury
- Immunisation and Countermeasures, Public Health England–National Infection Service, London NW9 5EQ, UK; (Z.A.-C.); (S.L.)
| | - Nicholas Andrews
- Statistics, Modelling and Economics, Public Health England–National Infection Service, London NW9 5EQ, UK;
| | - Shamez Ladhani
- Immunisation and Countermeasures, Public Health England–National Infection Service, London NW9 5EQ, UK; (Z.A.-C.); (S.L.)
| | - Norman K. Fry
- Vaccine Preventable Bacteria Section, Public Health England–National Infection Service, London NW9 5EQ, UK; (C.L.S.); (D.L.); (S.R.); (A.S.); (N.N.); (S.R.); (N.K.F.)
- Immunisation and Countermeasures, Public Health England–National Infection Service, London NW9 5EQ, UK; (Z.A.-C.); (S.L.)
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40
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The Genomics of Streptococcus Pneumoniae Carriage Isolates from UK Children and Their Household Contacts, Pre-PCV7 to Post-PCV13. Genes (Basel) 2019; 10:genes10090687. [PMID: 31500179 PMCID: PMC6771020 DOI: 10.3390/genes10090687] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 08/20/2019] [Accepted: 08/27/2019] [Indexed: 01/08/2023] Open
Abstract
We used whole genome sequencing (WGS) analysis to investigate the population structure of 877 Streptococcus pneumoniae isolates from five carriage studies from 2002 (N = 346), 2010 (N = 127), 2013 (N = 153), 2016 (N = 187) and 2018 (N = 64) in UK households which covers the period pre-PCV7 to post-PCV13 implementation. The genomic lineages seen in the population were determined using multi-locus sequence typing (MLST) and PopPUNK (Population Partitioning Using Nucleotide K-mers) which was used for local and global comparisons. A Roary core genome alignment of all the carriage genomes was used to investigate phylogenetic relationships between the lineages. The results showed an influx of previously undetected sequence types after vaccination associated with non-vaccine serotypes. A small number of lineages persisted throughout, associated with both non-vaccine and vaccine types (such as ST199), or that could be an example of serotype switching from vaccine to non-vaccine types (ST177). Serotype 3 persisted throughout the study years, represented by ST180 and Global Pneumococcal Sequencing Cluster (GPSC) 12; the local PopPUNK analysis and core genome maximum likelihood phylogeny separated them into two clades, one of which is only seen in later study years. The genomic data showed that serotype replacement in the carriage studies was mostly due to a change in genotype as well as serotype, but that some important genetic lineages, previously associated with vaccine types, persisted.
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