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von Gottberg A, Kleynhans J, de Gouveia L, Tempia S, Meiring S, Quan V, du Plessis M, von Mollendorf C, Crowther-Gibson P, Avenant T, du Plessis N, Kularatne R, Chibabhai V, Madhi SA, Klugman KP, Whitney CG, Cohen C. Long-term effect of pneumococcal conjugate vaccines on invasive pneumococcal disease incidence among people of all ages from national, active, laboratory-based surveillance in South Africa, 2005-19: a cohort observational study. Lancet Glob Health 2024; 12:e1470-e1484. [PMID: 39151982 DOI: 10.1016/s2214-109x(24)00263-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 05/16/2024] [Accepted: 06/10/2024] [Indexed: 08/19/2024]
Abstract
BACKGROUND In South Africa, 7-valent pneumococcal conjugate vaccine (PCV7) was introduced in 2009 and 13-valent PCV (PCV13) was introduced in 2011, both in a two plus one schedule. We evaluated the ongoing effects of PCV on the prevention of invasive pneumococcal disease (IPD) over 15 years of sustained surveillance in South Africa before the COVID-19 pandemic. METHODS We conducted national, active, laboratory-based surveillance for IPD among all ages in South Africa, including isolate serotyping and susceptibility testing. We fitted linear regression models with vaccine covariates to imputed IPD case counts each year by serotype and age to compare expected and actual IPD cases in 2019, which was the main outcome. Vaccine effects were set to zero to identify expected incidence after the introduction of PCV7 and PCV13. FINDINGS From Jan 1, 2005, to Dec 31, 2019, surveillance identified 52 957 IPD cases. Among the 50 705 individuals with age data available, 9398 (18·5%) were infants aged younger than 2 years. Compared with expected case numbers (no vaccination) predicted using all available data, overall IPD rates among children younger than 2 years declined by 76·0% (percentage risk difference; 95% CI -79·0 to -72·8%) in 2019; notably, PCV7 and additional PCV13 serotype IPD rates declined by 95·5% (-97·0 to -93·4%) and 93·8% (-96·2 to-90·5%), respectively, whereas non-vaccine serotypes (NVTs) did not change significantly. Among adults aged 25-44 years, overall IPD declined by 50·4% (-54·2 to -46·3%), and PCV7 and additional PCV13 serotype IPD rates declined by 86·1% (-88·7 to -83·1%) and 77·2% (-80·9 to -73·0%), respectively, whereas NVTs increased by 78·5% (56·8 to 103·4%). Individuals aged older than 64 years also benefited from declines in IPD (-30·2%; -41·9 to -16·2%), but NVTs increased (234·9%; 138·1 to 379·4%). INTERPRETATION We documented sustained direct and indirect benefits of PCV across age groups, and NVT increases in adults older than 24 years. Higher valency PCVs would have the added benefit of preventing this residual disease. FUNDING National Institute for Communicable Diseases of the National Health Laboratory Service (South Africa) and US Agency for International Development Antimicrobial Resistance Initiative, US Centers for Disease Control and Prevention.
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Affiliation(s)
- Anne von Gottberg
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases, a division of the National Health Laboratory Service, Johannesburg, South Africa; School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Jackie Kleynhans
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases, a division of the National Health Laboratory Service, Johannesburg, South Africa; School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Linda de Gouveia
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases, a division of the National Health Laboratory Service, Johannesburg, South Africa; School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Stefano Tempia
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Global Influenza Program, World Health Organization, Geneva, Switzerland
| | - Susan Meiring
- Division of Public Health Surveillance and Response, National Institute for Communicable Diseases, a division of the National Health Laboratory Service, Johannesburg, South Africa
| | - Vanessa Quan
- Division of Public Health Surveillance and Response, National Institute for Communicable Diseases, a division of the National Health Laboratory Service, Johannesburg, South Africa
| | - Mignon du Plessis
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases, a division of the National Health Laboratory Service, Johannesburg, South Africa; School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Department of Paediatrics, Kalafong Provincial Tertiary Hospital, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Claire von Mollendorf
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases, a division of the National Health Laboratory Service, Johannesburg, South Africa; School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Penny Crowther-Gibson
- Division of Public Health Surveillance and Response, National Institute for Communicable Diseases, a division of the National Health Laboratory Service, Johannesburg, South Africa
| | - Theunis Avenant
- Department of Paediatrics, Kalafong Provincial Tertiary Hospital, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Nicolette du Plessis
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases, a division of the National Health Laboratory Service, Johannesburg, South Africa
| | - Ranmini Kularatne
- School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Rahima Moosa Mother and Child Hospital, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand and National Health Laboratory Service, Johannesburg, South Africa
| | - Vindana Chibabhai
- Charlotte Maxeke Johannesburg Academic Hospital, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand and National Health Laboratory Service, Johannesburg, South Africa
| | - Shabir A Madhi
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Wits Infectious Diseases and Oncology Research Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Keith P Klugman
- Pneumonia and Pandemic Prevention, Surveillance and Epidemic Control, Bill & Melinda Gates Foundation, Seattle, WA, USA
| | - Cynthia G Whitney
- Global Health Institute and Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Cheryl Cohen
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases, a division of the National Health Laboratory Service, Johannesburg, South Africa; School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
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Li G, Ren T, Zhang H, Ti J, Chang X, Yin S, Guan Y, Liu G, Liang Q, Liu J. Persistence of immunity in children aged 2 months and 7 months - 5 years old after primary immunization with 13-valent pneumococcal conjugate vaccine. Vaccine 2024; 42:126209. [PMID: 39217777 DOI: 10.1016/j.vaccine.2024.126209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 07/25/2024] [Accepted: 08/04/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND Pneumococcus is a common cause of pneumonia, meningitis, and other serious infections in children. The previous study has proved that the 13-valent pneumococcal conjugate vaccine (PCV13) has sufficient immunogenicity in children. The data on long-term persistence of immunity will help the follow-up development work of pneumococcal vaccines. METHODS Children who received the full vaccination course of the tested PCV13 in the previous clinical trial were enrolled again, and these who received other pneumococcal vaccines, or were infected with one or more serotypes of S. pneumoniae corresponding to PCV13 before enrollment were excluded. Participants were divided into four groups by age which is same as that of previous trial. The study lasted for 5 years, during which we measured pneumococcal antibodies of 13 serotypes included in PCV13 at particular points in time. Geometric mean concentrations (GMCs) and seropositive rates (the rate of IgG concentration ≥0.35 μg/mL) of antibodies against 13 serotypes were calculated. RESULTS For the participants aged 2 months, five years after primary vaccination, except for serotypes 3 and 4, seropositive rates were 100%. GMCs of IgG antibodies against 13 serotypes ranged from 0.733 to 15.160 μg/mL. All of the participants aged 7-11 months had the serotype-specific IgG concentration ≥0.35 μg/mL four years after primary vaccination with the exception of serotypes 3, 4, 6 A and 9 V. IgG GMCs were 0.753-11.031 μg/mL. All participants aged 12-23 months and 2-5 years old had the serotype-specific IgG concentration ≥0.35 μg/mL three or two years after primary vaccination respectively, except for serotype 3. IgG GMCs ranged from 0.815 to 13.111 μg/mL, and 0.684 to 12.282 μg/mL respectively. CONCLUSION PCV13 was applied to the population aged 2 months and 7 months - 5 years old with a good immune persistence, providing more extensive evidence of long-term efficacy for that vaccine. TRIAL REGISTRATION The trial was registered with ClinicalTrials.gov, number NCT06210737.
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Affiliation(s)
- Guifan Li
- Beijing Minhai Biotechnology Co., Ltd., Beijing, China
| | - Tao Ren
- Beijing Minhai Biotechnology Co., Ltd., Beijing, China
| | - Hao Zhang
- Beijing Minhai Biotechnology Co., Ltd., Beijing, China
| | - Jing Ti
- Beijing Minhai Biotechnology Co., Ltd., Beijing, China
| | - Xianyun Chang
- Beijing Minhai Biotechnology Co., Ltd., Beijing, China
| | - Shanshan Yin
- Beijing Minhai Biotechnology Co., Ltd., Beijing, China
| | - Yanxin Guan
- Beijing Minhai Biotechnology Co., Ltd., Beijing, China
| | - Gaoran Liu
- Beijing Minhai Biotechnology Co., Ltd., Beijing, China
| | - Qi Liang
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China.
| | - Jiankai Liu
- Beijing Minhai Biotechnology Co., Ltd., Beijing, China.
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3
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Bondi A, Koumantakis E, Curtoni A, Barbui AM, Peradotto M, Lombardi D, Casale R, Alizzi S, Zanotto E, Charrier L, Cavallo R, Costa C. Epidemiology and Impact of Anti-Pneumococcal Vaccination and COVID-19 on Resistance of Streptococcus pneumoniae Causing Invasive Disease in Piedmont, Italy. Antibiotics (Basel) 2024; 13:740. [PMID: 39200039 PMCID: PMC11350834 DOI: 10.3390/antibiotics13080740] [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: 06/26/2024] [Revised: 07/25/2024] [Accepted: 07/30/2024] [Indexed: 09/01/2024] Open
Abstract
BACKGROUND The international surveillance of antimicrobial resistance (AMR) reports S. pneumoniae as one of leading causes of death associated with AMR. Against invasive disease, several vaccinations are available and a reduction in AMR in S. pneumoniae has been observed. Here, we evaluated the impact of anti-pneumococcal vaccination policy and the SARS-CoV2 outbreak on AMR in S. pneumoniae causing invasive disease. METHODS We collected all strains of S. pneumoniae causing invasive disease from 2008 in the Piedmont region (Italy). Each strain was typed in order to identify the serogroup and data about AMR were collected. The population under surveillance was classified as infants, children, adults, and the old population. RESULTS We collected n = 2076 S. pneumoniae strains, with 21.9% and 40.3% being resistant to penicillin G and erythromycin, respectively. We reported an increased risk of infection with penicillin-resistant S. pneumoniae among all populations and evaluated whether the infection was caused by a serotype included in the vaccine formulation. A similar increase was observed after the SARS-CoV2 outbreak. CONCLUSIONS In the Piedmont region, subsequently to the introduction of anti-pneumococcal vaccination, a significant increase in the risk of penicillin G-resistant invasive pneumococcal disease among infants and old population was reported. No significant impact was found for the SARS-CoV2 outbreak.
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Affiliation(s)
- Alessandro Bondi
- Microbiology and Virology Unit, AOU Città della Salute e della Scienza di Torino, 10126 Turin, Italy; (A.B.); (A.C.); (A.M.B.); (M.P.); (S.A.); (R.C.)
- Department of Public Health and Pediatrics, University of Turin, 10126 Turin, Italy; (E.K.); (R.C.); (L.C.)
| | - Emanuele Koumantakis
- Department of Public Health and Pediatrics, University of Turin, 10126 Turin, Italy; (E.K.); (R.C.); (L.C.)
- Post Graduate School of Medical Statistics, University of Turin, 10126 Turin, Italy
| | - Antonio Curtoni
- Microbiology and Virology Unit, AOU Città della Salute e della Scienza di Torino, 10126 Turin, Italy; (A.B.); (A.C.); (A.M.B.); (M.P.); (S.A.); (R.C.)
- Department of Public Health and Pediatrics, University of Turin, 10126 Turin, Italy; (E.K.); (R.C.); (L.C.)
| | - Anna Maria Barbui
- Microbiology and Virology Unit, AOU Città della Salute e della Scienza di Torino, 10126 Turin, Italy; (A.B.); (A.C.); (A.M.B.); (M.P.); (S.A.); (R.C.)
| | - Marco Peradotto
- Microbiology and Virology Unit, AOU Città della Salute e della Scienza di Torino, 10126 Turin, Italy; (A.B.); (A.C.); (A.M.B.); (M.P.); (S.A.); (R.C.)
| | - Daniela Lombardi
- Regional Epidemiology Reference Service for the Surveillance, Prevention and Control of Infectious Disease (SeREMI), 15121 Alessandria, Italy;
| | - Roberto Casale
- Department of Public Health and Pediatrics, University of Turin, 10126 Turin, Italy; (E.K.); (R.C.); (L.C.)
| | - Silvia Alizzi
- Microbiology and Virology Unit, AOU Città della Salute e della Scienza di Torino, 10126 Turin, Italy; (A.B.); (A.C.); (A.M.B.); (M.P.); (S.A.); (R.C.)
| | - Elisa Zanotto
- Microbiology and Virology Unit, AOU Città della Salute e della Scienza di Torino, 10126 Turin, Italy; (A.B.); (A.C.); (A.M.B.); (M.P.); (S.A.); (R.C.)
| | - Lorena Charrier
- Department of Public Health and Pediatrics, University of Turin, 10126 Turin, Italy; (E.K.); (R.C.); (L.C.)
| | - Rossana Cavallo
- Microbiology and Virology Unit, AOU Città della Salute e della Scienza di Torino, 10126 Turin, Italy; (A.B.); (A.C.); (A.M.B.); (M.P.); (S.A.); (R.C.)
- Department of Public Health and Pediatrics, University of Turin, 10126 Turin, Italy; (E.K.); (R.C.); (L.C.)
| | - Cristina Costa
- Microbiology and Virology Unit, AOU Città della Salute e della Scienza di Torino, 10126 Turin, Italy; (A.B.); (A.C.); (A.M.B.); (M.P.); (S.A.); (R.C.)
- Department of Public Health and Pediatrics, University of Turin, 10126 Turin, Italy; (E.K.); (R.C.); (L.C.)
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Danelian G, Burton L, Bayley T, Sanchez-Marroquin A, Park J, Manley H, Choi Y, Andrews N, Ladhani S, Earnshaw A, Gritzfeld JF, Trotter C, Panovska-Griffiths J. The impact and cost-effectiveness of pneumococcal immunisation strategies for the elderly in England. Vaccine 2024; 42:3838-3850. [PMID: 38763851 DOI: 10.1016/j.vaccine.2024.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 05/01/2024] [Indexed: 05/21/2024]
Abstract
Pneumococcal disease, presenting as invasive pneumococcal disease (IPD) or community-acquired pneumonia (CAP) is an important cause of illness and hospitalisation in the elderly. To reduce pneumococcal burden, since 2003, 65-year-olds in England have been offered a 23-valent pneumococcal polysaccharide vaccine (PPV23). This study compares the impact and cost-effectiveness (CE) of vaccination with the existing PPV23 vaccine to the new 15-and 20-valent pneumococcal conjugate vaccines (PCV15 and PCV20), targeting adults aged 65 or 75 years old. We developed a static Markov model for immunisation against pneumococcal disease, capturing different vaccine effectiveness and immunity waning assumptions, projecting the number of IPD/CAP cases averted over the thirty years following vaccination. Using an economic model and probabilistic sensitivity analysis we evaluated the CE of the different immunisation strategies at current vaccine list prices and the willingness-to-pay at a median threshold of £20,000/QALY and an uncertainty threshold of 90% of simulations below £30,000/QALY. PCV20 averted more IPD and CAP cases than PCV15 or PPV23 over the thirty years following vaccination: 353(360), 145(159) and 150(174) IPD and 581(673), 259(485) and 212(235) CAP cases at a vaccination age of 65(75) under base vaccine effectiveness assumptions. At the listed prices of PCV20 and PPV23 vaccines as of May 2023, both vaccines were cost-effective when vaccinating 65- or 75-year-olds with an ICER threshold of £20,000 per QALY. To achieve the same cost-effectiveness as PPV23, the additional cost of PCV20 should be less than £44(£91) at an ICER threshold of £20,000/QALY (£30,000/QALY) if vaccination age is 65 (or £54(£103) if vaccination age is increased to 75). We showed that both PPV23 and PCV20 were likely to be cost-effective. PCV20 was likely to avert more cases of pneumococcal disease in elderly adults in England than the current PPV23 vaccine, given input assumptions of a higher vaccine effectiveness and slower waning for PCV20.
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Affiliation(s)
| | - Lucy Burton
- UK Health Security Agency, South Colonnade, London, UK
| | - Thomas Bayley
- UK Health Security Agency, South Colonnade, London, UK
| | | | - Josie Park
- UK Health Security Agency, South Colonnade, London, UK
| | | | - Yoon Choi
- UK Health Security Agency, South Colonnade, London, UK
| | - Nick Andrews
- UK Health Security Agency, South Colonnade, London, UK
| | | | | | | | - Caroline Trotter
- Departments of Pathology and Veterinary Medicine, University of Cambridge, Cambridge, UK
| | - Jasmina Panovska-Griffiths
- UK Health Security Agency, South Colonnade, London, UK; The Pandemic Sciences Institute and The Big Data Institute, University of Oxford, Oxford, UK; The Queen's College, University of Oxford, Oxford, UK.
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Fletcher MA, Daigle D, Siapka M, Baay M, Hanquet G, del Carmen Morales G. Serotype distribution of invasive pneumococcal disease from countries of the WHO Africa, Americas, Eastern Mediterranean, South-East Asia, and Western Pacific regions: a systematic literature review from 2010 to 2021. Front Public Health 2024; 12:1402795. [PMID: 39050608 PMCID: PMC11266301 DOI: 10.3389/fpubh.2024.1402795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 06/20/2024] [Indexed: 07/27/2024] Open
Abstract
Background Most publications on invasive pneumococcal disease (IPD) serotype distribution are from about 20 countries (Australia, Canada, China, European Union members, Japan, New Zealand, South Korea, and USA). Here, we reviewed the literature among underrepresented countries in the Americas (AMRO), Africa (AFRO), Eastern Mediterranean (EMRO), South-East Asia (SEARO), and Western Pacific (WPRO) WHO regions. Methods We performed a systematic review of the most recent IPD serotype surveillance publications (from 01/01/2010 to 31/12/2021, Medline/Embase) in those WHO regions. Selection criteria were delineated by contemporality, within-country geographical scope, and number of samples. Reported serotype distributions for each country were stratified by age group, pneumococcal conjugate vaccine (PCV) serotype category (considering undifferentiated serotypes), and PCV program period (pre-PCV, intermediate, or PCVhv [higher valency PCV formulation]). Pre-PCV period pooled data estimated PCV serotype category distribution by age group across WHO regions, while for the PCVhv period, country-level dataset tables were prepared. Results Of 2,793 publications screened, 107 were included (58 pediatric, 11 adult, 37 all ages, and one comprising every age group). One-third of eligible countries (51/135) published serotype distribution, ranging from 30 to 43% by WHO region. Considering number of samples per WHO region, a few countries prevailed: AMRO (Brazil), AFRO (South Africa, Malawi, and Burkina Faso), and WPRO (Taiwan). In the pre-PCV period, PCV13 formulation serotypes predominated: ranging from 74 to 85% in children and 58-86% in adults in the different WHO regions. The PCVhv period represented half of the most recent IPD surveillance by countries (26/51). Undifferentiated serotypes represented >20% of IPD from most countries (34/51). Conclusion Ubiquity of undifferentiated serotypes among the publications could constrain estimates of PCV program impact and of serotype coverage for newer PCVhv formulations; consequently, we recommend that countries favor techniques that identify serotypes specifically and, rather than reporting PCV formulation serotype distributions, provide serotype results individually. Systematic review registration The protocol has been prospectively registered at PROSPERO, identifier: CRD42021278501. https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=278501.
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Affiliation(s)
- Mark A. Fletcher
- Pfizer Vaccines Emerging Markets, Medical Affairs, Paris, France
| | - Derek Daigle
- Pfizer Vaccines Emerging Markets, Medical Affairs, New York, NY, United States
| | | | - Marc Baay
- P95 Epidemiology & Pharmacovigilance, Leuven, Belgium
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Meyer J, Silas P, Ouedraogo GL, McElwee K, Keep G, Trammel J, Peng Y, Scully IL, Gruber WC, Scott DA, Watson W. A Phase 3, Single-arm Trial to Evaluate the Safety and Immunogenicity of a 20-Valent Pneumococcal Conjugate Vaccine in Healthy Children 15 Months Through <18 Years of Age. Pediatr Infect Dis J 2024; 43:574-581. [PMID: 38502894 PMCID: PMC11090515 DOI: 10.1097/inf.0000000000004318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/09/2024] [Indexed: 03/21/2024]
Abstract
BACKGROUND A 20-valent pneumococcal conjugate vaccine (PCV20), containing 13-valent PCV (PCV13) components and 7 additional polysaccharide conjugates, was developed to extend protection for pneumococcal disease. This phase 3 study assessed the safety and immunogenicity of PCV20 in children. METHODS In this single-arm study, children (≥15 months-<18 years of age) received 1 dose of PCV20. Children <5 years of age had ≥3 prior doses of PCV13; children ≥5 years were recruited regardless of previous PCV receipt. Serotype-specific IgG concentrations and opsonophagocytic activity (OPA) titers were measured before and 1 month after PCV20. Local reactions and systemic events, adverse events (AEs), serious AEs, and newly diagnosed chronic medical conditions were collected. RESULTS Of 839 enrolled participants, 831 (>99%) were vaccinated, and 819 (>97%) completed all study visits. Local reactions and systemic events were mostly mild to moderate in severity. No serious AEs were considered PCV20-related. IgG geometric mean fold rises (GMFRs) from before to 1 month after PCV20 ranged from 27.9-1847.7 (7 additional serotypes) and 2.9-44.9 (PCV13 serotypes) in children <5 years of age, and 10.5-187.7 (7 additional serotypes) and 4.3-127.9 (PCV13 serotypes) in children ≥5 years old. OPA GMFRs from before to 1 month after PCV20 ranged from 12.4-983.6 to 2.8-52.9 in children <5 years of age and from 11.5-499.0 to 5.3-147.9 in children ≥5 years of age. CONCLUSIONS Among children ≥15 months through <18 years of age, PCV20 was well tolerated and induced robust responses to all 20 serotypes, supporting the use of PCV20 in children.
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Affiliation(s)
- Jay Meyer
- From the Meridan Clinical Research, Lincoln, Nebraska
| | | | | | - Kathleen McElwee
- Vaccine Research and Development, Pfizer Inc, Collegeville, Pennsylvania
| | - Georgina Keep
- Vaccine Research and Development, Pfizer UK, Hurley, UK
| | - James Trammel
- Vaccine Research and Development, Pfizer Inc, Collegeville, Pennsylvania
| | - Yahong Peng
- Vaccine Research and Development, Pfizer Inc, Collegeville, Pennsylvania
| | - Ingrid L. Scully
- Vaccine Research and Development, Pfizer Inc, Pearl River, New York
| | | | - Daniel A. Scott
- Vaccine Research and Development, Pfizer Inc, Collegeville, Pennsylvania
| | - Wendy Watson
- Vaccine Research and Development, Pfizer Inc, Collegeville, Pennsylvania
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Singh G, Rana A, Smriti. Decoding antimicrobial resistance: unraveling molecular mechanisms and targeted strategies. Arch Microbiol 2024; 206:280. [PMID: 38805035 DOI: 10.1007/s00203-024-03998-2] [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: 03/31/2024] [Revised: 05/07/2024] [Accepted: 05/08/2024] [Indexed: 05/29/2024]
Abstract
Antimicrobial resistance poses a significant global health threat, necessitating innovative approaches for combatting it. This review explores various mechanisms of antimicrobial resistance observed in various strains of bacteria. We examine various strategies, including antimicrobial peptides (AMPs), novel antimicrobial materials, drug delivery systems, vaccines, antibody therapies, and non-traditional antibiotic treatments. Through a comprehensive literature review, the efficacy and challenges of these strategies are evaluated. Findings reveal the potential of AMPs in combating resistance due to their unique mechanisms and lower propensity for resistance development. Additionally, novel drug delivery systems, such as nanoparticles, show promise in enhancing antibiotic efficacy and overcoming resistance mechanisms. Vaccines and antibody therapies offer preventive measures, although challenges exist in their development. Non-traditional antibiotic treatments, including CRISPR-Cas systems, present alternative approaches to combat resistance. Overall, this review underscores the importance of multifaceted strategies and coordinated global efforts to address antimicrobial resistance effectively.
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Affiliation(s)
- Gagandeep Singh
- Department of Biosciences (UIBT), Chandigarh University, Punjab, 140413, India
| | - Anita Rana
- Department of Biosciences (UIBT), Chandigarh University, Punjab, 140413, India.
| | - Smriti
- Department of Biosciences (UIBT), Chandigarh University, Punjab, 140413, India
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8
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Hurst JH, Shaik-Dasthagirisaheb YB, Truong L, Boiditswe SC, Patel SM, Gilchrist J, Maciejewski J, Luinstra K, Smieja M, Steenhoff AP, Cunningham CK, Pelton SI, Kelly MS. Serotype epidemiology and antibiotic resistance of pneumococcal isolates colonizing infants in Botswana (2016-2019). PLoS One 2024; 19:e0302400. [PMID: 38787847 PMCID: PMC11125537 DOI: 10.1371/journal.pone.0302400] [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: 02/11/2024] [Accepted: 04/02/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND In 2012, Botswana introduced 13-valent pneumococcal conjugate vaccine (PCV-13) to its childhood immunization program in a 3+0 schedule, achieving coverage rates of above 90% by 2014. In other settings, PCV introduction has been followed by an increase in carriage or disease caused by non-vaccine serotypes, including some serotypes with a high prevalence of antibiotic resistance. METHODS We characterized the serotype epidemiology and antibiotic resistance of pneumococcal isolates cultured from nasopharyngeal samples collected from infants (≤12 months) in southeastern Botswana between 2016 and 2019. Capsular serotyping was performed using the Quellung reaction. E-tests were used to determine minimum inhibitory concentrations for common antibiotics. RESULTS We cultured 264 pneumococcal isolates from samples collected from 150 infants. At the time of sample collection, 81% of infants had received at least one dose of PCV-13 and 53% had completed the three-dose series. PCV-13 serotypes accounted for 27% of isolates, with the most prevalent vaccine serotypes being 19F (n = 20, 8%), 19A (n = 16, 6%), and 6A (n = 10, 4%). The most frequently identified non-vaccine serotypes were 23B (n = 29, 11%), 21 (n = 12, 5%), and 16F (n = 11, 4%). Only three (1%) pneumococcal isolates were resistant to amoxicillin; however, we observed an increasing prevalence of penicillin resistance using the meningitis breakpoint (2016: 41%, 2019: 71%; Cochran-Armitage test for trend, p = 0.0003) and non-susceptibility to trimethoprim-sulfamethoxazole (2016: 55%, 2019: 79%; p = 0.04). Three (1%) isolates were multi-drug resistant. CONCLUSIONS PCV-13 serotypes accounted for a substantial proportion of isolates colonizing infants in Botswana during a four-year period starting four years after vaccine introduction. A low prevalence of amoxicillin resistance supports its continued use as the first-line agent for non-meningeal pneumococcal infections. The observed increase in penicillin resistance at the meningitis breakpoint and the low prevalence of resistance to ceftriaxone supports use of third-generation cephalosporins for empirical treatment of suspected bacterial meningitis.
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Affiliation(s)
- Jillian H. Hurst
- Division of Pediatric Infectious Diseases, Duke School of Medicine, Durham, North Carolina, United States of America
| | | | - Loc Truong
- Division of Pediatric Infectious Diseases, Boston Medical Center, Boston, Massachusetts, United States of America
| | | | - Sweta M. Patel
- Division of Pulmonary, Allergy and Critical Care Medicine, Duke University, Durham, North Carolina, United States of America
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Jodi Gilchrist
- Department of Laboratory Medicine, St. Joseph’s Healthcare, Hamilton, Ontario, Canada
| | - Julia Maciejewski
- Department of Laboratory Medicine, St. Joseph’s Healthcare, Hamilton, Ontario, Canada
| | - Kathy Luinstra
- Department of Laboratory Medicine, St. Joseph’s Healthcare, Hamilton, Ontario, Canada
| | - Marek Smieja
- Department of Laboratory Medicine, St. Joseph’s Healthcare, Hamilton, Ontario, Canada
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Andrew P. Steenhoff
- Botswana-University of Pennsylvania Partnership, Gaborone, Botswana
- Faculty of Health Sciences, Department of Pediatric and Adolescent Health, School of Medicine, University of Botswana, Gaborone, Botswana
- Department of Pediatrics, Division of Pediatric Infectious Diseases and Global Health Center, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America
| | - Coleen K. Cunningham
- Department of Pediatrics, University of California, Irvine, California, United States of America
- Children’s Hospital of Orange County, Orange, California, United States of America
| | - Stephen I. Pelton
- Division of Pediatric Infectious Diseases, Boston Medical Center, Boston, Massachusetts, United States of America
- Division of Pediatric Infectious Diseases, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts, United States of America
| | - Matthew S. Kelly
- Division of Pediatric Infectious Diseases, Duke School of Medicine, Durham, North Carolina, United States of America
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
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9
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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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10
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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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11
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Mohanty S, Done N, Liu Q, Song Y, Wang T, Gaburo K, Sarpong EM, White M, Weaver JP, Signorovitch J, Weiss T. Incidence of pneumococcal disease in children ≤48 months old in the United States: 1998-2019. Vaccine 2024; 42:2758-2769. [PMID: 38485640 DOI: 10.1016/j.vaccine.2024.03.013] [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: 11/09/2023] [Revised: 02/12/2024] [Accepted: 03/05/2024] [Indexed: 04/16/2024]
Abstract
BACKGROUND Pneumococcal disease (PD) is a major cause of morbidity and mortality among children, particularly in the youngest age groups. This study aimed to assess the incidence of PD over time by age group in young children with commercial or Medicaid coverage in the US. METHODS Episodes of invasive pneumococcal disease (IPD), all-cause pneumonia (ACP), and acute otitis media (AOM) were identified in the MarketScan® Commercial and Medicaid claims databases using diagnosis codes among children aged ≤ 48 months with confirmed date of birth (DoB), at any time during the study period (1998-2019). DoB was assigned using diagnosis codes for birth or delivery using the child's or mother's medical claims to ensure accurate age determination. Annual incidence rates (IRs) were calculated as number of disease episodes/100,000 person-years (PY) for IPD and ACP and episodes/1,000 PY for AOM, for children aged 0-6, 7-12, 12-24, and 25-48 months. RESULTS Annual IPD IRs declined from 53 to 7 episodes/100,000 PY between 1998 and 2019 in commercially-insured and 58 to 9 episodes/100,000 PY between 2001 and 2019 in Medicaid-insured children. Annual ACP IRs declined from 5,600 to 3,952 episodes/100,000 PY, and from 6,706 to 4,521 episodes/100,000 PY, respectively, over these periods. In both populations, children aged 0-6 months had the highest incidence of IPD and inpatient ACP. Annual AOM IRs declined from 1,177 to 738 episodes/1,000 PY (commercially-insured) and 633 to 624 episodes/1,000 PY (Medicaid-insured), over these periods. IRs were higher in rural vs. urban areas for all disease manifestations. CONCLUSIONS Incidence rates of IPD, ACP, and AOM decreased in children with commercial insurance and Medicaid coverage from 1998 to 2019. However, burden of disease remained substantial, with higher annual IRs for IPD and ACP for Medicaid-insured vs. commercially-insured children. IPD and inpatient ACP were most common in the youngest children 0-6 months old, followed by the 7-12-month age group.
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Affiliation(s)
- Salini Mohanty
- Merck & Co., Inc., 126 East Lincoln Ave., Rahway, NJ 07065, USA.
| | - Nicolae Done
- Analysis Group, Inc., 111 Huntington Avenue, Boston, MA 02199, USA
| | - Qing Liu
- Analysis Group, Inc., 111 Huntington Avenue, Boston, MA 02199, USA
| | - Yan Song
- Analysis Group, Inc., 111 Huntington Avenue, Boston, MA 02199, USA
| | - Travis Wang
- Analysis Group, Inc., 111 Huntington Avenue, Boston, MA 02199, USA
| | - Katherine Gaburo
- Analysis Group, Inc., 111 Huntington Avenue, Boston, MA 02199, USA
| | - Eric M Sarpong
- Merck & Co., Inc., 126 East Lincoln Ave., Rahway, NJ 07065, USA
| | - Meghan White
- Merck & Co., Inc., 126 East Lincoln Ave., Rahway, NJ 07065, USA
| | | | | | - Thomas Weiss
- Merck & Co., Inc., 126 East Lincoln Ave., Rahway, NJ 07065, USA
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12
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Mackenzie GA, Hossain I, Salaudeen R, Badji H, Manjang A, Usuf E, Bottomley C, Greenwood B, Hill PC. Impact of pneumococcal conjugate vaccination on pneumococcal nasopharyngeal carriage in the Gambia: Population-based cross-sectional surveys. Vaccine 2024; 42:2680-2686. [PMID: 38490820 PMCID: PMC11004668 DOI: 10.1016/j.vaccine.2024.02.066] [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: 06/01/2023] [Revised: 02/07/2024] [Accepted: 02/22/2024] [Indexed: 03/17/2024]
Abstract
BACKGROUND The introduction of pneumococcal conjugate vaccines (PCV) has reduced carriage of vaccine-type (VT) pneumococci in many settings. We determined the impact of The Gambia's national PCV programme on carriage of VT pneumococci in the population. METHODS Seven-valent PCV (PCV7) was introduced in August 2009 without catch-up and with doses scheduled at 2, 3, 4 months of age; it was replaced by PCV13 in May 2011. We did cross-sectional carriage surveys in 2009, 2015, and 2017 in age-stratified, population-based samples. Nasopharyngeal specimens were collected and processed according to WHO guidelines. We calculated observed and adjusted prevalence ratios (PR) of VT carriage before and after PCV introduction. FINDINGS We enrolled 2988, 3162, and 2709 participants in 2009, 2015, and 2017 respectively. The baseline (2009) prevalence of VT pneumococcal carriage among children aged 0-4 years was 42.6 %, which declined to 14.9 % and 17.5 % in 2015 and 2017 respectively (adjPR 0.32 [95 % CI 0.27, 0.38] and 0.38 [0.31, 0.46] respectively). VT prevalence among children aged 5-14 years was 16.6 %, 15.1 %, and 15.8 % in the three surveys (2017 vs 2009, adjPR 0.70 [0.58, 0.83]). VT prevalence among 15-44 year-olds was 6.4 %, 5.7 %, and 7.1 % in the three surveys (2017 vs 2009, adjPR 0.59 [0.46, 0.75]), while in those aged ≥ 45 years it was 4.5 %, 6.5 %, and 4.5 % respectively. Non-VT carriage increased in all age-groups. Prevalent residual serotypes were 34 and 15B (age 0-4 years), 3 and 34 (age 5-14 years), and 3 and 16F (age ≥ 15 years). CONCLUSIONS Introduction of PCV was associated with reduced VT pneumococcal carriage in young, and older children, although with substantial residual prevalence. Persisting VT, and non-VT, carriage indicate significant, persistent transmission of pneumococci in the population.
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Affiliation(s)
- Grant A Mackenzie
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, PO Box 273, Banjul, Gambia; Murdoch Children's Research Institute, Parkville, 3052 Melbourne, Victoria, Australia; Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK; Department of Paediatrics, University of Melbourne, Parkville, 3052 Melbourne, Victoria, Australia.
| | - Ilias Hossain
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, PO Box 273, Banjul, Gambia
| | - Rasheed Salaudeen
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, PO Box 273, Banjul, Gambia
| | - Henry Badji
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, PO Box 273, Banjul, Gambia
| | - Ahmed Manjang
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, PO Box 273, Banjul, Gambia
| | - Effua Usuf
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, PO Box 273, Banjul, Gambia
| | - Christian Bottomley
- Tropical Epidemiology Group, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Brian Greenwood
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Philip C Hill
- Centre for International Health, University of Otago, McMillan Street, Dunedin 9010, New Zealand
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13
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Losada-Castillo I, Santiago-Pérez I, Juiz-Gonzalez PM, Méndez-Lage S, Purriños-Hermida MJ, Malvar A, Agulla-Budiño JA. Temporal progression of the distribution of Streptococcus pneumoniae serotypes causing invasive pneumococcal disease in Galicia (Spain) and its relationship with resistance to antibiotics (period 2011-2021). ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA (ENGLISH ED.) 2024; 42:179-186. [PMID: 37117145 DOI: 10.1016/j.eimce.2023.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 11/21/2022] [Accepted: 12/03/2022] [Indexed: 04/30/2023]
Abstract
INTRODUCTION Streptococcus pneumoniae causes serious diseases in the susceptible population. The 13-valent pneumococci conjugate vaccine (PCV13) was included in the children's calendar in 2011. The objective of the study was to analyze the evolution of pneumococcal serotypes and their resistance after PCV13. METHODS This study included the pneumococci serotyped in Galicia in 2011-2021. Antibiotic susceptibility was analyzed following EUCAST criteria. The data was analyzed in 3 sub-periods: initial (2011-2013), middle (2014-2017) and final (2018-2021). The prevalence of serotypes and their percentage of resistance to the most representative antibiotics were calculated. RESULTS A total of 2.869 isolates were included. Initially, 42.7% isolates presented capsular types included in PCV13, compared to 15.4% at the end. Those included in PCV20 and not in PCV13 and PCV15 were 12.5% at baseline and 41.3% at the end; 26.4% of the isolates throughout the study had serotypes not included in any vaccine. The prevalence of serotype 8 multiplied almost by 8 and that of 12F tripled. The 19A serotype was initially the most resistant, while the resistance of serotypes 11A and 15A increased throughout the study. CONCLUSIONS The introduction of PCV13 in the pediatric population determined a change in pneumococcal serotypes towards those included in PCV20 and those not included in any vaccine. Serotype 19A was initially the most resistant and the 15A, not included in any vaccine, deserves special follow-up. Serotype 8, which increased the most, did not show remarkable resistance.
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Affiliation(s)
- Isabel Losada-Castillo
- Servizo de Calidade Asistencial, Dirección Xeral de Asistencia Sanitaria, Consellería de sanidade, Santiago de Compostela, La Coruña, Spain.
| | - Isolina Santiago-Pérez
- Servizo de Epidemioloxía, Dirección Xeral de Saúde Pública, Consellería de Sanidade, Santiago de Compostela, La Coruña, Spain
| | | | - Susana Méndez-Lage
- Servizo de Microbioloxía, Complexo Hospitalario Universitario de Ferrol, Ferrol, La Coruña, Spain
| | | | - Alberto Malvar
- Servizo de Epidemioloxía, Dirección Xeral de Saúde Pública, Consellería de Sanidade, Santiago de Compostela, La Coruña, Spain
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14
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Hyams C, Lahuerta M, Theilacker C, King J, Adegbite D, McGuinness S, Grimes C, Campling J, Southern J, Pride MW, Begier E, Maskell N, Oliver J, Jodar L, Gessner BD, Finn A. Surveillance of pneumococcal serotypes in adults hospitalised with acute lower respiratory tract infection in Bristol, UK. Vaccine 2024; 42:1599-1607. [PMID: 38336560 DOI: 10.1016/j.vaccine.2024.02.007] [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: 11/05/2023] [Revised: 01/18/2024] [Accepted: 02/02/2024] [Indexed: 02/12/2024]
Abstract
INTRODUCTION Pneumococcus remains a major cause of adult lower respiratory tract infections (LRTI). Few data exist on the relative contribution of serotypes included in pneumococcal vaccines to community-acquired pneumonia (CAP) and non-pneumonic (NP) LRTI. We measured the burden of all and vaccine-serotype pneumococcal respiratory infection following SARS-CoV-2 emergence to inform evidence-based vaccination policy. METHODS A prospective cohort study at two Bristol hospitals (UK) including all adults age ≥ 18-years hospitalised with acute lower respiratory tract disease (aLRTD) from Nov2021-Nov2022. LRTI patients were classified as: a) radiographically-confirmed CAP (CAP+/RAD+), b) clinically-diagnosed CAP without radiological confirmation (CAP+/RAD-), or c) NP-LRTI. Pneumococcus was identified by blood culture, BinaxNOW™and serotype-specific urine antigen detection assays (UAD). RESULTS Of 12,083 aLRTD admissions, 10,026 had LRTI and 2,445 provided urine: 1,097 CAP + RAD+; 207 CAP + RAD-; and 1,141 NP-LRTI. Median age was 71.1y (IQR57.9-80.2) and Charlson comorbidity index = 4 (IQR2-5); 2.7 % of patients required intensive care, and 4.4 % died within 30-days of hospitalisation. Pneumococcus was detected in 280/2445 (11.5 %) participants. Among adults aged ≥ 65y and 18-64y, 12.9 % (198/1534) and 9.0 % (82/911), respectively, tested pneumococcus positive. We identified pneumococcus in 165/1097 (15.0 %) CAP + RAD+, 23/207 (11.1 %) CAP + RAD-, and 92/1141 (8.1 %) NP-LRTI cases. Of the 280 pneumococcal cases, 102 (36.4 %) were due to serotypes included in PCV13 + 6C, 115 (41.7 %) in PCV15 + 6C, 210 (75.0 %) in PCV20 + 6C/15C and 228 (81.4 %) in PPV23 + 15C. The most frequently identified serotypes were 8 (n = 78; 27.9 % of all pneumococcus), 7F (n = 25; 8.9 %), and 3 (n = 24; 8.6 %). DISCUSSION Among adults hospitalised with respiratory infection, pneumococcus is an important pathogen across all subgroups, including CAP+/RAD- and NP-LRTI. Despite 20-years of PPV23 use in adults ≥ 65-years and herd protection due to 17-years of PCV use in infants, vaccine-serotype pneumococcal disease still causes a significant proportion of LRTI adult hospitalizations. Direct adult vaccination with high-valency PCVs may reduce pneumococcal disease burden.
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Affiliation(s)
- Catherine Hyams
- Population Health Sciences, University of Bristol, Bristol, UK.
| | | | | | - Jade King
- Clinical Research and Imaging Centre, UHBW NHS Trust, Bristol, UK
| | - David Adegbite
- Bristol Vaccine Centre, Population Health Sciences, University of Bristol, Bristol, UK
| | - Serena McGuinness
- Bristol Vaccine Centre, Population Health Sciences, University of Bristol, Bristol, UK
| | | | | | | | | | | | - Nick Maskell
- Academic Respiratory Unit, University of Bristol, Bristol, UK
| | - Jennifer Oliver
- Bristol Vaccine Centre, Population Health Sciences, University of Bristol, Bristol, UK
| | | | | | - Adam Finn
- Bristol Vaccine Centre, Cellular and Molecular Medicine and Population Health Sciences, University of Bristol, Bristol, UK
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15
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Maraki S, Mavromanolaki VE, Stafylaki D, Iliaki-Giannakoudaki E, Kasimati A, Hamilos G. Antimicrobial Resistance of Streptococcus pneumoniae Clinical Serotypes between 2017 and 2022 in Crete, Greece. Infect Chemother 2024; 56:73-82. [PMID: 38403878 PMCID: PMC10990890 DOI: 10.3947/ic.2023.0098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 12/19/2023] [Indexed: 02/27/2024] Open
Abstract
BACKGROUND Pneumococcal disease is still considered a global problem. With the introduction of pneumococcal conjugate vaccines (PCVs) serotype epidemiology changed, but antimicrobial resistance persists constituting a serious problem. The current study aimed to determine the serotype distribution and the antimicrobial susceptibility of recent Streptococcus pneumoniae isolates, following implementation of the 13-valent conjugate vaccine (PCV13). MATERIALS AND METHODS From January 2017 to December 2022 we evaluated 116 nonduplicate S. pneumoniae isolates collected from adult patients (21 - 98 years) cared for in the University Hospital of Heraklion, Crete, Greece. Pneumococcal isolates were serotyped by the Quellung reaction, and antimicrobial susceptibility testing was performed using E-test. Multidrug resistance (MDR) was defined as non-susceptibility to at least one agent in ≥3 classes of antibiotics. RESULTS Among the 116 isolates, 31% were recognized as invasive pneumococcal strains, while 69% were non-invasive. The isolates tested belonged to 25 different serotypes. The most prevalent serotypes were 11A (10.3%), and 35B (10.3%), followed by 3 (9.5%), 15A (7.8%), 25F (6.9%), 19A (5.3%), 35F (5.3%), and others (44.6%). The coverage rates of PCV13 and the pneumococcal polysaccharide vaccine (PPSV23) were 26.7% and 57.8%, respectively. PCV13 and PPSV23 serotypes decreased between 2017 - 2019 and 2020 - 2022, with a parallel increase in the non-vaccine types. Resistance rates to erythromycin, clindamycin, trimethoprim/sulfamethoxazole, penicillin, levofloxacin, and ceftriaxone, were 40.5%, 21.6%, 13.8%, 12.1%, 3.4%, and 0%, respectively. All isolates were susceptible to vancomycin, linezolid, and daptomycin. MDR was observed among 36 (31%) S. pneumoniae isolates. CONCLUSION The increasing levels of resistance in S. pneumoniae in Crete, Greece, highlight the need for continuous surveillance of antimicrobial resistance and development of strategies for its reduction, including antimicrobial stewardship programs, increased pneumococcal vaccination, and development of next generation PCVs with a wider serotype coverage.
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Affiliation(s)
- Sofia Maraki
- Department of Clinical Microbiology and Microbial Pathogenesis, University Hospital of Heraklion, Crete, Greece.
| | | | - Dimitra Stafylaki
- Department of Clinical Microbiology and Microbial Pathogenesis, University Hospital of Heraklion, Crete, Greece
| | | | - Anna Kasimati
- Department of Clinical Microbiology and Microbial Pathogenesis, University Hospital of Heraklion, Crete, Greece
| | - George Hamilos
- Department of Clinical Microbiology and Microbial Pathogenesis, University Hospital of Heraklion, Crete, Greece
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Fuji N, Pham M, Kaur R, Pichichero M. Serotype 3 Antibody Response and Antibody Functionality Compared to Serotype 19A Following 13-Valent Pneumococcal Conjugate Immunization in Children. Pediatr Infect Dis J 2024; 43:294-300. [PMID: 38048644 PMCID: PMC10922043 DOI: 10.1097/inf.0000000000004192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/06/2023]
Abstract
BACKGROUND Prevention of infections in children vaccinated with 13-valent pneumococcal conjugate vaccine (PCV13) may be less effective against serotype 3 than 19A. OBJECTIVE The aim of this study was to to determine differences in IgG and functional antibody for serotype 3 versus 19A following PCV13 immunization, in IgG antibody levels induced by PCV13 compared to naturally-induced immunity, and assess effectiveness of PCV13 against serotype 3 and 19A in prevention of acute otitis media (AOM) and colonization among 6-36-month-old children. METHODS Samples were from a prospective, longitudinal, observational cohort study conducted in Rochester, NY. Pneumococcal detection was by culture. 713 serum were tested for antibody levels by enzyme-linked immunosorbent assay, 68 for functional antibody by opsonophagocytosis and 47 for antibody avidity by thiocyanate bond disruption. PCV13 effectiveness in preventing AOM and colonization was determined by comparison of pre-PCV13 detection of serotypes 3 and 19A to post-PCV13. RESULTS The proportion of children who reached the antibody threshold of ≧0.35 µg/mL after PCV13 was higher for serotype 19A than serotype 3. Only serotype 19A showed significant increase in PCV13-induced opsonophagocytosis assay titers and antibody avidity. Serotype 3 naturally-induced immune children showed a positive trend of increase in antibody level as children got older, but not PCV13-immunized children. PCV13 effectiveness was not identified in preventing AOM or colonization for serotype 3 but effectiveness of 19A was confirmed. CONCLUSIONS PCV13 elicits lower antibody levels and lower effectiveness to serotype 3 versus serotype 19A. Post-PCV13-induced antibody levels for serotype 3 are likely insufficient to prevent AOM and colonization in most young children.
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Affiliation(s)
- Naoko Fuji
- Rochester General Hospital Research Institute, Center for Infectious Diseases, 1425 Portland Ave, Rochester NY
| | - Minh Pham
- San Francisco State University, 1600 Holloway Ave, San Francisco CA
| | - Ravinder Kaur
- Rochester General Hospital Research Institute, Center for Infectious Diseases, 1425 Portland Ave, Rochester NY
| | - Michael Pichichero
- Rochester General Hospital Research Institute, Center for Infectious Diseases, 1425 Portland Ave, Rochester NY
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Yi Q, Li L, Wang H, Zhu C, Chen Y, Yang L, Zheng Y, Yang Y, Bao Y. A clade of Streptococcus pneumoniae clonal complex 320 with increased tolerance to β-lactam antibiotics in a Chinese metropolitan city. J Glob Antimicrob Resist 2024; 36:379-388. [PMID: 38307252 DOI: 10.1016/j.jgar.2024.01.016] [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: 09/19/2023] [Revised: 01/15/2024] [Accepted: 01/25/2024] [Indexed: 02/04/2024] Open
Abstract
OBJECTIVES We characterized the population structure and features of clinical Streptococcus pneumoniae isolates associated with invasive pneumococcal disease (IPD) from 2009 to 2017 in a Chinese metropolitan city using a whole-genome sequencing approach. METHODS Seventy-nine pneumococcal strains, including 60 serogroup-19 strains from children enduring IPD from a paediatric hospital in Shenzhen, were subjected to whole-genome sequencing. Population structure was characterized through phylogenetic analysis, sequence typing, serotyping, virulence factor, and antimicrobial drug resistance (AMR) gene profiling, combining the publicly available related WGS data. Clinical demography and antibiotic susceptibility profiles were compared among different populations to emphasize the higher-risk populations. Genetic regions associated with AMR gene mobilization were identified through comparative genomics. RESULTS These IPD strains mainly belonged to clonal complex 320 (CC320) and were composed of serotypes 19A and 19F. In addition to sporadic possible importation-related isolates (ST320), we identified an independent clade, CC320_SZpop (ST271), that predominantly circulated in Shenzhen and possibly expanded its range. Clinical features and antibiotic susceptibility analysis revealed that CC320_SZpop might manifest much higher pathogenicity and tolerance to β-lactams. Specific virulence factors in Shenzhen isolates of CC320_SZpop were identified. Furthermore, an ca. 40 kb hotspot genomic region enduring frequent recombination was identified, possibly associated with the divergence of S. pneumoniae strains. CONCLUSION A novel pneumococcal clade, CC320_SZpop, circulating in Shenzhen and other regions in China, possibly under expansion, was found and deserves more study and surveillance. Our study also emphasizes the importance of continuous genomic surveillance of clinical S. pneumoniae isolates, especially IPD isolates.
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Affiliation(s)
- Qiuwei Yi
- Shenzhen Children's Hospital, Guangdong, China
| | - Liqiang Li
- National Clinical Research Center for Infectious Diseases, The Third People's Hospital of Shenzhen, Southern University of Science and Technology, Guangdong Provincial Clinical Research Center for Infectious Diseases (Tuberculosis), Shenzhen Clinical Research Center for Tuberculosis, Shenzhen, China; Department of Clinical Laboratory, The Third People's Hospital of Shenzhen, Southern University of Science and Technology, Shenzhen, China.
| | - Heping Wang
- Shenzhen Children's Hospital, Guangdong, China
| | | | | | - Liang Yang
- Southern University of Science of and Technology, Guangdong, China
| | | | | | - Yanmin Bao
- Shenzhen Children's Hospital, Guangdong, China.
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18
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Bo L, Sun H, Li YD, Zhu J, Wurpel JND, Lin H, Chen ZS. Combating antimicrobial resistance: the silent war. Front Pharmacol 2024; 15:1347750. [PMID: 38420197 PMCID: PMC10899355 DOI: 10.3389/fphar.2024.1347750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 02/02/2024] [Indexed: 03/02/2024] Open
Abstract
Once hailed as miraculous solutions, antibiotics no longer hold that status. The excessive use of antibiotics across human healthcare, agriculture, and animal husbandry has given rise to a broad array of multidrug-resistant (MDR) pathogens, posing formidable treatment challenges. Antimicrobial resistance (AMR) has evolved into a pressing global health crisis, linked to elevated mortality rates in the modern medical era. Additionally, the absence of effective antibiotics introduces substantial risks to medical and surgical procedures. The dwindling interest of pharmaceutical industries in developing new antibiotics against MDR pathogens has aggravated the scarcity issue, resulting in an exceedingly limited pipeline of new antibiotics. Given these circumstances, the imperative to devise novel strategies to combat perilous MDR pathogens has become paramount. Contemporary research has unveiled several promising avenues for addressing this challenge. The article provides a comprehensive overview of these innovative therapeutic approaches, highlighting their mechanisms of action, benefits, and drawbacks.
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Affiliation(s)
- Letao Bo
- Department of Pharmaceutical Sciences, College of Pharmacy and Health Sciences, St. John’s University, Queens, NY, United States
| | - Haidong Sun
- Shenzhen Hospital of Guangzhou University of Chinese Medicine, Shenzhen, China
| | - Yi-Dong Li
- Department of Pharmaceutical Sciences, College of Pharmacy and Health Sciences, St. John’s University, Queens, NY, United States
| | - Jonathan Zhu
- Carle Place Middle and High School, Carle Place, NY, United States
| | - John N. D. Wurpel
- Department of Pharmaceutical Sciences, College of Pharmacy and Health Sciences, St. John’s University, Queens, NY, United States
| | - Hanli Lin
- Shenzhen Hospital of Guangzhou University of Chinese Medicine, Shenzhen, China
| | - Zhe-Sheng Chen
- Institute for Biotechnology, St. John’s University, Queens, NY, United States
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19
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Kim JH, Yoon D, Lee H, Choe YJ, Shin JY. Neurological and immunological adverse events after pneumococcal conjugate vaccine in children using national immunization programme registry data. Int J Epidemiol 2024; 53:dyae010. [PMID: 38302750 DOI: 10.1093/ije/dyae010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 01/16/2024] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND Despite the general consensus on the safety of pneumococcal conjugate vaccine (PCV), safety concerns unveiled during post-licensure surveillance need to be addressed. We investigated whether there is a transient increased risk following a three-dose series of pneumococcal conjugate vaccine (PCV) administered at 2, 4 and 6 months of age. METHODS This was a population-based cohort study using the Korea immunization registry data linked to nationwide administrative claims data. Self-controlled risk interval analysis was conducted for PCV recipients who had an outcome of interest within pre-defined risk and control intervals between 2018 and 2022. The outcomes were anaphylaxis, asthma, encephalopathy, febrile seizure, Kawasaki disease and thrombocytopenia. We used conditional Poisson regression model to estimate the incidence rate ratios (IRRs) and 95% confidence intervals (CIs) comparing the outcomes in the risk and control intervals. RESULTS Of 1 114 096 PCV recipients, 8661 had outcomes either in the risk or control intervals. Their mean age at Dose 1 was 10.0 weeks, 58.3% were boys, and 85.3% received 13-valent PCV. PCV was not associated with an increased risk of any outcomes except for febrile seizure. There were 408 (56.0%) cases of febrile seizure in the risk interval, corresponding to an IRR of 1.27 (95% CI 1.10-1.47). CONCLUSIONS It is reassuring to note that there was no increased risk of the potential safety concerns following PCV administration. Despite the transient increased risk of febrile seizure, absolute numbers of cases were small. Febrile seizure is generally self-limiting with a good prognosis, and should not discourage parents or caregivers from vaccinating their children.
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Affiliation(s)
- Ju Hwan Kim
- School of Pharmacy, Sungkyunkwan University, Suwon, Gyeonggi-do, South Korea
- Department of Biohealth Regulatory Science, School of Pharmacy, Sungkyunkwan University, Suwon, Gyeonggi-do, South Korea
| | - Dongwon Yoon
- School of Pharmacy, Sungkyunkwan University, Suwon, Gyeonggi-do, South Korea
- Department of Biohealth Regulatory Science, School of Pharmacy, Sungkyunkwan University, Suwon, Gyeonggi-do, South Korea
| | - Hyesung Lee
- School of Pharmacy, Sungkyunkwan University, Suwon, Gyeonggi-do, South Korea
- Department of Biohealth Regulatory Science, School of Pharmacy, Sungkyunkwan University, Suwon, Gyeonggi-do, South Korea
| | - Young June Choe
- Department of Pediatrics, Korea University Anam Hospital, Seoul, South Korea
| | - Ju-Young Shin
- School of Pharmacy, Sungkyunkwan University, Suwon, Gyeonggi-do, South Korea
- Department of Biohealth Regulatory Science, School of Pharmacy, Sungkyunkwan University, Suwon, Gyeonggi-do, South Korea
- Department of Clinical Research Design & Evaluation, Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University, Seoul, South Korea
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20
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Tong X, Gao L, Wong ICK, Chan VKY, Wong AYS, Mak JCW, Yuen JKY, Jit M, Hung IFN, Yiu KH, Li X. Effects of sequential vs single pneumococcal vaccination on cardiovascular diseases among older adults: a population-based cohort study. Int J Epidemiol 2024; 53:dyae005. [PMID: 38332579 PMCID: PMC10853609 DOI: 10.1093/ije/dyae005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 01/12/2024] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND Recommendations around the use of 23-valent pneumococcal polysaccharide vaccine (PPSV23) and 13-valent pneumococcal conjugate vaccine (PCV13) seldom focus on potential benefits of vaccine on comorbidities. We aimed to investigate whether sequential vaccination with PCV13 and PPSV23 among older adults would provide protection against cardiovascular diseases (CVD) compared with using a single pneumococcal vaccine. METHODS We conducted a Hong Kong-wide retrospective cohort study between 2012 and 2020. Adults aged ≥65 years were identified as receiving either a single or sequential dual vaccination and followed up until the earliest CVD occurrence, death or study end. To minimize confounding, we matched each person receiving a single vaccination to a person receiving sequential vaccination according to their propensity scores. We estimated the hazard ratio (HR) of CVD risk using Cox regression and applied structural equation modelling to test whether the effect of sequential dual vaccination on CVD was mediated via the reduction in pneumonia. RESULTS After matching, 69 390 people remained in each group and the median (interquartile range) follow-up time was 1.89 (1.55) years. Compared with those receiving a single vaccine, those receiving sequential dual vaccination had a lower risk of CVD [HR (95% CI): 0.75 (0.71, 0.80), P < 0.001]. Post-hoc mediation analysis showed strong evidence that the decreased CVD risk was mediated by the reduction in all-cause pneumonia. CONCLUSIONS Sequential dual pneumococcal vaccination was associated with lower risk of CVD compared with single-dose PCV13 or PPSV23 in older adults. Such additional CVD benefits should be considered when making decisions about pneumococcal vaccination.
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Affiliation(s)
- Xinning Tong
- Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
- Department of Orthopaedics, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Le Gao
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Ian C K Wong
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
- Laboratory of Data Discovery for Health (D4H), Hong Kong Science and Technology Park, Sha Tin, Hong Kong SAR, China
- Aston School of Pharmacy, Aston University, Birmingham, UK
| | - Vivien K Y Chan
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Angel Y S Wong
- Laboratory of Data Discovery for Health (D4H), Hong Kong Science and Technology Park, Sha Tin, Hong Kong SAR, China
- London School of Hygiene and Tropical Medicine, London, UK
| | - Judith C W Mak
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Jacqueline K Y Yuen
- Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Mark Jit
- Laboratory of Data Discovery for Health (D4H), Hong Kong Science and Technology Park, Sha Tin, Hong Kong SAR, China
- London School of Hygiene and Tropical Medicine, London, UK
| | - Ivan F N Hung
- Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Kai Hang Yiu
- Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Xue Li
- Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
- Laboratory of Data Discovery for Health (D4H), Hong Kong Science and Technology Park, Sha Tin, Hong Kong SAR, China
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21
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Steinberg J, Bressler SS, Orell L, Thompson GC, Kretz A, Reasonover AL, Bruden D, Bruce MG, Fischer M. Invasive Pneumococcal Disease and Potential Impact of Pneumococcal Conjugate Vaccines Among Adults, Including Persons Experiencing Homelessness-Alaska, 2011-2020. Clin Infect Dis 2024; 78:172-178. [PMID: 37787072 PMCID: PMC10868556 DOI: 10.1093/cid/ciad597] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 09/13/2023] [Accepted: 09/27/2023] [Indexed: 10/04/2023] Open
Abstract
BACKGROUND Adults aged ≥65 years, adults with certain underlying medical conditions, and persons experiencing homelessness are at increased risk for invasive pneumococcal disease (IPD). Two new pneumococcal conjugate vaccines, 15-valent pneumococcal conjugate vaccine (PCV15) and 20-valent pneumococcal conjugate vaccine (PCV20), were recently approved for use in US adults. We describe the epidemiology of IPD among Alaska adults and estimate the proportion of IPD cases potentially preventable by new vaccines. METHODS We used statewide, laboratory-based surveillance data to calculate and compare IPD incidence rates and 95% confidence intervals (CIs) among Alaska adults aged ≥18 years during 2011-2020 and estimate the proportion of IPD cases that were caused by serotypes in PCV15 and PCV20. RESULTS During 2011-2020, 1164 IPD cases were reported among Alaska adults for an average annual incidence of 21.3 cases per 100 000 adults per year (95% CI, 20.1-22.5). Incidence increased significantly during the study period (P < .01). IPD incidence among Alaska Native adults was 4.7 times higher than among non-Alaska Native adults (95% CI, 4.2-5.2). Among adults experiencing homelessness in Anchorage, IPD incidence was 72 times higher than in the general adult population (95% CI, 59-89). Overall, 1032 (89%) Alaska adults with IPD had an indication for pneumococcal vaccine according to updated vaccination guidelines; 456 (39%) and 700 (60%) cases were caused by serotypes in PCV15 and PCV20, respectively. CONCLUSIONS Use of PCV15 and PCV20 could substantially reduce IPD among adults in Alaska, including Alaska Native adults and adults experiencing homelessness.
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Affiliation(s)
- Jonathan Steinberg
- Arctic Investigations Program, Division of Infectious Disease Readiness and Innovation, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Anchorage, Alaska, USA
| | - Sara S Bressler
- Arctic Investigations Program, Division of Infectious Disease Readiness and Innovation, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Anchorage, Alaska, USA
| | - Laurie Orell
- Arctic Investigations Program, Division of Infectious Disease Readiness and Innovation, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Anchorage, Alaska, USA
| | - Gail C Thompson
- Arctic Investigations Program, Division of Infectious Disease Readiness and Innovation, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Anchorage, Alaska, USA
| | - Anthony Kretz
- Arctic Investigations Program, Division of Infectious Disease Readiness and Innovation, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Anchorage, Alaska, USA
| | - Alisa L Reasonover
- Arctic Investigations Program, Division of Infectious Disease Readiness and Innovation, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Anchorage, Alaska, USA
| | - Dana Bruden
- Arctic Investigations Program, Division of Infectious Disease Readiness and Innovation, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Anchorage, Alaska, USA
| | - Michael G Bruce
- Arctic Investigations Program, Division of Infectious Disease Readiness and Innovation, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Anchorage, Alaska, USA
| | - Marc Fischer
- Arctic Investigations Program, Division of Infectious Disease Readiness and Innovation, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Anchorage, Alaska, USA
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22
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Hammitt LL, Quinn D, Janczewska E, Pasquel FJ, Tytus R, Reddy KR, Abarca K, Khaertynova IM, Dagan R, Dawson R, McCauley J, Shekar T, Fu W, Pedley A, Sterling T, Tamms G, Musey L, Buchwald UK. Phase 3 trial to evaluate the safety, tolerability, and immunogenicity of V114, a 15-valent pneumococcal conjugate vaccine, followed by 23-valent pneumococcal polysaccharide vaccine 6 months later, in at-risk adults 18-49 years of age (PNEU-DAY): A subgroup analysis by baseline risk factors. Hum Vaccin Immunother 2023; 19:2177066. [PMID: 36864601 PMCID: PMC10026908 DOI: 10.1080/21645515.2023.2177066] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023] Open
Abstract
Immunocompetent adults with certain medical and behavioral factors are at increased risk of pneumococcal disease. In some countries, sequential vaccination with 13-valent pneumococcal conjugate vaccine (PCV13) followed by 23-valent pneumococcal polysaccharide vaccine (PPSV23) is recommended for at-risk adults. This subgroup analysis from a phase 3 study evaluated the safety, tolerability, and immunogenicity of sequential administration of either V114 (a 15-valent PCV containing serotypes 1, 3, 4, 5, 6A, 6B, 7F, 9V, 14, 18C, 19A, 19F, 22F, 23F, and 33F) or PCV13, followed 6 months later by PPSV23, in immunocompetent adults 18-49 years of age with pre-defined risk factors for pneumococcal disease. Safety and immunogenicity post-vaccination were analyzed by type and baseline number of risk factors for pneumococcal disease (1 and ≥2 risk factors). This analysis included 1,131 participants randomized 3:1 to receive either V114 or PCV13, followed by PPSV23. The majority (73.1%) of participants had at least one risk factor. Safety and tolerability profiles of V114 and PCV13 were similar across risk factor groups. V114 administered either alone or sequentially with PPSV23 6 months later was immunogenic for all 15 serotypes, including those not contained in PCV13, regardless of the number of baseline risk factors. V114 has the potential to broaden serotype coverage for at-risk adults.
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Affiliation(s)
- Laura L Hammitt
- International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Dean Quinn
- P3 Research, Wellington Clinical Trial Research Unit, Wellington, New Zealand
| | - Ewa Janczewska
- The School of Health Sciences in Bytom, Medical University of Silesia, Bytom, Poland
| | - Francisco J Pasquel
- Division of Endocrinology, Metabolism, and Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Richard Tytus
- Family Medicine, McMaster University, Ontario, Canada
| | - K Rajender Reddy
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Katia Abarca
- Escuela de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | | | - Ron Dagan
- The Shraga Segal Department of Microbiology, Immunology and Genetics, Faculty of Health Sciences of the Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | | | | | | | - Wei Fu
- Merck & Co., Inc., Rahway, NJ, USA
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Menéndez R, Torres A, España PP, Fernández-Villar JA, Marimón JM, Méndez R, Cilloniz C, Egurrola M, Botana-Rial M, Ercibengoa M, Méndez C, Cifuentes I, Gessner BD. Pneumococcal Serotypes Associated with Community-Acquired Pneumonia Hospitalizations in Adults in Spain, 2016-2020: The CAPA Study. Microorganisms 2023; 11:2781. [PMID: 38004792 PMCID: PMC10673231 DOI: 10.3390/microorganisms11112781] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 11/08/2023] [Accepted: 11/13/2023] [Indexed: 11/26/2023] Open
Abstract
Newer higher valency pneumococcal conjugate vaccines (PCVs) have the potential to reduce the adult community-acquired pneumonia (CAP) burden. We describe the evolution and distribution of adult community-acquired pneumonia (CAP) serotypes in Spain, focusing on serotypes contained in the 20-valent PCV (PCV20). This was a prospective, observational study of chest X-ray (CXR)-confirmed CAP in immunocompetent adults hospitalized in one of four Spanish hospitals between November 2016 and November 2020. Pneumococci were isolated from cultures and detected in urine using BinaxNow® and Pfizer serotype-specific urinary antigen tests UAD1 and UAD2. We included 1948 adults hospitalized with CXR-CAP. The median age was 69.0 years (IQR: 24 years). At least one comorbidity was present in 84.8% (n = 1653) of patients. At admission, 76.1% of patients had complicated pneumonia. Pneumococcus was identified in 34.9% (n = 680) of study participants. The PCV20 vaccine-type CAP occurred in 23.9% (n = 465) of all patients, 68.4% (n = 465) of patients with pneumococcal CAP, and 82.2% (83/101) of patients who had pneumococcus identified by culture. Serotypes 8 (n = 153; 7.9% of all CAP) and 3 (n = 152; 7.8% of all CAP) were the most frequently identified. Pneumococcus is a common cause of hospitalized CAP among Spanish adults and serotypes contained in PCV20 caused the majority of pneumococcal CAP.
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Affiliation(s)
- Rosario Menéndez
- Hospital Universitario y Politécnico la Fe, 46026 Valencia, Spain; (R.M.); (R.M.)
- Biomedical Research Center Network for Respiratory Diseases (CIBERES), 28029 Madrid, Spain
| | - Antoni Torres
- Biomedical Research Center Network for Respiratory Diseases (CIBERES), 28029 Madrid, Spain
- Hospital Clinic, 08036 Barcelona, Spain;
| | | | - Jose Alberto Fernández-Villar
- Hospital Alvaro Cunqueiro, Instituto de Investigación Biomédica Galicia Sur, 36312 Vigo, Spain; (J.A.F.-V.); (M.B.-R.)
| | - José María Marimón
- Biodonostia, Hospital Universitario Donostia, 20014 San Sebastián, Spain; (J.M.M.); (M.E.)
| | - Raúl Méndez
- Hospital Universitario y Politécnico la Fe, 46026 Valencia, Spain; (R.M.); (R.M.)
- Biomedical Research Center Network for Respiratory Diseases (CIBERES), 28029 Madrid, Spain
| | - Catia Cilloniz
- Hospital Clinic, 08036 Barcelona, Spain;
- Faculty of Health Sciences, Continental University, Huancayo 12001, Peru
| | - Mikel Egurrola
- Hospital Galdakao-Usansolo, 48960 Galdácano, Spain; (P.P.E.); (M.E.)
| | - Maribel Botana-Rial
- Hospital Alvaro Cunqueiro, Instituto de Investigación Biomédica Galicia Sur, 36312 Vigo, Spain; (J.A.F.-V.); (M.B.-R.)
| | - María Ercibengoa
- Biodonostia, Hospital Universitario Donostia, 20014 San Sebastián, Spain; (J.M.M.); (M.E.)
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Adamkiewicz TV, Yee MEM, Thomas S, Tunali A, Lai KW, Omole FS, Lane PA, Yildirim I. Pneumococcal infections in children with sickle cell disease before and after pneumococcal conjugate vaccines. Blood Adv 2023; 7:6751-6761. [PMID: 37698500 PMCID: PMC10660014 DOI: 10.1182/bloodadvances.2022009643] [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: 12/28/2022] [Revised: 07/13/2023] [Accepted: 07/13/2023] [Indexed: 09/13/2023] Open
Abstract
Children with sickle cell disease (SCD) are at increased risk of invasive pneumococcal disease (IPD). Over 25 years, the Georgia Emerging Infections Program/Centers for Disease Control and Prevention Active Bacterial Core Surveillance network identified 104 IPD episodes among 3707 children with hemoglobin SS (HbSS) or HbSC aged <10 years, representing 6% of IPD in Black or African American children residing in Metropolitan Atlanta (reference population). Children with IPD and HbSS/SC were older than those with IPD in the reference population (P < .001). From 1994-1999 to 2010-2018, IPD declined by 87% in children with HbSS aged 0 to 4 years, and by 80% in those aged 5 to 9 years. However, IPD incidence rate ratios when comparing children with SCD with the reference population increased from 20.2 to 29.2 over these periods. Among children with HbSS and IPD, death declined from 14% to 3% after 2002, and meningitis declined from 16% to 8%. Penicillin resistance was more prevalent in children with SCD before 7-valent pneumococcal conjugate vaccine (PCV7) licensure. After 2010, all IPD serotypes were not included in the 13-valent PCV (PCV13). Within 3 years of vaccination, the effectiveness of the 23-valent pneumococcal polysaccharide vaccine (PPSV23) against non-PCV13 serotypes included in PPSV23 plus 15A/15C was 92% (95% confidence interval, 40.8- 99.0, P = .014; indirect-cohort effect adjusted for age and hydroxyurea). PPSV23 would cover 62% of non-PCV13 serotype IPD in children with SCD, whereas PCV15, PCV20, and PCV21/V116 (in development) could cover 16%, 51%, and 92%, respectively. Although less frequent, IPD remains a life-threatening risk in children with SCD. Effective vaccines with broader coverage could benefit these children.
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Affiliation(s)
- Thomas V. Adamkiewicz
- Department of Family Medicine, Morehouse School of Medicine, Atlanta, GA
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
| | - Marianne E. M. Yee
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA
| | - Stepy Thomas
- Department of Medicine, Emory University School of Medicine, Atlanta, GA
- Georgia Emerging Infections Program, Atlanta, GA
- Atlanta Veterans Administration Health System, Decatur, GA
| | - Amy Tunali
- Department of Medicine, Emory University School of Medicine, Atlanta, GA
- Atlanta Veterans Administration Health System, Decatur, GA
| | - Kristina W. Lai
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA
- University of California, Davis, CA
| | - Folashade S. Omole
- Department of Family Medicine, Morehouse School of Medicine, Atlanta, GA
| | - Peter A. Lane
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA
| | - Inci Yildirim
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT
- Yale Center for Infection and Immunity, Yale Institute of Global Health, New Haven, CT
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25
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Lewnard JA, Hong V, Bruxvoort KJ, Grant LR, Jódar L, Cané A, Arguedas A, Pomichowski ME, Gessner BD, Tartof SY. Burden of Lower Respiratory Tract Infections Preventable by Adult Immunization With 15- and 20-Valent Pneumococcal Conjugate Vaccines in the United States. Clin Infect Dis 2023; 77:1340-1352. [PMID: 37293708 DOI: 10.1093/cid/ciad355] [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: 02/23/2023] [Revised: 05/16/2023] [Accepted: 06/07/2023] [Indexed: 06/10/2023] Open
Abstract
BACKGROUND Updated recommendations of the US Advisory Committee on Immunization Practices indicate that all adults aged ≥65 years and adults aged <65 years with comorbid conditions should receive 15- and 20-valent pneumococcal conjugate vaccines (PCV15/20). We aimed to assess the potential impact of these recommendations on the burden of lower respiratory tract infections (LRTIs) among adults. METHODS We estimated the incidence of LRTI cases and associated hospital admissions among enrollees of Kaiser Permanente Southern California from 2016 through 2019. We used a counterfactual inference framework to estimate excess LRTI-associated risk of death up to 180 days after diagnosis. We used prior estimates of PCV13 effectiveness against LRTI to model potential direct effects of PCV15/20 by age group and risk status. RESULTS Use of PCV15 and PCV20, respectively, could prevent 89.3 (95% confidence interval, 41.3-131.8) and 108.6 (50.4-159.1) medically attended LRTI cases; 21.9 (10.1-32.0) and 26.6 (12.4-38.7) hospitalized LRTI cases; and 7.1 (3.3-10.5) and 8.7 (4.0-12.7) excess LRTI-associated deaths, each per 10 000 person-years. Among at-risk adults aged <65 years, use of PCV15 and PCV20 could prevent 85.7 (39.6-131.5) and 102.7 (47.8-156.7) medically attended LRTI cases per 10 000 person-years; 5.1 (2.4-8.6) and 6.2 (2.8-10.2) LRTI hospitalizations per 10 000 person-years, and 0.9 (0.4-1.4) and 1.1 (0.5-1.7) excess LRTI-associated deaths per 10 000 person-years. CONCLUSIONS Our findings suggest recent recommendations, including PCV15/20 within adult pneumococcal vaccine series, may substantially reduce LRTI burden.
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Affiliation(s)
- Joseph A Lewnard
- Division of Epidemiology, School of Public Health, University of California -Berkeley, Berkeley, California, USA
- Division of Infectious Diseases & Vaccinology, School of Public Health, University of California -Berkeley, California, USA
- Center for Computational Biology, College of Engineering, University of California -Berkeley, California, USA
| | - Vennis Hong
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Katia J Bruxvoort
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | | | - Luis Jódar
- Pfizer Vaccines, Collegeville, Pennsylvania, USA
| | | | | | - Magdalena E Pomichowski
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | | | - Sara Y Tartof
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California, USA
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26
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Williams AN, Ma A, Croxen MA, Demczuk WHB, Martin I, Tyrrell GJ. Genomic analysis of Streptococcus pneumoniae serogroup 20 isolates in Alberta, Canada from 1993-2019. Microb Genom 2023; 9. [PMID: 38015202 DOI: 10.1099/mgen.0.001141] [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] [Indexed: 11/29/2023] Open
Abstract
In the province of Alberta, Canada, invasive disease caused by Streptococcus pneumoniae serogroup 20 (serotypes 20A/20B) has been increasing in incidence. Here, we characterize provincial invasive serogroup 20 isolates collected from 1993 to 2019 alongside invasive and non-invasive serogroup 20 isolates from the Global Pneumococcal Sequencing (GPS) Project collected from 1998 to 2015. Trends in clinical metadata and geographic location were evaluated, and serogroup 20 isolate genomes were subjected to molecular sequence typing, virulence and antimicrobial resistance factor mining, phylogenetic analysis and pangenome calculation. Two hundred and seventy-four serogroup 20 isolates from Alberta were sequenced, and analysed along with 95 GPS Project genomes. The majority of invasive Alberta serogroup 20 isolates were identified after 2007 in primarily middle-aged adults and typed predominantly as ST235, a sequence type that was rare among GPS Project isolates. Most Alberta isolates carried a full-length whaF capsular gene, suggestive of serotype 20B. All Alberta and GPS Project genomes carried molecular resistance determinants implicated in fluoroquinolone and macrolide resistance, with a few Alberta isolates exhibiting phenotypic resistance to azithromycin, clindamycin, erythromycin, tetracycline and trimethoprim-sulfamethoxazole, as well as non-susceptibility to tigecycline. All isolates carried multiple virulence factors including those involved in adherence, immune modulation and nutrient uptake, as well as exotoxins and exoenzymes. Phylogenetically, Alberta serogroup 20 isolates clustered with predominantly invasive GPS Project isolates from the USA, Israel, Brazil and Nepal. Overall, this study highlights the increasing incidence of invasive S. pneumoniae serogroup 20 disease in Alberta, Canada, and provides insights into the genetic and clinical characteristics of these isolates within a global context.
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Affiliation(s)
- Ashley N Williams
- Department of Laboratory Medicine and Pathology, University of Alberta, 5-411 Edmonton Clinic Health Academy, Edmonton, Alberta, T6G 1C9 Canada
- Alberta Precision Laboratory - Public Health Laboratory, 8440 112 Street NW, Edmonton, Alberta, T6G 2B7 Canada
| | - Angela Ma
- Department of Laboratory Medicine and Pathology, University of Alberta, 5-411 Edmonton Clinic Health Academy, Edmonton, Alberta, T6G 1C9 Canada
- Department of Pathology, University of Utah School of Medicine, 15 North Medical Drive East, Ste. #1100, Salt Lake City, UT, 84112 USA
| | - Matthew A Croxen
- Department of Laboratory Medicine and Pathology, University of Alberta, 5-411 Edmonton Clinic Health Academy, Edmonton, Alberta, T6G 1C9 Canada
- Alberta Precision Laboratory - Public Health Laboratory, 8440 112 Street NW, Edmonton, Alberta, T6G 2B7 Canada
- Li Ka Shing Institute of Virology, University of Alberta, 6-010 Katz Centre for Health Research, 11315 - 87 Ave NW, Edmonton, Alberta, T6G 2E1 Canada
- Women & Children's Health Research Institute (WCHRI), University of Alberta, 5-083 Edmonton Clinic Health Academy (ECHA), 11405 87 Avenue NW Edmonton, AB, T6G 1C9 Canada
| | - Walter H B Demczuk
- National Microbiology Laboratory, Public Health Agency of Canada, 1015 Arlington Street, Winnipeg, Manitoba, R3E 3R2 Canada
| | - Irene Martin
- National Microbiology Laboratory, Public Health Agency of Canada, 1015 Arlington Street, Winnipeg, Manitoba, R3E 3R2 Canada
| | - Gregory J Tyrrell
- Department of Laboratory Medicine and Pathology, University of Alberta, 5-411 Edmonton Clinic Health Academy, Edmonton, Alberta, T6G 1C9 Canada
- Alberta Precision Laboratory - Public Health Laboratory, 8440 112 Street NW, Edmonton, Alberta, T6G 2B7 Canada
- Li Ka Shing Institute of Virology, University of Alberta, 6-010 Katz Centre for Health Research, 11315 - 87 Ave NW, Edmonton, Alberta, T6G 2E1 Canada
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Chapman TJ, Patel SM, Flores SA, Xu S, Lupinacci R, Shi Y, Shekar T, Feemster K, Yi J, Tamms G, Kaminski J, Bickham K, Musey L, Buchwald UK, Banniettis N. Safety and Immunogenicity of V114 in Preterm Infants: A Pooled Analysis of Four Phase Three Studies. Pediatr Infect Dis J 2023; 42:1021-1028. [PMID: 37566897 PMCID: PMC10569678 DOI: 10.1097/inf.0000000000004069] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/04/2023] [Indexed: 08/13/2023]
Abstract
BACKGROUND Risk of invasive pneumococcal disease is 3-fold higher in preterm versus full-term infants. V114 is a 15-valent pneumococcal conjugate vaccine (PCV) containing the 13 serotypes in PCV13 plus 2 unique serotypes, 22F and 33F. A pooled subgroup analysis was performed in preterm infants (<37 weeks gestational age) enrolled in 4 pediatric phase 3 studies evaluating the safety and immunogenicity of different 4-dose regimens of V114 or PCV13. METHODS Healthy preterm infants were randomized 1:1 to receive V114/PCV13 in the 4 studies. Safety was evaluated as the proportion of participants with adverse events (AEs) following receipt of PCV. Serotype-specific antipneumococcal immunoglobulin G (IgG) geometric mean concentrations, IgG response rates and opsonophagocytic activity geometric mean titers were measured at 30 days postdose 3, pretoddler dose and 30 days postdose 4. RESULTS V114 and PCV13 were administered to 174 and 180 participants, respectively. Mean gestational age was 35.4 weeks (range: 27 - <37 weeks). Proportions of participants with AEs were comparable between vaccination groups; most AEs experienced were of short duration (≤3 days) and mild-to-moderate intensity. V114-elicited IgG geometric mean concentrations, IgG response rates and opsonophagocytic activity geometric mean titers were generally comparable to PCV13 for the 13 shared serotypes and higher for serotypes 22F and 33F at 30 days postdose 3 and postdose 4. CONCLUSIONS In preterm infants, V114 was well tolerated and induced comparable immune responses to PCV13 for the 13 shared serotypes and higher immune responses to serotypes 22F and 33F. Results support the use of V114 in preterm infants.
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Affiliation(s)
| | | | | | - Shengjie Xu
- From the Merck & Co., Inc., Rahway, New Jersey
| | | | - Yaru Shi
- From the Merck & Co., Inc., Rahway, New Jersey
| | | | | | - Jumi Yi
- From the Merck & Co., Inc., Rahway, New Jersey
| | | | | | | | - Luwy Musey
- From the Merck & Co., Inc., Rahway, New Jersey
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28
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Verma N, Gupta P, Pandey AK, Awasthi S. Nasopharyngeal carriage of Streptococcus pneumoniae serotypes among sick and healthy children in northern India: A case-control study. Vaccine 2023; 41:6619-6624. [PMID: 37758571 PMCID: PMC10663590 DOI: 10.1016/j.vaccine.2023.09.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 08/29/2023] [Accepted: 09/17/2023] [Indexed: 09/29/2023]
Abstract
BACKGROUND Streptococcus pneumoniae is leading bacterial cause of community acquired pneumonia and according to World Health Organization, responsible for 14 % death in children. There is effective vaccine available against Streptococcus pneumoniae. Hence the primary objective was to isolate Streptococcus pneumoniae from nasopharyngeal swabs in children aged 2-59 months with and without community acquired pneumonia and to assess their serotypes. METHODS This case-control study was conducted in tertiary teaching institutes in northern India. Hospitalized children, aged 2-59 months, with World Health Organization-defined community acquired pneumonia were included as cases. Age matched healthy controls were recruited from immunization clinic. All enrolments were done after written informed parental consent. Nasopharyngeal swabs were taken from both cases and controls, and were cultured on 5 % sheep blood agar with gentamycin plate for growth of Streptococcus pneumoniae and incubated in a jar at 370 for 18-24 hrs. Quellung reaction test was used for serotyping. RESULTS From March 2017 to December 2022, 2693 children (1910 cases and 783 controls), were recruited. The median age of cases was 7 months and controls 10 months. Almost all the cases had received antibiotics prior to hospitalization. Streptococcus pneumoniae positivity in nasopharyngeal swab was 8.1 % in cases, of which 56.8 % were vaccine serotypes and 23.6 % in controls, of which 37.8 % were vaccine serotypes. Adjusted odds ratio of isolating vaccine serotypes among cases as compared to controls was 1.77 (95 % CI, 1.09-2.88). CONCLUSION Streptococcus pneumoniae isolation from nasopharyngeal was found to be in lower proportion in cases as compared to control, though colonization with vaccine serotypes was higher in cases as compared to control. Therefore, pneumococcal vaccine coverage must be increased to prevent community acquired pneumonia.
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Affiliation(s)
- N Verma
- Department of Pediatrics, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - P Gupta
- Department of Microbiology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - A K Pandey
- Department of Pediatrics, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - S Awasthi
- Department of Pediatrics, King George's Medical University, Lucknow, Uttar Pradesh, India.
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29
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Wilck M, Cornely OA, Cordonnier C, Velez JD, Ljungman P, Maertens J, Selleslag D, Mullane KM, Nabhan S, Chen Q, Dagan R, Richmond P, Daus C, Geddie K, Tamms G, Sterling T, Patel SM, Shekar T, Musey L, Buchwald UK. A Phase 3, Randomized, Double-Blind, Comparator-Controlled Study to Evaluate Safety, Tolerability, and Immunogenicity of V114, a 15-Valent Pneumococcal Conjugate Vaccine, in Allogeneic Hematopoietic Cell Transplant Recipients (PNEU-STEM). Clin Infect Dis 2023; 77:1102-1110. [PMID: 37338158 PMCID: PMC10573722 DOI: 10.1093/cid/ciad349] [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: 04/13/2023] [Revised: 05/25/2023] [Accepted: 06/05/2023] [Indexed: 06/21/2023] Open
Abstract
BACKGROUND Individuals who receive allogeneic hematopoietic cell transplant (allo-HCT) are immunocompromised and at high risk of pneumococcal infections, especially in the months following transplant. This study evaluated the safety and immunogenicity of V114 (VAXNEUVANCE; Merck, Sharp & Dohme LLC, a subsidiary of Merck & Co., Inc., Rahway, NJ, USA), a 15-valent pneumococcal conjugate vaccine (PCV), when given to allo-HCT recipients. METHODS Participants received 3 doses of V114 or PCV13 (Prevnar 13; Wyeth LLC) in 1-month intervals starting 3-6 months after allo-HCT. Twelve months after HCT, participants received either PNEUMOVAX 23 or a fourth dose of PCV (if they experienced chronic graft vs host disease). Safety was evaluated as the proportion of participants with adverse events (AEs). Immunogenicity was evaluated by measuring serotype-specific immunoglobulin G (IgG) geometric mean concentrations (GMCs) and opsonophagocytic activity (OPA) geometric mean titers (GMTs) for all V114 serotypes in each vaccination group. RESULTS A total of 274 participants were enrolled and vaccinated in the study. The proportions of participants with AEs and serious AEs were generally comparable between intervention groups, and the majority of AEs in both groups were of short duration and mild-to-moderate intensity. For both IgG GMCs and OPA GMTs, V114 was generally comparable to PCV13 for the 13 shared serotypes, and higher for serotypes 22F and 33F at day 90. CONCLUSIONS V114 was well tolerated in allo-HCT recipients, with a generally comparable safety profile to PCV13. V114 induced comparable immune responses to PCV13 for the 13 shared serotypes, and was higher for V114 serotypes 22F and 33F. Study results support the use of V114 in allo-HCT recipients. Clinical Trials Registration. clinicaltrials.gov (NCT03565900) and European Union at EudraCT 2018-000066-11.
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Affiliation(s)
| | - Oliver A Cornely
- Institute of Translational Research, Cologne Excellence Cluster on Cellular Stress Responses In Aging-Associated Diseases (CECAD); Department of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), Germany
- Excellence Center for Medical Mycology (ECMM); Clinical Trials Centre Cologne (ZKS Köln), Faculty of Medicine and University Hospital Cologne, Cologne, Germany
- German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
| | - Catherine Cordonnier
- Centre Hospitalier Universitaire Henri Mondor, Haematology and Cellular Therapy Department, Créteil and University Paris-Est Créteil, Créteil, France, FR
| | | | - Per Ljungman
- Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
| | | | | | | | - Samir Nabhan
- Instituto de Cancer e Transplante de Curitiba ICTR, Curitiba, Puerto Rico
| | - Qiuxu Chen
- Merck & Co., Inc., Rahway, New Jersey, USA
| | - Ron Dagan
- The Shraga Segal Dept. of Microbiology, Immunology and Genetics, Faculty of Health Sciences of the Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Peter Richmond
- School of Medicine, University of Western Australia, Perth, Australia
| | | | | | | | | | | | | | - Luwy Musey
- Merck & Co., Inc., Rahway, New Jersey, USA
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30
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Lo SW, Hawkins PA, Jibir B, Hassan-Hanga F, Gambo M, Olaosebikan R, Olanipekun G, Munir H, Kocmich N, Rezac-Elgohary A, Gambo S, Bagenda D, Fey P, Breiman RF, McGee L, Bentley SD, Obaro SK. Molecular characterization of Streptococcus pneumoniae causing disease among children in Nigeria during the introduction of PCV10 (GSK). Microb Genom 2023; 9:001094. [PMID: 37712828 PMCID: PMC10569732 DOI: 10.1099/mgen.0.001094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 08/03/2023] [Indexed: 09/16/2023] Open
Abstract
Streptococcus pneumoniae (pneumococcus) is a leading vaccine-preventable cause of childhood invasive disease. Nigeria has the second highest pneumococcal disease burden globally, with an estimated ~49 000 child deaths caused by pneumococcal infections each year. Ten-valent pneumococcal conjugate vaccine (GSK; PCV10) was introduced in December 2014 in a phased approach. However, few studies have characterized the disease-causing pneumococci from Nigeria. This study assessed the prevalence of serotypes, antibiotic susceptibility and genomic lineages using whole genome sequencing and identified lineages that could potentially escape PCV10 (GSK). We also investigated the potential differences in pneumococcal lineage features between children with and without sickle cell disease. A collection of 192 disease-causing pneumococcal isolates was obtained from Kano (n=189) and Abuja (n=3) states, Nigeria, between 1 January 2014 and 31 May 2018. The majority (99 %, 190/192) of specimens were recovered from children aged 5 years or under. Among them, 37 children had confirmed or traits of sickle cell disease. Our findings identified 25 serotypes expressed by 43 Global Pneumococcal Sequence Clusters (GPSCs) and 85 sequence types (STs). The most common serotypes were 14 (18 %, n=35), 6B (16 %, n=31), 1 (9 %, n=17), 5 (9 %, n=17) and 6A (9 %, n=17); all except serotype 6A are included in PCV10 (GSK). PCV10 (SII; PNEUMOSIL) and PCV13 formulations include serotypes 6A and 19A which would increase the overall coverage from 67 % by PCV10 (GSK) to 78 and 82 %, respectively. The pneumococcal lineages were a mix of globally spreading and unique local lineages. Following the use of PCV10 (GSK), GPSC5 expressing serotype 6A, GPSC10 (19A), GPSC26 (12F and 46) and GPSC627 (9L) are non-vaccine type lineages that could persist and potentially expand under vaccine-selective pressure. Approximately half (52 %, 99/192) of the pneumococcal isolates were resistant to the first-line antibiotic penicillin and 44 % (85/192) were multidrug-resistant. Erythromycin resistance was very low (2 %, 3/192). There was no significant difference in clinical manifestation, serotype prevalence or antibiotic resistance between children with and without traits of or confirmed sickle cell disease. In summary, our findings show that a high percentage of the pneumococcal disease were caused by the serotypes that are covered by currently available vaccines. Given the low prevalence of resistance, macrolide antibiotics, such as erythromycin, should be considered as an option to treat pneumococcal disease in Nigeria. However, appropriate use of macrolide antibiotics should be vigilantly monitored to prevent the potential increase in macrolide resistance.
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Affiliation(s)
- Stephanie W. Lo
- Parasites and Microbes, Wellcome Sanger Institute, Hinxton, UK
| | | | - Binta Jibir
- Hasiya Bayero Pediatric Hospital, Kano, Nigeria
| | | | | | - Rasaq Olaosebikan
- Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, Philadelphia, PA, USA
| | - Grace Olanipekun
- International Foundation against Infectious Diseases in Nigeria, Abuja, Nigeria
| | - Huda Munir
- Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Nicholas Kocmich
- Division of Pediatric Infectious Disease, University of Nebraska Medical Center, Omaha, NE, USA
| | - Amy Rezac-Elgohary
- Division of Pediatric Infectious Disease, University of Nebraska Medical Center, Omaha, NE, USA
| | - Safiya Gambo
- Murtala Muhammad Specialist Hospital, Kano, Nigeria
| | - Danstan Bagenda
- Department of Anesthesiology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Paul Fey
- University of Nebraska Medical Center, Department of Pathology and Microbiology, Omaha, Nebraska, USA
| | - Robert F. Breiman
- Emory Global Health Institute, Emory University, Atlanta, GA, USA
- Rollins School Public Health, Emory University, Atlanta, GA, USA
| | - Lesley McGee
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Stephen K. Obaro
- Aminu Kano Teaching Hospital, Kano, Nigeria
- International Foundation against Infectious Diseases in Nigeria, Abuja, Nigeria
- Division of Pediatric Infectious Disease, University of Nebraska Medical Center, Omaha, NE, USA
- University of Nebraska Medical Center, Department of Pathology and Microbiology, Omaha, Nebraska, USA
- Pediatric - Infectious Disease, School of Medicine, The University of Alabama, Birmingham, AL, USA
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31
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Lister AJJ, Dombay E, Cleary DW, Sulaiman LH, Clarke SC. A brief history of and future prospects for pneumococcal vaccination in Malaysia. Pneumonia (Nathan) 2023; 15:12. [PMID: 37620925 PMCID: PMC10463521 DOI: 10.1186/s41479-023-00114-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 07/30/2023] [Indexed: 08/26/2023] Open
Abstract
Pneumococcal pneumonia remains a significant global public health issue. Malaysia has recently added the 10 valent pneumococcal conjugate vaccine to its national immunisation programme. Data on pneumococcal serotype epidemiology is vital for informing national vaccination policy. However, there remains a lack of representative population-based pneumococcal surveillance in Malaysia to help both the assessment of vaccine effectiveness in the country and to shape future vaccine policy. This review explores the history of pneumococcal vaccination, the burden of pneumococcal disease in Malaysia, and offers an insight into the prospects for reducing pneumococcal disease in Malaysia.
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Affiliation(s)
- Alex J J Lister
- Faculty of Medicine, Institute for Life Sciences, University of Southampton, Southampton, UK
| | - Evelin Dombay
- Faculty of Medicine, Institute for Life Sciences, University of Southampton, Southampton, UK
| | - David W Cleary
- Institute of Microbiology and Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, Institute of Translational Medicine, Birmingham, Birmingham, UK
| | - Lokman H Sulaiman
- Centre for Environment and Population Health, Institute for Research, Development, and Innovation, International Medical University, Kuala Lumpur, Malaysia
- Department of Community Medicine, School of Medicine, International Medical University, Kuala Lumpur, Malaysia
| | - Stuart C Clarke
- Faculty of Medicine, Institute for Life Sciences, University of Southampton, Southampton, UK.
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Trust, Southampton, UK.
- Global Health Research Institute, University of Southampton, Southampton, UK.
- School of Postgraduate Studies, International Medical University, Kuala Lumpur, Malaysia.
- Centre for Translational Research, Institute for Research, Development, and Innovation, International Medical University, Kuala Lumpur, Malaysia.
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32
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Méroc E, Fletcher MA, Hanquet G, Slack MPE, Baay M, Hayford K, Gessner BD, Grant LR. Systematic Literature Review of the Epidemiological Characteristics of Pneumococcal Disease Caused by the Additional Serotypes Covered by the 20-Valent Pneumococcal Conjugate Vaccine. Microorganisms 2023; 11:1816. [PMID: 37512988 PMCID: PMC10383425 DOI: 10.3390/microorganisms11071816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 07/06/2023] [Accepted: 07/12/2023] [Indexed: 07/30/2023] Open
Abstract
Higher valency pneumococcal conjugate vaccines (PCV15 and PCV20) have been developed to address the disease burden of current non-vaccine serotypes. This review describes the epidemiological characteristics of serotypes beyond PCV13 (serotypes 8, 10A, 11A, 12F, 15B/C, 22F, and 33F; PCV20nonPCV13 serotypes). Peer-reviewed studies published between 1 January 2010 (the year PCV13 became available) and 18 August 2020 were systematically reviewed (PROSPERO number: CRD42021212875). Data describing serotype-specific outcomes on disease proportions, incidence, severity, and antimicrobial non-susceptibility were summarized for individual and aggregate PCV20nonPCV13 serotypes by age group and by type and duration of pediatric PCV immunization program. Of 1168 studies, 127 (11%) were included in the analysis. PCV20nonPCV13 serotypes accounted for 28% of invasive pneumococcal disease (IPD), although the most frequent serotypes differed between children (10A, 15B/C) and adults (8, 12F, 22F). In children, serotype 15B/C tended to be more frequently associated with pneumococcal meningitis and acute otitis media; in adults, serotype 8 was more frequently associated with pneumonia and serotype 12F with meningitis. Serotypes 10A and 15B/C in children and 11A and 15B/C in adults were often associated with severe IPD. Serotype 15B/C was also among the most frequently identified penicillin/macrolide non-susceptible PCV20nonPCV13 serotypes. These results could inform decision making about higher valency PCV choice and use.
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Affiliation(s)
- Estelle Méroc
- P95 Epidemiology & Pharmacovigilance, Koning Leopold III-laan 1, 3001 Leuven, Belgium
| | - Mark A Fletcher
- Emerging Markets Medical Affairs, Vaccines, Pfizer, 23-25 Av. du Dr Lannelongue, 75014 Paris, France
| | - Germaine Hanquet
- 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, QLD 4222, Australia
| | - Marc Baay
- P95 Epidemiology & Pharmacovigilance, Koning Leopold III-laan 1, 3001 Leuven, Belgium
| | - Kyla Hayford
- 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
| | - Lindsay R Grant
- Medical Development and Scientific Clinical Affairs, Pfizer Vaccines, 500 Arcola Road, Collegeville, PA 19426, USA
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33
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Zeng Y, Song Y, Cui L, Wu Q, Wang C, Coelho AC, Zhang G, Wei D, Li C, Zhang J, Corbeil J, Li Y, Feng J. Phylogenomic insights into evolutionary trajectories of multidrug resistant S. pneumoniae CC271 over a period of 14 years in China. Genome Med 2023; 15:46. [PMID: 37403170 DOI: 10.1186/s13073-023-01200-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 05/31/2023] [Indexed: 07/06/2023] Open
Abstract
BACKGROUND Streptococcus pneumoniae is a gram-positive opportunistic pathogen, and infection risks of S. pneumoniae can be profoundly augmented by its acquired multidrug-resistance (MDR). The rapid development of MDR in S. pneumoniae was attributed to the international dissemination of a small number of multidrug-resistant "clones." Clonal complex (CC) 271 is a prevalent MDR CC in the world and the most prevalent CC in China. However, the evolutionary trajectories of multidrug-resistant S. pneumoniae CC271 in China still are largely unknown. METHODS We investigated a collection of 1312 S. pneumoniae isolates collected from 28 tertiary hospitals in China from 2007 to 2020. Recombination prediction and recombination-masked phylogenetic analysis were combined to determine the population structure and mode of evolution of CC271. Data from the Global Pneumococcal Sequencing program (GPS) were combined to understand the global distribution of clones identified in this study. Bayesian analysis were recruited to analysis the evolutionary dynamics of dominant clones within CC271 in China. RESULTS The phylogenomic analysis resulted in the discovery of two globally distributed clones, ST271-A and ST271-B. ST271-A was a derivative of ST236 and an ancestor of ST271-B and ST320, refining the internal phylogenetic relationship of CC271. ST271-B was the most dominant clone in China, with higher β-lactam resistance especially for cephalosporins comparing to other MDR clones. Bayesian skyline plot showed a rapid expansion of 19F ST271-B from 1995 to 2000, which correlates with the widespread use of cephalosporins in the 1990s in China. 19A ST320, a vaccine-escape clone, is the second largest population in China. The Bayesian skyline plot showed that the 19A ST320 began to expand rapidly around 2001, which appeared to coincide with the prevalence of 19A after application of PCV7 in 2000 in the USA. We also observed frequent transmission of 19A ST320 between countries. It suggests that mass vaccination in some countries could affect the prevalence of clones in unvaccinated countries in the context of high-frequency international transmission. CONCLUSIONS Our results refined the internal phylogenetic relationship of CC271, showing that the 19F ST271-B and 19A ST320 evolved independently from ST271-A, with different histories and driving forces for their evolution and dissemination in China.
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Affiliation(s)
- Yuan Zeng
- State Key Laboratory of Microbial Resources, Institute of Microbiology, Chinese Academy of Sciences, Beijing, China
- College of Life Science, University of Chinese Academy of Sciences, Beijing, China
| | - Yuqin Song
- State Key Laboratory of Microbial Resources, Institute of Microbiology, Chinese Academy of Sciences, Beijing, China
| | - Lanqing Cui
- Institute of Clinical Pharmacology, Peking University First Hospital, Beijing, China
| | - Qi Wu
- State Key Laboratory of Mycology, Institute of Microbiology, Chinese Academy of Sciences, Beijing, China
| | - Chao Wang
- State Key Laboratory of Microbial Resources, Institute of Microbiology, Chinese Academy of Sciences, Beijing, China
| | - Adriano Cappellazzo Coelho
- Departamento de Biologia Animal, Instituto de Biologia, Universidade Estadual de Campinas (UNICAMP), Campinas, Brazil
| | - Gang Zhang
- State Key Laboratory of Microbial Resources, Institute of Microbiology, Chinese Academy of Sciences, Beijing, China
| | - Dawei Wei
- State Key Laboratory of Microbial Resources, Institute of Microbiology, Chinese Academy of Sciences, Beijing, China
| | - Chao Li
- State Key Laboratory of Microbial Resources, Institute of Microbiology, Chinese Academy of Sciences, Beijing, China
| | - Jingren Zhang
- Center for Infectious Disease Research, Department of Basic Medical Science, School of Medicine, Tsinghua University, Beijing, China
| | - Jacques Corbeil
- Department of Molecular Medicine, Big Data Research Centre, Nutrition Health and Society Centre (NUTRISS), INAF Institute Intelligence and Data, Laval University, Québec, Canada
| | - Yun Li
- Institute of Clinical Pharmacology, Peking University First Hospital, Beijing, China.
| | - Jie Feng
- State Key Laboratory of Microbial Resources, Institute of Microbiology, Chinese Academy of Sciences, Beijing, China.
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Lee NK, Tong S, Tholen K, Boguniewicz J, Gitomer SA, Herrmann BW. Hearing outcomes in children with pneumococcal meningitis in the PCV13 era. Am J Otolaryngol 2023; 44:103886. [PMID: 37030130 PMCID: PMC10330152 DOI: 10.1016/j.amjoto.2023.103886] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 04/01/2023] [Indexed: 04/10/2023]
Abstract
INTRODUCTION Streptococcus pneumoniae, is associated with the highest incidence of post-meningitic SNHL. The exact impact of 13-valent pneumococcal conjugate vaccine (PCV) on pediatric SNHL from pneumococcal meningitis is unknown. We aimed to identify clinical factors associated with post-meningitic SNHL (pmSNHL) from pneumococcal meningitis and describe its rates based on three time periods: pre-PCV, PCV-7 and PCV13 eras. METHODS A retrospective case-control study was performed for patients 18 years and younger diagnosed with pneumococcal meningitis from January 1, 2010 to December 31, 2020 at Children's Hospital Colorado. Demographic and clinical risk factors between those with or without SNHL were compared. Detailed hearing outcomes of those with resulting SNHL are described. RESULTS 23 patients with CSF cultures or Meningitis/Encephalitis Panel positive for pneumococcal meningitis were identified. Twenty patients both survived the infection and had audiologic evaluation. Six patients had pmSNHL, with 50 % affected bilaterally. The rate of pmSNHL from S. pneumoniae in the PCV-13 era at our institution was similar to historical rates from the pre-PCV and PCV-7 eras. Similar proportions of patients with pmSNHL completed PCV vaccination (66.7 %) compared to those without (71.4 %). Non-PCV-13 serotypes were responsible 83 % of patients with pmSNHL versus 57 % of patients without pmSNHL. CONCLUSIONS Despite high rates of PCV-13 uptake in our cohort, pmSNHL was still common, severe, and commonly associated with non-PCV-13 serotypes. Non-PCV-13 serotypes may be contributing to the persistently high rate of post-meningitic SNHL and the severity of SNHL. Newer pneumococcal conjugate vaccines with expanded serotypes may help mitigate the SNHL associated with pneumococcal meningitis.
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Affiliation(s)
- Nam K Lee
- University of Colorado Anschutz School of Medicine, Aurora, CO 80045, USA.
| | - Suhong Tong
- Center for Research Outcomes in Children's Surgery, Center for Children's Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Kaitlyn Tholen
- Children's Hospital of Colorado (CHCO), Anschutz Medical Campus, Department of Otolaryngology-Pediatric, Aurora, CO 80045, USA
| | - Juri Boguniewicz
- University of Colorado Anschutz School of Medicine, Aurora, CO 80045, USA; Children's Hospital of Colorado (CHCO), Anschutz Medical Campus (CHCO), Department of Infectious Disease-Pediatrics, Aurora, CO 80045, USA
| | - Sarah A Gitomer
- University of Colorado Anschutz School of Medicine, Aurora, CO 80045, USA; Children's Hospital of Colorado (CHCO), Anschutz Medical Campus, Department of Otolaryngology-Pediatric, Aurora, CO 80045, USA
| | - Brian W Herrmann
- University of Colorado Anschutz School of Medicine, Aurora, CO 80045, USA; Children's Hospital of Colorado (CHCO), Anschutz Medical Campus, Department of Otolaryngology-Pediatric, Aurora, CO 80045, USA
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35
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Wilck M, Barnabas S, Chokephaibulkit K, Violari A, Kosalaraksa P, Yesypenko S, Chukhalova I, Dagan R, Richmond P, Mikviman E, Morgan L, Feemster K, Lupinacci R, Chiarappa J, Madhi SA, Bickham K, Musey L. A phase 3 study of safety and immunogenicity of V114, a 15-valent pneumococcal conjugate vaccine, followed by 23-valent pneumococcal polysaccharide vaccine, in children with HIV. AIDS 2023; 37:1227-1237. [PMID: 36939067 PMCID: PMC10241418 DOI: 10.1097/qad.0000000000003551] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 02/08/2023] [Indexed: 03/21/2023]
Abstract
OBJECTIVES To evaluate the safety and immunogenicity of V114 [15-valent pneumococcal conjugate vaccine (PCV) containing serotypes 1, 3, 4, 5, 6A, 6B, 7F, 9 V, 14, 18C, 19A, 19F, 22F, 23F, 33F], followed by 23-valent pneumococcal polysaccharide vaccine (PPSV23) 8 weeks later, in children with HIV. DESIGN This phase 3 study (NCT03921424) randomized participants 6-17 years of age with HIV (CD4 + T-cell count ≥200 cells/μl, plasma HIV RNA <50 000 copies/ml) to receive V114 or 13-valent PCV (PCV13) in a double-blind manner on Day 1, followed by PPSV23 at Week 8. METHODS Adverse events (AEs), pneumococcal serotype-specific immunoglobulin G (IgG), and opsonophagocytic activity (OPA) were evaluated 30 days after each vaccination. RESULTS The proportion of participants experiencing at least one AE post-PCV was 78.8% in the V114 group ( n = 203) and 69.6% in the PCV13 group ( n = 204); respective proportions post-PPSV23 were 75.4% ( n = 203) and 77.2% ( n = 202). There were no vaccine-related serious AEs. IgG geometric mean concentrations (GMCs) and OPA geometric mean titers (GMTs) were generally comparable between V114 and PCV13 for shared serotypes at Day 30, and were higher for V114 compared with PCV13 for the additional V114 serotypes 22F and 33F. Approximately 30 days after PPSV23, IgG GMCs and OPA GMTs were generally comparable between the V114 and PCV13 groups for all 15 serotypes in V114. CONCLUSIONS In children with HIV, a sequential administration of V114 followed 8 weeks later with PPSV23 is well tolerated and induces immune responses for all 15 pneumococcal serotypes included in V114.
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Affiliation(s)
| | - Shaun Barnabas
- Department of Paediatrics, University of Stellenbosch, Cape Town, South Africa
| | - Kulkanya Chokephaibulkit
- Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Avy Violari
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | | | - Iryna Chukhalova
- Dnipropetrovsk Regional Medical Center Of Socially Significant Diseases, Dnipro, Ukraine
| | - Ron Dagan
- The Shraga Segal Department of Microbiology, Immunology and Genetics Faculty of Health Sciences of the Ben-Gurion University of the Negev Beer-Sheva, Israel
| | | | | | | | | | | | | | - Shabir A. Madhi
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Luwy Musey
- Merck & Co., Inc., Rahway, New Jersey, USA
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36
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Mashraqi MM, Alzamami A, Alturki NA, Alshamrani S, Alshahrani MM, Almasoudi HH, Basharat Z. Molecular Mimicry Mapping in Streptococcus pneumoniae: Cues for Autoimmune Disorders and Implications for Immune Defense Activation. Pathogens 2023; 12:857. [PMID: 37513704 PMCID: PMC10383125 DOI: 10.3390/pathogens12070857] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 06/08/2023] [Accepted: 06/20/2023] [Indexed: 07/30/2023] Open
Abstract
Streptococcus pneumoniae contributes to a range of infections, including meningitis, pneumonia, otitis media, and sepsis. Infections by this bacterium have been associated with the phenomenon of molecular mimicry, which, in turn, may contribute to the induction of autoimmunity. In this study, we utilized a bioinformatics approach to investigate the potential for S. pneumoniae to incite autoimmunity via molecular mimicry. We identified 13 S. pneumoniae proteins that have significant sequence similarity to human proteins, with 11 of them linked to autoimmune disorders such as psoriasis, rheumatoid arthritis, and diabetes. Using in silico tools, we predicted the sequence as well as the structural homology among these proteins. Database mining was conducted to establish links between these proteins and autoimmune disorders. The antigenic, non-allergenic, and immunogenic sequence mimics were employed to design and validate an immune response via vaccine construct design. Mimic-based vaccine construct can prove effective for immunization against the S. pneumoniae infections. Immune response simulation and binding affinity was assessed through the docking of construct C8 to human leukocyte antigen (HLA) molecules and TLR4 receptor, with promising results. Additionally, these mimics were mapped as conserved regions on their respective proteins, suggesting their functional importance in S. pneumoniae pathogenesis. This study highlights the potential for S. pneumoniae to trigger autoimmunity via molecular mimicry and the possibility of vaccine design using these mimics for triggering defense response.
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Affiliation(s)
- Mutaib M Mashraqi
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, Najran University, Najran 61441, Saudi Arabia
| | - Ahmad Alzamami
- Clinical Laboratory Science Department, College of Applied Medical Science, Shaqra University, AlQuwayiyah 11961, Saudi Arabia
| | - Norah A Alturki
- Clinical Laboratory Science Department, College of Applied Medical Science, King Saud University, Riyadh 11433, Saudi Arabia
| | - Saleh Alshamrani
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, Najran University, Najran 61441, Saudi Arabia
| | - Mousa M Alshahrani
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, Najran University, Najran 61441, Saudi Arabia
| | - Hassan H Almasoudi
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, Najran University, Najran 61441, Saudi Arabia
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Farrar JL, Childs L, Ouattara M, Akhter F, Britton A, Pilishvili T, Kobayashi M. Systematic Review and Meta-Analysis of the Efficacy and Effectiveness of Pneumococcal Vaccines in Adults. Pathogens 2023; 12:732. [PMID: 37242402 PMCID: PMC10222197 DOI: 10.3390/pathogens12050732] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 05/12/2023] [Accepted: 05/17/2023] [Indexed: 05/28/2023] Open
Abstract
New pneumococcal conjugate vaccines (PCVs), 15- and 20-valent (PCV15 and PCV20), have been licensed for use among U.S. adults based on safety and immunogenicity data compared with the previously recommended 13-valent PCV (PCV13) and 23-valent pneumococcal polysaccharide vaccines (PPSV23). We conducted a systematic review of the literature on PCV13 and PPSV23 efficacy (randomized controlled trials [RCTs]) or effectiveness (observational studies) against vaccine type (PCV13 type or PPSV23 type, respectively), invasive pneumococcal disease (IPD), and pneumococcal pneumonia (PP) in adults. We utilized the search strategy from a previous systematic review of the literature published during the period from January 2016 to April 2019, and updated the search through March 2022. The certainty of evidence was assessed using the Cochrane risk-of-bias 2.0 tool and the Newcastle-Ottawa scale. When feasible, meta-analyses were conducted. Of the 5085 titles identified, 19 studies were included. One RCT reported PCV13 efficacy of 75% (PCV13-type IPD) and 45% (PCV13-type PP). Three studies each reported PCV13 effectiveness against PCV13-type IPD (range 47% to 68%) and against PCV13-type PP (range 38% to 68%). The pooled PPSV23 effectiveness was 45% (95% CI: 37%, 51%) against PPSV23-type IPD (nine studies) and 18% (95% CI: -4%, 35%) against PPSV23-type PP (five studies). Despite the heterogeneity across studies, our findings suggest that PCV13 and PPSV23 protect against VT-IPD and VT-PP in adults.
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Affiliation(s)
- Jennifer L. Farrar
- Respiratory Diseases Branch, U.S. Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | | | - Mahamoudou Ouattara
- Respiratory Diseases Branch, U.S. Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | - Fahmina Akhter
- Respiratory Diseases Branch, U.S. Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | - Amadea Britton
- Respiratory Diseases Branch, U.S. Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | - Tamara Pilishvili
- Respiratory Diseases Branch, U.S. Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | - Miwako Kobayashi
- Respiratory Diseases Branch, U.S. Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
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38
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Singleton D, Ibarz-Pavon A, Swarthout TD, Bonomali F, Cornick J, Kalizang'oma A, Ntiza N, Brown C, Chipatala R, Nyangulu W, Chirombo J, Kawalazira G, Chibowa H, Mwansambo C, Maleta KM, French N, Heyderman RS. Cross-sectional health centre and community-based evaluation of the impact of pneumococcal and malaria vaccination on antibiotic prescription and usage, febrile illness and antimicrobial resistance in young children in Malawi: the IVAR study protocol. BMJ Open 2023; 13:e069560. [PMID: 37173105 DOI: 10.1136/bmjopen-2022-069560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/15/2023] Open
Abstract
INTRODUCTION Vaccination is a potentially critical component of efforts to arrest development and dissemination of antimicrobial resistance (AMR), though little is known about vaccination impact within low-income and middle-income countries. This study will evaluate the impact of vaccination on reducing carriage prevalence of resistant Streptococcus pneumoniae and extended spectrum beta-lactamase-producing Escherichia coli and Klebsiella species. We will leverage two large ongoing cluster-randomised vaccine evaluations in Malawi assessing; first, adding a booster dose to the 13-valent pneumococcal conjugate vaccine (PCV13) schedule, and second, introduction of the RTS,S/AS01 malaria vaccine. METHODS AND ANALYSIS Six cross-sectional surveys will be implemented within primary healthcare centres (n=3000 users of outpatient facilities per survey) and their local communities (n=700 healthy children per survey): three surveys in Blantyre district (PCV13 component) and three surveys in Mangochi district (RTS,S/AS01 component). We will evaluate antibiotic prescription practices and AMR carriage in children ≤3 years. For the PCV13 component, surveys will be conducted 9, 18 and 33 months following a 3+0 to 2+1 schedule change. For the RTS,S/AS01 component, surveys will be conducted 32, 44 and 56 months post-RTS,S/AS01 introduction. Six health centres in each study component will be randomly selected for study inclusion. Between intervention arms, the primary outcome will be the difference in penicillin non-susceptibility prevalence among S. pneumoniae nasopharyngeal carriage isolates in healthy children. The study is powered to detect an absolute change of 13 percentage points (ie, 35% vs 22% penicillin non-susceptibility). ETHICS AND DISSEMINATION This study has been approved by the Kamuzu University of Health Sciences (Ref: P01-21-3249), University College London (Ref: 18331/002) and University of Liverpool (Ref: 9908) Research Ethics Committees. Parental/caregiver verbal or written informed consent will be obtained prior to inclusion or recruitment in the health centre-based and community-based activities, respectively. Results will be disseminated via the Malawi Ministry of Health, WHO, peer-reviewed publications and conference presentations.
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Affiliation(s)
- David Singleton
- Department of Clinical Infection, Microbiology & Immunology, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
| | - Ana Ibarz-Pavon
- Department of Clinical Infection, Microbiology & Immunology, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Todd D Swarthout
- Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
- Research Department of Infection, Division of Infection and Immunity, UCL, London, UK
| | - Farouck Bonomali
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Jennifer Cornick
- Department of Clinical Infection, Microbiology & Immunology, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Akuzike Kalizang'oma
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Kamuzu University of Health Sciences, Blantyre, Malawi
- Research Department of Infection, Division of Infection and Immunity, UCL, London, UK
| | - Noah Ntiza
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Comfort Brown
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Raphael Chipatala
- Department of Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Wongani Nyangulu
- Department of Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - James Chirombo
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Kamuzu University of Health Sciences, Blantyre, Malawi
| | | | | | | | | | - Neil French
- Department of Clinical Infection, Microbiology & Immunology, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
| | - Robert S Heyderman
- Research Department of Infection, Division of Infection and Immunity, UCL, London, UK
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Yan X, Liu X, Zhao C, Chen GQ. Applications of synthetic biology in medical and pharmaceutical fields. Signal Transduct Target Ther 2023; 8:199. [PMID: 37169742 PMCID: PMC10173249 DOI: 10.1038/s41392-023-01440-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 03/15/2023] [Accepted: 03/24/2023] [Indexed: 05/13/2023] Open
Abstract
Synthetic biology aims to design or assemble existing bioparts or bio-components for useful bioproperties. During the past decades, progresses have been made to build delicate biocircuits, standardized biological building blocks and to develop various genomic/metabolic engineering tools and approaches. Medical and pharmaceutical demands have also pushed the development of synthetic biology, including integration of heterologous pathways into designer cells to efficiently produce medical agents, enhanced yields of natural products in cell growth media to equal or higher than that of the extracts from plants or fungi, constructions of novel genetic circuits for tumor targeting, controllable releases of therapeutic agents in response to specific biomarkers to fight diseases such as diabetes and cancers. Besides, new strategies are developed to treat complex immune diseases, infectious diseases and metabolic disorders that are hard to cure via traditional approaches. In general, synthetic biology brings new capabilities to medical and pharmaceutical researches. This review summarizes the timeline of synthetic biology developments, the past and present of synthetic biology for microbial productions of pharmaceutics, engineered cells equipped with synthetic DNA circuits for diagnosis and therapies, live and auto-assemblied biomaterials for medical treatments, cell-free synthetic biology in medical and pharmaceutical fields, and DNA engineering approaches with potentials for biomedical applications.
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Affiliation(s)
- Xu Yan
- School of Life Sciences, Tsinghua University, 100084, Beijing, China
| | - Xu Liu
- PhaBuilder Biotech Co. Ltd., Shunyi District, Zhaoquan Ying, 101309, Beijing, China
| | - Cuihuan Zhao
- School of Life Sciences, Tsinghua University, 100084, Beijing, China
| | - Guo-Qiang Chen
- School of Life Sciences, Tsinghua University, 100084, Beijing, China.
- Center for Synthetic and Systems Biology, Tsinghua University, 100084, Beijing, China.
- MOE Key Lab for Industrial Biocatalysis, Dept Chemical Engineering, Tsinghua University, 100084, Beijing, China.
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40
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Prasad N, Stoecker C, Xing W, Cho BH, Leidner AJ, Kobayashi M. Public health impact and cost-effectiveness of 15-valent pneumococcal conjugate vaccine use among the pediatric population of the United States. Vaccine 2023; 41:2914-2921. [PMID: 37012118 PMCID: PMC10962013 DOI: 10.1016/j.vaccine.2023.03.045] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 03/22/2023] [Indexed: 04/03/2023]
Abstract
BACKGROUND Although use of the 13-valent pneumococcal conjugate vaccine (PCV13) among children has reduced incidence of pneumococcal disease, a considerable burden of disease remains. PCV15 is a new vaccine that contains pneumococcal serotypes 22F and 33F in addition to serotypes contained in PCV13. To inform deliberations by the Advisory Committee on Immunization Practices on recommendations for PCV15 use among U.S. children, we estimated the health impact and cost-effectiveness of replacing PCV13 with PCV15 within the routine infant immunization program in the United States. We also assessed the impact and cost-effectiveness of a supplementary PCV15 dose among children aged 2-5 years who have already received a full PCV13 series. METHODS We estimated the incremental number of pneumococcal disease events and deaths averted, costs per quality adjusted life-year (QALY) gained, and costs per life-year gained under different vaccination strategies using a probabilistic model following a single birth cohort of 3.9 million individuals (based on 2020 U.S. birth cohort). We assumed that vaccine effectiveness (VE) of PCV15 against the two additional serotypes was the same as the VE of PCV13. The cost of PCV15 use among children was informed from costs of PCV15 use among adults and from discussions with the manufacturer. RESULTS Our base case results found that replacing PCV13 with PCV15 prevented 92,290 additional pneumococcal disease events and 22 associated deaths, while also saving $147 million in costs. A supplementary PCV15 dose among children aged 2-5 years who were fully vaccinated with PCV13 prevented further pneumococcal disease events and associated deaths but at a cost of more than $2.5 million per QALY gained. CONCLUSIONS A further decrease in pneumococcal disease in conjunction with considerable societal cost savings could be expected from replacing PCV13 with PCV15 within the routine infant immunization program in the United States.
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Affiliation(s)
- Namrata Prasad
- Respiratory Diseases Branch, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, United States; Epidemic Intelligence Service, Centers for Disease Control and Prevention, United States.
| | - Charles Stoecker
- Department of Health Policy and Management, School of Public Health and Tropical Medicine, Tulane University, United States
| | - Wei Xing
- Respiratory Diseases Branch, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, United States
| | - Bo-Hyun Cho
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, United States
| | - Andrew J Leidner
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, United States
| | - Miwako Kobayashi
- Respiratory Diseases Branch, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, United States
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Martinon-Torres F, Wysocki J, Szenborn L, Carmona-Martinez A, Poder A, Dagan R, Richmond P, Gilbert C, Trudel MC, Flores S, Lupinacci R, McFetridge R, Wiedmann RT, Chen Q, Gerrits H, Banniettis N, Musey L, Bickham K, Kaminski J. A Phase III, multicenter, randomized, double-blind, active comparator-controlled study to evaluate the safety, tolerability, and immunogenicity of V114 compared with PCV13 in healthy infants (PNEU-PED-EU-1). Vaccine 2023; 41:3387-3398. [PMID: 37105892 DOI: 10.1016/j.vaccine.2023.04.036] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 04/05/2023] [Accepted: 04/11/2023] [Indexed: 04/29/2023]
Abstract
BACKGROUND V114 (15-valent pneumococcal conjugate vaccine [PCV]) contains all serotypes in 13-valent PCV (PCV13) and additional serotypes 22F and 33F. This study evaluated safety and immunogenicity of V114 compared with PCV13 in healthy infants, and concomitant administration with DTPa-HBV-IPV/Hib and rotavirus RV1 vaccines. METHODS V114 and PCV13 were administered in a 2+1 schedule at 2, 4, and 11-15 months of age. Adverse events (AEs) were collected on Days 1-14 following each vaccination. Serotype-specific anti-pneumococcal immunoglobulin G (IgG) was measured 30 days post-primary series (PPS), immediately prior to a toddler dose, and 30 days post-toddler dose (PTD). Primary objectives included non-inferiority of V114 to PCV13 for 13 shared serotypes and superiority of V114 to PCV13 for the two additional serotypes. RESULTS 1184 healthy infants 42-90 days of age were randomized 1:1 to V114 (n = 591) or PCV13 (n = 593). Proportions of participants with solicited AEs and serious AEs were comparable between vaccination groups. V114 met pre-specified non-inferiority criteria for all 13 shared serotypes, based on the difference in proportions of participants with serotype-specific IgG concentrations ≥0.35 μg/mL (response rate; lower bound of two-sided 95% confidence interval [CI] >-10.0) and IgG geometric mean concentration (GMC) ratios (lower bound of two-sided 95% CI >0.5), and pre-specified superiority criteria for serotypes 22F and 33F (lower bound of two-sided 95% CI >10.0 for response rates and >2.0 for GMC ratios). Antibody responses to DTPa-HBV-IPV/Hib and RV1 vaccines met pre-specified non-inferiority criteria, based on antigen-specific response rates to DTPa-HBV-IPV/Hib and anti-rotavirus IgA geometric mean titers. CONCLUSIONS After a 2+1 schedule, V114 elicited non-inferior immune responses to 13 shared serotypes and superior responses to the two additional serotypes compared with PCV13, with comparable safety profile. These results support the routine use of V114 in infants. TRIAL REGISTRATION ClinicalTrials.gov: NCT04031846; EudraCT: 2018-003787-31.
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Affiliation(s)
- Federico Martinon-Torres
- Translational Pediatrics and Infectious Diseases, Pediatrics Department, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain; Genetics, Vaccines and Infections Research Group (GENVIP), Instituto de Investigación Sanitaria de Santiago, University of Santiago de Compostela, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | | | | | | | - Airi Poder
- Clinical Research Center, Tartu, Estonia
| | - Ron Dagan
- The Shraga Segal Dept. of Microbiology, Immunology and Genetics, Faculty of Health Sciences of the Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Peter Richmond
- Telethon Kids Institute and School of Medicine, The University of Western Australia, Crawley, WA 6009, Australia
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Andresen S, de Mojana di Cologna N, Archer-Hartmann S, Rogers AM, Samaddar S, Ganguly T, Black IM, Glushka J, Ng KKS, Azadi P, Lemos JA, Abranches J, Szymanski CM. Involvement of the Streptococcus mutans PgfE and GalE 4-epimerases in protein glycosylation, carbon metabolism, and cell division. Glycobiology 2023; 33:245-259. [PMID: 36637425 PMCID: PMC10114643 DOI: 10.1093/glycob/cwad004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 01/02/2023] [Accepted: 01/03/2023] [Indexed: 01/14/2023] Open
Abstract
Streptococcus mutans is a key pathogen associated with dental caries and is often implicated in infective endocarditis. This organism forms robust biofilms on tooth surfaces and can use collagen-binding proteins (CBPs) to efficiently colonize collagenous substrates, including dentin and heart valves. One of the best characterized CBPs of S. mutans is Cnm, which contributes to adhesion and invasion of oral epithelial and heart endothelial cells. These virulence properties were subsequently linked to post-translational modification (PTM) of the Cnm threonine-rich repeat region by the Pgf glycosylation machinery, which consists of 4 enzymes: PgfS, PgfM1, PgfE, and PgfM2. Inactivation of the S. mutans pgf genes leads to decreased collagen binding, reduced invasion of human coronary artery endothelial cells, and attenuated virulence in the Galleria mellonella invertebrate model. The present study aimed to better understand Cnm glycosylation and characterize the predicted 4-epimerase, PgfE. Using a truncated Cnm variant containing only 2 threonine-rich repeats, mass spectrometric analysis revealed extensive glycosylation with HexNAc2. Compositional analysis, complemented with lectin blotting, identified the HexNAc2 moieties as GlcNAc and GalNAc. Comparison of PgfE with the other S. mutans 4-epimerase GalE through structural modeling, nuclear magnetic resonance, and capillary electrophoresis demonstrated that GalE is a UDP-Glc-4-epimerase, while PgfE is a GlcNAc-4-epimerase. While PgfE exclusively participates in protein O-glycosylation, we found that GalE affects galactose metabolism and cell division. This study further emphasizes the importance of O-linked protein glycosylation and carbohydrate metabolism in S. mutans and identifies the PTM modifications of the key CBP, Cnm.
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Affiliation(s)
- Silke Andresen
- Complex Carbohydrate Research Center, University of Georgia, Athens, GA 30602, USA
- Department of Microbiology and Complex Carbohydrate Research Center, University of Georgia, Athens, GA 30602, USA
| | | | | | - Ashley M Rogers
- Complex Carbohydrate Research Center, University of Georgia, Athens, GA 30602, USA
- Department of Microbiology and Complex Carbohydrate Research Center, University of Georgia, Athens, GA 30602, USA
| | - Sandip Samaddar
- Department of Oral Biology, College of Dentistry, University of Florida, Gainesville, FL 32603, USA
| | - Tridib Ganguly
- Department of Oral Biology, College of Dentistry, University of Florida, Gainesville, FL 32603, USA
| | - Ian M Black
- Complex Carbohydrate Research Center, University of Georgia, Athens, GA 30602, USA
| | - John Glushka
- Complex Carbohydrate Research Center, University of Georgia, Athens, GA 30602, USA
| | - Kenneth K S Ng
- Department of Chemistry and Biochemistry, University of Windsor, Windsor, ON N9B 3P4, Canada
| | - Parastoo Azadi
- Complex Carbohydrate Research Center, University of Georgia, Athens, GA 30602, USA
| | - José A Lemos
- Department of Oral Biology, College of Dentistry, University of Florida, Gainesville, FL 32603, USA
| | - Jacqueline Abranches
- Department of Oral Biology, College of Dentistry, University of Florida, Gainesville, FL 32603, USA
| | - Christine M Szymanski
- Complex Carbohydrate Research Center, University of Georgia, Athens, GA 30602, USA
- Department of Microbiology and Complex Carbohydrate Research Center, University of Georgia, Athens, GA 30602, USA
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Puzia W, Gawor J, Gromadka R, Skoczyńska A, Sadowy E. Comparative genomic analysis of two ST320 Streptococcus pneumoniae isolates, representing serotypes 19A and 19F. BMC Genom Data 2023; 24:19. [PMID: 37032356 PMCID: PMC10084702 DOI: 10.1186/s12863-023-01118-5] [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: 09/29/2022] [Accepted: 03/03/2023] [Indexed: 04/11/2023] Open
Abstract
BACKGROUND Streptococcus pneumoniae (pneumococcus) represents an important human pathogen, responsible for respiratory and invasive infections in the community. The efficacy of polysaccharide conjugate vaccines formulated against pneumococci is reduced by the phenomenon of serotype replacement in population of this pathogen. The aim of the current study was to obtain and compare complete genomic sequences of two pneumococcal isolates, both belonging to ST320 but differing by the serotype. RESULTS Here, we report genomic sequences of two isolates of important human pathogen, S. pneumoniae. Genomic sequencing resulted in complete sequences of chromosomes of both isolates, 2,069,241 bp and 2,103,144 bp in size, and confirmed the presence of cps loci specific for serotypes 19A and 19F. The comparative analysis of these genomes revealed several instances of recombination, which involved not only S. pneumoniae but also presumably other streptococci as donors. CONCLUSIONS We report the complete genomic sequences of two S. pneumoniae isolates of ST320 and serotypes 19A and 19F. The detailed comparative analysis of these genomes revealed the history of several recombination events, clustered in the region including the cps locus.
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Affiliation(s)
- Weronika Puzia
- Department of Epidemiology and Clinical Microbiology, National Medicines Institute, Warsaw, Poland
- DNA Sequencing and Synthesis Facility, Institute of Biochemistry and Biophysics PAS, Warsaw, Poland
| | - Jan Gawor
- DNA Sequencing and Synthesis Facility, Institute of Biochemistry and Biophysics PAS, Warsaw, Poland
| | - Robert Gromadka
- DNA Sequencing and Synthesis Facility, Institute of Biochemistry and Biophysics PAS, Warsaw, Poland
| | - Anna Skoczyńska
- Department of Epidemiology and Clinical Microbiology, National Medicines Institute, Warsaw, Poland
- National Reference Centre for Bacterial Meningitis, National Medicines Institute, Warsaw, Poland
| | - Ewa Sadowy
- Department of Molecular Microbiology, National Medicines Institute, Ul. Chelmska 30/34, 00-725, Warsaw, Poland.
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Micoli F, Romano MR, Carboni F, Adamo R, Berti F. Strengths and weaknesses of pneumococcal conjugate vaccines. Glycoconj J 2023; 40:135-148. [PMID: 36652051 PMCID: PMC10027807 DOI: 10.1007/s10719-023-10100-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 11/24/2022] [Accepted: 01/09/2023] [Indexed: 01/19/2023]
Abstract
Multivalent vaccines addressing an increasing number of Streptococcus pneumoniae types (7-, 10-, 13-, 15-, 20-valent) have been licensed over the last 22 years. The use of polysaccharide-protein conjugate vaccines has been pivotal in reducing the incidence of invasive pneumococcal disease despite the emergence of non-vaccine serotypes. Notwithstanding its undoubtable success, some weaknesses have called for continuous improvement of pneumococcal vaccination. For instance, despite their inclusion in pneumococcal conjugate vaccines, there are challenges associated with some serotypes. In particular, Streptococcus pneumoniae type 3 remains a major cause of invasive pneumococcal disease in several countries.Here a deep revision of the strengths and weaknesses of the licensed pneumococcal conjugate vaccines and other vaccine candidates currently in clinical development is reported.
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Cannon K, Cardona JF, Yacisin K, Thompson A, Belanger TJ, Lee DY, Peng Y, Moyer L, Ginis J, Gruber WC, Scott DA, Watson W. Safety and immunogenicity of a 20-valent pneumococcal conjugate vaccine coadministered with quadrivalent influenza vaccine: A phase 3 randomized trial. Vaccine 2023; 41:2137-2146. [PMID: 36828719 DOI: 10.1016/j.vaccine.2022.11.046] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 11/01/2022] [Accepted: 11/20/2022] [Indexed: 02/25/2023]
Abstract
INTRODUCTION Older adults are at increased risk of adverse outcomes from pneumococcal disease and influenza infections. Vaccination is an established strategy for preventing both illnesses. This study evaluated coadministration of 20-valent pneumococcal conjugate vaccine (PCV20) and an adjuvanted quadrivalent inactivated influenza vaccine (QIV). METHODS This phase 3, randomized, double-blind, multicenter study included 1796 US adults ≥ 65 years of age randomized 1:1 to receive either PCV20 and QIV followed 1 month later by saline (Coadministration group) or QIV and saline followed 1 month later by PCV20 (Separate Administration group). Primary immunogenicity objectives were to show noninferiority of PCV20 and QIV coadministration compared with separate administration of either vaccine based on serotype-specific opsonophagocytic activity (OPA) titers for PCV20 and strain-specific hemagglutination inhibition assay (HAI) titers for QIV. Safety endpoints included local reactions, systemic events, and adverse events (AEs). RESULTS Noninferiority for pneumococcal and influenza antibody responses (lower bound 95 % CI of the OPA and HAI geometric mean ratios of > 0.5 and > 0.67, respectively) was shown for the Coadministration group compared with the Separate Administration group for all 20 pneumococcal serotypes and all 4 influenza vaccine strains. Local reactions and systemic events were mostly mild or moderate in severity across groups; injection site pain was the most frequent local reaction, and fatigue was the most frequent systemic event. Mild and moderate fatigue were reported more frequently after PCV20 and QIV coadministration compared with separate administration (mild, 20.0 % vs 10.8 %-12.6 %; moderate, 12.3 % vs 8.4 %-9.6 %); this was not considered clinically significant. AE reporting rates were similar across groups, and no serious AEs were considered vaccination-related. CONCLUSIONS Immune responses after coadministration of PCV20 and QIV were noninferior to separate administration of either vaccine. The PCV20 safety profile was similar when given together with or after QIV. These findings support PCV20 and QIV coadministration. TRIAL REGISTRATION ClinicalTrials.gov, NCT04526574.
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Affiliation(s)
- Kevin Cannon
- PMG Research of Wilmington, LLC, 1202 Medical Center Dr, Wilmington, NC 28401, USA.
| | - Jose F Cardona
- Indago Research & Health Center, Inc., 3700 W 12th Ave, Suite 300, Hialeah, FL 33012, USA
| | - Kari Yacisin
- Vaccine Research and Development, Pfizer Inc, 500 Arcola Rd, Collegeville, PA 19426, USA
| | - Allison Thompson
- Vaccine Research and Development, Pfizer Inc, 401 North Middletown Rd, Pearl River, NY 10965, USA
| | - Todd J Belanger
- Vaccine Research and Development, Pfizer Inc, 401 North Middletown Rd, Pearl River, NY 10965, USA
| | - Dung-Yang Lee
- Vaccine Research and Development, Pfizer Inc, 500 Arcola Rd, Collegeville, PA 19426, USA
| | - Yahong Peng
- Vaccine Research and Development, Pfizer Inc, 500 Arcola Rd, Collegeville, PA 19426, USA
| | - Lisa Moyer
- Vaccine Research and Development, Pfizer Inc, 500 Arcola Rd, Collegeville, PA 19426, USA
| | - John Ginis
- Vaccine Research and Development, Pfizer Inc, 500 Arcola Rd, Collegeville, PA 19426, USA
| | - William C Gruber
- Vaccine Research and Development, Pfizer Inc, 401 North Middletown Rd, Pearl River, NY 10965, USA
| | - Daniel A Scott
- Vaccine Research and Development, Pfizer Inc, 500 Arcola Rd, Collegeville, PA 19426, USA
| | - Wendy Watson
- Vaccine Research and Development, Pfizer Inc, 500 Arcola Rd, Collegeville, PA 19426, USA
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Ono T, Watanabe M, Hashimoto K, Kume Y, Chishiki M, Okabe H, Sato M, Norito S, Chang B, Hosoya M. Serotypes and Antibiotic Resistance of Streptococcus pneumoniae before and after the Introduction of the 13-Valent Pneumococcal Conjugate Vaccine for Adults and Children in a Rural Area in Japan. Pathogens 2023; 12:pathogens12030493. [PMID: 36986414 PMCID: PMC10056172 DOI: 10.3390/pathogens12030493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 03/15/2023] [Accepted: 03/16/2023] [Indexed: 03/30/2023] Open
Abstract
The increase in non-vaccine serotypes of Streptococcus pneumoniae and their multidrug resistance have become an issue following the introduction of the 13-valent pneumococcal conjugate vaccine (PCV13). In this study, we investigated the serotypes and drug resistance of S. pneumoniae detected in adult and pediatric outpatients at a hospital in a rural area of Japan between April 2012 and December 2016. Serotypes of the bacterium were identified using the capsular swelling test and multiplex polymerase chain reaction testing of DNA extracted from the specimens. Antimicrobial susceptibility was determined using the broth microdilution method. The serotype 15A was classified using multilocus sequence typing. The results showed that the prevalence of non-vaccine serotypes increased significantly in children from 50.0% in 2012-2013 to 74.1% in 2016 (p ≤ 0.006) and in adults from 15.8% in 2012-2013 to 61.5% in 2016 (p ≤ 0.026), but no increase in drug-resistant isolates was evident. However, an increase in the drug-resistant serotypes 15A and 35B was observed in children. Although isolates of these two serotypes showed cefotaxime susceptibility, cefotaxime resistance was confirmed for the serotype 15A isolates. Future trends in the spread of these isolates should be monitored with caution.
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Affiliation(s)
- Takashi Ono
- Department of Pediatrics, Minamiaizu Hospital, Minamiaizu 967-0006, Fukushima, Japan
- Department of Pediatrics, Fukushima Medical University, Fukushima 960-1295, Fukushima, Japan
| | - Masahiro Watanabe
- Department of Pediatrics, Fukushima Medical University, Fukushima 960-1295, Fukushima, Japan
| | - Koichi Hashimoto
- Department of Pediatrics, Fukushima Medical University, Fukushima 960-1295, Fukushima, Japan
| | - Yohei Kume
- Department of Pediatrics, Fukushima Medical University, Fukushima 960-1295, Fukushima, Japan
| | - Mina Chishiki
- Department of Pediatrics, Fukushima Medical University, Fukushima 960-1295, Fukushima, Japan
| | - Hisao Okabe
- Department of Pediatrics, Fukushima Medical University, Fukushima 960-1295, Fukushima, Japan
| | - Masatoki Sato
- Department of Pediatrics, Fukushima Medical University, Fukushima 960-1295, Fukushima, Japan
| | - Sakurako Norito
- Department of Pediatrics, Fukushima Medical University, Fukushima 960-1295, Fukushima, Japan
| | - Bin Chang
- Department of Bacteriology I, National Institute of Infectious Diseases, Shinjuku-ku 162-8640, Tokyo, Japan
| | - Mitsuaki Hosoya
- Department of Pediatrics, Fukushima Medical University, Fukushima 960-1295, Fukushima, Japan
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Iwata S, Hanada S, Takata M, Morozumi M, Kamei S, Ubukata K. Risk factors and pathogen characteristics associated with unfavorable outcomes among adults with pneumococcal meningitis in Japan, 2006 to 2016. J Infect Chemother 2023; 29:637-645. [PMID: 36907551 DOI: 10.1016/j.jiac.2023.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 02/03/2023] [Accepted: 03/04/2023] [Indexed: 03/13/2023]
Abstract
PURPOSE In this study, we aimed to clarify the risk factors associated with unfavorable outcomes in adults with pneumococcal meningitis (PnM). METHODS Surveillance was conducted between 2006 and 2016. Adults with PnM (n = 268) were followed up for outcomes within 28 days after admission using the Glasgow Outcome Scale (GOS). After classifying the patients into the unfavorable (GOS1-4) and favorable (GOS5) outcome groups, i) the underlying diseases, ii) biomarkers at admission, and iii) serotype, genotype, and antimicrobial susceptibility for all isolates were compared between both groups. RESULTS Overall, 58.6% of patients with PnM survived,15.3% died, and 26.1% had sequelae. The number of living days in the GOS1 group was highly heterogeneous. Motor dysfunction, disturbance of consciousness, and hearing loss were the commonest sequelae. Of the underlying diseases identified in 68.9% of the PnM patients, liver and kidney diseases were significantly associated with unfavorable outcomes. Of the biomarkers, creatinine and blood urea nitrogen, followed by platelet and C-reactive protein had the most significant associations with unfavorable outcomes. There was a significant difference in the high protein concentrations in the cerebrospinal fluid between the groups. Serotypes 23F, 6C, 4, 23A, 22F, 10A, and 12F were associated with unfavorable outcomes. These serotypes were not penicillin-resistant isolates possessing three abnormal pbp genes (pbp1a, 2x, and 2b), except for 23F. The expected coverage rate of the pneumococcal conjugate vaccine (PCV) was 50.7% for PCV15 and 72.4% for PCV20. CONCLUSIONS In the introduction of PCV for adults, the risk factors for underlying diseases should be prioritized over age, and serotypes with unfavorable outcomes should be considered.
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Affiliation(s)
- Satoshi Iwata
- Department of Infectious Diseases, National Cancer Center Hospital, Tokyo, Japan; Department of Infectious Diseases, Keio University School of Medicine, Tokyo, Japan.
| | - Shigeo Hanada
- Department of Respiratory Medicine, Respiratory Center, Toranomon Hospital, Tokyo, Japan
| | - Misako Takata
- Department of Microbiology, Tokyo Medical University, Japan
| | - Miyuki Morozumi
- Department of Infectious Diseases, Keio University School of Medicine, Tokyo, Japan
| | - Satoshi Kamei
- Center for Neuro-Infections, Ageo Central General Hospital, Saitama Pref, Japan
| | - Kimiko Ubukata
- Department of Microbiology, Tokyo Medical University, Japan; Department of General Medicine, Keio University School of Medicine, Tokyo, Japan
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Cleary DW, Lo SW, Kumar N, Bentley SD, Faust SN, Clarke SC. Comparative genomic epidemiology of serotype 3 IPD and carriage isolates from Southampton, UK between 2005 and 2017. Microb Genom 2023; 9. [PMID: 36867094 PMCID: PMC10132069 DOI: 10.1099/mgen.0.000945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023] Open
Abstract
Serotype 3 pneumococci remains a significant cause of disease despite its inclusion in PCV13. Whilst clonal complex 180 (CC180) represents the major clone, recent studies have refined the population structure into three clades: Iα, Iβ and II, with the last being a recent divergent and more antibiotic-resistant. We present a genomic analysis of serotype 3 isolates from paediatric carriage and all-age invasive disease, collected between 2005 and 2017 in Southampton, UK. Forty-one isolates were available for analysis. Eighteen were isolated during the annual cross-sectional surveillance of paediatric pneumococcal carriage. The remaining 23 were isolated from blood/cerebrospinal fluid specimens at the University Hospital Southampton NHS Foundation Trust laboratory. All carriage isolates were CC180 GPSC12. Greater diversity was seen with invasive pneumococcal disease (IPD) with three GPSC83 (ST1377: n=2, ST260: n=1) and one GPSC3 (ST1716). For both carriage and IPD, Clade Iα was dominant (94.4 and 73.9 % respectively). Two isolates were Clade II with one from carriage (a 34-month-old, October 2017) and one invasive isolate (49-year-old, August 2015). Four IPD isolates were outside the CC180 clade. All isolates were genotypically susceptible to penicillin, erythromycin, tetracycline, co-trimoxazole and chloramphenicol. Two isolates (one each from carriage and IPD; both CC180 GPSC12) were phenotypically resistant to erythromycin and tetracycline; the IPD isolate was also resistant to oxacillin.In the Southampton area, carriage and invasive disease associated with serotype 3 is predominantly caused by Clade Iα CC180 GPSC12.
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Affiliation(s)
- David W Cleary
- Institute of Microbiology and Infection, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, UK.,Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton, UK
| | - Stephanie W Lo
- Parasites and Microbes, Wellcome Sanger Institute, Hinxton, UK
| | - Narender Kumar
- Parasites and Microbes, Wellcome Sanger Institute, Hinxton, UK
| | | | - Saul N Faust
- Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton, UK.,NIHR Southampton Biomedical Research Centre, University Hospital Southampton Foundation NHS Trust, Southampton, UK.,Southampton Clinical Research Facility, University Hospital Southampton Foundation NHS Trust, Southampton, UK
| | - Stuart C Clarke
- Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton, UK.,NIHR Southampton Biomedical Research Centre, University Hospital Southampton Foundation NHS Trust, Southampton, UK.,Global Health Research Institute, University of Southampton, Southampton, UK
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Frequent Transmission of Streptococcus pneumoniae Serotype 35B and 35D, Clonal Complex 558 Lineage, across Continents and the Formation of Multiple Clades in Japan. Antimicrob Agents Chemother 2023; 67:e0108322. [PMID: 36651739 PMCID: PMC9933736 DOI: 10.1128/aac.01083-22] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Streptococcus pneumoniae is a common bacterial pathogen that causes infections in children worldwide, even after administration of the pneumococcal conjugate vaccine. S. pneumoniae serotype 35B, especially the clonal complex 558 (CC558) lineage, has emerged globally following implementation of the 13-valent pneumococcal conjugate vaccine. Serotype 35B strains are also associated with multidrug resistance to both β-lactams and non-β-lactam drugs. In addition, a novel serotype, 35D, which is closely related to 35B and differs in polysaccharide structure, was recently reported. However, the genetic relationship among globally disseminating serotype 35B and D (35B/D) strains remains unknown. To investigate the molecular epidemiology of global serotype 35B/D strains, we conducted a genomic analysis of serotype 35B/D strains from various continents, including those from the Japanese national surveillance collection. A total of 87 isolates were identified as serotype 35B/D in the Japanese surveillance collection (n = 1,358). All the isolates were assigned to either CC558 or CC2755. Serotype 35D isolates were interspersed with serotype 35B isolates. Phylogenetic analysis revealed the formation of multiple clusters by the Japanese serotype 35B/D-CC558 isolates among the foreign isolates, which suggested multiple events of introduction of the clone into Japan. The global 35B/D-CC558 strains were found to share specific penicillin-binding protein profiles, pbp1a-4, pbp2b-7, and pbp2x-7, associated with penicillin, cephalosporin, and carbapenem nonsusceptibility. Moreover, 88.5% of the Japanese 35B/D-CC558 and 35B/D-CC2755 isolates were found to harbor the Tn916-like integrative and conjugative elements Tn2009, Tn2010, and Tn6002, associated with multidrug resistance to macrolides and tetracyclines. The results of this study imply that serotype 35B/D-CC558 strains could be frequently transmitted intercontinentally.
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Guo MY, Shi XH, Gao W, Tian JL, Yuan L, Yang J, Wumaier D, Cao J, Abulimiti R, Zhang WL, Yao KH. The dynamic change of serotype distribution and antimicrobial resistance of pneumococcal isolates since PCV13 administration and COVID-19 control in Urumqi, China. Front Cell Infect Microbiol 2023; 13:1110652. [PMID: 36844410 PMCID: PMC9951612 DOI: 10.3389/fcimb.2023.1110652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 01/18/2023] [Indexed: 02/01/2023] Open
Abstract
Objective This study aims to analyze the serotype distribution and drug resistance of Streptococcus pneumoniae isolated from children aged 8 days to 7 years in Urumqi, China, between 2014 to 2021, during which PCV13 was introduced in the private sector's immunization program and COVID-19 control was administrated in the last 2 years. Methods Serotypes of S. pneumoniae isolates were determined by Quellung reaction, and their susceptibility against 14 antimicrobials were tested. According to the start year of PCV13 administration (2017) and COVID-19 control (2020), the study period was divided into three stages: 2014-2015, 2018-2019, and 2020-2021. Results A total of 317 isolates were involved in this study. The most common serotypes were type 19F (34.4%), followed by 19A (15.8%), 23F (11.7%), 6B (11.4%), and 6A(5.0%). The coverage rate of both PCV13 and PCV15 was 83.0%. The coverage of PCV20 was a little higher at 85.2%. The resistance rate against penicillin was 28.6% according to the breakpoints of oral penicillin, which would reach up to 91.8% based on the breakpoints of parenteral penicillin for meningitis. The resistance rates to erythromycin, clindamycin, tetracycline, and sulfamethoxazole-trimethoprim were 95.9%, 90.2%, 88.9%, and 78.8%, respectively. The PCV13 isolate was more resistant to penicillin than the non-PCV13 ones. There was not any significant change found in the serotype distribution since the PCV13 introduction and the COVID-19 control. The resistance rate against oral penicillin slightly elevated to 34.5% in 2018-2019 from 30.7% in 2014-2015 and then decreased significantly to 18.1% in 2020-2021 (χ 2 = 7.716, P < 0.05), while the resistance rate to ceftriaxone (non-meningitis) continuously declined from 16.0% in 2014-2015 to 1.4% in 2018-2019 and 0% in 2020-2021 (Fisher = 24.463, P < 0.01). Conclusion The common serotypes of S. pneumoniae isolated from children in Urumqi were types 19F, 19A, 23F, 6B, and 6A, which we found to have no marked change since the PCV13 introduction and the COVID-19 control However, the resistance rate to oral penicillin and ceftriaxone significantly declined in the COVID-19 control stage.
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Affiliation(s)
- Meng-Yang Guo
- Ministry of Education (MOE) Key Laboratory of Major Diseases in Children, Beijing Key Laboratory of Pediatric Respiratory Infection Diseases, Beijing Pediatric Research Institute, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Xing-Hai Shi
- Medical Laboratory, Urumqi Children’s Hospital, Beijing, China
| | - Wei Gao
- Ministry of Education (MOE) Key Laboratory of Major Diseases in Children, Beijing Key Laboratory of Pediatric Respiratory Infection Diseases, Beijing Pediatric Research Institute, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Ju-Ling Tian
- Medical Laboratory, Urumqi Children’s Hospital, Beijing, China
| | - Lin Yuan
- Ministry of Education (MOE) Key Laboratory of Major Diseases in Children, Beijing Key Laboratory of Pediatric Respiratory Infection Diseases, Beijing Pediatric Research Institute, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Juan Yang
- Medical Laboratory, Urumqi Children’s Hospital, Beijing, China
| | | | - Jiang Cao
- Medical Laboratory, Urumqi Children’s Hospital, Beijing, China
| | | | - Wen-Li Zhang
- Medical Laboratory, Urumqi Children’s Hospital, Beijing, China,*Correspondence: Wen-Li Zhang, ; Kai-Hu Yao,
| | - Kai-Hu Yao
- Ministry of Education (MOE) Key Laboratory of Major Diseases in Children, Beijing Key Laboratory of Pediatric Respiratory Infection Diseases, Beijing Pediatric Research Institute, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China,*Correspondence: Wen-Li Zhang, ; Kai-Hu Yao,
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