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Guo X, Li J, Qiu J, Zhang R, Ren J, Huang Z, Li Z, Liang X, Lan F, Chen J, Huang F, Sun X. Persistence of antibody to 23-valent pneumococcal polysaccharide vaccine: a 5-year prospective follow-up cohort study. Expert Rev Vaccines 2024; 23:237-245. [PMID: 38369970 DOI: 10.1080/14760584.2023.2296934] [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: 08/18/2023] [Accepted: 12/15/2023] [Indexed: 02/20/2024]
Abstract
BACKGROUND Pneumococcal vaccines are effective in preventing pneumococcal diseases in adults. The evaluation of the antibodies persistence to the 23-valent pneumococcal polysaccharide vaccine (PPV23) could provide evidence on PPV23 revaccination. RESEARCH DESIGN AND METHODS Adults aged ≥ 60 years were selected and vaccinated with PPV23 in Shanghai, and followed up for 5 years with blood samples collection of a 1-year interval. The geometric mean concentrations (GMC) of the IgG against 23 pneumococcal serotypes covered by PPV23 were detected using enzyme-linked immunosorbent assay. The antibodies to 23 pneumococcal serotypes among different groups was analyzed using statistical analysis. RESULTS Overall, 517 participants completed all six visits over a 5-year period (2013-2018). The GMC of 23 serotypes in adults aged ≥ 60 years decreased slowly after PPV23 vaccination compared to baseline pre-vaccination (P < 0.05), except serotype 3. Additionally, the multiplicative increase in the antibody concentration after PPV23 vaccination was greater, and the antibody levels of serotypes 1 and 6B were significantly higher at visit 5 than at visit 4 (P < 0.05). CONCLUSIONS The pneumococcal antibodies in elderly after PPV23 vaccination could sustain high levels over long-term follow-up, which suggested that the interval of revaccination with PPV23 in elderly should be at least 5 years after the first vaccination.
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Affiliation(s)
- Xiang Guo
- Institute of Immunization, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Juan Li
- Institute of Immunization, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Jing Qiu
- Institute of Immunization, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Rui Zhang
- Vaccine Engineering Research Center of Sichuan Province, Chengdu Institute of Biological Products Co, Ltd, Chengdu, China
| | - Jia Ren
- Institute of Immunization, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Zhuoying Huang
- Institute of Immunization, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Zhi Li
- Institute of Immunization, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Xiufang Liang
- Institute of Immunization, Yangpu District Center for Disease Control and Prevention, Shanghai, China
| | - Fang Lan
- Vaccine Engineering Research Center of Sichuan Province, Chengdu Institute of Biological Products Co, Ltd, Chengdu, China
| | - Juan Chen
- Vaccine Engineering Research Center of Sichuan Province, Chengdu Institute of Biological Products Co, Ltd, Chengdu, China
| | - Fang Huang
- Institute of Immunization, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Xiaodong Sun
- Institute of Immunization, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
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Lyngstad TM, Kristoffersen AB, Winje BA, Steens A. Estimation of the incidence of hospitalization for non-invasive pneumococcal pneumonia in the Norwegian population aged 50 years and older. Epidemiol Infect 2022; 150:1-21. [PMID: 35373724 PMCID: PMC9044527 DOI: 10.1017/s0950268822000607] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 03/22/2022] [Accepted: 03/24/2022] [Indexed: 11/06/2022] Open
Abstract
The purpose of this study was to estimate simple measures of the burden of non-invasive pneumococcal pneumonia (PnPn) hospitalisations in those aged 50 years and older (50+) in Norway. We conducted a retrospective register-based study and used discharge codes from the Norwegian Patient Register (NPR). We identified episodes of non-invasive PnPn in 2015 to 2016 and predicted its incidence from 2015 to 2019 based on the trend found in notified invasive pneumococcal disease cases. Overall, we identified 45–46 hospital episodes per 100 000 population of non-invasive PnPn in 2015 and 2016, each episode taking 6–8 days, and with increasing incidence with higher age. Among all identified PnPn episodes, 3 out of 4 were classified as non-invasive. We predicted that the monthly number of non-invasive PnPn episodes ranges from 39 [95% confidence interval (CI) 24–55] in August to 97 (95% CI 74–134) in December. No annual trend was identified. This study indicates that the burden of non-invasive PnPn hospitalisation has a substantial impact on the health and health care use of the 50+ population in Norway, despite the childhood immunisation programme. Many hospitalisations may be prevented through vaccination.
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Affiliation(s)
- Trude Marie Lyngstad
- Norwegian Institute of Public Health, Oslo, Norway
- European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
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Gladstone RA, Siira L, Brynildsrud OB, Vestrheim DF, Turner P, Clarke SC, Srifuengfung S, Ford R, Lehmann D, Egorova E, Voropaeva E, Haraldsson G, Kristinsson KG, McGee L, Breiman RF, Bentley SD, Sheppard CL, Fry NK, Corander J, Toropainen M, Steens A. International links between Streptococcus pneumoniae vaccine serotype 4 sequence type (ST) 801 in Northern European shipyard outbreaks of invasive pneumococcal disease. Vaccine 2022; 40:1054-1060. [PMID: 34996643 PMCID: PMC8820377 DOI: 10.1016/j.vaccine.2021.10.046] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 09/01/2021] [Accepted: 10/20/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Pneumococcal disease outbreaks of vaccine preventable serotype 4 sequence type (ST)801 in shipyards have been reported in several countries. We aimed to use genomics to establish any international links between them. METHODS Sequence data from ST801-related outbreak isolates from Norway (n = 17), Finland (n = 11) and Northern Ireland (n = 2) were combined with invasive pneumococcal disease surveillance from the respective countries, and ST801-related genomes from an international collection (n = 41 of > 40,000), totalling 106 genomes. Raw data were mapped and recombination excluded before phylogenetic dating. RESULTS Outbreak isolates were relatively diverse, with up to 100 SNPs (single nucleotide polymorphisms) and a common ancestor estimated around the year 2000. However, 19 Norwegian and Finnish isolates were nearly indistinguishable (0-2 SNPs) with the common ancestor dated around 2017. CONCLUSION The total diversity of ST801 within the outbreaks could not be explained by recent transmission alone, suggesting that harsh environmental and associated living conditions reported in the shipyards may facilitate invasion of colonising pneumococci. However, near identical strains in the Norwegian and Finnish outbreaks does suggest that transmission between international shipyards also contributed to those outbreaks. This indicates the need for improved preventative measures in this working population including pneumococcal vaccination.
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Affiliation(s)
- R A Gladstone
- Department of Biostatistics, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway; Parasites and Microbes, Wellcome Sanger Institute, Cambridge, UK
| | - L Siira
- Department of Health Security, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - O B Brynildsrud
- Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - D F Vestrheim
- Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - P Turner
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK; Cambodia Oxford Medical Research Unit, Angkor Hospital for Children, Siem Reap, Cambodia
| | - S C Clarke
- Faculty of Medicine and Institute of Life Sciences, University of Southampton, UK; NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Trust, Southampton, United Kingdom; Global Health Research Institute, University of Southampton, Southampton, United Kingdom; School of Postgraduate Studies, International Medical University, Kuala Lumpur, Malaysia; Centre for Translational Research, IMU Institute for Research, Development and Innovation (IRDI), Kuala Lumpur, Malaysia
| | | | - R Ford
- Papua New Guinea Institute of Medical Research, PO Box 60, Goroka 441, Eastern Highlands Province, Papua New Guinea
| | - D Lehmann
- Telethon Kids Institute, the University of Western Australia, Perth, WA, Australia
| | - E Egorova
- G.N. Gabrichevsky Research Institute for Epidemiology and Microbiology, Moscow, Russia
| | - E Voropaeva
- G.N. Gabrichevsky Research Institute for Epidemiology and Microbiology, Moscow, Russia
| | - G Haraldsson
- Department of Clinical Microbiology, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland and Faculty of Medicine, University of Iceland
| | - K G Kristinsson
- Department of Clinical Microbiology, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland and Faculty of Medicine, University of Iceland
| | - L McGee
- Centers for Disease Control and Prevention, Atlanta, USA
| | - R F Breiman
- Emory Global Health Institute, Atlanta, USA; Rollins School Public Health, Emory University, USA
| | - S D Bentley
- Parasites and Microbes, Wellcome Sanger Institute, Cambridge, UK
| | - C L Sheppard
- Vaccine Preventable Bacteria Section, Public Health England - National Infection Service, London, United Kingdom
| | - N K Fry
- Vaccine Preventable Bacteria Section, Public Health England - National Infection Service, London, United Kingdom; Immunisation and Countermeasures Division, Public Health England - National Infection Service, London, United Kingdom
| | - J Corander
- Department of Biostatistics, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway; Parasites and Microbes, Wellcome Sanger Institute, Cambridge, UK
| | - M Toropainen
- Department of Health Security, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - A Steens
- Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
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Cripps AW, Folaranmi T, Johnson KD, Musey L, Niederman MS, Buchwald UK. Immunogenicity following revaccination or sequential vaccination with 23-valent pneumococcal polysaccharide vaccine (PPSV23) in older adults and those at increased risk of pneumococcal disease: a review of the literature. Expert Rev Vaccines 2021; 20:257-267. [PMID: 33567914 DOI: 10.1080/14760584.2021.1889374] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Introduction: Immunogenicity studies evaluating sequential administration of pneumococcal conjugate vaccine (PCV) followed by 23-valent pneumococcal polysaccharide vaccine (PPSV23) or revaccination with PPSV23 have raised concerns that PPSV23 may not elicit higher antibody levels than those measured following PCV or first PPSV23 dose.Areas covered: Recent literature was evaluated for evidence of blunted immune response (hyporesponsiveness), focusing on studies using adequate intervals between doses in accordance with vaccination recommendations. In eight of nine studies that evaluated revaccination with PPSV23 at an interval of ≥5 years after the previous dose, immunoglobulin G geometric mean concentrations and/or opsonophagocytic assay geometric mean titers for most serotypes increased from pre- to post-repeat vaccination and were comparable between repeat and primary vaccination groups post-vaccination. In seven studies in which PPSV23 was administered after PCVs (8 weeks to 1 year apart), responses to PPSV23 were comparable to those seen after initial PCV dose for shared vaccine serotypes. Studies in which PCVs were administered after PPSV23 were not evaluated.Expert opinion: Published data suggest immune responses following repeat vaccination with PPSV23, or sequential PCV/PPSV23 vaccination, are robust, without evidence of hyporesponsiveness. PPSV23 vaccination of at-risk adults is essential to ensure broad protection against all 23 vaccine serotypes.
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Affiliation(s)
- Allan W Cripps
- Mucosal Immunology Research Group, Menzies Health Institute and School of Medicine, Griffith University, Gold Coast Campus, Southport QLD, Australia
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Steens A, Winje BA, White RA, Odsbu I, Brantsæter AB, Vestrheim DF. Indirect Effects of Pneumococcal Childhood Vaccination in Individuals Treated With Immunosuppressive Drugs in Ambulatory Care: A Case-cohort Study. Clin Infect Dis 2020; 68:1367-1373. [PMID: 30957160 DOI: 10.1093/cid/ciy714] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 08/20/2018] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The extent to which iatrogenically-immunosuppressed individuals benefit from indirect effects of childhood vaccination with pneumococcal conjugate vaccines (PCVs) is unknown. We determined how the sequential introduction of PCV7 (2006) and PCV13 (2011) in the Norwegian childhood vaccination program has affected the epidemiology of invasive pneumococcal disease (IPD) in individuals treated with immunosuppressants in ambulatory care. METHODS We conducted a case-cohort study comprising 7926 IPD cases reported to the Norwegian Surveillance System for Communicable Diseases in 2005-2014 and 249998 individuals randomly selected from the National Registry in 2012. We defined immunosuppressive treatment groups based on dispensed prescriptions retrieved from the Norwegian Prescription Database. Incidences and age-adjusted relative risks (RR) were estimated. RESULTS IPD incidences decreased in all groups. The PCV13 incidence decreased by 5-12% across groups. The non-PCV13 incidence increased by 4-10%, mostly in individuals on chemotherapy (overlapping 95% confidence intervals). In the PCV13 era, the RR for IPD was highest (significant) and the percentage of cases caused by the polysaccharide vaccine PPV23 serotypes lowest (numerical) in individuals on chemotherapy (RR = 20.4, PPV23 = 52%), followed by individuals on corticosteroids (RR = 6.2, PPV23 = 64%), other immunosuppressants (RR = 5.6, PPV23 = 68%), and no immunosuppressants (RR = 1 [reference], PPV23 = 74%). CONCLUSIONS IPD incidences declined after PCV introduction in both immunocompetent and iatrogenically-immunosuppressed individuals, underscoring the benefit of childhood vaccination for the entire population. Still, individuals treated with immunosuppressants in ambulatory care are at increased risk of IPD caused by a more diverse group of serotypes.
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Affiliation(s)
- Anneke Steens
- Department of Vaccine Preventable Diseases, Norwegian Institute of Public Health.,Faculty of Medicine, University of Oslo
| | - Brita A Winje
- Department of Vaccine Preventable Diseases, Norwegian Institute of Public Health
| | - Richard A White
- Department of Infectious Disease Epidemiology and Modelling, Norwegian Institute of Public Health, Oslo, Norway
| | - Ingvild Odsbu
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Arne B Brantsæter
- Department of Infectious Diseases and Department of Acute Medicine, Oslo University Hospital Ullevål, Norway
| | - Didrik F Vestrheim
- Department of Vaccine Preventable Diseases, Norwegian Institute of Public Health
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Løvlie A, Vestrheim DF, Aaberge IS, Steens A. Changes in pneumococcal carriage prevalence and factors associated with carriage in Norwegian children, four years after introduction of PCV13. BMC Infect Dis 2020; 20:29. [PMID: 31924177 PMCID: PMC6954625 DOI: 10.1186/s12879-019-4754-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 12/30/2019] [Indexed: 11/26/2022] Open
Abstract
Background Streptococcus pneumoniae carriage is often asymptomatic but can cause invasive pneumococcal disease. Pneumococcal carriage is a prerequisite for disease, with children as main reservoir and transmitters. Childhood carriage can therefore be used to determine which serotypes circulate in the population and which may cause disease in the non-vaccinated population. In 2006, a pneumococcal conjugate vaccine (PCV7) was introduced into the Norwegian Childhood Immunisation Programme, which was replaced by the more valent PCV13 in 2011. We investigated changes in pneumococcal carriage prevalence 4 years after switching to PCV13 compared to three previous surveys, and analysed factors associated with carriage in children. Methods We conducted a cross-sectional study in Norway, autumn 2015, among children attending day-care centres. We collected questionnaire data and nasopharyngeal swabs to identify pneumococcal serotypes. We compared the carriage prevalence in 2015 with surveys conducted in the same setting performed before widespread vaccination (2006; n = 610), 2 years after PCV7 introduction (2008; n = 600), and 2 years after switching to PCV13 (2013; n = 874). Using multilevel logistic regression we determined the association between pneumococcal carriage and previously associated factors. Results In 2015, 896 children participated, with age ranging from 8 to 80 months. The overall carriage prevalence was 48/100 children [95%CI 44–53] in 2015, 38% [29–46] lower than in 2006 pre-PCV7, and 23% [12–32] lower than in 2013, 2 years after switching to PCV13. The PCV13 carriage prevalence was 2.8/100 children [1.9–4.2] in 2015. Increasing age (p < 0.001), recent antimicrobial use (odds ratio = 0.42 [0.21–0.57]) and being vaccinated (odds ratio = 0.37 [0.29–0.47]) were negatively associated with carriage. Conclusions Our study showed a continued decrease in overall pneumococcal carriage, mainly fuelled by the decline in vaccine serotypes after vaccine introduction. Childhood vaccination with PCV13 should be continued to keep low PCV13 carriage, transmission and disease. Furthermore, the low prevalence of PCV13-type carriage in children endorse the choice of not recommending PCV13 in addition to the 23-valent pneumococcal polysaccharide vaccine to most medical risk groups in Norway, as little disease caused by these serotypes can be expected.
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Affiliation(s)
- A Løvlie
- Division for Infection Control and Environmental Health, Norwegian Institute of Public Health (NIPH), P.o.box 222 Skøyen, 0213, Oslo, Norway. .,European Program for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden.
| | - D F Vestrheim
- Division for Infection Control and Environmental Health, Norwegian Institute of Public Health (NIPH), P.o.box 222 Skøyen, 0213, Oslo, Norway
| | - I S Aaberge
- Division for Infection Control and Environmental Health, Norwegian Institute of Public Health (NIPH), P.o.box 222 Skøyen, 0213, Oslo, Norway
| | - A Steens
- Division for Infection Control and Environmental Health, Norwegian Institute of Public Health (NIPH), P.o.box 222 Skøyen, 0213, Oslo, Norway
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Jayaraman R, Varghese R, Kumar JL, Neeravi A, Shanmugasundaram D, Ralph R, Thomas K, Veeraraghavan B. Invasive pneumococcal disease in Indian adults: 11 years' experience. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2018; 52:736-742. [PMID: 29884448 DOI: 10.1016/j.jmii.2018.03.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 02/09/2018] [Accepted: 03/15/2018] [Indexed: 10/16/2022]
Abstract
PURPOSE To investigate the epidemiology of invasive pneumococcal disease (IPD), prevalent serotypes, and pattern of antimicrobial resistance (AMR) in Indian adults. METHODS Prospective laboratory based surveillance of IPD was carried out in >18 years age group between January 2007 and July 2017, from a tertiary care hospital in South India. All Streptococcus pneumoniae culture positives from blood, CSF and sterile body fluids were characterized to identify the serotypes and AMR. RESULTS A total of 408 IPD cases were characterized in this study. The overall case fatality rate in this study was 17.8% (95% confidence interval (CI): 14.1, 22.4). Pneumonia (39%), meningitis (24.3%), and septicaemia (18.4%) were the most common clinical conditions associated with IPD. Serotypes 1, 3, 5, 19F, 8, 14, 23F, 4, 19A and 6B were the predominant serotypes in this study. Penicillin non-susceptibility was low with 6.4% CONCLUSION: Serotype data from this study helped in accurate estimation of pneumococcal conjugate vaccine-13 and pneumococcal polysaccharide vaccine-23 protective coverage against serotypes causing IPD in India as 58.7% (95% CI: 53.8, 63.4) and 67.4% (95% CI: 62.7, 71.8) respectively. Penicillin non-susceptibility in meningeal IPD cases is 27.4%. Empirical therapy for meningeal IPD must be cephalosporin in combination with vancomycin since cefotaxime non-susceptibility in meningeal IPD is 9.9.
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Affiliation(s)
- Ranjith Jayaraman
- Department of Clinical Microbiology, Christian Medical College and Hospital, Vellore 632004, India.
| | - Rosemol Varghese
- Department of Clinical Microbiology, Christian Medical College and Hospital, Vellore 632004, India.
| | - Jones Lionel Kumar
- Department of Clinical Microbiology, Christian Medical College and Hospital, Vellore 632004, India.
| | - Ayyanraj Neeravi
- Department of Clinical Microbiology, Christian Medical College and Hospital, Vellore 632004, India.
| | - Devika Shanmugasundaram
- Department of Biostatistics, National Institute for Research in Environmental Health (ICMR), Bhopal 462001, India.
| | - Ravikar Ralph
- Department of General Medicine, Christian Medical College and Hospital, Vellore 632004, India.
| | - Kurien Thomas
- Department of General Medicine, Christian Medical College and Hospital, Vellore 632004, India.
| | - Balaji Veeraraghavan
- Department of Clinical Microbiology, Christian Medical College and Hospital, Vellore 632004, India.
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Slotved HC. Other age groups than children need to be considered as carriers of Streptococcal pneumoniae serotypes. Hum Vaccin Immunother 2016; 12:2670-2674. [PMID: 27322025 DOI: 10.1080/21645515.2016.1197451] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
We need to raise the issue that focus on children as the only carriage group for pneumococci is not optimal; we need to consider that other age groups might also be carriers of pneumococcal serotypes causing invasive pneumococcal diseases (IPD) in unvaccinated age groups. The pneumococcal conjugate vaccines (PCV) have successfully removed IPD from vaccinated children. Studies have shown an effect of PCV reducing the pneumococcal carriage of PCV serotypes in children. The status for several countries having used PCV for many years is that they do not see PCV serotypes neither carried nor as a cause of IPD in children. PCV vaccination of children has shown a herd protection effect in unvaccinated groups as a reduction in IPD cases caused by PCV serotypes. However, not all PCV serotypes have disappeared as the cause of IPD in the unvaccinated age groups. The author therefore believes that if we are to see PCV serotypes disappear as a cause of IPD in unvaccinated age groups, we need to perform further carriage studies to examine carriage in other age groups. Alternatively, all age groups should be vaccinated against pneumococci to eliminate IPD caused by PCV serotypes from possible hidden carriers.
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Affiliation(s)
- Hans-Christian Slotved
- a The Neisseria and Streptococcus Reference Laboratory, Department of Microbiology and Infection Control, Statens Serum Institut , Copenhagen , Denmark
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Askim Å, Mehl A, Paulsen J, DeWan AT, Vestrheim DF, Åsvold BO, Damås JK, Solligård E. Epidemiology and outcome of sepsis in adult patients with Streptococcus pneumoniae infection in a Norwegian county 1993-2011: an observational study. BMC Infect Dis 2016; 16:223. [PMID: 27216810 PMCID: PMC4877975 DOI: 10.1186/s12879-016-1553-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Accepted: 05/07/2016] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Invasive pneumococcal disease (IPD) is responsible for significant mortality and morbidity worldwide. There are however few longitudinal studies on the changes in case fatality rate of IPD in recent years. We carried out a prospective observational study of patients with IPD in Nord Trøndelag county in Norway from 1993 to 2011 to study the clinical variables and disease outcome. The main outcome was all-cause mortality after 30 and 90 days. METHODS Patients with positive blood cultures were registered prospectively by the microbiology laboratory and clinical variables were registered retrospectively from patients' hospital records. The severity of sepsis was assigned according to the 2001 International Sepsis Definition Conference criteria. The association between mortality and predictive factors was studied using a logistic regression model. RESULTS The total number of patients was 414 with mean age of 67 years and 53 % were male. Comorbidity was assessed by the Charlson Comorbidity Index (CCI). A CCI-score of 0 was registered in 144 patients (34.8 %), whereas 190 had a score of 1-2 (45.9 %) and 80 (19.3 %) had a score ≥3. 68.8 % of the patients received appropriate antibiotics within the first 6 h. The 30-day mortality risk increased by age and was 3-fold higher for patients aged ≥80 years (24.9, 95 % CI 16.4-33.4 %) compared to patients aged <70 (8.0, 95 % CI 3.5-12.4 %). 110 patients, (26.6 %) had severe sepsis and 37 (8.9 %) had septic shock. The 30 day all-cause mortality risk for those with sepsis without organ failure was 5.4 % (95 % CI 2.7-8.0 %), 20.2 % (95 % CI 13.5-27.4 %) for those with severe sepsis and 35.0 % (95 % CI 21.6-49.0 %) for those with septic shock. The mortality risk did not differ between the first and the second halves of the study period with a 30-day mortality risk of 13.5 % (95 % CI 7.9-19.2 %) for 1993-2002 versus 11.8 % (95 % CI 8.2-15.3 %) for 2003-2011. CONCLUSION IPD carries a high mortality despite early and appropriate antibiotics in most cases. We found no substantial decrease in case fatality rate during the study period of 18 years. Older age and higher severity of disease were important risk factors for death in IPD.
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Affiliation(s)
- Åsa Askim
- Clinic of Anaesthesia and Intensive Care, St Olav University Hospital, Trondheim, Norway.
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway.
- Middle Norway Sepsis Research Center, Norwegian University of Science and Technology, Trondheim, Norway.
- Faculty of medicine, Department of Circulation and Medical Imaging, Po box 8905, N-7491, Trondheim, Norway.
| | - Arne Mehl
- Centre of Molecular Inflammation Research Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Medicine, Levanger Hospital, Nord-Trøndelag Health Trust, Levanger, Norway
- Middle Norway Sepsis Research Center, Norwegian University of Science and Technology, Trondheim, Norway
| | - Julie Paulsen
- Centre of Molecular Inflammation Research Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Medicine, Levanger Hospital, Nord-Trøndelag Health Trust, Levanger, Norway
- Middle Norway Sepsis Research Center, Norwegian University of Science and Technology, Trondheim, Norway
| | - Andrew T DeWan
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA
| | | | - Bjørn Olav Åsvold
- Department of Public Health, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Endocrinology, St Olav University Hospital, Trondheim, Norway
- Middle Norway Sepsis Research Center, Norwegian University of Science and Technology, Trondheim, Norway
| | - Jan Kristian Damås
- Centre of Molecular Inflammation Research Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Infectious Diseases, St Olav University Hospital, Trondheim, Norway
- Middle Norway Sepsis Research Center, Norwegian University of Science and Technology, Trondheim, Norway
| | - Erik Solligård
- Clinic of Anaesthesia and Intensive Care, St Olav University Hospital, Trondheim, Norway
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
- Middle Norway Sepsis Research Center, Norwegian University of Science and Technology, Trondheim, Norway
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Slotved HC, Dalby T, Hoffmann S. The effect of pneumococcal conjugate vaccines on the incidence of invasive pneumococcal disease caused by ten non-vaccine serotypes in Denmark. Vaccine 2016; 34:769-74. [DOI: 10.1016/j.vaccine.2015.12.056] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Revised: 12/04/2015] [Accepted: 12/22/2015] [Indexed: 11/25/2022]
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11
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Dunn-Walters DK. The ageing human B cell repertoire: a failure of selection? Clin Exp Immunol 2015; 183:50-6. [PMID: 26332693 DOI: 10.1111/cei.12700] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2015] [Indexed: 12/15/2022] Open
Abstract
B cells undergo a number of different developmental stages, from initial formation of their B cell receptor (BCR) genes to differentiation into antibody-secreting plasma cells. Because the BCR is vital in these differentiation steps, autoreactive and exogenous antigen binding to the BCR exert critical selection pressures to shape the B cell repertoire. Older people are more prone to infectious disease, less able to respond well to vaccination and more likely to have autoreactive antibodies. Here we review evidence of changes in B cell repertoires in older people, which may be a reflection of age-related changes in B cell selection processes.
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Affiliation(s)
- D K Dunn-Walters
- Faculty of Life Sciences & Medicine, King's College London, London, UK
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12
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Patterson L, Irvine N, Wilson A, Doherty L, Loughrey A, Jessop L. Outbreak of invasive pneumococcal disease at a Belfast shipyard in men exposed to welding fumes, Northern Ireland, April-May 2015: preliminary report. ACTA ACUST UNITED AC 2015; 20. [PMID: 26062559 DOI: 10.2807/1560-7917.es2015.20.21.21138] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We report an outbreak of four confirmed cases of invasive pneumococcal disease (IPD) in individuals occupationally exposed to welding fumes, at a Belfast shipyard (Northern Ireland). All cases were hospitalised. A high-risk sub-group of 679 workers has been targeted for antibiotic prophylaxis and pneumococcal vaccination. Physicians and public health institutions outside Northern Ireland should be alert to individuals presenting with pneumonia or IPD and recent links to the shipyard, to facilitate early assessment and treatment.
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Affiliation(s)
- L Patterson
- UK Field Epidemiology Training Programme, Public Health England, United Kingdom
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13
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Steens A, Vestrheim DF, de Blasio BF. Pneumococcal vaccination in older adults in the era of childhood vaccination: Public health insights from a Norwegian statistical prediction study. Epidemics 2015; 11:24-31. [PMID: 25979279 DOI: 10.1016/j.epidem.2015.01.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Revised: 01/08/2015] [Accepted: 01/12/2015] [Indexed: 11/25/2022] Open
Abstract
Two different vaccines, a 23-valent polysaccharide vaccine (PPV23) and a 13-valent conjugate vaccine (PCV13), are available for prevention of invasive pneumococcal disease (IPD) in the population aged 65 years and older (65+). The IPD epidemiology in the 65+ is undergoing change due to indirect effects of childhood immunisation. Vaccine recommendations for the 65+ must take into account these trends in epidemiology. We therefore explored the preventive potential of vaccination strategies to prevent IPD in the 65+, including PPV23, PCV13 or PCV13 + PPV23 in 2014-2019. Quasi-Poisson regression models were fitted to 2004-2014 population-wide surveillance data and used to predict incidences for vaccine-type and non-vaccine type IPD. We determined the number of people needed to be vaccinated to prevent one case per season (NNV) for each strategy and estimated the public health impact on the IPD case counts from increasing the vaccine uptake to 28-45%. Our results indicate that PCV13-IPD will decrease by 71% from 58 (95% prediction interval 55-61) cases in 2014/15 to 17 (6-52) in 2018/19 and PPV23-IPD by 32% from 168 (162-175) to 115 (49-313) cases. The NNV will increase over time for all strategies because of a decreasing vaccine-type IPD incidence. In 2018/19, the PCV13-NNV will be 5.3 times higher than the PPV23-NNV. Increasing the vaccine uptake will lead to a larger public health impact for all scenarios. Combining PCV13 and PPV23 is most effective, but the additional effect of PCV13 will decrease and is only marginal in 2018/19. Our study demonstrates the importance of increasing PPV23 uptake and of developing vaccines that confer broader immunity.
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Affiliation(s)
- Anneke Steens
- Division of Infectious Disease Control, Norwegian Institute of Public Health, Norway; European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Sweden.
| | - Didrik F Vestrheim
- Division of Infectious Disease Control, Norwegian Institute of Public Health, Norway
| | - Birgitte Freiesleben de Blasio
- Division of Infectious Disease Control, Norwegian Institute of Public Health, Norway; Oslo Center for Biostatistics and Epidemiology, Department of Biostatistics, Institute of Basic Medical Sciences, University of Oslo, Norway
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14
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Abstract
Gram-positive organisms, including the pathogens Staphylococcus aureus, Streptococcus pneumoniae, and Enterococcus faecalis, have dynamic cell envelopes that mediate interactions with the environment and serve as the first line of defense against toxic molecules. Major components of the cell envelope include peptidoglycan (PG), which is a well-established target for antibiotics, teichoic acids (TAs), capsular polysaccharides (CPS), surface proteins, and phospholipids. These components can undergo modification to promote pathogenesis, decrease susceptibility to antibiotics and host immune defenses, and enhance survival in hostile environments. This chapter will cover the structure, biosynthesis, and important functions of major cell envelope components in gram-positive bacteria. Possible targets for new antimicrobials will be noted.
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