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López-Lacort M, Amini M, Emborg HD, Nielsen J, McDonald SA, Valentiner-Branth P, Díez-Domingo J, Orrico-Sánchez A. Incidence of Invasive and Noninvasive Pneumococcal Pneumonia Hospitalizations in People Aged ≥50 Years: Assessing Variability Across Denmark and Spain. J Infect Dis 2024:jiae088. [PMID: 38459772 DOI: 10.1093/infdis/jiae088] [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: 10/30/2023] [Accepted: 02/22/2024] [Indexed: 03/10/2024] Open
Abstract
Determining pneumococcal pneumonia (PP) burden in the elderly population is challenging due to limited data on invasive PP (IPP) and, in particular, noninvasive PP (NIPP) incidence. Using retrospective cohorts of adults aged ≥50 years in Denmark (2 782 303) and the Valencia region, Spain (2 283 344), we found higher IPP hospitalization rates in Denmark than Valencia (18.3 vs 9/100 000 person-years [PY], respectively). Conversely, NIPP hospitalization rates were higher in Valencia (48.2 vs 7.2/100 000 PY). IPP and NIPP rates increased with age and comorbidities in both regions, with variations by sex and case characteristics (eg, complications, mortality). The burden of PP in adults is substantial, yet its true magnitude remains elusive. Discrepancies in clinical practices impede international comparisons; for instance, Valencia employed a higher frequency of urinary antigen tests compared to Denmark. Additionally, coding practices and prehospital antibiotic utilization may further influence these variations. These findings could guide policymakers and enhance the understanding of international disparities in disease burden assessments.
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Affiliation(s)
- Mónica López-Lacort
- Vaccine Research Department of Fisabio-Public Health, Valencia, Spain
- CIBER de Epidemiología y Salud Pública, Instituto de Salud Carlos III, Madrid, Spain
| | - Marzyeh Amini
- P95 Epidemiology and Pharmacovigilance, Leuven, Belgium
| | - Hanne-Dorthe Emborg
- Department of Infectious Disease Epidemiology and Prevention, Statens Serum Institut, Copenhagen, Denmark
| | - Jens Nielsen
- Department of Infectious Disease Epidemiology and Prevention, Statens Serum Institut, Copenhagen, Denmark
| | - Scott A McDonald
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Amsterdam, The Netherlands
| | - Palle Valentiner-Branth
- Department of Infectious Disease Epidemiology and Prevention, Statens Serum Institut, Copenhagen, Denmark
| | - Javier Díez-Domingo
- Vaccine Research Department of Fisabio-Public Health, Valencia, Spain
- CIBER de Epidemiología y Salud Pública, Instituto de Salud Carlos III, Madrid, Spain
- Chair of Vaccines, Universidad Católica de Valencia San Vicente Mártir, Valencia, Spain
| | - Alejandro Orrico-Sánchez
- Vaccine Research Department of Fisabio-Public Health, Valencia, Spain
- CIBER de Epidemiología y Salud Pública, Instituto de Salud Carlos III, Madrid, Spain
- Chair of Vaccines, Universidad Católica de Valencia San Vicente Mártir, Valencia, Spain
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Arya S, Norton N, Kaushik P, Brandtmüller A, Tsoumani E. Recent changes to adult national immunization programs for pneumococcal vaccination in Europe and how they impact coverage: A systematic review of published and grey literature. Hum Vaccin Immunother 2023; 19:2279394. [PMID: 38014651 PMCID: PMC10760380 DOI: 10.1080/21645515.2023.2279394] [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: 08/14/2023] [Accepted: 11/01/2023] [Indexed: 11/29/2023] Open
Abstract
Despite widespread use of pneumococcal vaccines throughout Europe, the burden of pneumococcal disease (PD) in adults is considerable. To mitigate this burden, National Immunization Technical Advisory Groups (NITAGs) and Health Technology Assessment (HTA) agencies assess the value of different vaccine schedules for protecting against PD. The aim of this review was to assess the evidence and rationales used by NITAGs/HTA agencies, when considering recent changes to National Immunization Programs (NIPs) for adults, and how identified changes affected vaccine coverage rates (VCRs). A systematic review was conducted of published literature from PubMed® and Embase®, and gray literature from HTA/NITAG websites from the last 5 y, covering 31 European countries. Evidence related to NIP recommendations, epidemiology (invasive PD, pneumonia), health economic assessments and VCRs were collected and synthesized. Eighty-four records providing data for 26 countries were identified. Of these, eight described explicit changes to NIPs for adults in seven countries. Despite data gaps, some trends were observed; first, there appears to be a convergence of NIP recommendations in many countries toward sequential vaccination, with a pneumococcal conjugate vaccine (PCV), followed by pneumococcal polysaccharide vaccine 23. Second, reducing economic or healthcare burden were common rationales for implementing changes. Third, most health economic analyses assessing higher-valency PCVs for adults found its inclusion in NIPs cost-effective. Finally, higher coverage rates were seen in most cases where countries had expanded their NIPs to cover at-risk populations. The findings can encourage agencies to improve surveillance systems and work to reach the NIP's target populations more effectively.
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Affiliation(s)
- Stuti Arya
- Evidence Review and Synthesis, Quantify Research, Mohali, India
| | - Nicholas Norton
- Evidence Review and Synthesis, Quantify Research, Stockholm, Sweden
| | - Puneet Kaushik
- Evidence Review and Synthesis, Quantify Research, Mohali, India
| | - Agnes Brandtmüller
- Center for Observational and Real-World Evidence, MSD, Budapest, Hungary
| | - Eleana Tsoumani
- Center for Observational and Real-World Evidence, MSD, Athens, Greece
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Manzanal A, Vicente D, Alonso M, Azkue N, Ercibengoa M, Marimón JM. Impact of the progressive uptake of pneumococcal conjugate vaccines on the epidemiology and antimicrobial resistance of invasive pneumococcal disease in Gipuzkoa, northern Spain, 1998-2022. Front Public Health 2023; 11:1238502. [PMID: 37719737 PMCID: PMC10501722 DOI: 10.3389/fpubh.2023.1238502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 08/18/2023] [Indexed: 09/19/2023] Open
Abstract
Objectives To analyze the impact of pneumococcal conjugate vaccines (PCVs) on the incidence of invasive pneumococcal diseases (IPDs) and pneumococcal antibiotic resistance in Gipuzkoa, northern Spain for a 25 years period. Methods All cases of IPD confirmed by culture between 1998 and 2022 in a population of around 427,416 people were included. Pneumococci were serotyped and antimicrobial susceptibility was assessed by the EUCAST guidelines. Results Overall, 1,516 S. pneumoniae isolates were collected. Annual IPD incidence rates (per 100,000 people) declined from 19.9 in 1998-2001 to 11.5 in 2017-19 (42.2% reduction), especially in vaccinated children (from 46.7 to 24.9) and non-vaccinated older adult individuals (from 48.0 to 23.6). After PCV13 introduction, the decrease in the incidence of infections caused by PCV13 serotypes was balanced by the increase in the incidence of non-PCV13 serotypes. In the pandemic year of 2020, IPD incidence was the lowest: 2.81. The annual incidence rates of penicillin-resistant isolates also decreased, from 4.91 in 1998-2001 to 1.49 in 2017-19 and 0.70 in 2020. Since 2017, serotypes 14, 19A, and 11A have been the most common penicillin-resistant types. The incidence of erythromycin-resistant strains declined, from 3.65 to 1.73 and 0.70 in the same years. Conclusion PCV use was associated with declines in the incidence of IPD and the spread of non-vaccine serotypes, that balanced the beneficial effect off PCV13, some of them showing high rates of antibiotic resistance.
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Affiliation(s)
- Ayla Manzanal
- Microbiology Department, Osakidetza Basque Health Service, Donostialdea Integrated Health Organization, San Sebastián, Spain
- Department of Preventive Medicine, University of the Basque Country (UPV/EHU), San Sebastián, Spain
| | - Diego Vicente
- Microbiology Department, Osakidetza Basque Health Service, Donostialdea Integrated Health Organization, San Sebastián, Spain
- Department of Preventive Medicine, University of the Basque Country (UPV/EHU), San Sebastián, Spain
- Infectious Diseases Area, Respiratory Infection and Antimicrobial Resistance Group, Biodonostia Health Research Institute, San Sebastián, Spain
| | - Marta Alonso
- Microbiology Department, Osakidetza Basque Health Service, Donostialdea Integrated Health Organization, San Sebastián, Spain
- Infectious Diseases Area, Respiratory Infection and Antimicrobial Resistance Group, Biodonostia Health Research Institute, San Sebastián, Spain
| | - Nekane Azkue
- Microbiology Department, Osakidetza Basque Health Service, Donostialdea Integrated Health Organization, San Sebastián, Spain
| | - Maria Ercibengoa
- Infectious Diseases Area, Respiratory Infection and Antimicrobial Resistance Group, Biodonostia Health Research Institute, San Sebastián, Spain
| | - José María Marimón
- Microbiology Department, Osakidetza Basque Health Service, Donostialdea Integrated Health Organization, San Sebastián, Spain
- Infectious Diseases Area, Respiratory Infection and Antimicrobial Resistance Group, Biodonostia Health Research Institute, San Sebastián, Spain
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Ochoa-Gondar O, Torras-Vives V, de Diego-Cabanes C, Satué-Gracia EM, Vila-Rovira A, Forcadell-Perisa MJ, Ribas-Seguí D, Rodríguez-Casado C, Vila-Córcoles A. Incidence and risk factors of pneumococcal pneumonia in adults: a population-based study. BMC Pulm Med 2023; 23:200. [PMID: 37291502 DOI: 10.1186/s12890-023-02497-2] [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: 03/22/2023] [Accepted: 05/26/2023] [Indexed: 06/10/2023] Open
Abstract
BACKGROUND Infection caused by Streptococcus pneumoniae, mainly invasive pneumococcal disease (IPD) and pneumococcal pneumonia (PP), are a major public health problem worldwide. This study investigated population-based incidence and risk of PP among Catalonian persons ≥ 50 years-old with and without specific underlying conditions/comorbidities, examining the influence of single and multi-comorbidities in the risk of suffering PP. METHODS Population-based cohort study involving 2,059,645 persons ≥ 50 years-old in Catalonia, Spain, who were retrospectively followed between 01/01/2017-31/12/2018. The Catalonian information system for development of research in primary care (SIDIAP) was used to establish baseline characteristics of the cohort (comorbidities/underlying conditions), and PP cases were collected from discharge codes (ICD-10: J13) of the 68 referral Catalonian hospitals. RESULTS Global incidence rate (IR) was 90.7 PP cases per 100,000 person-years, with a 7.6% (272/3592) case-fatality rate (CFR). Maximum IRs emerged among persons with history of previous IPD or all-cause pneumonia, followed by haematological neoplasia (475.0), HIV-infection (423.7), renal disease (384.9), chronic respiratory disease (314.7), liver disease (232.5), heart disease (221.4), alcoholism (204.8), solid cancer (186.2) and diabetes (159.6). IRs were 42.1, 89.9, 201.1, 350.9, 594.3 and 761.2 in persons with 0, 1, 2, 3, 4 and ≥ 5 comorbidities, respectively. In multivariable analyses, HIV-infection (hazard ratio [HR]: 5.16; 95% CI: 3.57-7.46), prior all-cause pneumonia (HR: 3.96; 95% CI: 3.45-4.55), haematological neoplasia (HR: 2.71; 95% CI: 2.06-3.57), chronic respiratory disease (HR: 2.66; 95% CI: 2.47-2.86) and prior IPD (HR: 2.56; 95% CI: 2.03-3.24) were major predictors for PP. CONCLUSION Apart of increasing age and immunocompromising conditions (classically recognised as high-risk conditions), history of prior IPD/pneumonia, presence of chronic pulmonary/respiratory disease and/or co-existing multi-comorbidity (i.e., two or more underlying conditions) are major risk factors for PP in adults, with an excess risk near to immunocompromised subjects. Redefining risk categories for PP, including all the above-mentioned conditions into the high-risk category, could be necessary to improve prevention strategies in middle-aged and older adults.
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Affiliation(s)
- Olga Ochoa-Gondar
- Primary Health Care Service "Camp de Tarragona", Institut Català de la Salut, Tarragona, Spain
| | - Verónica Torras-Vives
- Primary Health Care Service "Camp de Tarragona", Institut Català de la Salut, Tarragona, Spain
| | - Cinta de Diego-Cabanes
- Primary Health Care Service "Camp de Tarragona", Institut Català de la Salut, Tarragona, Spain.
- Unitat de Suport a la Recerca of Tarragona, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Tarragona, Spain.
| | - Eva M Satué-Gracia
- Primary Health Care Service "Camp de Tarragona", Institut Català de la Salut, Tarragona, Spain
- Unitat de Suport a la Recerca of Tarragona, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Tarragona, Spain
| | - Angel Vila-Rovira
- Primary Health Care Service "Camp de Tarragona", Institut Català de la Salut, Tarragona, Spain
| | | | - Domingo Ribas-Seguí
- Primary Health Care Service "Camp de Tarragona", Institut Català de la Salut, Tarragona, Spain
| | - Clara Rodríguez-Casado
- Information System for the Improvement of Research in Primary Care (SIDIAP), Primary Care Research Institute Jordi Gol, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Angel Vila-Córcoles
- Primary Health Care Service "Camp de Tarragona", Institut Català de la Salut, Tarragona, Spain
- Unitat de Suport a la Recerca of Tarragona, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Tarragona, Spain
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Vila-Córcoles A, Ochoa-Gondar O, de Diego-Cabanes C, Satué-Gracia EM, Torras-Vives V, Forcadell-Peris MJ, Ribas-Seguí D, Vila-Rovira A, Rodríguez-Casado C. Evaluating clinical effectiveness and impact of anti-pneumococcal vaccination in adults after universal childhood PCV13 implementation in Catalonia, 2017-2018. Vaccine X 2023; 13:100264. [PMID: 36798107 PMCID: PMC9926188 DOI: 10.1016/j.jvacx.2023.100264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 01/18/2023] [Accepted: 01/18/2023] [Indexed: 01/22/2023] Open
Abstract
Background At present, because of indirect effects derived from routine childhood immunisation, clinical benefits vaccinating adults with the 23-valent pneumococcal polysaccharide vaccine (PPsV23) and/or the 13-valent pneumococcal conjugate vaccine (PCV13) are uncertain. This study investigated clinical effectiveness for both PPsV23/PCV13 in preventing pneumonia among Catalonian adults during an earlier 2-year period post-PCV13 free (publicly funded) approval for infants. Methods We conducted a Population-based cohort study involving 2,059,645 adults ≥ 50 years in Catalonia, Spain, who were followed between 01/01/2017-31/12/2018. Primary outcomes were hospitalisation from pneumococcal pneumonia (PP) or all-cause pneumonia (ACP) and main explanatory variable was PCV13/PPsV23 vaccination status. Cox regression models were used to estimate vaccination effectiveness adjusted by age/sex and underlying-risk conditions. Results Cohort members were followed for 3,958,528 person-years (32,328 PCV13-vaccinated, 1,532,186 PPsV23-vaccinated), observing 3592 PP (131 in PCV13-vaccinated vs 2476 in PPsV23-vaccinated) and 24,136 ACP (876 in PCV13-vaccinated vs 17,550 in PPsV23-vaccinated). Incidence rates (per 100,000 person-years) were 90.7 for PP (394.2 in PCV13-vaccinated vs 161.6 in PPsV23-vaccinated) and 609.7 for ACP (2636.3 in PCV13-vaccinated vs 1145.4 in PPsV23-vaccinated). The PCV13 was associated with an increased risk of PP (hazard ratio [HR]: 1.24; 95% CI: 1.00-1.52; p = 0.046) and ACP (HR: 1.38; 95% CI: 1.28-1.49; p < 0.001) whereas the PPsV23 did not alter the risk of PP (HR: 1.07; 95% CI: 0.98-1.18; p = 0.153) and slightly increased the risk of ACP (HR: 1.14; 95% CI: 1.10-1.18; p < 0.001). In supplementary analyses focused on at-risk individuals (i.e., elderly persons, immunocompromissing and other chronic illnesses) protective effects of vaccination did not emerge either. Conclusions Data does not support clinical benefits from pneumococcal vaccination (nor PCV13 neither PPsV23) against pneumonia among Catalonian middle-aged and older adults in the current era of universal PCV13 childhood immunisation in our setting. New extended valency PCVs are greatly needed.
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Affiliation(s)
- Angel Vila-Córcoles
- Primary Health Care Service “Camp de Tarragona”, Institut Català de la Salut, Tarragona, Spain,Unitat de Suport a la Recerca of Tarragona, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Tarragona, Spain
| | - Olga Ochoa-Gondar
- Primary Health Care Service “Camp de Tarragona”, Institut Català de la Salut, Tarragona, Spain
| | - Cinta de Diego-Cabanes
- Primary Health Care Service “Camp de Tarragona”, Institut Català de la Salut, Tarragona, Spain,Corresponding author at: Institut Catalá de la Salut, Rambla Nova 124, D, 1°A, 43001 Tarragona, Spain.
| | - Eva M. Satué-Gracia
- Primary Health Care Service “Camp de Tarragona”, Institut Català de la Salut, Tarragona, Spain,Unitat de Suport a la Recerca of Tarragona, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Tarragona, Spain
| | - Verónica Torras-Vives
- Primary Health Care Service “Camp de Tarragona”, Institut Català de la Salut, Tarragona, Spain
| | - M. José Forcadell-Peris
- Primary Health Care Service “Camp de Tarragona”, Institut Català de la Salut, Tarragona, Spain
| | - Domingo Ribas-Seguí
- Primary Health Care Service “Camp de Tarragona”, Institut Català de la Salut, Tarragona, Spain
| | - Angel Vila-Rovira
- Primary Health Care Service “Camp de Tarragona”, Institut Català de la Salut, Tarragona, Spain
| | - Clara Rodríguez-Casado
- Information System for the Improvement of Research in Primary Care (SIDIAP), Primary Care Research Institute Jordi Gol, Universitat Autonoma de Barcelona, Barcelona, Spain
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Gil-Prieto R, Allouch N, Jimeno I, Hernández-Barrera V, Arguedas-Sanz R, Gil-de-Miguel Á. Burden of Hospitalizations Related to Pneumococcal Infection in Spain (2016-2020). Antibiotics (Basel) 2023; 12:antibiotics12010172. [PMID: 36671373 PMCID: PMC9854580 DOI: 10.3390/antibiotics12010172] [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: 11/25/2022] [Revised: 01/09/2023] [Accepted: 01/11/2023] [Indexed: 01/18/2023] Open
Abstract
Pneumococcal infection strongly contributes to morbidity and mortality in Spain. A total of 253,899 hospitalizations related to pneumococcal infection occurred from 2016 to 2020. Fifty-eight percent were men, the mean age was 67 years old, and the average length of hospitalization was 12.72 days. The annual hospitalization rate was 10.84 hospitalizations per 10,000 population, increasing significantly with age, reaching 65.75 per 10,000 population in those aged >85 years. The hospitalization rates for pneumococcal pneumonia, sepsis, and meningitis were 2.91, 0.12, and 0.08 hospitalizations per 10,000, respectively, and reached the highest value in those aged >85 for pneumococcal pneumonia and sepsis, with 22.29 and 0.71 hospitalizations per 10,000, respectively, and in children up to 1 year old for pneumococcal meningitis, with 0.33 hospitalizations per 10,000. The total number of deaths during the study period was 35,716, with a case-fatality rate of 14.07%. For pneumococcal pneumonia, sepsis, and meningitis, the case-fatality rates were 8.47%, 23.71%, and 9.99%, respectively. The case-fatality rate increased with age and did not vary by sex. The annual cost of these hospitalizations was more than EUR 359 million. There is therefore a high burden of disease and mortality caused by pneumococcal infection in our country, especially in elderly individuals.
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Affiliation(s)
- Ruth Gil-Prieto
- Preventive Medicine and Public Health, Rey Juan Carlos University, 28922 Madrid, Spain
- Correspondence:
| | - Nizar Allouch
- Preventive Medicine and Public Health, Rey Juan Carlos University, 28922 Madrid, Spain
| | - Isabel Jimeno
- Primary Care Health Center Isla de Oza, Vaccine Responsible of SEMG, 28035 Madrid, Spain
| | | | - Raquel Arguedas-Sanz
- Department of Business Economics and Accounting, Universidad Nacional de Educación a Distancia UNED, 28004 Madrid, Spain
| | - Ángel Gil-de-Miguel
- Preventive Medicine and Public Health, Rey Juan Carlos University, 28922 Madrid, Spain
- CIBER of Respiratory Diseases (CIBERES), Instituto de Salud Carlos III, 28029 Madrid, Spain
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Vaccination Coverage during Childhood and Adolescence among Undergraduate Health Science Students in Greece. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9101553. [PMID: 36291489 PMCID: PMC9601163 DOI: 10.3390/children9101553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 09/27/2022] [Accepted: 10/04/2022] [Indexed: 01/24/2023]
Abstract
High rates of vaccination coverage in childhood represent one of the most important cost-effective tools of primary prevention and have substantially reduced the incidence of and mortality from vaccine-preventable diseases globally. Vaccination coverage of young people has not been well estimated in Greece. Anonymous self-completed questionnaires and the participants’ Child Health Booklet were used to estimate complete vaccination coverage of mandatory vaccinations against vaccine-preventable diseases of undergraduate students at the University of West Attica during the academic year 2020−2021. Student’s t-tests were used to estimate mean values. Overall, 79% (95% CI: 78−81%) of study participants were fully vaccinated. This coverage was lower in males especially for vaccines that should be done during childhood (p = 0.045). High vaccination percentage (>90%) was observed for the meningococcus group A, C, W135, Y, measles-mumps-rubella, hepatitis B and meningitis C vaccine. Nevertheless, suboptimal coverage was assessed for the booster dose of tetanus, diphtheria, pertussis, for the human papillomavirus vaccine among girls, for the tuberculosis, for the meningococcus group B, for the pneumococcal, and for the seasonal influenza vaccines. In conclusion, the promotion of routine vaccination programs for young adults needs to be strengthened. An identification system for under-vaccinated students, an efficient reminder system and university campus vaccine program practices should be established, particularly among males.
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Bizri A, Ibrahim A, Dagher E, Matar M, Mohammed M, Bitar N, Atallah P, Moghnieh R, Musharrafieh U, Aoun-Bacha Z. Pneumococcal Disease in High-Risk Adults in Lebanon: Expert Opinion. Vaccines (Basel) 2022; 10:vaccines10101650. [PMID: 36298515 PMCID: PMC9607522 DOI: 10.3390/vaccines10101650] [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: 08/26/2022] [Revised: 09/22/2022] [Accepted: 09/27/2022] [Indexed: 11/07/2022] Open
Abstract
Pneumococcal disease affects people across all ages but is more prevalent in young children and the elderly. Despite the availability of the pneumococcal vaccine for adults, the disease burden and mortality associated with it remains a challenge. A few studies conducted in Lebanon have reported epidemiology of pneumococcal disease, concurring the high burden among adults and older adults in the region. The pneumococcal vaccine is a part of the routine immunization schedule for children, but there are no recommendations for adult vaccination. A medical advisory board was hence conducted in September 2020 to discuss the burden of pneumococcal disease (PD) among adults in Lebanon. The participants were experts from the fields of internal medicine, family medicine, hematology, cardiology, oncology, endocrinology, pulmonology, and infectious diseases. The experts reached a consensus that there is a need to take steps to increase the rate of adult vaccination uptake and create awareness among physicians, pharmacists, caregivers, and patients. The physicians should be trained on adult immunization and should actively discuss the importance of the pneumococcal vaccine, especially with high-risk adult patients. Implementing adult vaccination as a routine practice and involving various stakeholders to address the gaps can help in reducing the burden of pneumococcal disease in adults.
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Affiliation(s)
- Abdulrahman Bizri
- American University of Beirut Medical Center, Riad El Solh P.O. Box 11-0236, Lebanon
| | - Ahmad Ibrahim
- Al Makassed General Hospital, Tarik Jdide P.O. Box 6301, Lebanon
| | - Elissar Dagher
- School of Medicine and Medical Sciences, Centre Hospitalier Universitaire Notre Dame des Secours, Holy Spirit University of Kaslik, Jounieh P.O. Box 446, Lebanon
| | - Madonna Matar
- School of Medicine and Medical Sciences, Centre Hospitalier Universitaire Notre Dame des Secours, Holy Spirit University of Kaslik, Jounieh P.O. Box 446, Lebanon
| | | | - Nizar Bitar
- Sahel General Hospital, Ghobeiry P.O. Box 99/25, Lebanon
| | - Paola Atallah
- Saint George Hospital University Medical Center, Rmeil P.O. Box 166378, Lebanon
| | - Rima Moghnieh
- Al Makassed General Hospital, Tarik Jdide P.O. Box 6301, Lebanon
- Correspondence: ; Tel.: +96-13829363
| | - Umayya Musharrafieh
- American University of Beirut Medical Center, Riad El Solh P.O. Box 11-0236, Lebanon
| | - Zeina Aoun-Bacha
- Pulmonary and Critical Care Department, Hotel Dieu de France Hospital, University Medical Center, Saint Joseph University, Alfred Naccache P.O. Box 166830, Lebanon
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Astengo M, Paganino C, Amicizia D, Trucchi C, Tassinari F, Sticchi C, Sticchi L, Orsi A, Icardi G, Piazza MF, Di Silverio B, Deb A, Senese F, Prandi GM, Ansaldi F. Economic Burden of Pneumococcal Disease in Individuals Aged 15 Years and Older in the Liguria Region of Italy. Vaccines (Basel) 2021; 9:vaccines9121380. [PMID: 34960127 PMCID: PMC8706914 DOI: 10.3390/vaccines9121380] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 11/11/2021] [Accepted: 11/20/2021] [Indexed: 11/23/2022] Open
Abstract
Despite the availability of vaccines against Streptococcus pneumoniae, the global incidence and economic cost of pneumococcal disease (PD) among adults is still high. This retrospective cohort analysis estimated the cost of emergency department (ED) visits/hospitalizations associated with non-invasive pneumonia and invasive pneumococcal disease among individuals ≥15 years of age in the Liguria region of Italy during 2012–2018. Data from the Liguria Region Administrative Health Databases and the Ligurian Chronic Condition Data Warehouse were used, including hospital admission date, length of stay, discharge date, outpatient visits, and laboratory/imaging procedures. A ≥30-day gap between two events defined a new episode, and patients with ≥1 ED or inpatient claim for PD were identified. The total mean annual number of hospitalizations for PD was 13,450, costing ~€49 million per year. Pneumonia accounted for the majority of hospitalization costs. The median annual cost of hospitalization for all-cause pneumonia was €38,416,440 (per-capita cost: €26.78) and was €30,353,928 (per-capita cost: €20.88) for pneumococcal and unspecified pneumonia. The total number and associated costs of ED visits/hospitalizations generally increased over the study period. PD still incurs high economic costs in adults in the Liguria region of Italy.
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Affiliation(s)
- Matteo Astengo
- Regional Health Agency of Liguria (ALiSa), 16121 Genoa, Italy; (C.P.); (D.A.); (C.T.); (F.T.); (C.S.); (M.F.P.); (B.D.S.); (F.A.)
- Correspondence: ; Tel.: +39-0105488257
| | - Chiara Paganino
- Regional Health Agency of Liguria (ALiSa), 16121 Genoa, Italy; (C.P.); (D.A.); (C.T.); (F.T.); (C.S.); (M.F.P.); (B.D.S.); (F.A.)
| | - Daniela Amicizia
- Regional Health Agency of Liguria (ALiSa), 16121 Genoa, Italy; (C.P.); (D.A.); (C.T.); (F.T.); (C.S.); (M.F.P.); (B.D.S.); (F.A.)
| | - Cecilia Trucchi
- Regional Health Agency of Liguria (ALiSa), 16121 Genoa, Italy; (C.P.); (D.A.); (C.T.); (F.T.); (C.S.); (M.F.P.); (B.D.S.); (F.A.)
- Department of Health Sciences (DiSSal), University of Genoa, 16132 Genoa, Italy; (L.S.); (A.O.); (G.I.)
| | - Federico Tassinari
- Regional Health Agency of Liguria (ALiSa), 16121 Genoa, Italy; (C.P.); (D.A.); (C.T.); (F.T.); (C.S.); (M.F.P.); (B.D.S.); (F.A.)
| | - Camilla Sticchi
- Regional Health Agency of Liguria (ALiSa), 16121 Genoa, Italy; (C.P.); (D.A.); (C.T.); (F.T.); (C.S.); (M.F.P.); (B.D.S.); (F.A.)
| | - Laura Sticchi
- Department of Health Sciences (DiSSal), University of Genoa, 16132 Genoa, Italy; (L.S.); (A.O.); (G.I.)
| | - Andrea Orsi
- Department of Health Sciences (DiSSal), University of Genoa, 16132 Genoa, Italy; (L.S.); (A.O.); (G.I.)
| | - Giancarlo Icardi
- Department of Health Sciences (DiSSal), University of Genoa, 16132 Genoa, Italy; (L.S.); (A.O.); (G.I.)
| | - Maria Francesca Piazza
- Regional Health Agency of Liguria (ALiSa), 16121 Genoa, Italy; (C.P.); (D.A.); (C.T.); (F.T.); (C.S.); (M.F.P.); (B.D.S.); (F.A.)
| | - Bruno Di Silverio
- Regional Health Agency of Liguria (ALiSa), 16121 Genoa, Italy; (C.P.); (D.A.); (C.T.); (F.T.); (C.S.); (M.F.P.); (B.D.S.); (F.A.)
| | - Arijita Deb
- Merck & Co., Inc., Kenilworth, NJ 07033, USA;
| | | | | | - Filippo Ansaldi
- Regional Health Agency of Liguria (ALiSa), 16121 Genoa, Italy; (C.P.); (D.A.); (C.T.); (F.T.); (C.S.); (M.F.P.); (B.D.S.); (F.A.)
- Department of Health Sciences (DiSSal), University of Genoa, 16132 Genoa, Italy; (L.S.); (A.O.); (G.I.)
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