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Do LAH, Tsedenbal N, Khishigmunkh C, Tserendulam B, Altanbumba L, Luvsantseren D, Ulziibayar M, Suuri B, Narangerel D, Tsolmon B, Demberelsuren S, Nguyen C, Mungun T, von Mollendorf C, Badarch D, Mulholland K. Impact of pneumococcal conjugate vaccine 13 introduction on severe lower respiratory tract infections associated with respiratory syncytial virus or influenza virus in hospitalized children in Ulaanbaatar, Mongolia. IJID REGIONS 2024; 11:100357. [PMID: 38577554 PMCID: PMC10992709 DOI: 10.1016/j.ijregi.2024.100357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 03/14/2024] [Accepted: 03/15/2024] [Indexed: 04/06/2024]
Abstract
Objectives Limited data indicate a beneficial effect of pneumococcal conjugate vaccines (PCVs) on respiratory syncytial virus (RSV) and influenza infections in young children. We evaluated the impact of 13-valent PCV (PCV13) introduction on the incidence of severe lower respiratory tract infections (LRTIs) associated with RSV or influenza in hospitalized children. Methods Our study was restricted to children aged <2 years with arterial oxygen saturation <93% and children with radiologically confirmed pneumonia nested in a pneumonia surveillance project in four districts of Ulaanbaatar city, Mongolia. We tested nasopharyngeal swabs collected on admission for RSV and influenza using quantitative reverse transcription-polymerase chain reaction. The impact of PCV13 on the incidence of LRTI outcomes associated with RSV or with influenza for the period April 2015-March 2020 was estimated. Incidence rate ratios comparing pre- and post-vaccine periods were estimated for each outcome for each district using negative binomial models and for all districts combined with a mixed-effects negative binomial model. Adjusted models accounted for seasonality. Sensitivity analyses were conducted to assess the robustness of our findings. Results Among 5577 tested cases, the adjusted incidence rate ratios showed a trend toward a reduction in RSV-associated outcomes: all LRTIs (0.77, 95% confidence interval [CI] 0.44-1.36), severe LRTIs (0.88, 95% CI 0.48-1.62), very severe LRTIs (0.76, 95% CI 0.42-1.38), and radiologically confirmed pneumonia (0.66, 95% CI 0.32-1.38) but inconsistent trends in outcomes associated with influenza. Conclusions No significant reductions were observed in any outcomes associated with RSV and influenza after PCV introduction.
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Affiliation(s)
- Lien Anh Ha Do
- New Vaccines Group, Murdoch Children's Research Institute, Melbourne, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia
| | | | | | | | | | | | | | | | - Dorj Narangerel
- Ministry of Health, National Center for Communicable Diseases, Ulaanbaatar, Mongolia
| | - Bilegtsaikhan Tsolmon
- National Center of Communicable Diseases, Ulaanbaatar, Mongolia
- Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | | | - Cattram Nguyen
- New Vaccines Group, Murdoch Children's Research Institute, Melbourne, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia
| | - Tuya Mungun
- National Center of Communicable Diseases, Ulaanbaatar, Mongolia
| | - Claire von Mollendorf
- New Vaccines Group, Murdoch Children's Research Institute, Melbourne, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia
| | - Darmaa Badarch
- National Center of Communicable Diseases, Ulaanbaatar, Mongolia
| | - Kim Mulholland
- New Vaccines Group, Murdoch Children's Research Institute, Melbourne, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia
- London School of Hygiene and Tropical Medicine, London, United Kingdom
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Do L, Tsedenbal N, Khishigmunkh C, Tserendulam B, Altanbumba L, Luvsantseren D, Ulziibayar M, Suuri B, Narangerel D, Tsolmon B, Demberelsuren S, Pell C, Manna S, Satzke C, Nguyen C, Mungun T, von Mollendorf C, Badarch D, Mulholland K. Respiratory Syncytial Virus and Influenza Infections in Children in Ulaanbaatar, Mongolia, 2015-2021. Influenza Other Respir Viruses 2024; 18:e13303. [PMID: 38757258 PMCID: PMC11099724 DOI: 10.1111/irv.13303] [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: 02/06/2024] [Revised: 03/29/2024] [Accepted: 04/16/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND Data available for RSV and influenza infections among children < 2 years in Mongolia are limited. We present data from four districts of Ulaanbaatar from April 2015 to June 2021. METHODS This study was nested in an enhanced surveillance project evaluating pneumococcal conjugate vaccine (PCV13) impact on the incidence of hospitalized lower respiratory tract infections (LRTIs). Our study was restricted to children aged < 2 years with arterial O2 saturation < 93% and children with radiological pneumonia. Nasopharyngeal (NP) swabs collected at admission were tested for RSV and influenza using qRT-PCR. NP swabs of all patients with radiological pneumonia and of a subset of randomly selected NP swabs were tested for S. pneumoniae (S.p.) by qPCR and for serotypes by culture and DNA microarray. RESULTS Among 5705 patients, 2113 (37.0%) and 386 (6.8%) had RSV and influenza infections, respectively. Children aged 2-6 months had a higher percentage of very severe RSV infection compared to those older than 6 months (42.2% versus 31.4%, p-value Fisher's exact = 0.001). S.p. carriage was detected in 1073/2281 (47.0%) patients. Among S.p. carriage cases, 363/1073 (33.8%) had S.p. and RSV codetection, and 82/1073 (7.6%) had S.p. and influenza codetection. S.p. codetection with RSV/influenza was not associated with more severe LRTIs, compared to only RSV/influenza cases. CONCLUSION In Mongolia, RSV is an important pathogen causing more severe LRTI in children under 6 months of age. Codetection of RSV or influenza virus and S.p. was not associated with increased severity.
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Affiliation(s)
- Lien Anh Ha Do
- New Vaccines GroupMurdoch Children's Research InstituteMelbourneAustralia
- Department of PaediatricsThe University of MelbourneParkvilleAustralia
| | - Naranzul Tsedenbal
- Virology DepartmentNational Center of Communicable DiseasesUlaanbaatarMongolia
| | | | | | | | | | | | - Bujinlkham Suuri
- Virology DepartmentNational Center of Communicable DiseasesUlaanbaatarMongolia
| | - Dorj Narangerel
- National Center for Communicable DiseasesMinistry of HealthUlaanbaatarMongolia
| | - Bilegtsaikhan Tsolmon
- Virology DepartmentNational Center of Communicable DiseasesUlaanbaatarMongolia
- Medical DepartmentMongolian National University of Medical SciencesUlaanbaatarMongolia
| | | | - Casey L Pell
- Translational Microbiology GroupMurdoch Children's Research InstituteMelbourneAustralia
| | - Sam Manna
- Translational Microbiology GroupMurdoch Children's Research InstituteMelbourneAustralia
| | - Catherine Satzke
- Department of PaediatricsThe University of MelbourneParkvilleAustralia
- Translational Microbiology GroupMurdoch Children's Research InstituteMelbourneAustralia
- Department of Microbiology and Immunology at the Peter Doherty Institute for Infection and ImmunityThe University of MelbourneMelbourneVictoriaAustralia
| | - Cattram Nguyen
- New Vaccines GroupMurdoch Children's Research InstituteMelbourneAustralia
- Department of PaediatricsThe University of MelbourneParkvilleAustralia
| | - Tuya Mungun
- Virology DepartmentNational Center of Communicable DiseasesUlaanbaatarMongolia
| | - Claire von Mollendorf
- New Vaccines GroupMurdoch Children's Research InstituteMelbourneAustralia
- Department of PaediatricsThe University of MelbourneParkvilleAustralia
| | - Darmaa Badarch
- Virology DepartmentNational Center of Communicable DiseasesUlaanbaatarMongolia
| | - Kim Mulholland
- New Vaccines GroupMurdoch Children's Research InstituteMelbourneAustralia
- Department of PaediatricsThe University of MelbourneParkvilleAustralia
- Infectious Disease Epidemiology & International HealthLondon School of Hygiene and Tropical MedicineLondonUK
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Do LAH, Toh ZQ, Licciardi PV, Mulholland EK. Can early measles vaccination control both measles and respiratory syncytial virus infections? THE LANCET GLOBAL HEALTH 2022; 10:e288-e292. [PMID: 34953518 PMCID: PMC8694706 DOI: 10.1016/s2214-109x(21)00464-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 09/19/2021] [Accepted: 09/24/2021] [Indexed: 12/11/2022] Open
Abstract
Measles virus and respiratory syncytial virus (RSV) are two important global health pathogens causing substantial morbidity and mortality worldwide. The current measles vaccination schedule has the first dose given at 9–12 months of age and the second dose given at 15–18 months of age. Measles outbreaks have been associated with an increase in severe RSV infections in children younger than 6 months, probably as a result of measles-induced immunosuppression. A resurgence in measles cases was already occurring before the COVID-19 pandemic, which has affected global immunisation programmes, resulting in millions of children, mostly in low-income and middle-income countries (LMICs), missing out on their measles vaccine. This will leave many children living in the most vulnerable of circumstances highly susceptible to measles and RSV infections when current COVID-19 public health control measures are lifted. This Viewpoint discusses these issues and highlights the need for urgent action to address this looming crisis. The use of early measles vaccination at 4 months of age could be an effective strategy to prevent severe morbidity and death from both measles and RSV infections in many LMICs.
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Affiliation(s)
- Lien Anh Ha Do
- New Vaccines Group, Murdoch Children's Research Institute, Melbourne, VIC, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia.
| | - Zheng Quan Toh
- New Vaccines Group, Murdoch Children's Research Institute, Melbourne, VIC, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia
| | - Paul Vincent Licciardi
- New Vaccines Group, Murdoch Children's Research Institute, Melbourne, VIC, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia
| | - Edward Kim Mulholland
- New Vaccines Group, Murdoch Children's Research Institute, Melbourne, VIC, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia; Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
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