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Mungall BA, Hoet B, Nieto Guevara J, Soumahoro L. A systematic review of invasive pneumococcal disease vaccine failures and breakthrough with higher-valency pneumococcal conjugate vaccines in children. Expert Rev Vaccines 2021; 21:201-214. [PMID: 34882050 DOI: 10.1080/14760584.2022.2012455] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
INTRODUCTION : The pneumococcal non-typeable Haemophilus influenzae protein D-conjugate vaccine (PHiD-CV or PCV10) and 13-valent pneumococcal conjugate vaccine (PCV13) protect against vaccine-serotype invasive pneumococcal disease (VT IPD). However, VT IPD can still occur in fully or partially vaccinated children (vaccine failure or breakthrough). We performed a systematic review of vaccine failures and breakthrough IPD with PCV10 and PCV13 in ≤5-year-olds. AREAS COVERED : We searched Scopus/Medline/EMBASE to retrieve articles/abstracts published between 1/2008-7/2019. We excluded reports from studies only including data from adults or children ≥6 years, exclusively assessing PCV7-vaccinated children or children with underlying comorbidities. Twenty-six reports (20 PCV13, 1 PCV10, 5 both), covering studies with various designs in six continents, using different schedules, were included. Collectively, these studies reported 469 VT IPD cases classified as vaccine failures and 403 as breakthrough. Vaccine failure and breakthrough rates were low: 8.4% and 9.3%, respectively, of all IPD in vaccinated children, consistent with the vaccines' high effectiveness. The main serotypes associated with vaccine failure or breakthrough were 19A, 3 and 19F in PCV13 studies and 14, 6B and vaccine-related 19A and 6A in PCV10 studies. EXPERT OPINION : As we move to vaccines with more serotypes, it is not only important to consider which serotypes are added, but also to monitor and address incomplete protection against specific serotypes.
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Valdivielso Martínez AI, Ramos Fernández JM, Pérez Frías J, Moreno Pérez D. Influence of pneumococcal vaccination on the hospitalization of healthy pediatric patients due to typical Community-Acquired Pneumonia. Int J Infect Dis 2020; 98:194-199. [PMID: 32553718 DOI: 10.1016/j.ijid.2020.06.034] [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: 04/24/2020] [Revised: 06/09/2020] [Accepted: 06/10/2020] [Indexed: 10/24/2022] Open
Abstract
INTRODUCTION Community-Acquired Pneumonia (CAP) is one of the most frequent causes of hospital admission in children. Our objective is to measure the impact of the introduction of pneumococcal conjugate vaccines on the hospitalization of previously healthy children due to CAP. METHOD From 2011 to 2016, a partially retrospective, prospective, and descriptive study was carried out on healthy pediatric patients (3 months-14 years old) with CAP, who required hospital admission. Clinical, epidemiological, and demographic characteristics were collected, and vaccination status was obtained from medical records. RESULTS A total of 292 cases were included, with a mean age of 33.4 months, 54% males. There was a progressive and significant 42% decrease in the number of admissions each year, without significant changes in the annual percentage of parapneumonic pleural effusion (PPE). Fifty-six percent of patients were immunized with a pneumococcal conjugate vaccine (PCV). The percentage of children who were not vaccinated decreased by 14%, and the coverage with PCV-13 increased by 46%. This revealed a significant increase of PPE in vaccinated patients with PCV-7 (63%) compared with unvaccinated (45%) and with PCV-13 (57%), without association with the presence of severe PPE. Moreover, no significant differences in severity or hospital stay were observed in unvaccinated patients, compared to those who were vaccinated. In >2-year-olds, we observed a significant increase in PPE (59%) compared to 45% in younger children. CONCLUSIONS The increase in vaccination coverage with PCV-13 resulted in a decrease in hospitalizations due to CAP and PPE. Vaccination with PCV-7 is associated in our sample with an increase in PPE but not with severe PPE nor an increase in the hospital stay. There was an epidemiological shift of severe forms of pneumonia and empyema at later ages (>2 years).
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Affiliation(s)
- Ana Isabel Valdivielso Martínez
- Pediatría Distrito Sanitario Málaga-Guadalhorce, Pediatría Hospital Regional Universitario de Málaga, Programa del Doctorado de Universidad de Ciencias de la Salud.
| | - Jose Miguel Ramos Fernández
- Facultativo Especialista de Área de Neuropediatría, Pediatría Hospital Materno-Infantil Regional Universitario de Málaga, Grupo de Investigación IBIMA; Departamento de Pediatría y Farmacología, Facultad de Medicina, Universidad de Málaga
| | - Javier Pérez Frías
- Facultativo Especialista de Área de Neumología pediátrica, Pediatría Hospital Materno-Infantil Regional Universitario de Málaga, Grupo de Investigación IBIMA; Profesor Catedrático del Departamento de Pediatría y Farmacología, Facultad de Medicina, Universidad de Málaga
| | - David Moreno Pérez
- Departamento de Pediatría y Farmacología, Facultad de Medicina, Universidad de Málaga; Infectología Pediátrica e Inmunodeficiencias, UGC Pediatría, Hospital Materno-Infantil, Hospital Regional Universitario de Málaga, Málaga, Spain; Grupo de Investigación IBIMA; Red de Investigación Translacional en Infectología Pediátrica (RITIP)
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Ceyhan M, Aykac K, Gurler N, Ozsurekci Y, Öksüz L, Altay Akısoglu Ö, Öz FN, Emiroglu M, TurkDagi H, Yaman A, Söyletir G, Öztürk C, Akpolat N, Özakin C, Aydın F, Aydemir Ş, Kiremitci A, Gültekin M, Camcıoglu Y, Zer Y, Güdücüoğlu H, Gülay Z, Birinci A, Arabaci C, Karbuz A, Devrim I, Sorguc Y, Baysan BÖ, Karadag Oncel E, Yilmaz N, Altintop YA. Serotype distribution of Streptococcus pneumonia in children with invasive disease in Turkey: 2015-2018. Hum Vaccin Immunother 2020; 16:2773-2778. [PMID: 32530357 PMCID: PMC7734139 DOI: 10.1080/21645515.2020.1747931] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Objectives: To determine the serotype distribution of pneumococcus causing invasive pneumococcal disease (meningitidis, bacteremia and empyema) in children in Turkey, and to observe potential changes in this distribution in time to guide effective vaccine strategies. Methods: We surveyed S. pneumoniae with conventional bacteriological techniques and with real-time polymerase chain reaction (RT-PCR) in samples of cerebrospinal fluid (CSF), blood and pleural fluid. S. pneumoniae strains were isolated from 33 different hospitals in Turkey, which are giving health services to approximately 60% of the Turkish population. Results: A total of 167 cases were diagnosed with invasive pneumococcal disease between 2015 and 2018. We diagnosed 52 (31.1%) patients with meningitis, 104 (62.2%) patients with bacteremia, and 11 (6.6%) patients with empyema. Thirty-three percent of them were less than 2 years old and 56% less than 5 years old. Overall PCV13 serotypes accounted for 56.2% (94/167). The most common serotypes were 19 F (11.9%), 1 (10.7%) and 3 (10.1%). Conclusions: Besides the increasing frequency of non-vaccine serotypes, vaccine serotypes continue to be a problem for Turkey despite routine and high-rate vaccination with PCV13 and significant reduction reported for the incidence of IPD in young children. Since new candidate pneumococcal conjugate vaccines with more serotype antigens are being developed, continuing IPD surveillance is a significant source of information for decision-making processes on pneumococcal vaccination.
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Affiliation(s)
- Mehmet Ceyhan
- Department of Pediatric Infectious Diseases, Hacettepe University , Ankara, Turkey
| | - Kubra Aykac
- Department of Pediatric Infectious Diseases, Hacettepe University , Ankara, Turkey
| | - Nezahat Gurler
- Department of Microbiology and Clinical Microbiology, Istanbul University , Istanbul, Turkey
| | - Yasemin Ozsurekci
- Department of Pediatric Infectious Diseases, Hacettepe University , Ankara, Turkey
| | - Lütfiye Öksüz
- Department of Microbiology and Clinical Microbiology, Istanbul University , Istanbul, Turkey
| | - Özlem Altay Akısoglu
- Department of Microbiology, Dr. Sami Ulus Children's Health and Diseases Training and Research Hospital , Ankara, Turkey
| | - Fatma Nur Öz
- Department of Pediatric Infectious Diseases, Dr. Sami Ulus Children's Health and Diseases Training and Research Hospital , Ankara, Turkey
| | - Melike Emiroglu
- Department of Pediatric Infectious Diseases, Selcuk University , Konya, Turkey
| | - Hatice TurkDagi
- Department of Microbiology, Selcuk University , Konya, Turkey
| | - Akgün Yaman
- Department of Microbiology, Cukurova University , Adana, Turkey
| | - Güner Söyletir
- Department of Microbiology, Marmara University Pendik Training and Research Hospital , Istanbul, Turkey
| | - Candan Öztürk
- Department of Microbiology, Mersin University , Mersin, Turkey
| | - Nezahat Akpolat
- Department of Microbiology, Dicle University , Diyarbakır, Turkey
| | - Cüneyt Özakin
- Department of Microbiology, Uludag University , Bursa, Turkey
| | - Faruk Aydın
- Department of Microbiology, Karadeniz Technical University , Trabzon, Turkey
| | - Şöhret Aydemir
- Department of Microbiology, Ege University , Izmir, Turkey
| | | | - Meral Gültekin
- Department of Microbiology, Akdeniz University , Antalya, Turkey
| | - Yıldız Camcıoglu
- Department of Pediatric Infectious Disease, Istanbul University Cerrahpasa , Istanbul, Turkey
| | - Yasemin Zer
- Department of Microbiology, Gaziantep University , Gaziantep, Turkey
| | | | - Zeynep Gülay
- Department of Microbiology, Dokuz Eylül University , Izmir, Turkey
| | - Asuman Birinci
- Department of Microbiology, Samsun Ondokuz Mayıs University , Samsun, Turkey
| | - Cigdem Arabaci
- Department of Microbiology, Okmeydani Education and Research Hospital , Istanbul, Turkey
| | - Adem Karbuz
- Department of Pediatric Infectious Diseases, Okmeydani Education and Research Hospital , Istanbul, Turkey
| | - Ilker Devrim
- Department of Pediatric Infectious Diseases, Dr. Behçet Uz Children's Hospital , İzmir, Turkey
| | - Yelda Sorguc
- Department of Microbiology, Dr. Behçet Uz Children's Hospital , İzmir, Turkey
| | | | - Eda Karadag Oncel
- Department of Pediatric Infectious Diseases, University of Health Sciences, Tepecik Training and Research Hospital , İzmir, Turkey
| | - Nisel Yilmaz
- Department of Microbiology, University of Health Sciences, Tepecik Training and Research Hospital , İzmir, Turkey
| | - Yasemin Ay Altintop
- Department of Microbiology, Kayseri Training and Research Hospital , Kayseri, Turkey
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Invasive Streptococcus pneumoniae Infections and Vaccine Failures in Children in Ireland From the Postvaccine Era From 2007 to 2018. Pediatr Infect Dis J 2020; 39:339-344. [PMID: 31815827 DOI: 10.1097/inf.0000000000002549] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Invasive pneumococcal disease (IPD) causes life-threatening illnesses including meningitis and bloodstream infection. Here, we report the impact of 7- and 13-valent pneumococcal conjugate vaccines (PCV7/PCV13) after introduction into the Irish pediatric immunization schedule in 2008 and 2010, respectively, and the clinical details surrounding suspected PCV vaccine failures. METHODS Serotyping and antimicrobial susceptibility testing of all culture-confirmed cases referred from children <16 years of age from July 2007 to June 2018 were assessed. Surveillance data were assessed to identify any potential vaccine failures. RESULTS The number of IPD cases has decreased by >50% since the introduction of PCVs. The most significant decline PCV serotypes in children <2 years of age, with a 97% decline in PCV7 serotypes, incidence rate ratio (IRR) 0.03, 95% confidence interval (CI): 0.00-0.21; and a 78% decline PCV13-only (PCV13-7) serotypes, IRR 0.22, 95% CI: 0.05-1.04, respectively. However, there has been an increase in non-PCV13 serotypes in children <2 years during the same period (IRR: 2.82, 95% CI: 1.02-7.84; P = 0.0463), with similar serotype trends observed for those 2-4 and 5-15 years of age. There were no clear vaccine replacement serotypes, instead a number of different serotypes emerged. Sixteen vaccine failures were identified, 10 of which were postbooster vaccine failures. Most failures were serotype 19A and resistant to antimicrobials. CONCLUSIONS Further reducing the incidence of IPD is more challenging as the number of non-PCV13 serotypes has expanded and is now less susceptible to antimicrobials. Consequently, higher valency or broader target vaccines are now required to further prevent IPD in children.
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Increase in Streptococcus pneumoniae serotype 3 associated parapneumonic pleural effusion/empyema after the introduction of PCV13 in Germany. Vaccine 2019; 38:570-577. [PMID: 31735502 DOI: 10.1016/j.vaccine.2019.10.056] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 10/19/2019] [Accepted: 10/21/2019] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Pediatric pneumococcal pneumonia complicated by parapneumonic pleural effusion/empyema (PPE/PE) remains a major concern despite general immunization with pneumococcal conjugate vaccines (PCVs). METHODS In a nationwide pediatric hospital surveillance study in Germany we identified 584 children <18 years of age with bacteriologically confirmed PPE/PE from October 2010 to June 2018. Streptococcus pneumoniae was identified by culture and/or PCR of blood samples and/or pleural fluid and serotyped. RESULTS S. pneumoniae was identified in 256 of 584 (43.8%) children by culture (n = 122) and/or PCR (n = 207). The following pneumococcal serotypes were detected in 114 children: serotype 3 (42.1%), 1 (25.4%), 7F (12.3%), 19A (7.9%), other PCV13 serotypes (4.4%) and non-PCV13 serotypes (7.9%). Between October 2010 and June 2014 serotype 1 (38.1%) and serotype 3 (25.4%) were most prevalent, whereas between July 2014 and June 2018 serotype 3 (62.7%) and non-PCV13 serotypes (15.7%) were dominant. Compared to children with other pneumococcal serotypes, children with serotype 3 associated PPE/PE were younger (median 3.2 years [IQR 2.1-4.3 years] vs. median 5.6 years [IQR 3.8-8.2 years]; p < 0.001) and more frequently admitted to intensive care (43 [89.6%] vs. 48 [73.8%]; p = 0.04). Seventy-six of 114 (66.7%) children with pneumococcal PPE/PE had been vaccinated with pneumococcal vaccines. Thirty-nine of 76 (51.3%) had received a vaccine covering the serotype detected. Thirty of these 39 breakthrough cases were age-appropriately vaccinated with PCV13 and considered vaccine failures, including 26 children with serotype 3, three children with serotype 19A and one child with serotype 1. CONCLUSION Following the introduction of PCV13 in general childhood vaccination we observed a strong emergence of serotype 3 associated PPE/PE in the German pediatric population, including a considerable number of younger children with serotype 3 vaccine breakthrough cases and failures. Future PCVs should not only cover newly emerging serotypes, but also include a more effective component against serotype 3.
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Kaplan SL, Barson WJ, Lin PL, Romero JR, Bradley JS, Tan TQ, Pannaraj PS, Givner LB, Hulten KG. Invasive Pneumococcal Disease in Children's Hospitals: 2014-2017. Pediatrics 2019; 144:peds.2019-0567. [PMID: 31420369 DOI: 10.1542/peds.2019-0567] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/17/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The 13-valent pneumococcal conjugate vaccine (PCV13) was licensed in the United States in 2010. We describe invasive pneumococcal disease (IPD) in children at 8 children's hospitals in the US from 2014 to 2017. METHODS Children with IPD occurring from 2014 to 2017 were identified from a prospective study. Demographic and clinical data, including results of any immune evaluation along with the number and dates of previous pneumococcal conjugate vaccines administered, were recorded on case report forms. Isolate serotypes were determined in a central laboratory. Pneumococcal conjugate vaccine doses were counted if IPD occurred ≥2 weeks after a dose. RESULTS PCV13 serotypes accounted for 23.9% (115 out of 482) of IPD isolates from 2014 to 2017. Serotypes 3, 19A, and 19F accounted for 91% of PCV13 serotypes. The most common non-PCV13 serotypes were 35B, 23B, 33F, and 22F. An underlying condition was significantly (P < .0001) more common in children with IPD due to non-PCV13 serotypes (200 out of 367, 54.5%) than for children with PCV13 serotypes (27 out of 115, 23.5%). An immune evaluation was undertaken in 28 children who received ≥2 PCV13 doses before IPD caused by a PCV13 serotype. Only 1 was found to have an immunodeficiency. CONCLUSIONS PCV13 serotypes (especially serotypes 3, 19A, and 19F) continue to account for nearly a quarter of IPD in US children 4 to 7 years after PCV13 was introduced. Underlying conditions are more common in children with non-PCV13 serotype IPD. Immune evaluations in otherwise healthy children with PCV13 serotype IPD despite receiving ≥2 PCV13 doses did not identify an immunodeficiency.
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Affiliation(s)
- Sheldon L Kaplan
- Department of Pediatrics, Pediatric Infectious Diseases Section, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas;
| | - William J Barson
- Department of Pediatrics, Nationwide Children's Hospital and College of Medicine and Public Health, The Ohio State University, Columbus, Ohio
| | - Philana Ling Lin
- Department of Pediatrics, Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - José R Romero
- Department of Pediatrics, Arkansas Children's Hospital and University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - John S Bradley
- Department of Pediatrics, Rady Children's Hospital-San Diego and University of California, San Diego, San Diego, California
| | - Tina Q Tan
- Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital of Chicago and Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Pia S Pannaraj
- Department of Pediatrics, Children's Hospital Los Angeles and School of Medicine, University of Southern California, Los Angeles, California; and
| | - Laurence B Givner
- Department of Pediatrics, Brenner Children's Hospital and Wake Forest School of Medicine, Wake Forest University, Winston-Salem, North Carolina
| | - Kristina G Hulten
- Department of Pediatrics, Pediatric Infectious Diseases Section, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas
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Levy C, Varon E, Ouldali N, Béchet S, Bonacorsi S, Cohen R. Changes in Invasive Pneumococcal Disease Spectrum After 13-Valent Pneumococcal Conjugate Vaccine Implementation. Clin Infect Dis 2019; 70:446-454. [DOI: 10.1093/cid/ciz221] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 03/13/2019] [Indexed: 01/28/2023] Open
Affiliation(s)
- Corinne Levy
- Association Clinique et Thérapeutique Infantile du Val-de-Marne, Saint Maur-des-Fossés
- Groupe de Pathologie Infectieuse Pédiatrique, Paris
- Université Paris Est, Institut Mondor de Recherche Biomédicale - Groupe de Recherche Clinique, Groupe d’Etude des Maladies Infectieuses Néonatales et Infantiles, Créteil
- Clinical Research Center, Créteil
| | - Emmanuelle Varon
- National Reference Center for Pneumococci, Centre Hospitalier Intercommunal de Créteil
| | - Naim Ouldali
- Association Clinique et Thérapeutique Infantile du Val-de-Marne, Saint Maur-des-Fossés
- Groupe de Pathologie Infectieuse Pédiatrique, Paris
- Unité d’épidémiologie clinique, Assistance Publique–Hôpitaux de Paris (AP-HP), Hôpital Robert Debré, Epidémiologie Clinique et Evaluation Economique Appliquée aux Populations Vulnérables Institut National de la Santé et de la Recherche Médicale Unité Mixte de Recherche, Paris
- Urgences pédiatriques, Hôpital Necker Enfants Malades, Université Paris Descartes
| | - Stéphane Béchet
- Association Clinique et Thérapeutique Infantile du Val-de-Marne, Saint Maur-des-Fossés
- Université Paris Est, Institut Mondor de Recherche Biomédicale - Groupe de Recherche Clinique, Groupe d’Etude des Maladies Infectieuses Néonatales et Infantiles, Créteil
- Clinical Research Center, Créteil
| | - Stéphane Bonacorsi
- Université Paris Diderot, Sorbonne Paris Citépital Robert-Debré, Paris
- Service de Microbiologie, AP-HP, Hôpital Robert-Debré, Paris
| | - Robert Cohen
- Association Clinique et Thérapeutique Infantile du Val-de-Marne, Saint Maur-des-Fossés
- Groupe de Pathologie Infectieuse Pédiatrique, Paris
- Université Paris Est, Institut Mondor de Recherche Biomédicale - Groupe de Recherche Clinique, Groupe d’Etude des Maladies Infectieuses Néonatales et Infantiles, Créteil
- Clinical Research Center, Créteil
- Unité Court Séjour, Petits nourrissons, Service de Néonatalogie, Centre Hospitalier Intercommunal de Créteil, France
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Rybak A, Vié le Sage F, Béchet S, Werner A, Thiebault G, Bakhache P, Virey B, Caulin E, Cohen R, Levy C. Timeliness of routine immunization in non-preterm children less than 2 years old using electronic data capture in an ambulatory setting in France in the context of vaccine hesitancy. Arch Pediatr 2019; 26:56-64. [DOI: 10.1016/j.arcped.2018.11.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 10/19/2018] [Accepted: 11/17/2018] [Indexed: 10/27/2022]
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Genome-wide analysis of Streptococcus pneumoniae serogroup 19 in the decade after the introduction of pneumococcal conjugate vaccines in Australia. Sci Rep 2018; 8:16969. [PMID: 30446692 PMCID: PMC6240094 DOI: 10.1038/s41598-018-35270-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 10/18/2018] [Indexed: 11/09/2022] Open
Abstract
The decline in invasive pneumococcal disease (IPD), following the introduction of the 7-valent pneumococcal conjugate vaccination (PCV-7), was tempered by emergence of non-vaccine serotypes, particularly 19A. In Australia, three years after PCV-7 was replaced by PCV-13, containing 19A and 19F antigens, serogroup 19 was still a prominent cause of IPD in children under five. In this study we examined the evolution of serogroup 19 before and after introduction of paediatric vaccines in New South Wales (NSW), Australia. Genomes of 124 serogroup 19 IPD isolates collected before (2004) and after introduction of PCV-7 (2008) and PCV-13 (2014), from children under five in NSW, were analysed. Eleven core genome sequence clusters (cgSC) and 35 multilocus sequence types (ST) were identified. The majority (78/124) of the isolates belonged to four cgSCs: cgSC7 (ST199), cgSC11 (ST320), cgSC8 (ST63) and cgSC9 (ST2345). ST63 and ST2345 were exclusively serotype 19A and accounted for its predominantly intermediate penicillin resistance; these two clusters first appeared in 2008 and largely disappeared after introduction of PCV-13. Serogroup 19 was responsible for the highest proportion of vaccine failures in NSW. Relatively low immunogenicity of serogroup 19 antigens and Australia's three-dose vaccine schedule could affect the population dynamics of this serogroup.
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Outpacing the pneumococcus: Antibody dynamics in the first few days following pneumococcal capsular antigen stimulation. Sci Rep 2018; 8:15376. [PMID: 30337597 PMCID: PMC6193966 DOI: 10.1038/s41598-018-33735-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 09/19/2018] [Indexed: 11/08/2022] Open
Abstract
Children in developing countries are frequently exposed to the pneumococcus, but few develop invasive pneumococcal disease (IPD). We test the hypothesis that natural variation exists in the rapidity of IgG responses following exposure to pneumococcal polysaccharides, and that these differences are sufficiently great to affect susceptibility to and outcome of IPD. We recruited children aged 24–36 months, who had recovered from IPD, and age-matched healthy controls and vaccinated them with 1 dose of the 23-valent PPV to mimic natural exposure. We collected serum samples after vaccination and analysed the dynamics of anti-polysaccharide antibody responses to several capsular antigens. Mean IgG response times to different serotypes were 6.4–7.3 days, with standard deviations of 0.9–1.85 days, suggesting a natural range in response times of up to 7 days. Serotype 1 elicited the largest fold-rise, serotype 23F the smallest. The proportion of responses achieved by day 7 was similar in children with a history of IPD and healthy children. There was considerable natural variation in the rapidity of anti-capsular IgG responses extending over 4–7 days. There was no evidence to suggest that children who have experienced IPD respond more slowly to heterologous pneumococcal capsular antigens than do healthy children.
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Characteristics of Streptococcus pneumoniae serotype 19A isolates from children in the pre and post Conjugate Vaccine Era. Single center experience 1986–2015. Vaccine 2018; 36:5245-5250. [DOI: 10.1016/j.vaccine.2018.07.055] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 07/20/2018] [Accepted: 07/23/2018] [Indexed: 12/30/2022]
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Changes in the Nature and Severity of Invasive Pneumococcal Disease in Children Before and After the Seven-valent and Thirteen-valent Pneumococcal Conjugate Vaccine Programs in Calgary, Canada. Pediatr Infect Dis J 2018; 37:22-27. [PMID: 28737622 DOI: 10.1097/inf.0000000000001709] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Since the introduction of childhood pneumococcal conjugate vaccines, invasive pneumococcal disease (IPD) incidence has decreased in children and the predominant serotypes causing disease have changed. This study describes changes in the clinical features of IPD in children (<18 years) before and after the conjugate vaccine introduction. METHODS The Calgary Area Streptococcus pneumoniae Epidemiology Research study collects information on all IPD cases in Calgary, Alberta, Canada. Descriptive and regression analyses were used to compare IPD in the pre-vaccine (January 2000 to August 2002), post-7-valent protein-polysaccharide conjugate vaccine (September 2002 to June 2010) and post-13-valent protein-polysaccharide conjugate vaccine (PCV13) (July 2010 to December 2015) periods; intensive care unit and inpatient admissions were outcome measures. RESULTS The incidence of IPD in children (<18 years) decreased from an average of 17 cases/100,000/yr in 2000-2001 to 4 cases/100,000/yr in 2015. The median age of children presenting with IPD shifted from 2.0 years (interquartile range: 2.5) in the pre-vaccine period to 3.9 years (interquartile range: 6.2) in the post-PCV13 period. The proportion of children with a comorbidity that is an indication for pneumococcal vaccination did not change. Invasive disease with focus (meningitis, pneumonia, empyema, peritonitis) compared with invasive disease with bacteremia only increased from 44.6% in pre-vaccine to 64.0% and 61.4% in the post-7-valent protein-polysaccharide conjugate vaccine and post-PCV13 periods, respectively (P = 0.017). Having IPD in the post-PCV13 period compared with the pre-vaccine period was associated with an increased odds of hospitalization [Odds ratio (OR): 2.9; 95% Confidence Interval (CI): 1.4-6.2]. CONCLUSIONS Clinical features of IPD have changed since pneumococcal conjugate vaccines were introduced, with a shift toward more focal infections requiring hospitalization. Although overall IPD cases have declined, disease that does occur appears to be more severe.
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Alari A, Chaussade H, Domenech De Cellès M, Le Fouler L, Varon E, Opatowski L, Guillemot D, Watier L. Impact of pneumococcal conjugate vaccines on pneumococcal meningitis cases in France between 2001 and 2014: a time series analysis. BMC Med 2016; 14:211. [PMID: 27998266 PMCID: PMC5175381 DOI: 10.1186/s12916-016-0755-7] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 11/23/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pneumococcal meningitis (PM) is a major invasive pneumococcal disease. Two pneumococcal conjugate vaccines (PCVs) have been introduced in France: PCV7 was recommended in 2003 and replaced in 2010 by PCV13, which has six additional serotypes. The impact of introducing those vaccines on the evolution of PM case numbers and serotype distributions in France from 2001 to 2014 is assessed herein. METHODS Data on 5166 Streptococcus pneumoniae strains isolated from cerebrospinal fluid between 2001 and 2014 in the 22 regions of France were obtained from the National Reference Center for Pneumococci. The effects of the different vaccination campaigns were estimated using time series analyses through autoregressive moving-average models with exogenous variables ("flu-like" syndromes incidence) and intervention functions. Intervention functions used 11 dummy variables representing each post vaccine epidemiological period. The evolution of serotype distributions was assessed for the entire population and the two most exposed age groups (<5 and > 64 years old). RESULTS For the first time since PCV7 introduction in 2003, total PM cases decreased significantly after starting PCV13 use: -7.1 (95% CI, -10.85 to -3.35) cases per month during 2013-2014, and was confirmed in children < 5 years old (-3.5; 95% CI, -4.81 to -2.13) and adults > 64 years old (-2.0; 95% CI, -3.36 to -0.57). During 2012-2014, different non-vaccine serotypes emerged: 12F, 24F in the entire population and children, 6C in the elderly; serotypes 3 and 19F persisted in the entire population. CONCLUSIONS Unlike other European countries, the total PM cases in France declined only after introduction of PCV13. This suggests that vaccine pressure alone does not explain pneumococcal epidemiological changes and that other factors could play a role. Serotype distribution had changed substantially compared to the pre-vaccine era, as in other European countries, but very differently from the US. A highly reactive surveillance system is thus necessary not only to monitor evolutions due to vaccine pressure and to verify the local serotypic appropriateness of new higher-valent pneumococcal vaccines, but also to recognise and prevent unexpected changes due to other internal or external factors.
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Affiliation(s)
- Anna Alari
- Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases (B2PHI), Inserm, UVSQ, Institut Pasteur, Université Paris-Saclay, Paris, France
| | - Hélène Chaussade
- Service de Médecine Interne et Maladies Infectieuses, Hôpital Bretonneau CHRU de Tours, Tours, France
| | - Matthieu Domenech De Cellès
- Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases (B2PHI), Inserm, UVSQ, Institut Pasteur, Université Paris-Saclay, Paris, France
| | - Lénaig Le Fouler
- Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases (B2PHI), Inserm, UVSQ, Institut Pasteur, Université Paris-Saclay, Paris, France
| | - Emmanuelle Varon
- National Reference Center for Pneumococci, APHP, Paris, France
- Hôpital Européen Georges-Pompidou, Laboratoire de Microbiologie Clinique, APHP, Paris, France
| | - Lulla Opatowski
- Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases (B2PHI), Inserm, UVSQ, Institut Pasteur, Université Paris-Saclay, Paris, France
| | - Didier Guillemot
- Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases (B2PHI), Inserm, UVSQ, Institut Pasteur, Université Paris-Saclay, Paris, France
- APHP, Hôpital Raymond-Poincaré, Unité Fonctionnelle de Santé Publique (D.G.), Garches, France
| | - Laurence Watier
- Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases (B2PHI), Inserm, UVSQ, Institut Pasteur, Université Paris-Saclay, Paris, France
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Cohen R, Biscardi S, Levy C. The multifaceted impact of pneumococcal conjugate vaccine implementation in children in France between 2001 to 2014. Hum Vaccin Immunother 2016; 12:277-84. [PMID: 26905678 DOI: 10.1080/21645515.2015.1116654] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
In 2003, France was the first European country to recommend 7-valent pneumococcal conjugate vaccine (PCV7) for a large proportion of healthy children. With complicated recommendations, the vaccine coverage during the first 4 y of implementation was low, then progressively increased to reach 90% in 2008. The aim of this review was to describe the particular impact of PCVs in a country where the vaccine coverage was initially suboptimal. After PCV7 implementation, the PCV7 serotypes nearly disappeared among pneumococci isolated from meningitis (-73%), other invasive pneumococcal disease (IPD; -90%) and pneumococcal carriage (-97%). Consequently, the rates of penicillin-resistant strains declined. However, because of important serotype replacement, the global effect on the incidence of meningitis (-31%) or other IPD (-14%) was modest and observed only in young children < 2 y old. After PCV13 transition, with immediate high vaccine coverage, the vaccine had an important impact on all pneumococcal disease: reduction of -20% for pneumococcal meningitis, -36% for non-meningitis IPD, -32% for community acquired pneumonia and -15% for S. pneumoniae carriage. These findings underline the complexity of pneumococcal epidemiology and the importance of high and fast vaccination coverage to obtain the optimal effect of PCVs.
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Affiliation(s)
- Robert Cohen
- a Université Paris Est ; IMRB- GRC GEMINI ; Créteil , France.,b ACTIV; Association Clinique et Thérapeutique Infantile du Val de Marne ; Saint-Maur des Fossés , France.,c Clinical Research Center (CRC) ; Centre Hospitalier Intercommunal de Créteil ; Créteil , France.,d Unité Court Séjour; Petits Nourrissons ; Service de Néonatologie; Centre Hospitalier Intercommunal de Créteil ; France.,e GPIP (Groupe de Pathologie Infectieuse Pédiatrique) de la SFP (Société Française de Pédiatrie) ; Paris , France
| | - Sandra Biscardi
- a Université Paris Est ; IMRB- GRC GEMINI ; Créteil , France.,c Clinical Research Center (CRC) ; Centre Hospitalier Intercommunal de Créteil ; Créteil , France.,e GPIP (Groupe de Pathologie Infectieuse Pédiatrique) de la SFP (Société Française de Pédiatrie) ; Paris , France.,f Service des urgences pédiatriques ; Centre Hospitalier Intercommunal de Créteil ; Créteil , France
| | - Corinne Levy
- a Université Paris Est ; IMRB- GRC GEMINI ; Créteil , France.,b ACTIV; Association Clinique et Thérapeutique Infantile du Val de Marne ; Saint-Maur des Fossés , France.,c Clinical Research Center (CRC) ; Centre Hospitalier Intercommunal de Créteil ; Créteil , France.,e GPIP (Groupe de Pathologie Infectieuse Pédiatrique) de la SFP (Société Française de Pédiatrie) ; Paris , France
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Tanır Basaranoglu S, Karadag Oncel E, Aykac K, Ozsurekci Y, Cengiz AB, Kara A, Ceyhan M. Invasive pneumococcal disease: From a tertiary care hospital in the post-vaccine era. Hum Vaccin Immunother 2016; 13:962-964. [PMID: 27905836 DOI: 10.1080/21645515.2016.1256519] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
A breakthrough infection occurring with 13-valent pneumococcal conjugate vaccine (PCV13) in Turkey are previously described. A breakthrough infection is defined as IPD in a child who had received ≥ 1 PCV-7 or PCV-13 and for which the pneumococcal isolate was a vaccine serotype. During one year period, among 6 patients with invasive pneumococcal infection, 2 patients were considered to have a vaccine failure with serotype 19F. Antibiotic resistance results were remarkable; macrolide resistance were observed in all strains except one, and high and intermediate penicillin resistance were determined in 2 strains.
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Affiliation(s)
- Sevgen Tanır Basaranoglu
- a Department of Pediatric Infectious Diseases , Hacettepe University Faculty of Medicine , Ankara , Turkey
| | - Eda Karadag Oncel
- a Department of Pediatric Infectious Diseases , Hacettepe University Faculty of Medicine , Ankara , Turkey
| | - Kubra Aykac
- a Department of Pediatric Infectious Diseases , Hacettepe University Faculty of Medicine , Ankara , Turkey
| | - Yasemin Ozsurekci
- a Department of Pediatric Infectious Diseases , Hacettepe University Faculty of Medicine , Ankara , Turkey
| | - Ali Bülent Cengiz
- a Department of Pediatric Infectious Diseases , Hacettepe University Faculty of Medicine , Ankara , Turkey
| | - Ates Kara
- a Department of Pediatric Infectious Diseases , Hacettepe University Faculty of Medicine , Ankara , Turkey
| | - Mehmet Ceyhan
- a Department of Pediatric Infectious Diseases , Hacettepe University Faculty of Medicine , Ankara , Turkey
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Oligbu G, Hsia Y, Folgori L, Collins S, Ladhani S. Pneumococcal conjugate vaccine failure in children: A systematic review of the literature. Vaccine 2016; 34:6126-6132. [PMID: 27838066 DOI: 10.1016/j.vaccine.2016.10.050] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 10/12/2016] [Accepted: 10/20/2016] [Indexed: 01/22/2023]
Abstract
BACKGROUND Pneumococcal conjugate vaccines (PCVs) are highly effective in preventing pneumococcal invasive disease (IPD) due to serotypes included in the vaccines. The risk of vaccine-type IPD in immunised children (i.e. vaccine failure) has not been systematically assessed in countries with established PCV programmes. METHODS We undertook a systematic review of the English literature published from January 2000 to April 2016 to evaluate the vaccine schedule, risk factors, serotype distribution, clinical presentation and outcomes of vaccine failure in children vaccinated with the 7-valent (PCV7), 10-valent (PCV10), and 13-valent (PCV13) vaccines. Data sources included MEDLINE, EMBASE, Cochrane library, and references within identified articles. RESULTS We identified 1742 potential studies and included 20 publications involving 7584 participants in children aged ⩽5year-olds: 5202 received 2 doses followed by a booster in 10 studies, (68.6%), 64 (0.8%) received 3 doses without a booster in 2 studies, and 2318 received a 3+1 schedule (30.6%) in 8 studies. A total of 159 vaccine failure cases were identified, representing 2.1% [95% CI: 1.8-2.4%] of the reported IPD cases. Most studies did not report clinical characteristics or outcomes. Among eight studies reporting comorbidities, 33/77 patients (42.9%) had an underlying condition. The main serotypes associated with vaccine failure were 19F (51/128 cases with known serotype; 39.8%), 6B (33/128; 25.8%), and 4 (10/128; 7.8%). Only five studies reported patient outcomes, with a crude case fatality rate of 2.4% (2/85; 95%CI: 0.3-8.5%). CONCLUSION Pneumococcal conjugate vaccines have been implemented in national immunisation programmes for more than a decade, yet there are only a few studies reporting vaccine failure. PCV failure is rare, irrespective of vaccine or schedule. Co-morbidity prevalence was high amongst vaccine failure cases but case fatality rate was relatively low. There is a need for more systematic reporting vaccine failure cases in countries with established pneumococcal vaccination programmes.
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Affiliation(s)
- Godwin Oligbu
- Paediatric Infectious Disease Research Group, St. George's University of London, United Kingdom
| | - Yingfen Hsia
- Paediatric Infectious Disease Research Group, St. George's University of London, United Kingdom.
| | - Laura Folgori
- Paediatric Infectious Disease Research Group, St. George's University of London, United Kingdom
| | - Sarah Collins
- Immunisation, Hepatitis, and Blood Safety Department, Public Health of England, United Kingdom
| | - Shamez Ladhani
- Paediatric Infectious Disease Research Group, St. George's University of London, United Kingdom; Immunisation, Hepatitis, and Blood Safety Department, Public Health of England, United Kingdom
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Kayemba‐Kay's S, Badran AM, Lagneaux C, Kovacs T, Heron A. Streptococcus pneumoniae serotype 19A meningitis in well-vaccinated immunocompetent 13-month-old child: a case of PCV13 failure. Clin Case Rep 2016; 4:1023-1025. [PMID: 27830065 PMCID: PMC5093155 DOI: 10.1002/ccr3.660] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Revised: 04/21/2016] [Accepted: 07/24/2016] [Indexed: 11/21/2022] Open
Abstract
We report a 13-month-old immune-competent male child who was diagnosed with pneumococcal serotype 19A meningitis despite having received three PCV13 injections. Clinicians are reminded that bacterial meningitis can still occur, even in correctly vaccinated children. Investigations should include immune system screening along with abdominal ultrasound to exclude asplenia.
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Affiliation(s)
- Simon Kayemba‐Kay's
- Paediatrics & Neonatal Medicine DepartmentVictor Jousselin HospitalDreuxFrance
- Unité de Recherche Clinique URC28DreuxFrance
| | - Abdul Monem Badran
- Paediatrics & Neonatal Medicine DepartmentVictor Jousselin HospitalDreuxFrance
| | - Cécile Lagneaux
- Paediatrics DepartmentCHU de BicêtreLe Kremlin BicetreFrance
| | - Tamas Kovacs
- Paediatrics & Neonatal Medicine DepartmentVictor Jousselin HospitalDreuxFrance
| | - Anne Heron
- Unité de Recherche Clinique URC28DreuxFrance
- Université Paris‐DescartesParisFrance
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