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Mackenzie GA, McLellan J, Machuka E, Ndiaye M, Pathirana J, Fombah A, Abatan B, Hossain I, Manjang A, Greenwood B, Hill P. Aetiology of lobar pneumonia determined by multiplex molecular analyses of lung and pleural aspirate specimens in the Gambia: findings from population-based pneumonia surveillance. BMJ Open 2022; 12:e056706. [PMID: 35273059 PMCID: PMC8915295 DOI: 10.1136/bmjopen-2021-056706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES To determine the causes of lobar pneumonia in rural Gambia. DESIGN AND SETTING Population-based pneumonia surveillance at seven peripheral health facilities and two regional hospitals in rural Gambia. 7-valent pneumococcal conjugate vaccine (PCV7) was introduced routinely in August 2009 and replaced by PCV13 from May 2011. METHODS Prospective pneumonia surveillance was undertaken among all ages with referral of suspected pneumonia cases to the regional hospitals. Blood culture and chest radiographs were performed routinely while lung or pleural aspirates were collected from selected, clinically stable patients with pleural effusion on radiograph and/or large, dense, peripheral consolidation. We used conventional microbiology, and from 8 April 2011 to 17 July 2012, used a multiplex PCR assay on lung and pleural aspirates. We calculated proportions with pathogens, associations between coinfecting pathogens and PCV effectiveness. PARTICIPANTS 2550 patients were admitted with clinical pneumonia; 741 with lobar pneumonia or pleural effusion. We performed 181 lung or pleural aspirates and multiplex PCR on 156 lung and 4 pleural aspirates. RESULTS Pathogens were detected in 116/160 specimens, the most common being Streptococcus pneumoniae(n=68), Staphylococcus aureus (n=26) and Haemophilus influenzae type b (n=11). Bacteria (n=97) were more common than viruses (n=49). Common viruses were bocavirus (n=11) and influenza (n=11). Coinfections were frequent (n=55). Moraxella catarrhalis was detected in eight patients and in every case there was coinfection with S. pneumoniae. The odds ratio of vaccine-type pneumococcal pneumonia in patients with two or three compared with zero doses of PCV was 0.17 (95% CI 0.06 to 0.51). CONCLUSIONS Lobar pneumonia in rural Gambia was caused primarily by bacteria, particularly S. pneumoniae and S. aureus. Coinfection was common and M. catarrhalis always coinfected with S. pneumoniae. PCV was highly efficacious against vaccine-type pneumococcal pneumonia.
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Affiliation(s)
- Grant Austin Mackenzie
- Disease Control and Elimination, Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, Gambia
- Infection and Immunity, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Faculty of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Jessica McLellan
- Disease Control and Elimination, Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, Gambia
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Eunice Machuka
- Disease Control and Elimination, Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, Gambia
| | - Malick Ndiaye
- Disease Control and Elimination, Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, Gambia
| | - Jayani Pathirana
- Disease Control and Elimination, Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, Gambia
| | - Augustin Fombah
- Disease Control and Elimination, Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, Gambia
| | - Baderinwa Abatan
- Disease Control and Elimination, Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, Gambia
| | - Ilias Hossain
- Disease Control and Elimination, Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, Gambia
| | - Ahmed Manjang
- Disease Control and Elimination, Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, Gambia
| | - Brian Greenwood
- Faculty of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Philip Hill
- Centre for International Health, University of Otago, Dunedin, New Zealand
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Agudelo CI, Castañeda-Orjuela C, Brandileone MCDC, Echániz-Aviles G, Almeida SCG, Carnalla-Barajas MN, Regueira M, Fossati S, Alarcón P, Araya P, Duarte C, Sánchez J, Novas M, Toraño-Peraza G, Rodríguez-Ortega M, Chamorro-Cortesi G, Kawabata A, García-Gabarrot G, Camou T, Spadola E, Payares D, Andrade AL, Di Fabio JL, Castañeda E. The direct effect of pneumococcal conjugate vaccines on invasive pneumococcal disease in children in the Latin American and Caribbean region (SIREVA 2006-17): a multicentre, retrospective observational study. THE LANCET. INFECTIOUS DISEASES 2020; 21:405-417. [PMID: 32986996 DOI: 10.1016/s1473-3099(20)30489-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 04/02/2020] [Accepted: 04/24/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Streptococcus pneumoniae isolated from patients with invasive pneumococcal disease has been subjected to laboratory-based surveillance in Latin American and Caribbean countries since 1993. Invasive pneumococcal diseases remain a major cause of death and disability worldwide, particularly in children. We therefore aimed to assess the direct effect of pneumococcal conjugate vaccines (PCVs) on the distribution of pneumococcal serotypes causing invasive pneumococcal disease in children younger than 5 years before and after PCV introduction. METHODS We did a multicentre, retrospective observational study in eight countries that had introduced PCV (ie, PCV countries) in the Latin American and Caribbean region: Argentina, Brazil, Chile, Colombia, Dominican Republic, Mexico, Paraguay, and Uruguay. Cuba and Venezuela were also included as non-PCV countries. Isolate data for Streptococcus pneumoniae were obtained between 2006 and 2017 from children younger than 5 years with an invasive pneumococcal disease from local laboratories or hospitals. Species' confirmation and capsular serotyping were done by the respective national reference laboratories. Databases from the Sistema Regional de Vacunas (SIREVA) participating countries were managed and cleaned in a unified database using Microsoft Excel 2016 and the program R (version 3.6.1). Analysis involved percentage change in vaccine serotypes between pre-PCV and post-PCV periods and the annual reporting rate of invasive pneumococcal diseases per 100 000 children younger than 5 years, which was used as a population reference to calculate percentage vaccine type reduction. FINDINGS Between 2006 and 2017, 12 269 isolates of invasive pneumococcal disease were collected from children younger than 5 years in the ten Latin American and Caribbean countries. The ten serotypes included in ten-valent pneumococcal conjugate vaccine (PCV10) decreased significantly (p<0·0001) after any PCV introduction, except for the Dominican Republic. The percentage change for the ten vaccine serotypes in PCV10 countries was -91·6% in Brazil (530 [72·9%] of 727 before, 27 [6·1%] of 441 after); -85·0% in Chile (613 [72·6%] of 844 before, 44 [10·9%] of 404] after); -84·7% in Colombia (231 [63·1%] of 366 before, 34 [9·7%] of 352 after); and -73·8% in Paraguay (127 [77·0%] of 165 before, 22 [20·2%] of 109 after). In the 13-valent pneumococcal conjugate vaccine (PCV13) countries, the percentage change for the 13 vaccine serotypes was -59·6% in Argentina (853 [85·0%] of 1003 before, 149 [34·3%] of 434 after); -16·5% in the Dominican Republic (95 [80·5%] of 118 before, 39 [67·2%] of 58 after); -43·7% in Mexico (202 [73·2%] of 276 before, 63 [41·2%] of 153 after); and -45·9% in Uruguay (138 [80·7%] of 171 before, 38 [43·7%] of 87 after). Annual reporting rates showed a reduction from -82·5% (6·21 before vs 1·09 after per 100 000, 95% CI -61·6 to -92·0) to -94·7% (1·15 vs 0·06 per 100 000, -89·7 to -97·3) for PCV10 countries, and -58·8% (2·98 vs 1·23 per 100 000, -21·4 to -78·4) to -82·9% (7·80 vs 1·33 per 100 000, -76·9 to -87·4) for PCV13 countries. An increase in the amount of non-vaccine types was observed in the eight countries after PCV introduction together with an increase in their percentage in relation to total invasive strains in the post-PCV period. INTERPRETATION SIREVA laboratory surveillance was able to confirm the effect of PCV vaccine on serotypes causing invasive pneumococcal disease in the eight PCV countries. Improved monitoring of the effect and trends in vaccine type as well as in non-vaccine type isolates is needed, as this information will be relevant for future decisions associated with new PCVs. FUNDING None. TRANSLATIONS For the Portuguese and Spanish translations of the abstract see Supplementary Materials section.
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Affiliation(s)
| | | | | | - Gabriela Echániz-Aviles
- Centro de Investigaciones Sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, Mexico
| | | | - María Noemí Carnalla-Barajas
- Centro de Investigaciones Sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, Mexico
| | - Mabel Regueira
- Departamento Bacteriología, INEI-ANLIS Dr Carlos G Malbrán, Buenos Aires, Argentina
| | - Sofia Fossati
- Departamento Bacteriología, INEI-ANLIS Dr Carlos G Malbrán, Buenos Aires, Argentina
| | - Pedro Alarcón
- Sección Bacteriología, Instituto de Salud Pública de Chile, Santiago, Chile
| | - Pamela Araya
- Sección Bacteriología, Instituto de Salud Pública de Chile, Santiago, Chile
| | - Carolina Duarte
- Grupo de Microbiología, Instituto Nacional de Salud, Bogotá, Colombia
| | - Jacqueline Sánchez
- Laboratorio de Microbiología-DEI, Hospital Infantil Dr Robert Reid Cabral, Santo Domingo, Dominican Republic
| | - Mirna Novas
- Laboratorio de Microbiología-DEI, Hospital Infantil Dr Robert Reid Cabral, Santo Domingo, Dominican Republic
| | - Gilda Toraño-Peraza
- Departamento de Bacteriología y Micología, Instituto Pedro Kouri, La Habana, Cuba
| | | | - Gustavo Chamorro-Cortesi
- Departamento de Bacteriología y Micología, Laboratorio Central de Salud Pública, Asunción, Paraguay
| | - Anibal Kawabata
- Departamento de Bacteriología y Micología, Laboratorio Central de Salud Pública, Asunción, Paraguay
| | | | - Teresa Camou
- Departamento de Laboratorios, Ministerio de Salud, Montevideo, Uruguay
| | - Enza Spadola
- Sección de Aislamiento e Identificación Bacteriana, Instituto Nacional de Higiene Rafael Rangel, Caracas, Venezuela
| | - Daisy Payares
- Sección de Aislamiento e Identificación Bacteriana, Instituto Nacional de Higiene Rafael Rangel, Caracas, Venezuela
| | - Ana Lucía Andrade
- Instituto de Patología Tropical e Saúde Pública, Universidade Federal de Goias, Goiania, Goias, Brazil
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Decline in childhood respiratory-related mortality after the introduction of the pneumococcal conjugate vaccine in Morocco. J Infect Public Health 2020; 13:402-406. [DOI: 10.1016/j.jiph.2019.06.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Revised: 06/19/2019] [Accepted: 06/20/2019] [Indexed: 11/22/2022] Open
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Delfino Sosa M, Zabala C, Pardo L, Fernández L, Nieves C, Más M, Barrios P, Algorta G, Mota MI, Varela A, Gutiérrez C, Gutiérrez S, Giachetto G, Pírez MC. Haemophilus influenzae type b invasive infections in children hospitalized between 2000 and 2017 in a Pediatric Reference Hospital (PRH). Heliyon 2020; 6:e03483. [PMID: 32215324 PMCID: PMC7083785 DOI: 10.1016/j.heliyon.2020.e03483] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 10/12/2019] [Accepted: 02/20/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Uruguay incorporated the conjugate vaccine against Haemophilus influenzae b (Hib) in 1994. In 2008, the vaccine was changed from one with natural conjugated capsular polysaccharide to one with a synthetic polysaccharide component. We describe the frequency and characteristics of invasive Hib infections in children hospitalized in a Pediatric Reference Hospital (PRH) between January 1st, 2000 and December 31st, 2017. METHODS Sterile site Hib isolations from hospitalized children were included. Clinical and microbiological characteristics were analyzed. Favorable conditions for the infection were considered: incomplete immunization, immunodeficiencies and associated pathologies. Two periods are described: 1, prior to vaccine change (1/1 st/2000- 12/31/08) and 2, post-change (1/1 st/09- 12/31st/17). RESULTS 45 children were hospitalized: 5 in the first period and 40 in the second. The hospitalization rate per 10,000 discharges was 0.41 (95% CI 0.05-0.77) and 4.2/10,000 (95% CI 2.89-5.48), respectively (p < 0.01). The diagnoses at discharge were: meningitis/ventriculitis (20), pneumonia (16), bacteremia (3), epiglottitis (1), arthritis (1), cellulitis (3) and obstruction of the upper airway (1). Four children presented comorbidities. Twenty seven received less than 3 doses of anti-Hib vaccination and 18 were properly vaccinated (2 were immunodeficient). The median hospitalization was 14 days, 18 children required intensive therapy. CONCLUSIONS Observed change may be due to: incomplete primary series, inhomogeneous vaccine coverage and immunogenicity of the synthetic polysaccharide. To reduce this public health problem, epidemiological surveillance.
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Affiliation(s)
- Marcos Delfino Sosa
- Facultad de Medicina, Universidad de la República. Hospital Pediátrico, Centro Hospitalario Pereira Rossell, Uruguay
| | - Cristina Zabala
- Facultad de Medicina, Universidad de la República. Hospital Pediátrico, Centro Hospitalario Pereira Rossell, Uruguay
| | - Lorena Pardo
- Facultad de Medicina, Universidad de la República. Hospital Pediátrico, Centro Hospitalario Pereira Rossell, Uruguay
| | - Lucía Fernández
- Facultad de Medicina, Universidad de la República. Hospital Pediátrico, Centro Hospitalario Pereira Rossell, Uruguay
| | - Cecilia Nieves
- Facultad de Medicina, Universidad de la República. Hospital Pediátrico, Centro Hospitalario Pereira Rossell, Uruguay
| | - Mariana Más
- Facultad de Medicina, Universidad de la República. Hospital Pediátrico, Centro Hospitalario Pereira Rossell, Uruguay
| | - Patricia Barrios
- Facultad de Medicina, Universidad de la República. Hospital Pediátrico, Centro Hospitalario Pereira Rossell, Uruguay
| | - Gabriela Algorta
- Laboratorio de Microbiología, Centro Hospitalario Pereira Rossell. Facultad de Medicina, Universidad de la República, Uruguay
| | - María Inés Mota
- Laboratorio de Microbiología, Centro Hospitalario Pereira Rossell. Facultad de Medicina, Universidad de la República, Uruguay
| | - Adriana Varela
- Laboratorio de Microbiología, Centro Hospitalario Pereira Rossell. Facultad de Medicina, Universidad de la República, Uruguay
| | - Claudia Gutiérrez
- Laboratorio de Microbiología, Centro Hospitalario Pereira Rossell. Facultad de Medicina, Universidad de la República, Uruguay
| | - Stella Gutiérrez
- Facultad de Medicina, Universidad de la República. Hospital Pediátrico, Centro Hospitalario Pereira Rossell, Uruguay
| | - Gustavo Giachetto
- Facultad de Medicina, Universidad de la República. Hospital Pediátrico, Centro Hospitalario Pereira Rossell, Uruguay
| | - María Catalina Pírez
- Facultad de Medicina, Universidad de la República. Hospital Pediátrico, Centro Hospitalario Pereira Rossell, Uruguay
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Ali M, Chang BA, Johnson KW, Morris SK. Incidence and aetiology of bacterial meningitis among children aged 1-59 months in South Asia: systematic review and meta-analysis. Vaccine 2018; 36:5846-5857. [PMID: 30145101 DOI: 10.1016/j.vaccine.2018.07.037] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 06/22/2018] [Accepted: 07/15/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Bacterial meningitis is a significant cause of morbidity and mortality worldwide among children aged 1-59 months. We aimed to describe its burden in South Asia, focusing on vaccine-preventable aetiologies. METHODS We searched five databases for studies published from January 1, 1990, to April 25, 2017. We estimated incidence and aetiology-specific proportions using random-effects meta-analysis. In secondary analyses, we described vaccine impact and pneumococcal meningitis serotypes. RESULTS We included 48 articles cumulatively reporting 20,707 cases from 1987 to 2013. Mean annual incidence was 105 (95% confidence interval [CI], 53-173) cases per 100,000 children. On average, Haemophilus influenzae type b (Hib) accounted for 13% (95% CI, 8-19%) of cases, pneumococcus for 10% (95% CI, 6-15%), and meningococcus for 1% (95% CI, 0-2%). These meta-analyses had substantial between-study heterogeneity (I2 > 78%, P < 0.0001). Among studies reporting only confirmed cases, these three bacteria caused a median of 78% cases (IQR, 50-87%). Hib meningitis incidence declined by 72-83% at sentinel hospitals in Pakistan and Bangladesh, respectively, within two years of implementing nationwide vaccination. On average, PCV10 covered 49% (95% CI, 39-58%), PCV13 covered 51% (95% CI, 40-61%), and PPSV23 covered 74% (95% CI, 67-80%) of pneumococcal meningitis serotypes. Lower PCV10 and PCV13 serotype coverage in Bangladesh was associated with higher prevalence of serotype 2, compared to India and Pakistan. CONCLUSIONS South Asia has relatively high incidence of bacterial meningitis among children aged 1-59 months, with vaccine-preventable bacteria causing a substantial proportion. These estimates are likely underestimates due to multiple epidemiological and microbiological factors. Further research on vaccine impact and distribution of pneumococcal serotypes will inform vaccine policymaking and implementation.
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Affiliation(s)
- Mohsin Ali
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Brian A Chang
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Kipp W Johnson
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, USA; Institute for Next Generation Healthcare, Icahn Institute for Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Shaun K Morris
- Division of Infectious Diseases, Hospital for Sick Children, Toronto, Canada; Centre for Global Child Health, Hospital for Sick Children Research Institute, Toronto, Canada; Department of Paediatrics, University of Toronto, Toronto, Canada.
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Gentile A, Bakir J, Firpo V, Casanueva EV, Ensinck G, Lopez Papucci S, Lución MF, Abate H, Cancellara A, Molina F, Gajo Gane A, Caruso AM, Santillán Iturres A, Fossati S. PCV13 vaccination impact: A multicenter study of pneumonia in 10 pediatric hospitals in Argentina. PLoS One 2018; 13:e0199989. [PMID: 30020977 PMCID: PMC6051625 DOI: 10.1371/journal.pone.0199989] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Accepted: 06/17/2018] [Indexed: 11/25/2022] Open
Abstract
Introduction In 2012, PCV13 was introduced into the National Immunization Program in Argentina, 2+1 schedule for children <2 years. Coverage rates for 1st and 3rd doses were 69% and 41.0% in 2012, 98% and 86% in 2013; 99% and 89% in 2014, respectively. The aims of this study were to evaluate impact of PCV13 on Consolidated Pneumonia (CP) and Pneumococcal Pneumonia (PP) burden, and to describe epidemiological-clinical pattern of PP during the three-year period following vaccine introduction. Methods Hospital-based study at 10 pediatric surveillance units in Argentina. CP and PP discharge rates per 10,000 hospital discharges were compared between the pre-vaccination period 2007–2011 (preVp), the year of intervention (2012) and the post-vaccination period 2013–2014 (postVp). Results Significant reduction in CP and PP discharge rates was observed in patients <5 years [% reduction (95%CI)]: 10.2% (6.3; 14.0) in 2012 and 24.8% (21.3; 28.2) in postVp for CP discharge rate; 59.5% (48.0; 68.5) in 2012 and 68.8% (58.3; 76.6) in postVp for PP discharge rate. Significant changes were also observed in children ≥5 years, mainly in PP discharge rate. A total of 297 PP cases were studied; 59.3% male; 31.3% <2 years; 42.9% had received PCV13 in 2012 and 84.5% in posVp. Case fatality rate was 3.4%. PCV13 serotypes decreased from 83.0% (39/47) in 2012 to 64.2% (52/81) in postVp, p = 0.039. Conclusions After PCV13 introduction, significant reduction in CP and PP discharge rates was observed in hospitalized children <5 years. In patients ≥5 years, PP discharge rate also decreased significantly.
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Affiliation(s)
- Angela Gentile
- Epidemiology, Ricardo Gutiérrez Children’s Hospital, Buenos Aires, Argentina
- * E-mail:
| | - Julia Bakir
- Epidemiology, Ricardo Gutiérrez Children’s Hospital, Buenos Aires, Argentina
| | - Verónica Firpo
- Infectology, Niño Jesus Children’s Hospital, Tucumán, Argentina
| | | | - Gabriela Ensinck
- Infectology, Victor Vilela Children’s Hospital, Rosario, Santa Fe, Argentina
| | | | - María F. Lución
- Epidemiology, Ricardo Gutiérrez Children’s Hospital, Buenos Aires, Argentina
| | - Hector Abate
- Infectology, Humberto Notti Pediatric Hospital, Mendoza, Argentina
| | - Aldo Cancellara
- Infectology, Pedro Elizalde Children's Hospital, Buenos Aires, Argentina
| | - Fabiana Molina
- Clinic, Orlando Alassia Children's Hospital, Santa Fe, Argentina
| | - Andrea Gajo Gane
- Infectology, Juan Paul II Pediatric Hospital, Corrientes, Argentina
| | | | | | - Sofía Fossati
- INEI- ANLIS "Dr. Carlos G. Malbran ", Buenos Aires, Argentina
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Lara C, De Graeve D, Franco F. Cost-Effectiveness Analysis of Pneumococcal and Influenza Vaccines Administered to Children Less Than 5 Years of Age in a Low-Income District of Bogota, Colombia. Value Health Reg Issues 2018; 17:21-31. [PMID: 29626706 DOI: 10.1016/j.vhri.2018.01.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2015] [Revised: 12/19/2017] [Accepted: 01/09/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND The Colombian health authorities introduced the pneumococcal conjugated vaccine and the seasonal influenza vaccine into the national immunization schedule for children in 2009 and 2007, respectively. Despite this, the health authorities continue to be concerned about the high economic and disease burden among children from low-income households caused by these vaccine-preventable diseases. OBJECTIVES 1) To evaluate the potential health outcomes of four vaccination strategies for subsidized children younger than 5 years in a low-income district in Colombia from a public, direct medical health care perspective. 2) To perform univariate, multivariate, and probabilistic sensitivity analysis to evaluate the robustness of these results. METHODS We built a Markov deterministic cohort model to evaluate five consecutive cohorts across four alternative situations: 1) no vaccination; 2) vaccination with the 10-valent pneumococcal conjugate vaccine (PCV10 vaccine); 3) vaccination with the trivalent inactivated vaccine (TIV) annually; and 4) combined vaccination with PCV10 vaccine and TIV. RESULTS The introduction of PCV10 vaccine and TIV and their combined use in particular would be highly cost-effective in comparison to no vaccination. For the combined vaccination with PCV10 vaccine and TIV, the incremental cost-effectiveness ratio would be $1,280 per disability-adjusted life-year (DALY) averted, the total incremental cost of the vaccination program would be $776,800, and it would avert four deaths and 332 DALYs for the five cohorts. CONCLUSIONS The introduction of PCV10 vaccine and TIV would be highly cost-effective from a public, direct medical health care perspective. Despite these results, we have not observed decreases in severity or hospitalizations. Our findings highlight the need for further studies of the immunization campaign indicators and socioeconomic indicators for this low-income community.
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Affiliation(s)
- Carlos Lara
- Department of Economics, University of Antwerp, Antwerp, Belgium.
| | - Diana De Graeve
- Department of Economics, University of Antwerp, Antwerp, Belgium
| | - Fabian Franco
- Department of Finance, Hospital la Victoria, Bogota, D.C., Colombia
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López EL, Glatstein E, Ezcurra GC, Iacono M, Teplitz E, Garnero AV, Lazzarini DL, Vázquez M, Contrini MM. Rapid Decrease in Rates of Hospitalization Resulting From Invasive Pneumococcal Disease and Community-Acquired Pneumonia in Children Aged <60 Months After 13-Valent Pneumococcal Conjugate Vaccine Introduction in Argentina. J Pediatric Infect Dis Soc 2018; 7:30-35. [PMID: 28339727 DOI: 10.1093/jpids/piw089] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 02/14/2017] [Indexed: 11/12/2022]
Abstract
BACKGROUND In January 2012, Argentina included universal pneumococcal vaccination in the routine childhood vaccination program using a 13-valent pneumococcal conjugate vaccine (PCV13). A 2 + 1 schedule (2 doses in the first year of life and a booster dose at 12 months of age) in children aged <2 years and 2-dose catch-up immunization in children aged 13 to 24 months was administered during the first year of vaccine introduction. The purpose of this study was to assess the burdens of invasive pneumococcal disease (IPD) and/or community-acquired pneumonia (CAP) in hospitalized children younger than 5 years during the first 2 years of the program compared to those in the prevaccination period in our setting. METHODS This was a multicenter, prospective, and descriptive study. Rates of hospitalization resulting from IPD and/or CAP in 5 pediatric reference centers across the country were analyzed (every 10 000 admissions). Clinical, epidemiologic, and microbiological data were recorded. Statistical analysis using Stata 8.0 was performed. RESULTS A comparison of rates of hospitalization resulting from global IPD and/or CAP in the prevaccine (2009-2011) and postvaccine (2012-2013) periods revealed significant decreases of 50% (P = .003) and 51% (P < .0001), respectively. Significant decreases were also observed in number of hospitalizations resulting from empyema (39%; P = .03) and pneumococcal empyema (67.8%; P = .007); the reduction was not statistically significant for pneumococcal CAP (58%; P = .18). Hospital stays for IPD and/or CAP decreased by 56%. CONCLUSION Rapid and significant decreases in the rates of hospitalization resulting from IPD and/or CAP during the first 2 years after PCV13 introduction were observed. A longer surveillance period is required to confirm these results and the effectiveness of the vaccination program.
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Affiliation(s)
- Eduardo L López
- Hospital de Niños "Ricardo Gutiérrez," Buenos Aires, Argentina
| | | | | | - Marisa Iacono
- Hospital Provincial "Dr. Eduardo C. Rendón," Neuquén, Argentina
| | | | | | | | - Miryan Vázquez
- Hospital de Niños "Ricardo Gutiérrez," Buenos Aires, Argentina
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9
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Ruvinsky RO, Rearte A, Kupervaser J, Gentile F, Haidar A, Cafure ME, ElisaTito M, Avaro F, Cortiana C, Cozzani H, Véliz O, Fossati S, Regueira M, Vizzotti C. Community acquired pneumonia incidence among children less than 5 years of age in Concordia, Argentina: vaccination impact. Rev Panam Salud Publica 2018; 42:e167. [PMID: 31093195 PMCID: PMC6386047 DOI: 10.26633/rpsp.2018.167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Accepted: 05/29/2018] [Indexed: 12/04/2022] Open
Abstract
Objective To measure the effectiveness of pneumococcal conjugated vaccine (PCV13) against Community Acquired Pneumonia (CAP) and invasive pneumococcal disease, 2 years after the vaccine (2+1) was included into the National Immunization Program of Argentina, and to describe variables associated with bacterial pneumonia and hospitalization. Methods This was a prospective, population-based surveillance study of CAP incidence (ambulatory and hospitalized) among children less than 5 years of age in the Department of Concordia (Entre Rios, Argentina) from April 2014 – March 2016. The diagnosis of probable bacterial pneumonia (PBP) was determined following the standardized WHO protocol. Incidence during the post-vaccine introduction period was compared with the results from a previous study that used similar methodology for the pre-PCV13 introduction period from 2002 – 2005. Results During the study period, 330 patients had a clinical diagnosis of CAP, of which 92 were PBP (6 with pleural effusion). S. pneumoniae was not isolated from any sample. No factors associated with PBP were found in multivariable analysis. The decrease in PBP and pleural effusion was significant in relation to the previous study: 63% (P < 0.0001) and 80.9% (P < 0.003), respectively. PCV13 uptake was 97.3% for the 1st dose and 84.8% for the booster dose. Conclusions PCV13 was effective to reduce incidence of consolidated pneumonia and pleural effusion, among children less than 5 years of age in Concordia, Argentina. Vaccination is a very effective public health strategy for reducing vaccine preventable diseases, with impact on burden of disease and hospitalization.
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Affiliation(s)
- Raúl O. Ruvinsky
- Dirección de Control de Enfermedades Inmunoprevenibles, Ministerio de Salud de la Nación, Buenos Aires, Argentina
| | - Anaía Rearte
- Dirección de Control de Enfermedades Inmunoprevenibles, Ministerio de Salud de la Nación, Buenos Aires, Argentina
| | - Judit Kupervaser
- Hospital Delicia Concepción Masvernat, Concordia, Entre Ríos, Argentina
| | | | - Adriana Haidar
- Hospital Delicia Concepción Masvernat, Concordia, Entre Ríos, Argentina
| | - Maria E. Cafure
- Centro Provincial de Salud Constitución, Concordia, Entre Ríos, Argentina
| | - Maria ElisaTito
- Hospital Delicia Concepción Masvernat, Concordia, Entre Ríos, Argentina
| | | | | | - Hugo Cozzani
- Hospital de Niños Ricardo Gutiérrez, Buenos Aires, Argentina
| | - Omar Véliz
- Bacteriología Clínica, Instituto Nacional de Enfermedades Infecciosas, Administración Nacional de Laboratorios e Institutos de Salud “Dr. Carlos Malbrán,” Buenos Aires, Argentina
| | - Sofia Fossati
- Bacteriología Clínica, Instituto Nacional de Enfermedades Infecciosas, Administración Nacional de Laboratorios e Institutos de Salud “Dr. Carlos Malbrán,” Buenos Aires, Argentina
| | - Mabel Regueira
- Bacteriología Clínica, Instituto Nacional de Enfermedades Infecciosas, Administración Nacional de Laboratorios e Institutos de Salud “Dr. Carlos Malbrán,” Buenos Aires, Argentina
| | - Carla Vizzotti
- Dirección de Control de Enfermedades Inmunoprevenibles, Ministerio de Salud de la Nación, Buenos Aires, Argentina
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10
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Pneumococcal Meningitis Before and After Universal Vaccination With Pneumococcal Conjugate Vaccines 7/13, Impact on Pediatric Hospitalization in Public and Nonpublic Institutions, in Uruguay. Pediatr Infect Dis J 2017; 36:1000-1001. [PMID: 28661966 DOI: 10.1097/inf.0000000000001671] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This is the first study showing the impact of 13-valent pneumococcal conjugate vaccine on pneumococcal meningitis in Latin America; a significant (63.5%) reduction in hospitalization was observed during the first 6 years after starting vaccination. A 90% reduction of pneumococcal conjugate vaccines 7/13 serotypes was observed (P < 0.0001). After vaccination, all strains were penicillin susceptible. Mortality had a reduction of 71%.
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Alicino C, Paganino C, Orsi A, Astengo M, Trucchi C, Icardi G, Ansaldi F. The impact of 10-valent and 13-valent pneumococcal conjugate vaccines on hospitalization for pneumonia in children: A systematic review and meta-analysis. Vaccine 2017; 35:5776-5785. [DOI: 10.1016/j.vaccine.2017.09.005] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 08/28/2017] [Accepted: 09/01/2017] [Indexed: 10/18/2022]
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12
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Andrade AL, Afonso ET, Minamisava R, Bierrenbach AL, Cristo EB, Morais-Neto OL, Policena GM, Domingues CMAS, Toscano CM. Direct and indirect impact of 10-valent pneumococcal conjugate vaccine introduction on pneumonia hospitalizations and economic burden in all age-groups in Brazil: A time-series analysis. PLoS One 2017; 12:e0184204. [PMID: 28880953 PMCID: PMC5589174 DOI: 10.1371/journal.pone.0184204] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 08/18/2017] [Indexed: 01/15/2023] Open
Affiliation(s)
- Ana Lucia Andrade
- Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiânia, Goiás, Brazil
- * E-mail:
| | - Eliane T. Afonso
- Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiânia, Goiás, Brazil
- Faculty of Medicine, Federal University of Goiás, Goiânia, Goiás, Brazil
- Department of Medicine, Pontifical Catholic University of Goiás, Goiânia, Goiás, Brazil
| | - Ruth Minamisava
- School of Nursing, Federal University of Goiás, Goiânia, Goiás, Brazil
| | - Ana Luiza Bierrenbach
- Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiânia, Goiás, Brazil
| | | | - Otaliba L. Morais-Neto
- Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiânia, Goiás, Brazil
| | - Gabriela M. Policena
- Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiânia, Goiás, Brazil
| | - Carla M. A. S. Domingues
- National Immunization Program, Secretariat for Health Surveillance, Ministry of Health, Brasília, Federal District, Brazil
| | - Cristiana M. Toscano
- Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiânia, Goiás, Brazil
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Madhi SA, Nunes MC. The potential impact of pneumococcal conjugate vaccine in Africa: Considerations and early lessons learned from the South African experience. Hum Vaccin Immunother 2016; 12:314-25. [PMID: 26317537 DOI: 10.1080/21645515.2015.1084450] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
The introduction of pneumococcal conjugate vaccine (PCV) into the South African public immunization program since 2009 adopted a novel vaccination schedule of 3 doses at 6, 14 and 40 weeks of age. Over the past 5 y it has been shown that infant PCV immunization in South Africa is effective in reducing the burden of invasive pneumococcal disease (IPD) among HIV-infected and HIV-uninfected children. Furthermore, indirect protection of unvaccinated age-groups (including high risk groups such as HIV-infected adults) against IPD was demonstrated despite the absence of any substantial catch-up campaign of older children. This indirect effect against IPD is corroborated by the temporal reduction in vaccine-serotype colonization among age-groups targeted for PCV immunization as well as unvaccinated HIV-infected and HIV-uninfected adults, which was evident within 2 y of PCV introduction into the immunization program. Vaccine effectiveness has also been demonstrated in children against presumed bacterial pneumonia. The evaluation of the impact of PCV in South Africa, however, remains incomplete. The knowledge gaps remaining include the evaluation of PCV on the incidence of all-cause pneumonia hospitalization among vaccinated and unvaccinated age-groups. Furthermore, ongoing surveillance is required to determine whether there is ongoing replacement disease by non-vaccine serotypes, which could offset the early gains associated with the immunization program in the country.
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Affiliation(s)
- Shabir A Madhi
- a Medical Research Council; Respiratory and Meningeal Pathogens Research Unit; University of the Witwatersrand ; Johannesburg , South Africa.,b Department of Science and Technology/National Research Foundation ; Vaccine Preventable Diseases; University of the Witwatersrand ; Johannesburg , South Africa.,c National Institute for Communicable Diseases; National Health Laboratory Service; Center for Vaccines and Immunology ; Johannesburg , South Africa
| | - Marta C Nunes
- a Medical Research Council; Respiratory and Meningeal Pathogens Research Unit; University of the Witwatersrand ; Johannesburg , South Africa.,b Department of Science and Technology/National Research Foundation ; Vaccine Preventable Diseases; University of the Witwatersrand ; Johannesburg , South Africa
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14
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Andrade AL, Minamisava R, Policena G, Cristo EB, Domingues CMS, de Cunto Brandileone MC, Almeida SCG, Toscano CM, Bierrenbach AL. Evaluating the impact of PCV-10 on invasive pneumococcal disease in Brazil: A time-series analysis. Hum Vaccin Immunother 2016; 12:285-92. [PMID: 26905679 DOI: 10.1080/21645515.2015.1117713] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Routine infant immunization with 10-valent pneumococcal conjugate vaccine (PCV-10) began in Brazil in 2010. The impact of the PCV-10 on rates of invasive pneumococcal disease (IPD) at the population level was not yet evaluated. Serotype-specific IPD changes after PCV-10 introduction is still to be determined. Data from national surveillance system for notifiable diseases (SINAN) and national reference laboratory for S. pneumoniae in Brazil (IAL) were linked to enhance case ascertainment of IPD. An interrupted time-series analysis was conducted to predict trends in the postvaccination IPD rates in the absence of PCV-10 vaccination, taking into consideration seasonality and secular trends. PCVs serotype-specific distribution were assessed before (2008-2009) and after (2011-2013) the introduction of PCV-10 in the immunization program. A total of 9,827 IPD cases were identified from 2008-2013 when combining SINAN and IAL databases. Overall, PCV-10 types decreased by 41.3% after PCV-10 vaccination period, mostly in children aged 2-23 months, while additional PCV-13 serotypes increased by 62.8% mainly in children under 5-year of age. For children aged 2-23 months, targeted by the immunization program, we observed a 44.2% (95%CI, 15.8-72.5%) reduction in IPD rates. In contrast, significant increase in IPD rates were observed for adults aged 18-39 y (18.9%, 95%CI 1.1-36.7%), 40-64 y (52.5%, 95%CI 24.8-80.3%), and elderly ≥ 65 y (79.3%, 95%CI 62.1-96.5%). This is the first report of a time-series analysis for PCV impact in IPD conducted at national level data in a developing country. We were able to show significant impact of PCV-10 on IPD for age groups targeted by vaccination in Brazil, 3 y after its introduction. No impact on other age groups was demonstrated.
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Affiliation(s)
- Ana Lucia Andrade
- a Institute of Tropical Pathology and Public Health ; Federal University of Goias ; Goiânia , Brazil
| | - Ruth Minamisava
- b School of Nursing ; Federal University of Goias ; Goiânia , Brazil
| | - Gabriela Policena
- a Institute of Tropical Pathology and Public Health ; Federal University of Goias ; Goiânia , Brazil
| | - Elier B Cristo
- c Advisor of the Ministry of Health ; San Paulo , Brazil
| | - Carla Magda S Domingues
- d Secretariat of Health Surveillance ; Brazilian Ministry of Health ; Brasilia , Federal District , Brazil
| | - Maria Cristina de Cunto Brandileone
- e Laboratory for Meningitis , Pneumonia and Pneumococcal Infection; Center of Bacteriology; Adolfo Lutz Institute; Secretary of Health of State of Sao Paulo ; Sao Paulo , Brazil
| | - Samanta Cristine Grassi Almeida
- e Laboratory for Meningitis , Pneumonia and Pneumococcal Infection; Center of Bacteriology; Adolfo Lutz Institute; Secretary of Health of State of Sao Paulo ; Sao Paulo , Brazil
| | - Cristiana Maria Toscano
- a Institute of Tropical Pathology and Public Health ; Federal University of Goias ; Goiânia , Brazil
| | - Ana Luiza Bierrenbach
- a Institute of Tropical Pathology and Public Health ; Federal University of Goias ; Goiânia , Brazil
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15
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Schuck-Paim C, Taylor RJ, Simonsen L, Lustig R, Kürüm E, Bruhn CAW, Weinberger DM. Challenges to estimating vaccine impact using hospitalization data. Vaccine 2016; 35:118-124. [PMID: 27899227 PMCID: PMC5664940 DOI: 10.1016/j.vaccine.2016.11.030] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Revised: 11/04/2016] [Accepted: 11/08/2016] [Indexed: 11/05/2022]
Abstract
Because the real-world impact of new vaccines cannot be known before they are implemented in national programs, post-implementation studies at the population level are critical. Studies based on analysis of hospitalization rates of vaccine-preventable outcomes are typically used for this purpose. However, estimates of vaccine impact based on hospitalization data are particularly prone to confounding, as hospitalization rates are tightly linked to changes in the quality, access and use of the healthcare system, which often occur simultaneously with introduction of new vaccines. Here we illustrate how changes in healthcare delivery coincident with vaccine introduction can influence estimates of vaccine impact, using as an example reductions in infant pneumonia hospitalizations after introduction of the 10-valent pneumococcal conjugate vaccine (PCV10) in Brazil. To this end, we explore the effect of changes in several metrics of quality and access to public healthcare on trends in hospitalization rates before (2008–09) and after (2011–12) PCV10 introduction in 2010. Changes in infant pneumonia hospitalization rates following vaccine introduction were significantly associated with concomitant changes in hospital capacity and the fraction of the population using public hospitals. Importantly, reduction of pneumonia hospitalization rates after PCV10 were also associated with the expansion of outpatient services in several Brazilian states, falling more sharply where primary care coverage and the number of health units offering basic and emergency care increased more. We show that adjustments for unrelated (non-vaccine) trends commonly employed by impact studies, such as use of single control outcomes, are not always sufficient for accurate impact assessment. We discuss several ways to identify and overcome such biases, including sensitivity analyses using different denominators to calculate hospitalizations rates and methods that track changes in the outpatient setting. Employing these practices can improve the accuracy of vaccine impact estimates, particularly in evolving healthcare settings typical of low- and middle-income countries.
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Affiliation(s)
| | | | - Lone Simonsen
- Department of Global Health, Milken Institute School of Public Health, George Washington University, Washington, DC, United States
| | | | - Esra Kürüm
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, United States; Department of Statistics, University of California, Riverside, CA, United States
| | - Christian A W Bruhn
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, United States
| | - Daniel M Weinberger
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, United States
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Rurangwa J, Rujeni N. Decline in Child Hospitalization and Mortality After the Introduction of the 7-Valent Pneumococcal Conjugative Vaccine in Rwanda. Am J Trop Med Hyg 2016; 95:680-2. [PMID: 27430538 PMCID: PMC5014278 DOI: 10.4269/ajtmh.15-0923] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2015] [Accepted: 05/19/2016] [Indexed: 01/12/2023] Open
Abstract
Pneumonia is a public health problem in the tropics, and the 7-valent pneumococcal conjugative vaccine (PCV-7) has been introduced in an effort to prevent the disease and therefore reduce childhood mortality. In Rwanda, PCV-7 was introduced in 2009, and we aimed to determine its impact on the rate of child hospitalization/mortality due to pneumonia. A retrospective survey was conducted on hospitalization rates and pediatric deaths between two periods, that is, before the introduction of PCV-7 (2007-2009) and after the introduction of PCV-7 (2010-2013) in Kabutare District Hospital. There was a 53% reduction in hospitalization, with a significant decline in in-hospital deaths between the two periods. There was also a significant correlation between vaccination coverage and decline in hospitalization rates between 2009 and 2013. We conclude that PCV-7 vaccine is associated with significant reduction in the rate of child hospitalization and mortality but more mechanistic studies are warranted to determine the immunological impact, especially in the context of coinfections and malnutrition.
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Affiliation(s)
- Janvier Rurangwa
- Department of Biology, College of Science and Technology, University of Rwanda, Kigali, Rwanda
| | - Nadine Rujeni
- Department of Biomedical Laboratory Sciences, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda.
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Pneumococcus and the Elderly in Italy: A Summary of Available Evidence Regarding Carriage, Clinical Burden of Lower Respiratory Tract Infections and On-Field Effectiveness of PCV13 Vaccination. Int J Mol Sci 2016; 17:ijms17071140. [PMID: 27428964 PMCID: PMC4964513 DOI: 10.3390/ijms17071140] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Revised: 07/07/2016] [Accepted: 07/11/2016] [Indexed: 11/17/2022] Open
Abstract
Streptococcus pneumoniae is currently the leading cause of community-acquired pneumonia (CAP) and lower respiratory tract infections (LRTI) in adults, elderly and high-risk subjects worldwide. The clear benefits of pneumococcal conjugate vaccination in childhood have been accompanied by a decrease of vaccine-serotype invasive diseases among adults in several countries, mainly due to the herd effect mediated by the reduction of vaccine-serotype nasopharyngeal colonization in both age groups, but this reduction in the incidence of pneumonia has not been observed. The "Community Acquired Pneumonia Immunization Trial in Adults" (CAPITA) study provided conclusive evidence about 13-valent pneumococcal conjugate vaccine (PCV13) efficacy in preventing CAP in adults and led Western countries to issue new recommendations for pneumococcal immunization targeting subjects >50 years and high-risk groups, with marked differences with respect to age and/or risk groups immunized, eligibility for reimbursement and national, regional or local implementation. Several Italian regions implemented PCV13 immunization programs in adults and interesting data have been come available in the last years, especially from Liguria, a Northern region with a high and long-lasting pneumococcal vaccine immunological pressure in infants. In this review, currently available evidence from Italy and Liguria regarding pneumococcal carriage, burden of CAP and LRTI, and on-field effectiveness of PCV13 immunization in adults and elderly will be summarized.
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18
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Otczyk DC, Cripps AW. Vaccination for the control of childhood bacterial pneumonia - Haemophilus influenzae type b and pneumococcal vaccines. Pneumonia (Nathan) 2016; 2:2-15. [PMID: 31463182 PMCID: PMC6707409 DOI: 10.15172/pneu.2013.2/229] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2012] [Revised: 10/25/2012] [Accepted: 02/14/2013] [Indexed: 12/31/2022] Open
Abstract
Pneumonia in childhood is endemic in large parts of the world and in particular, in developing countries, as well as in many indigenous communities within developed nations. Haemophilus influenzae type b and Streptococcus pneumoniae conjugate vaccines are currently available against the leading bacterial causes of pneumonia. The use of the vaccines in both industrialised and developing countries have shown a dramatic reduction in the burden of pneumonia and invasive disease in children. However, the greatest threat facing pneumococcal conjugate vaccine effectiveness is serotype replacement. The current vaccines provide serotype-specific, antibody-mediated protection against only a few of the 90+ capsule serotypes. Therefore, there has been a focus in recent years to rapidly advance technologies that will result in broader disease coverage and more affordable vaccines that can be used in developing countries. The next generation of pneumococcal vaccines have advanced to clinical trials.
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Affiliation(s)
- Diana C. Otczyk
- School of Medicine, Griffith Health Institute, Griffith University, Gold Coast Campus, Queensland, 4222 Australia
| | - Allan W. Cripps
- School of Medicine, Griffith Health Institute, Griffith University, Gold Coast Campus, Queensland, 4222 Australia
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Sartori AMC, Nascimento ADF, Yuba TY, Soárez PCD, Novaes HMD. Methods and challenges for the health impact assessment of vaccination programs in Latin America. Rev Saude Publica 2016; 49:S0034-89102015000100410. [PMID: 26759964 PMCID: PMC4687821 DOI: 10.1590/s0034-8910.2015049006058] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Accepted: 04/12/2015] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE To describe methods and challenges faced in the health impact assessment of vaccination programs, focusing on the pneumococcal conjugate and rotavirus vaccines in Latin America and the Caribbean. METHODS For this narrative review, we searched for the terms “rotavirus”, “pneumococcal”, “conjugate vaccine”, “vaccination”, “program”, and “impact” in the databases Medline and LILACS. The search was extended to the grey literature in Google Scholar. No limits were defined for publication year. Original articles on the health impact assessment of pneumococcal and rotavirus vaccination programs in Latin America and the Caribbean in English, Spanish or Portuguese were included. RESULTS We identified 207 articles. After removing duplicates and assessing eligibility, we reviewed 33 studies, 25 focusing on rotavirus and eight on pneumococcal vaccination programs. The most frequent studies were ecological, with time series analysis or comparing pre- and post-vaccination periods. The main data sources were: health information systems; population-, sentinel- or laboratory-based surveillance systems; statistics reports; and medical records from one or few health care services. Few studies used primary data. Hospitalization and death were the main outcomes assessed. CONCLUSIONS Over the last years, a significant number of health impact assessments of pneumococcal and rotavirus vaccination programs have been conducted in Latin America and the Caribbean. These studies were carried out few years after the programs were implemented, meet the basic methodological requirements and suggest positive health impact. Future assessments should consider methodological issues and challenges arisen in these first studies conducted in the region.
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Affiliation(s)
- Ana Marli Christovam Sartori
- Departamento de Moléstias Infecciosas e Parasitárias, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | | | - Tânia Yuka Yuba
- Departamento de Medicina Preventiva, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Patrícia Coelho de Soárez
- Departamento de Medicina Preventiva, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
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Patrzałek M, Kotowska M, Goryński P, Albrecht P. Indirect effects of a 7 year PCV7/PCV13 mass vaccination program in children on the incidence of pneumonia among adults: a comparative study based on two Polish cities. Curr Med Res Opin 2016; 32:397-403. [PMID: 26566258 DOI: 10.1185/03007995.2015.1119676] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES In 2006 the city of Kielce, Poland, introduced a mandatory PCV7 (replaced by PCV13 in 2011) vaccination program against S. pneumoanie for all children under 2 years old. At that time, the neighboring city of Ostrowiec Świętokrzyski had no such large-scale vaccination program in place. This created an opportunity to observe the results of the vaccination by comparing the incidence of pneumonia in these two cities. The aim of this study was to analyze how the incidence of pneumonia among adults was indirectly affected by the PCV7/PCV13 vaccination program in children during the 7 year follow-up period. METHODS We performed a retrospective study. PCV7/PCV13 vaccinations were delivered according to a 2 + 1 schedule. The vaccination rate in the analyzed period amounted to almost 99%. The following age groups were analyzed: 30-49, 50-64 and 65+. The Cochran-Armitage test was used to investigate the significance of the observed trend in pneumonia morbidity. The significance of deviations from a linear trend was also tested. In addition, the importance of the trend (in the case of deviations from linearity) was confirmed with the use of the Mantel test. RESULTS In the 65+ age group there was a decrease of 66.5% in the incidence of diagnosed pneumonia (p < 0.0001). This was followed by smaller, but statistically significant, declines in the other age groups: 30.75% in the 30-49 age group (p = 0.001) and 56.8% in the 50-64 age group (p < 0.0001). This decreasing trend continued for seven consecutive years of observation. In addition, we demonstrated a statistically significant higher rate of pneumonia in all age groups in the City of Ostrowiec Świętokrzyski. CONCLUSIONS The results clearly indicate that the indirect effectiveness of the PCV7/PCV13 vaccine program, performed according to the 2 + 1 schedule and applied in Kielce, Poland, is statistically significant.
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Affiliation(s)
| | - M Kotowska
- b b Department of Paediatric Gastroenterology and Nutrition , Medical University of Warsaw , Poland
| | - P Goryński
- c c National Institute of Public Health, National Institute of Hygiene , Warsaw , Poland
| | - P Albrecht
- b b Department of Paediatric Gastroenterology and Nutrition , Medical University of Warsaw , Poland
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Bonner K, Welch E, Elder K, Cohn J. Impact of Pneumococcal Conjugate Vaccine Administration in Pediatric Older Age Groups in Low and Middle Income Countries: A Systematic Review. PLoS One 2015; 10:e0135270. [PMID: 26332848 PMCID: PMC4557974 DOI: 10.1371/journal.pone.0135270] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Accepted: 07/20/2015] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Pneumococcal conjugate vaccine (PCV) is included in the World Health Organization's routine immunization schedule and is recommended by WHO for vaccination in high-risk children up to 60 months. However, many countries do not recommend vaccination in older age groups, nor have donors committed to supporting extended age group vaccination. To better inform decision-making, this systematic review examines the direct impact of extended age group vaccination in children over 12 months in low and middle income countries. METHODS An a priori protocol was used. Using pre-specified terms, a search was conducted using PubMed, LILACS, Cochrane Infectious Diseases Group Specialized Register, Cochrane Central Register of Controlled Trials, CAB Abstracts, clinicaltrials.gov and the International Symposium on Pneumococci and Pneumococcal Diseases abstracts. The primary outcome was disease incidence, with antibody titers and nasopharyngeal carriage included as secondary outcomes. RESULTS Eighteen studies reported on disease incidence, immune response, and nasopharyngeal carriage. PCV administered after 12 months of age led to significant declines in invasive pneumococcal disease. Immune response to vaccine type serotypes was significantly higher for those vaccinated at older ages than the unimmunized at the established 0.2 ug/ml and 0.35 ug/ml thresholds. Vaccination administered after one year of age significantly reduced VT carriage with odds ratios ranging from 0.213 to 0.69 over four years. A GRADE analysis indicated that the studies were of high quality. DISCUSSION PCV administration in children over 12 months leads to significant protection. The direct impact of PCV administration, coupled with the large cohort of children missed in first year vaccination, indicates that countries should initiate or expand PCV immunization for extended age group vaccinations. Donors should support implementation of PCV as part of delayed or interrupted immunization for older children. For countries to effectively implement extended age vaccinations, access to affordably-priced PCV is critical.
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Affiliation(s)
- Kimberly Bonner
- Médecins Sans Frontières, Access Campaign, Geneva, Switzerland
| | - Emily Welch
- School of Public Health, Boston University, Boston, Massachusetts, United States of America
| | - Kate Elder
- Médecins Sans Frontières, Access Campaign, New York, New York, United States of America
| | - Jennifer Cohn
- Médecins Sans Frontières, Access Campaign, Geneva, Switzerland
- Division of Infectious Diseases, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, United States of America
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Menzies RI, Jardine A, McIntyre PB. Pneumonia in Elderly Australians: Reduction in Presumptive Pneumococcal Hospitalizations but No Change in All-Cause Pneumonia Hospitalizations Following 7-Valent Pneumococcal Conjugate Vaccination. Clin Infect Dis 2015; 61:927-33. [PMID: 26066319 DOI: 10.1093/cid/civ429] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Accepted: 05/31/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Studies evaluating long-term trends in hospitalizations coded as pneumonia following introduction of the 7-valent pneumococcal vaccine (PCV7) are sparse, especially in adults. We extended our previous analysis to 6.5 years after the "3 + 0" PCV7 schedule was introduced in Australia in 2005. METHODS We estimated vaccine impact on hospitalizations coded as pneumonia (pneumococcal/lobar, other specified, unspecified, and all-cause) using a multivariate negative binomial regression model of monthly hospitalization rates by age group for the pre-PCV7 (July 1998 to December 2004) and post-PCV7 (January 2005 to June 2011) periods, adjusting for vaccination coverage. Changes in pneumonia hospitalizations were measured as incidence rate ratios. RESULTS A total of 791 000 hospitalizations coded as pneumonia were identified; unspecified causes accounted for >85%. Reductions in pneumonia coded as pneumococcal/lobar were statistically significant in all age groups and greatest in children. Significant reductions in all-cause pneumonia were seen only in children aged <2 years (32%; 95% confidence interval [CI], 28%-37%) and 2-4 years (20%; 95% CI, 14%-27%), with no significant changes in other age groups, including adults aged 65-74 (4%; 95% CI, -3% to 10%), 75-84 (2%; 95% CI, -4% to 9%), and ≥85 years (3%; 95% CI, -3% to 10%). CONCLUSIONS We could not replicate reductions of 23% in all-cause pneumonia 7-9 years post-PCV7 introduction reported for adults aged ≥85 years in the United States. This could be attributable to vaccine program factors, differing proportions of pneumonia due to pneumococci, or data limitations. More data from countries with differing PCV schedules and from the PCV13 era are needed to inform vaccination strategies for elderly adults.
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Affiliation(s)
- Robert I Menzies
- National Centre for Immunisation Research and Surveillance, The Children's Hospital at Westmead, Sydney Sydney Medical School, University of Sydney
| | - Andrew Jardine
- National Centre for Immunisation Research and Surveillance, The Children's Hospital at Westmead, Sydney National Centre for Epidemiology and Population Health, Australian National University, Canberra
| | - Peter B McIntyre
- National Centre for Immunisation Research and Surveillance, The Children's Hospital at Westmead, Sydney Sydney Medical School, University of Sydney
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Camacho-Badilla K, Falleiros-Arlant LH, Brea J, Avila-Aguero ML. Challenges in the Surveillance of Invasive Pneumococcal Disease in the Postvaccination Era. J Pediatric Infect Dis Soc 2015; 4:91-3. [PMID: 26407406 DOI: 10.1093/jpids/piv025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Kattia Camacho-Badilla
- Pediatric Infectious Diseases Service, Hospital Nacional de Niños, "Dr. Carlos Sáenz Herrera", San José, Costa Rica
| | | | - José Brea
- Pediatrics, Centro Universitario Médico del Este, Santo Domingo, Dominican Republic
| | - María L Avila-Aguero
- Pediatric Infectious Diseases Service, Hospital Nacional de Niños, "Dr. Carlos Sáenz Herrera", San José, Costa Rica
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Hirose TE, Maluf EMCP, Rodrigues CO. Pneumococcal meningitis: epidemiological profile pre- and post-introduction of the pneumococcal 10-valent conjugate vaccine. J Pediatr (Rio J) 2015; 91:130-5. [PMID: 25451210 DOI: 10.1016/j.jped.2014.07.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Revised: 05/20/2014] [Accepted: 07/10/2014] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVES To evaluate the possible effects of the introduction of the pneumococcal conjugate 10-valent vaccine schedule in the state of Parana on pneumococcal meningitis cases and to assess the distribution of serotypes among cases. METHOD Cross-sectional study with retrospective data collection of cases of pneumococcal meningitis in the state of Paraná reported to Sistema de Informação de Agravos de Notificação (SINAN), from 1998 to 2011. A total of 1,339 cases of pneumococcal meningitis were analyzed; 1,205 cases from the pre-vaccine period (1998-2009) were compared to 134 cases from the post-vaccine period (2010-2011). Descriptive and comparative statistical analyses (chi-squared test and prevalence ratio) were performed using JMP 5.1.2 statistical software (JMP Statistical Discovery, North Carolina, USA) and EPI INFO 6 (Centers for Disease Control and Prevention, Georgia, EUA). RESULTS There was a significant reduction in the mean rates of incidence and mortality in the general population. The analysis of cases in the pre- and post-vaccination periods in the age groups covered by vaccination (younger than 2 years) showed significant reductions in incidence rates (6.01 cases/100,000 to 2.49 cases/100,000 individuals) and mortality (1.85 cases/100,000 population to 0.47 cases/100,000 population), while the mean lethality rate did not change significantly. There was a significant reduction in cases whose serotypes are included in the vaccine (80.7% to 53.3%). CONCLUSION Even after a short time of use, the 10-valent pneumococcal conjugate vaccine has already had a significant impact in reducing the incidence and mortality of meningitis cases among infants, as well as the reduction of cases whose serotypes are included in the vaccine.
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Affiliation(s)
- Tatiane E Hirose
- Department of Pediatrics, Health Sciences Section, Universidade Federal do Paraná (UFPR), Curitiba, PR, Brazil.
| | - Eliane M C P Maluf
- Department of Internal Medicine, Health Sciences Section, Universidade Federal do Paraná (UFPR), Curitiba, PR, Brazil; Discipline of Family Health, Maternal-Child Section, Universidade Positivo, Curitiba, PR, Brazil
| | - Cristina O Rodrigues
- Department of Pediatrics, Health Sciences Section, Universidade Federal do Paraná (UFPR), Curitiba, PR, Brazil
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Hirose TE, Maluf EM, Rodrigues CO. Pneumococcal meningitis: epidemiological profile pre‐ and post‐introduction of the pneumococcal 10‐valent conjugate vaccine. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2015. [DOI: 10.1016/j.jpedp.2014.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Effect of pneumococcal conjugate vaccination in Uruguay, a middle-income country. PLoS One 2014; 9:e112337. [PMID: 25375647 PMCID: PMC4223029 DOI: 10.1371/journal.pone.0112337] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Accepted: 10/10/2014] [Indexed: 11/21/2022] Open
Abstract
Background In 2008, a 7-valent pneumococcal conjugate vaccine (PCV7) was introduced into the routine childhood immunization program in Uruguay, with a 2+1 schedule. In 2010, PCV13 replaced PCV7, and the same 2+1 schedule was used. The effect of these pneumococcal vaccines on the incidence of invasive pneumococcal infections (IPD) and on serotype distribution was analyzed retrospectively, based on passive national laboratory surveillance. Methods Data from 1,887 IPD isolates from 5 years before and 5 years after PCV7 introduction (7 before and 3 after PCV13 introduction) was examined to assess the incidence rate per 100,000 age-specific population of all IPD, PCV7-serotypes, and PCV13-serotypes associated IPD among children <2 years and 2 to 4 years old, and patients ≥5 years old. Trends of frequency for each serotype were also analyzed. Results Comparison of pre-vaccination (2003–2007) and post-vaccination (2008–2012) periods showed a significant decrease in IPD incidence among children <2 years old (IR 68.7 to IR 29.6, p<0.001) and children 2 to 4 years (p<0.04). IPD caused by serotypes in PCV7 was reduced by 95.6% and IPD caused by 6 serotypes added in PCV13 was reduced by 83.9% in children <5 years old. Indirect effects of both conjugate vaccines were observed among patients ≥5 years old one year after the introduction of each vaccine, in 2010 for PCV7 and in 2012 for PCV13. Nevertheless, for reasons that still need to be explained, perhaps due to ascertainment bias, total IPD in this group increased after 2007. In 2012, the relative frequency of vaccine serotypes among vaccinated and unvaccinated population declined, except for serotype 3. Non vaccine serotypes with increasing frequency were identified, in rank order: 12F, 8, 24F, 22F, 24A, 15C, 9N, 10A and 33. Conclusion Consecutive immunization with PCV7 and PCV13 has significantly reduced IPD in children <5 years of age in Uruguay.
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Becker-Dreps S, Amaya E, Liu L, Rocha J, Briceño R, Moreno G, Alemán J, Hudgens MG, Woods CW, Weber DJ. Impact of a combined pediatric and adult pneumococcal immunization program on adult pneumonia incidence and mortality in Nicaragua. Vaccine 2014; 33:222-7. [PMID: 25444795 DOI: 10.1016/j.vaccine.2014.10.073] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Revised: 09/20/2014] [Accepted: 10/06/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND In 2010, Nicaragua implemented an adult immunization program with the 23-valent pneumococcal polysaccharide vaccine (PPSV-23) and a pediatric immunization program with the 13-valent pneumococcal conjugate vaccine (PCV-13). We assessed incidence rates of ambulatory visits and hospitalizations for pneumonia and pneumonia-related mortality in adults over the age of 50 years before and after the program's implementation in the Department of León, Nicaragua. METHODS We collected visit diagnoses from all 107 public health facilities between 2008 and 2012 in León. We compared incidence rates of ambulatory visits for pneumonia, pneumonia hospitalizations, and pneumonia-related mortality in the pre-vaccine (2008-2009) and vaccine (2011-2012) periods among older adults using Poisson regression with generalized estimating equations (GEE), controlling for age group, municipality, and proportions of adults who were immunized against influenza. Exposure time was estimated by official municipality population estimates. RESULTS We did not observe lower incidence rates of ambulatory visits or hospitalizations for pneumonia among adults during the vaccine period versus the pre-vaccine period. However, pneumonia-related mortality was lower in the vaccine period versus the pre-vaccine period, with an adjusted incidence rate ratio (IRRa) of 0.73 (0.56, 0.94) among adults aged 50-64 years, and 0.55 (0.43, 0.70) among adults aged ≥65 years. CONCLUSIONS These early results following introduction of a combined pediatric and adult pneumococcal immunization program in Nicaragua show a probable impact of the program on the reduction of pneumonia-related deaths in older adults, but a less clear impact on the reduction of health facility visits for pneumonia.
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Affiliation(s)
| | - Erick Amaya
- National Autonomous University of Nicaragua, León, Nicaragua
| | - Lan Liu
- UNC Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Julio Rocha
- Hospital Escuela Oscar Danilo Rosales Argüello (HEODRA), León, Nicaragua
| | - Rafaela Briceño
- Sistemas Locales de Atención Integral a la Salud, León (SILAIS-León), León, Nicaragua
| | - Gilberto Moreno
- Sistemas Locales de Atención Integral a la Salud, León (SILAIS-León), León, Nicaragua
| | - Jorge Alemán
- Hospital Escuela Oscar Danilo Rosales Argüello (HEODRA), León, Nicaragua
| | | | | | - David J Weber
- University of North Carolina School of Medicine, Chapel Hill, NC, USA
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Epidemiology of pediatric pneumococcal meningitis and bacteremia in Latin America and the Caribbean: a systematic review and meta-analysis. Pediatr Infect Dis J 2014; 33:971-8. [PMID: 24830699 DOI: 10.1097/inf.0000000000000363] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Pneumococcal meningitis and bacteremia pose a significant disease burden in Latin America and the Caribbean (LAC). METHODS To perform a systematic review of studies of pediatric pneumococcal meningitis and non-pneumonia, non-meningitis pneumococcal bacteremia in LAC, we conducted an exhaustive search from 2000 to 2010 in electronic databases and grey literature. Pairs of independently selected reviewers assessed the quality and extracted the studies' data. A STROBE-based checklist was used to assess the risk of bias in observational studies. Meta-analyses were performed. RESULTS Of 1218 retrieved studies, 39 were included. In children <5 years, the pooled 95% confidence interval (CI) percentage of pneumococcal etiology out of cases studied with cerebrospinal fluid/blood cultures was 6.0% (95% CI: 3.3-9.5) for meningitis and 8.0% (95% CI: 5.3-12.4) for bacteremia. The incidences per 100,000 children were 4.7 (95% CI: 3.2-6.1) and 3.9 (95% CI: 2.0-5.9) for pneumococcal meningitis and non-pneumonia, non-meningitis bacteremia, respectively. The mortality was 8.3 (95% CI: 0.0-21.0) and 0.5 (95% CI: 0.3.0-0.6)/100,000 for meningitis and sepsis, respectively. The case fatality ratio was 33.2% (95% CI: 21.3-46.2) for meningitis and 29.0% (95% CI: 21.9-36.8) for sepsis. The pooled serotype distribution from SIREVA surveillance data showed that 14, 5, 6B (for meningitis) and 14, 6B, 19F (for bacteremia) were the most frequent serotypes, all included in licensed vaccines. CONCLUSION Pneumococcal meningitis and bacteremia are important causes of morbidity and mortality in LAC children <5 years of age. This systematic review provided evidence about the burden of pneumococcal disease and the serotype distribution to assess the impact the pneumococcal vaccines and to assist decision makers in the region.
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Pírez MC, Algorta G, Chamorro F, Romero C, Varela A, Cedres A, Giachetto G, Montano A. Changes in hospitalizations for pneumonia after universal vaccination with pneumococcal conjugate vaccines 7/13 valent and haemophilus influenzae type b conjugate vaccine in a Pediatric Referral Hospital in Uruguay. Pediatr Infect Dis J 2014; 33:753-9. [PMID: 24492286 DOI: 10.1097/inf.0000000000000294] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND In 1994, Uruguay included Haemophilus influenzae b (Hib) conjugated vaccine in a 3 + 1 schedule. In March 2008, 7-valent pneumococcal conjugate vaccines (PCV7) was included in a 2 +1 schedule. In 2010, 13-valent PCV replaced PCV7. Catch-up immunization was offered. The aim of this study was to describe the etiology of community-acquired pneumonia (CAP) in children 0-14 years of age hospitalized at the Hospital Pediatrico-Centro Hospitalario Pereira Rossell between 2003 and 2012. METHODS Annual hospitalization rates (per 10,000 discharges) for CAP and bacterial-confirmed CAP in children 0-14 years of age was described prior PCV7 vaccination (2003-2007), during the year of implementation of PCV7 (2008) and after the introduction of PCV7 (2009-2012). Data regarding age, strains isolated from pleural fluid and/or blood, vaccination status, pneumococcal and H. influenzae serotypes were obtained from Hospital Pediatrico-Centro Hospitalario Pereira Rossell databases and vaccination records. RESULTS Hospitalization rates for CAP and pneumococcal CAP between prevaccine years and the last year after introduction of vaccination with PCV (2012) significantly decreased by 78.1% and 92.4%, respectively. Significant reduction for 13-valent PCV vaccine serotypes and significant increase for nonvaccine serotypes was observed. A decrease in Staphylococcus aureus pneumonia was observed. Hospitalization rates for H. influenzae CAP remain stable before and after pneumococcal vaccination. CONCLUSIONS Three years after PCV7/13 introduction into the routine vaccination schedule, there was a rapid and significant reduction in rates of CAP and P-CAP. An increase of etiology of CAP by other agents was not observed.
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Affiliation(s)
- María Catalina Pírez
- From the *Facultad de Medicina, Universidad de la República; and †Laboratorio de Microbiología, Hospital Pediátrico, Centro Hospitalario Pereira Rossell, Montevideo, Uruguay
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Hortal M, Estevan M, Meny M, Iraola I, Laurani H. Impact of pneumococcal conjugate vaccines on the incidence of pneumonia in hospitalized children after five years of its introduction in Uruguay. PLoS One 2014; 9:e98567. [PMID: 24905093 PMCID: PMC4048159 DOI: 10.1371/journal.pone.0098567] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Accepted: 05/05/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Data on the burden of pneumococcal disease and the most frequent serotypes demonstrated that invasive disease and pneumonia were important manifestations affecting children under 5 years of age. Therefore, pneumococcal diseases prevention became a public health priority. Uruguay was the first Latin American country to incorporate PCV7 into its National Immunization Program. The aim of this study is to compare the incidence rates for hospitalized pneumonia in children from the pre PCV introduction period and the following five years of PCVs application in Uruguay. METHODS AND FINDINGS Population-based surveillance of pneumonia hospitalization rates, in children, less than 14 years of age, had been performed prior pneumococcal vaccination, and continued following PCV7 introduction and PCV13 replacement, using the same methodology. Hospitalized children with pneumonia were enrolled from January 1, 2009 through December 31st, 2012. The study was carried out in an area with a population of 238,002 inhabitants of whom 18, 055 were under five years of age. Patients with acute lower respiratory infections for whom a chest radiograph was performed on admission were eligible. Digitalized radiographs were interpreted by a reference radiologist, using WHO criteria. Pneumonia was confirmed in 2,697 patients, 1,267 with consolidated and 1,430 with non consolidated pneumonia of which incidence decrease, between 2009 and 2012, was 27.3% and 46.4% respectively. 2001-2004 and 2009-2012 comparison showed a significant difference of 20.4% for consolidated pneumonia hospitalizations. A significant incidence decline was recorded among children 6 to 35 months of age. CONCLUSIONS An overall significant reduction in pneumonia hospitalizations was observed following the introduction of PCV7 and furthermore following the change to PCV13.
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Affiliation(s)
- María Hortal
- Basic Sciences Development, National University, Montevideo, Uruguay
- * E-mail:
| | - Miguel Estevan
- Radiology Department, Children's Hospital, Ministry of Health, Montevideo, Uruguay
| | - Miguel Meny
- Statistics Department, Montevideo Municipality, Uruguay
| | - Inés Iraola
- Pediatric Department, Social Security, Montevideo, Uruguay
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Changes in childhood pneumonia and infant mortality rates following introduction of the 13-valent pneumococcal conjugate vaccine in Nicaragua. Pediatr Infect Dis J 2014; 33:637-42. [PMID: 24445827 DOI: 10.1097/inf.0000000000000269] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND In 2010, Nicaragua became the first developing nation to add 13-valent pneumococcal conjugate vaccine (PCV-13) to its national immunization schedule, using a "3+0" dosing schedule. We assessed changes in incidence rates of health facility visits for childhood pneumonia and infant mortality after PCV-13 introduction in the Department of León, Nicaragua. METHODS We collected visit diagnoses from all 107 public health facilities in León between 2008 and 2012. We compared rates of pneumonia hospitalizations, ambulatory visits for pneumonia and infant mortality during the prevaccine (2008-2010) and vaccine (2011-2012) periods among different age groups of children using generalized estimating equations, accounting for clustering by municipality. Exposure time was estimated by official municipality population estimates. RESULTS The adjusted incidence rate ratio for pneumonia hospitalization in the vaccine versus prevaccine period was 0.67 (0.59-0.75) among infants and 0.74 (0.67-0.81) among 1-year olds. The adjusted incidence rate ratio for ambulatory visits for pneumonia was 0.87 (0.75-1.01) among infants, and 0.84 (0.74, 0.95) among 1-year olds. The adjusted incidence rate ratio for infant mortality was 0.67 (0.57-0.80). We also observed lower rates of health facility visits for pneumonia among age groups (2- to 4-year old and 5- to 14-year old) not eligible to receive PCV-13. CONCLUSIONS Within the first 2 years of a PCV-13 immunization program in Nicaragua, we observed lower rates of hospitalizations and ambulatory visits for pneumonia among children of all ages and a lower infant mortality rate. Lower rates of pneumonia among age groups not eligible to receive PCV-13 suggest an indirect effect of the vaccine.
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Tregnaghi MW, Sáez-Llorens X, López P, Abate H, Smith E, Pósleman A, Calvo A, Wong D, Cortes-Barbosa C, Ceballos A, Tregnaghi M, Sierra A, Rodriguez M, Troitiño M, Carabajal C, Falaschi A, Leandro A, Castrejón MM, Lepetic A, Lommel P, Hausdorff WP, Borys D, Guiñazú JR, Ortega-Barría E, Yarzábal JP, Schuerman L. Efficacy of pneumococcal nontypable Haemophilus influenzae protein D conjugate vaccine (PHiD-CV) in young Latin American children: A double-blind randomized controlled trial. PLoS Med 2014; 11:e1001657. [PMID: 24892763 PMCID: PMC4043495 DOI: 10.1371/journal.pmed.1001657] [Citation(s) in RCA: 180] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Accepted: 04/24/2014] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND The relationship between pneumococcal conjugate vaccine-induced antibody responses and protection against community-acquired pneumonia (CAP) and acute otitis media (AOM) is unclear. This study assessed the impact of the ten-valent pneumococcal nontypable Haemophilus influenzae protein D conjugate vaccine (PHiD-CV) on these end points. The primary objective was to demonstrate vaccine efficacy (VE) in a per-protocol analysis against likely bacterial CAP (B-CAP: radiologically confirmed CAP with alveolar consolidation/pleural effusion on chest X-ray, or non-alveolar infiltrates and C-reactive protein ≥ 40 µg/ml); other protocol-specified outcomes were also assessed. METHODS AND FINDINGS This phase III double-blind randomized controlled study was conducted between 28 June 2007 and 28 July 2011 in Argentine, Panamanian, and Colombian populations with good access to health care. Approximately 24,000 infants received PHiD-CV or hepatitis control vaccine (hepatitis B for primary vaccination, hepatitis A at booster) at 2, 4, 6, and 15-18 mo of age. Interim analysis of the primary end point was planned when 535 first B-CAP episodes, occurring ≥2 wk after dose 3, were identified in the per-protocol cohort. After a mean follow-up of 23 mo (PHiD-CV, n = 10,295; control, n = 10,201), per-protocol VE was 22.0% (95% CI: 7.7, 34.2; one-sided p = 0.002) against B-CAP (conclusive for primary objective) and 25.7% (95% CI: 8.4%, 39.6%) against World Health Organization-defined consolidated CAP. Intent-to-treat VE was 18.2% (95% CI: 5.5%, 29.1%) against B-CAP and 23.4% (95% CI: 8.8%, 35.7%) against consolidated CAP. End-of-study per-protocol analyses were performed after a mean follow-up of 28-30 mo for CAP and invasive pneumococcal disease (IPD) (PHiD-CV, n = 10,211; control, n = 10,140) and AOM (n = 3,010 and 2,979, respectively). Per-protocol VE was 16.1% (95% CI: -1.1%, 30.4%; one-sided p = 0.032) against clinically confirmed AOM, 67.1% (95% CI: 17.0%, 86.9%) against vaccine serotype clinically confirmed AOM, 100% (95% CI: 74.3%, 100%) against vaccine serotype IPD, and 65.0% (95% CI: 11.1%, 86.2%) against any IPD. Results were consistent between intent-to-treat and per-protocol analyses. Serious adverse events were reported for 21.5% (95% CI: 20.7%, 22.2%) and 22.6% (95% CI: 21.9%, 23.4%) of PHiD-CV and control recipients, respectively. There were 19 deaths (n = 11,798; 0.16%) in the PHiD-CV group and 26 deaths (n = 11,799; 0.22%) in the control group. A significant study limitation was the lower than expected number of captured AOM cases. CONCLUSIONS Efficacy was demonstrated against a broad range of pneumococcal diseases commonly encountered in young children in clinical practice. TRIAL REGISTRATION www.ClinicalTrials.gov NCT00466947.
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Affiliation(s)
- Miguel W. Tregnaghi
- Centro de Desarrollo del Proyectos Avanzados en Pediatría, Córdoba, Argentina
| | - Xavier Sáez-Llorens
- Department of Infectious Diseases, Hospital del Niño, Panama City, Panama
- * E-mail:
| | - Pio López
- Centro de Estudios en Infectología Pediátrica, Cali, Colombia
| | - Hector Abate
- Department of Infectious Diseases, Hospital Notti, Mendoza, Argentina
| | - Enrique Smith
- Centro de Desarrollo del Proyectos Avanzados en Pediatría, Santiago del Estero, Argentina
| | - Adriana Pósleman
- Centro de Desarrollo del Proyectos Avanzados en Pediatría, San Juan, Argentina
| | - Arlene Calvo
- Health Research International, Panama City, Panama
| | - Digna Wong
- Instituto de Investigaciones Científicas y Servicios de Alta Tecnología, Panama City, Panama
| | | | - Ana Ceballos
- Centro de Desarrollo del Proyectos Avanzados en Pediatría, Córdoba, Argentina
| | - Marcelo Tregnaghi
- Centro de Desarrollo del Proyectos Avanzados en Pediatría, Córdoba, Argentina
| | | | - Mirna Rodriguez
- Instituto de Investigaciones Científicas y Servicios de Alta Tecnología, Panama City, Panama
| | | | - Carlos Carabajal
- Centro de Desarrollo del Proyectos Avanzados en Pediatría, Santiago del Estero, Argentina
| | - Andrea Falaschi
- Department of Infectious Diseases, Hospital Notti, Mendoza, Argentina
| | - Ana Leandro
- Department of Pediatrics, Hospital del Niño, Panama City, Panama
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Picón T, Alonso L, García Gabarrot G, Speranza N, Casas M, Arrieta F, Camou T, Rosa R, De Oliveira LH, Verani JR. Effectiveness of the 7-valent pneumococcal conjugate vaccine against vaccine-type invasive disease among children in Uruguay: an evaluation using existing data. Vaccine 2014; 31 Suppl 3:C109-13. [PMID: 23777683 DOI: 10.1016/j.vaccine.2013.01.059] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2012] [Revised: 11/07/2012] [Accepted: 01/30/2013] [Indexed: 11/19/2022]
Abstract
The 7-valent pneumococcal conjugate vaccine (PCV7) was introduced into the routine immunization program in Uruguay in March 2008 with a 2-dose primary series (given at 2 and 4 months) plus a booster (at 12 months) and a catch-up campaign (two doses given at 15 and 17 months). We used a case-control methodology and existing laboratory surveillance and immunization registry data from Uruguay to evaluate PCV7 effectiveness against vaccine-type invasive pneumococcal disease (VT-IPD). Cases of VT-IPD (with pneumococcus obtained from a normally sterile site) were identified through the National Reference Laboratory. Age- and neighborhood-matched controls were obtained through a national immunization registry in which all children are enrolled at birth regardless of vaccine receipt; all eligible controls were included. Immunization status of cases and controls was assessed through the immunization registry, and conditional logistic regression was used to calculate PCV7 effectiveness. Between April 2008 and February 2010, 44 cases of VT-IPD among children<5 years were identified; 43 (98%) of those children were located in the registry. Among located case patients, 7 (16.3%) were age-eligible to have received at least one dose of PCV7. A total of 637 matched controls were included. Vaccine effectiveness was 91.3% (95% CI: 46.4, 98.6) for ≥ 1 PCV7 doses and 94.8% (95% CI: 43.1, 99.5) for ≥ 2 PCV7 doses. Using existing data we demonstrated high effectiveness of PCV7 against VT-IPD in Uruguay-a middle-income country using a 2-dose primary series plus a booster dose and a limited catch-up campaign. These data also highlight the utility of surveillance and high-quality immunization registries for evaluating the effectiveness of vaccines.
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Affiliation(s)
- Teresa Picón
- Immunization Unit, Epidemiology Division, Ministry of Public Health, Montevideo, Uruguay
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Ulloa-Gutierrez R, Miño G, Odio C, Avila-Aguero ML, Brea J. Vaccine-preventable diseases and their impact on Latin American children. Expert Rev Vaccines 2014; 10:1671-3. [DOI: 10.1586/erv.11.153] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Rodgers GL, Esposito S, Principi N, Gutierrez-Brito M, Diez-Domingo J, Pollard AJ, Snape MD, Martinón-Torres F, Gruber WC, Patterson S, Thompson A, Gurtman A, Paradiso P, Scott DA. Immune response to 13-valent pneumococcal conjugate vaccine with a reduced dosing schedule. Vaccine 2013; 31:4765-74. [PMID: 23965217 DOI: 10.1016/j.vaccine.2013.08.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2012] [Revised: 07/17/2013] [Accepted: 08/05/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND The 7-valent pneumococcal conjugate vaccine (PCV7) has demonstrated effectiveness against pneumococcal illnesses when administered as 3 infant doses plus a toddler dose (3+1 schedule) or as an abbreviated schedule of 2 infant doses plus a toddler dose (2+1 schedule). The 13-valent pneumococcal conjugate vaccine (PCV13) is approved and World Health Organization-prequalified for administration in a 2+1 schedule when used as part of routine immunization programs. OBJECTIVE To summarize immunologic responses elicited by PCV13 administered in a 2+1 schedule and following 2 doses in a 3+1 schedule. METHODS Studies were double-blind, randomized, active-controlled, multicenter studies except the Mexico study (open-label, single-arm). In 2+1 studies, PCV13 was administered at 2, 4, and 12 (UK) or 3, 5, and 11 (Italy) months. In 3+1 studies (Spain and Mexico), assessment was made postdose 2 of the primary series (2, 4, and 6 months). The primary immunogenicity endpoint was the proportion of participants achieving serotype-specific antipolysaccharide immunoglobulin (Ig)G concentrations ≥ 0.35μg/mL (i.e., responders) 1 month postdose 2. Pneumococcal IgG geometric mean concentrations (GMCs), opsonophagocytic activity (OPA), and concomitant vaccine responses were assessed. RESULTS PCV13 and PCV7 elicited comparable immune responses for the 7 common serotypes after 2 infant doses. The proportion of PCV13 responders postdose 2 was >85% for most of the 7 common and 6 additional serotypes, except common serotypes 6B (27.9-81.4%) and 23F (55.8-77.5%) and additional serotypes 3 (73.8-96.9%) and 6A (79.2-94.4%). Serotypes 6B and 23F elicited lower IgG GMCs postdose 2 compared with other serotypes; all serotypes demonstrated boosting posttoddler dose. All serotypes demonstrated functional activity; >95% of participants achieved OPA levels ≥ 1:8 postdose 2. Concomitant vaccine responses were similar between PCV13 and PCV7 groups. CONCLUSION Immune responses elicited by PCV13 following 2 infant doses support transition from PCV7 to PCV13 in countries using a 2+1 schedule.
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Abstract
Pneumonia remains the leading cause of childhood mortality and the most common reason for adult hospitalisation in low and middle income countries, despite advances in preventative and management strategies. In the last decade, pneumonia mortality in children has fallen to approximately 1.3 million cases in 2011, with most deaths occurring in low income countries. Important recent advances include more widespread implementation of protein-polysaccharide conjugate vaccines against Haemophilus influenzae type B and Streptococcus pneumoniae, implementation of case-management algorithms and better prevention and treatment of HIV. Determining the aetiology of pneumonia is challenging in the absence of reliable diagnostic tests. High uptake of new bacterial conjugate vaccines may impact on pneumonia burden, aetiology and empiric therapy but implementation in immunisation programmes in many low and middle income countries remains an obstacle. Widespread implementation of currently effective preventative and management strategies for pneumonia remains challenging in many low and middle income countries.
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Affiliation(s)
- H J Zar
- Department of Paediatrics and Child Health, Red Cross War Memorial Childrens Hospital, University of Cape Town, , Cape Town, South Africa
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Davis SM, Deloria-Knoll M, Kassa HT, O'Brien KL. Impact of pneumococcal conjugate vaccines on nasopharyngeal carriage and invasive disease among unvaccinated people: review of evidence on indirect effects. Vaccine 2013; 32:133-45. [PMID: 23684824 DOI: 10.1016/j.vaccine.2013.05.005] [Citation(s) in RCA: 146] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Revised: 04/26/2013] [Accepted: 05/01/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Invasive disease due to Streptococcus pneumoniae remains an important worldwide cause of morbidity and mortality, particularly in young children and the elderly. The development and use of pneumococcal conjugate vaccines (PCVs) have had a dramatic impact on rates of vaccine-type invasive pneumococcal disease (IPD) not only in the pediatric population targeted for vaccination but in non-vaccinated age-groups as well. This indirect effect is directly mediated by a reduction of vaccine-type nasopharyngeal carriage and thus transmission by vaccinated children. Current PCV licensing procedures do not take into consideration nasopharyngeal carriage impact, and thus the indirect effect. This review summarizes the evidence for the indirect effect of PCV on vaccine-type disease and its correlation with changes in carriage among unvaccinated populations, to assess the basis for inclusion of carriage in the PCV licensing process. METHODS Randomized controlled trials, surveillance and other observational studies published between 1994 and 2013 were systematically identified from global, regional and review databases and conference abstracts. We included as primary evidence, studies in non-vaccinated groups addressing changes in both vaccine-type IPD and carriage between pre- and post-PCV introduction periods; studies missing one of these four components were included as supporting rather than primary evidence. RESULTS We identified studies from 14 countries, nearly all developed countries. Vaccine-type IPD and carriage in non-targeted populations consistently decreased after PCV introduction, with the magnitude of decrease growing over time. Where IPD and carriage were observed in the same population, VT-decreases occurred contemporaneously. These relationships held true across age-groups and between indigenous and non-indigenous populations in the US and Australia. CONCLUSIONS Indirect PCV impact on VT-IPD and VT-carriage has been significant. Impact on carriage should be considered for inclusion in the PCV licensure process as a predictor of indirect effects.
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Affiliation(s)
- Stephanie M Davis
- International Vaccine Access Center, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Maria Deloria-Knoll
- International Vaccine Access Center, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Hilina T Kassa
- International Vaccine Access Center, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Katherine L O'Brien
- International Vaccine Access Center, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States; Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States.
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Decrease in Hospitalizations for Pneumonia in Children under Five Years of Age in an Indian Reservation in Panama after the Introduction of the Heptavalent Pneumococcal Conjugate Vaccine (PCV7). Int J Pediatr 2013; 2013:514578. [PMID: 23762081 PMCID: PMC3665215 DOI: 10.1155/2013/514578] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Accepted: 04/11/2013] [Indexed: 11/30/2022] Open
Abstract
This study quantifies the impact of Heptavalent-Pneumococcal Conjugate Vaccine (PCV7) in Panama on indigenous children younger than 5 years old, based on clinical pneumonia cases. This study demonstrates a significant 41.2% reduction in hospitalizations and 38.6% reduction in referrals for pneumonia following the introduction of PCV7. Burden of disease from pneumonia appears reduced in the ≤12-month- and 13-to-24-month-old groups.
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Moore DP, Dagan R, Madhi SA. Respiratory viral and pneumococcal coinfection of the respiratory tract: implications of pneumococcal vaccination. Expert Rev Respir Med 2013; 6:451-65. [PMID: 22971069 DOI: 10.1586/ers.12.32] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The interactions between Streptococcus pneumoniae and other respiratory pathogens have been studied in vitro, in animal models and in humans - including epidemiologic and vaccine probe studies. Interactions of pneumococcus with respiratory viruses are common, and many mechanisms have been suggested to explain this phenomenon. The aim of this review is to explore pneumococcal interactions with respiratory viruses and consider the potential role that the pneumococcal polysaccharide-protein conjugate vaccine may play in modifying pneumococcal-respiratory viral interactions.
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Affiliation(s)
- David Paul Moore
- Department of Science and Technology, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
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Madhi SA, Izu A, Violari A, Cotton MF, Panchia R, Dobbels E, Sewraj P, van Niekerk N, Jean-Philippe P, Adrian PV. Immunogenicity following the first and second doses of 7-valent pneumococcal conjugate vaccine in HIV-infected and -uninfected infants. Vaccine 2012; 31:777-83. [PMID: 23228814 DOI: 10.1016/j.vaccine.2012.11.076] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2012] [Revised: 11/14/2012] [Accepted: 11/26/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND The immunogenicity of pneumococcal conjugate vaccine (PCV) has not been evaluated in HIV-infected infants following the first and second PCV-doses. We studied antibody kinetics of serotypes included in 7-valent PCV in HIV-infected and HIV-uninfected infants prior to and following each of three PCV-doses. METHODS HIV-uninfected infants born to HIV-uninfected (HUU) and HIV-infected mothers (HEU); and perinatal HIV-infected children with CD(4+)<25% randomized to initiate antiretroviral treatment (ART) when clinically and/or immunologically indicated (ART-) or immediately (ART+) were enrolled. Vaccination occurred at approximately 7.4, 11.5 and 15.5 weeks of age. Serotype-specific antibody was measured by ELISA following each PCV-dose and opsonophagocytic activity (OPA) to three serotypes following the second and third doses. RESULTS Pre-vaccination, antibody geometric mean concentrations (GMCs) were higher in HUU compared to HIV-exposed groups for most serotypes. GMCs and proportion of infants with antibody ≥0.35 μg/ml were similar in HUU compared to other groups following the second PCV-dose. In all groups, GMCs were greater following the third compared to post-second dose; and a higher proportion within each group had antibody ≥0.35 μg/ml to 6B and 23F. OPA GMTs increased after the third compared to post-second dose for studied-serotypes; as did the proportion with OPA ≥8 to 23F. CONCLUSION A two-dose primary-series of PCV probably confers similar protection against invasive pneumococcal disease in HIV-infected compared to HUU children. The inferior response to serotypes 6B and 23F, and lower GMCs and OPA GMTs, following two compared to after three PCV-doses may have implications in the prevention of pneumococcal disease in high-burden countries.
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Affiliation(s)
- Shabir A Madhi
- National Institute for Communicable Diseases - Division of National Health Laboratory Service, Centre for Vaccines and Immunology, Sandringham, South Africa.
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Laboratory surveillance of invasive pneumococcal disease in New South Wales, Australia, before and after introduction of 7-valent conjugate vaccine: reduced disease, but not antibiotic resistance rates. Epidemiol Infect 2012; 141:1797-806. [PMID: 23010351 DOI: 10.1017/s095026881200218x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
We compared serotype distributions of Streptococcus pneumoniae isolates from patients aged <5 and o5 years with invasive pneumococcal disease in New South Wales, Australia, and antibiotic susceptibilities of isolates from the <5 years age group only, before (2002–2004) and after(2005–2009) introduction of the 7-valent pneumococcal conjugate vaccine (PCV7). Overall, there were significant decreases in the mean annual number of referred isolates (770 vs. 515) and the proportion belonging to PCV7 serotypes (74% vs. 38%), but non-PCV7 serotypes, particularly 19A, increased (5% vs. 18%). All changes were more marked in the <5 years age group.Susceptibility testing of isolates from the <5 years age group showed variation in resistance between serotypes, but significant overall increases in penicillin non-susceptibility (23% vs. 31%),ceftriaxone resistance (2% vs. 12%) and multidrug resistance (4% vs. 7%) rates ; erythromycin resistance fell (32% vs. 25%). Continued surveillance is needed to monitor changes following the introduction of 13-valent PCV in 2012.
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Patrzalek M, Gorynski P, Albrecht P. Indirect population impact of universal PCV7 vaccination of children in a 2 + 1 schedule on the incidence of pneumonia morbidity in Kielce, Poland. Eur J Clin Microbiol Infect Dis 2012; 31:3023-8. [PMID: 22895889 DOI: 10.1007/s10096-012-1656-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2012] [Accepted: 05/15/2012] [Indexed: 10/28/2022]
Abstract
The aim of this study was an analysis of the population effects of a seven-valent pneumococcal conjugate vaccine (PCV7) on pneumonia incidence rates in the 5-year follow-up period after the introduction in 2006 of a universal PCV7 vaccination programme in the city of Kielce, Poland. Vaccinations were carried out according to a 2 + 1 schedule. The vaccination compliance rate amounted to approximately 99 %. The age groups 0-2, 30-49, 50-65 and 65+ years were analysed. The Cochran-Armitage test was used to investigate the significance of observed trends in pneumonia morbidity. The significance of deviations from a linear trend was also tested. The importance of the trend was confirmed by the Mantel test. Between 2005 and 2010, the greatest decline, 82.9 % (2005, 25.31/1,000; 2010, 4.34/1,000), in pneumonia morbidity was observed for children <2 years of age. In the 65+ years age group, this amounted to 43.5 %. Lesser declines, but still of statistical significance, were observed for the other age groups: 16.5 % in the 30-49 years group and 40.4 % in the 50-64 years group. All reductions are statistically significant and confirmed by the Mantel test. Five years after the introduction of a universal PCV7 vaccination programme in Kielce, Poland, its effectiveness in pneumonia prevention has been demonstrated in both the <2 years of age group and indirectly for other groups.
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Abstract
BACKGROUND Pneumococcal conjugate vaccines (PCV) are emerging as one of the most promising means to prevent pediatric disease. The 7-valent PCV (PCV-7) has been extensively evaluated in clinical trials, and recent evidence from the introduction of PCV-7 through national immunization programs has demonstrated impact on pneumococcal disease. METHODS Clinical trials have shown PCV-7 to be effective against the more severe forms of pneumococcal infections: pneumonia and invasive pneumococcal disease (IPD), as well as overall child mortality. A review shows the tremendous impact PCV-7 has had to date, and the potential further benefits of the emerging multi-valent vaccines. RESULTS Since its introduction, the PCV-7 has substantially reduced the incidence of IPD, hospital admissions due to pneumonia and acute otitis media in numerous, mostly high income, low-disease burden countries. The reductions in IPD and pneumonia have also been observed among unvaccinated age groups in countries with routine use of PCV-7, demonstrating that PCV-7 provides herd immunity. Some settings observed an increase in rate of nonvaccine serotype IPD, yet rates of overall and vaccine-serotype IPD show marked reductions post-PCV-7 introduction. Limited data are available on the impact of PCV-7 in lower income countries. The available data from efficacy trials from The Gambia and South Africa suggest that PCV-7 will have substantial impact on reducing pneumococcal disease. CONCLUSION PCV-7 has shown dramatic reduction in disease and mortality rates in the countries in which it has been introduced. The newly introduced 10-valent and 13-valent pneumococcal vaccines are expected to have substantial disease impact, but monitoring is essential to determine their true impact and sustain further introduction of pneumococcal conjugate vaccines.
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The pharmacoeconomics of pneumococcal conjugate vaccines in Latin America. Vaccine 2012; 29 Suppl 3:C35-42. [PMID: 21896351 DOI: 10.1016/j.vaccine.2011.06.095] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2011] [Accepted: 06/24/2011] [Indexed: 11/24/2022]
Abstract
Streptococcus pneumoniae continues to be the most important causative agent of invasive bacterial infections in children and is the most common cause of vaccine-preventable deaths in children less than 5 years of age. Due to some conditions in the Latin America region, economic assessments of pneumococcal conjugate vaccines (PCVs) have unique characteristics. First, distribution of S. pneumoniae serotypes, and thus coverage by vaccines that incorporate certain serotypes, varies within the region and compared with other parts of the world. Second, the mortality rate of pneumococcal infections in developing countries is significantly higher than in the US and Europe. Third, the economies of the Latin American region are very different from those of developed countries. For these reasons, the Pan American Health Organization (PAHO) is promoting the need for economic valuation studies of the impact of pneumococcal vaccines Latin America. Given the importance of pneumonia in the burden of pneumococcal disease in Latin America, the number of pneumonia cases prevented by the vaccine has a large impact on the economic valuation of PCVs, due to a strong correlation with numbers of deaths averted, quality-adjusted life-years (QALYs) gained or disability-adjusted life-years (DALYs) avoided. In terms of cost, analysis of impact on acute otitis media (short-term) and sequelae (long-term) show a significant and important expenditure avoided by vaccination. Cost-effectiveness is significantly modified by vaccine cost, mortality due to pneumonia, vaccine efficacy/effectiveness and herd immunity. Finally the validity of certain assumptions based on the uncertainty of the data should be considered in economic assessments of new PCVs. These include assumptions related to the impact on otitis media, estimates of efficacy/effectiveness based on measured antibody levels and the extrapolation to PCV10 and PCV13 of previous experience with PCV7.
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Andrade AL, Toscano CM, Minamisava R, Costa PS, Andrade JG. Pneumococcal disease manifestation in children before and after vaccination: what's new? Vaccine 2012; 29 Suppl 3:C2-14. [PMID: 21896349 DOI: 10.1016/j.vaccine.2011.06.096] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2011] [Accepted: 06/24/2011] [Indexed: 12/25/2022]
Abstract
Pneumococcal infections remain a relevant cause of morbidity and mortality in children, especially in countries where vaccination has not been introduced. In contrast to the common belief by many pediatricians, the most important pneumococcal infections are of the respiratory tract and not invasive diseases. The recent pandemic of the H1N1 virus prompted studies to better understand the interaction between the influenza virus, Streptococcus pneumoniae, and pneumonia outcomes. Radiological findings of bacteremic pneumonia have been well investigated and besides the typical alveolar consolidation, a broad spectrum of atypical patterns has been reported. Molecular techniques, such as real-time polymerase chain reaction (PCR), can improve the detection of S. pneumoniae in sterile fluids, mainly in regions where previous antibiotic therapy is a common practice. In the post vaccination era, new manifestations of pneumococcal invasive disease, such as hemolytic uremic syndrome, have increased in association with parapneumonic empyema. Moreover, serotypes not included in PCV7, particularly serotypes 1, 3, 5, 7F, and 19A, have been among the most common isolates in pneumococcal disease. In Latin America, pneumococcal primary peritonitis has been described as an important clinical syndrome in a growing proportion of patients, mainly in girls. The development of newer and more specific diagnostic markers to distinguish bacterial and viral pneumonia are urgently sought, and will be especially pertinent after the introduction of pneumococcal conjugate vaccines with expanded serotypes. Such markers would minimize inappropriate diagnosis of false positive cases and treatment with antibacterial agents, while increasing positive predictive values for diagnosis of bacterial pneumonia. The extension of serotype coverage with the new conjugate vaccines is promising for pneumococcal infections and coverage against antibiotic-resistant strains.
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Affiliation(s)
- Ana Lucia Andrade
- Department of Community Health, Institute of Tropical Pathology and Public Health, Federal University of Goias, Rua 235, esq 1a. Avenida, Setor Leste Universitário, 74605-050 Goiania, Goias, Brazil.
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Rodgers GL, Klugman KP. The future of pneumococcal disease prevention. Vaccine 2012; 29 Suppl 3:C43-8. [PMID: 21896352 DOI: 10.1016/j.vaccine.2011.07.047] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2011] [Accepted: 07/15/2011] [Indexed: 11/30/2022]
Abstract
Pneumococcal disease (PD) is the leading cause of vaccine preventable deaths in children <5 years of age worldwide, with most of the deaths occurring in the developing world. Prevention of PD in children has been achieved by vaccination with pneumococcal conjugate vaccine (PCV), the basis for which is induction of a protective antibody response against the bacterial polysaccharide capsule. Conjugation of the polysaccharide capsule to a protein carrier enables the generation of an immunologic response to the vaccine in young children, leading to protection against infection. The heptavalent PCV, which contains 7 of the 93 known pneumococcal serotypes (4, 6B, 9V, 14, 18C, 19F, 23F) was the first PCV available, licensed in the US in 2000 and subsequently in many countries worldwide, including Latin American and Caribbean countries. Since its introduction, PCV7 has been documented effective for reducing invasive PD mortality and burden, as well as that of pneumonia and otitis media. Additionally, PD caused by the vaccine serotypes has decreased in the unimmunized population due to herd immunity induced by PCV7. Despite this success, significant disease burden still exists globally due to serotypes not included in PCV7. Currently there are 2 new PCVs that have been approved for use in children, a 10-valent vaccine (includes PCV7 serotypes plus serotypes 1, 5 and 7F) and a 13-valent vaccine (includes PCV7 serotypes plus serotypes 1, 3, 5, 6A, 7F and 19A). The selection of new serotypes to be included was based on importance of these serotypes as causes of PD. An additional 15-valent vaccine (includes PCV 7 serotypes plus serotypes 1, 3, 5, 6A, 7F, 19A, 22F and 33F) is undergoing clinical trial testing. In view of the 93 serotypes that are currently known, it seems clear that vaccines with greater coverage, likely based on proteins common to all serotypes, will be needed in the future. Technical and regulatory challenges to the development and approval of newer PCVs include a need for licensing criteria of common protein vaccines, establishment of correlates of protection for disease manifestations other than invasive disease, comparative efficacy data, and clinical trial testing of concomitant immunization of higher valency PCVs with other vaccines.
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Affiliation(s)
- Gail L Rodgers
- Scientific Affairs, Vaccines, Pfizer Inc., 500 Arcola Road, Collegeville, PA 19426, USA.
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Arguedas A, Soley C, Abdelnour A. Prevenar experience. Vaccine 2011; 29 Suppl 3:C26-34. [DOI: 10.1016/j.vaccine.2011.06.104] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2011] [Accepted: 06/27/2011] [Indexed: 10/17/2022]
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Prevention of pneumococcal disease through vaccination. Vaccine 2011; 29 Suppl 3:C15-25. [DOI: 10.1016/j.vaccine.2011.07.121] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2011] [Accepted: 07/26/2011] [Indexed: 11/23/2022]
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