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Age-Dependent Serotype-Associated Case-Fatality Rate in Invasive Pneumococcal Disease in the Autonomous Community of Madrid between 2007 and 2020. Microorganisms 2021; 9:microorganisms9112286. [PMID: 34835413 PMCID: PMC8625439 DOI: 10.3390/microorganisms9112286] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 10/26/2021] [Accepted: 10/29/2021] [Indexed: 11/21/2022] Open
Abstract
The aim of this study was to investigate the serotype-associated fatality rate in cases of invasive pneumococcal disease (IPD) in the Spanish region of Madrid between 2007 and 2020. Serotyping was performed by Pneumotest Latex and the Quellung reaction using commercial antisera. Case-fatality rate was estimated as the ratio between the number of deaths at hospital discharge and the number of cases attributable to each serotype. To evaluate the association measures, the odds ratios with a 95% confidence interval were calculated. Twenty five pneumococcal serotypes were associated to mortality and comprised 87.8% of the total number of isolates characterized. Serotypes 8, 3, 19A, 1, 7F, 22F, 12F, and 11A were the most prevalent (≥3% each). Serotypes 31, 11A, and 19F were significantly associated to high case-fatality rates (>20% each). The lower significantly associated case-fatality rate (<10% each) was found in serotypes 5, 1, 12B, 7F, 12F, 8, 33, and 10A. The serotypes with higher mortality levels (≥0.04 per 100,000 population) were 11A (fatality 24.0%), 3 (fatality 18.7%), 19A (fatality 12.5%), and 8 (fatality 7.2%). Serotype 3 was worrisome because it is associated with important fatality levels combined with very high incidence and mortality rates. Serotype 11A also showed a high fatality with marked incidence and mortality levels. Some few frequent serotypes as 31, 19F, and 15A despite its high fatality had low levels of mortality. By contrast other serotypes as 8 showing low fatality had high mortality ranges because it shows a wide extended distribution. Finally, common serotypes, such as 1 and 5, presented small mortality length, due to their low case-fatality rates.
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Evolución de la distribución de serotipos de Streptococcus pneumoniae aislados en líquido pleural en la Comunidad de Madrid entre los años 2007 y 2018. Enferm Infecc Microbiol Clin 2021; 39:25-28. [DOI: 10.1016/j.eimc.2020.02.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Revised: 02/03/2020] [Accepted: 02/08/2020] [Indexed: 11/18/2022]
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Pneumococcal serotypes in children, clinical presentation and antimicrobial susceptibility in the PCV13 era. Epidemiol Infect 2020; 148:e279. [PMID: 33148361 PMCID: PMC7770381 DOI: 10.1017/s0950268820002708] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
The aim was to analyse invasive pneumococcal disease (IPD) serotypes in children aged ⩽17 years according to clinical presentation and antimicrobial susceptibility. We conducted a prospective study (January 2012–June 2016). IPD cases were diagnosed by culture and/or real-time polymerase chain reaction (PCR). Demographic, microbiological and clinical data were analysed. Associations were assessed using the odds ratio (OR) and 95% confidence intervals (CI). Of the 253 cases, 34.4% were aged <2 years, 38.7% 2–4 years and 26.9% 5–17 years. Over 64% were 13-valent pneumococcal conjugate vaccine (PCV13) serotypes. 48% of the cases were diagnosed only by real-time PCR. Serotypes 3 and 1 were associated with complicated pneumonia (P < 0.05) and non-PCV13 serotypes with meningitis (OR 7.32, 95% CI 2.33–22.99) and occult bacteraemia (OR 3.6, 95% CI 1.56–8.76). Serotype 19A was more frequent in children aged <2 years and serotypes 3 and 1 in children aged 2–4 years and 5–17 years, respectively. 36.1% of cases were not susceptible to penicillin and 16.4% were also non-susceptible to cefotaxime. Serotypes 14, 24F and 23B were associated with non-susceptibility to penicillin (P < 0.05) and serotypes 11, 14 and 19A to cefotaxime (P < 0.05). Serotype 19A showed resistance to penicillin (P = 0.002). In conclusion, PCV13 serotypes were most frequent in children aged ⩽17 years, mainly serotypes 3, 1 and 19A. Non-PCV13 serotypes were associated with meningitis and occult bacteraemia and PCV13 serotypes with pneumonia. Non-susceptibility to antibiotics of non-PCV13 serotypes should be monitored.
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Andrés-Martín A, Escribano Montaner A, Figuerola Mulet J, García García ML, Korta Murua J, Moreno-Pérez D, Rodrigo-Gonzalo de Liria C, Moreno Galdó A. Consensus Document on Community-Acquired Pneumonia in Children. SENP-SEPAR-SEIP. Arch Bronconeumol 2020; 56:725-741. [PMID: 32534869 DOI: 10.1016/j.arbres.2020.03.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 02/28/2020] [Accepted: 03/30/2020] [Indexed: 12/23/2022]
Abstract
Community-acquired pneumonia (CAP) is a prevalent disease among children and is frequently associated with both diagnostic and therapeutic uncertainties. Consensus has been reached between SEPAR, SENP and SEIP, and their conclusions are as follows.
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Affiliation(s)
- Anselmo Andrés-Martín
- Sección de Neumología Pediátrica, Hospital Universitario Virgen Macarena, Universidad de Sevilla, Sevilla, España.
| | - Amparo Escribano Montaner
- Unidad de Neumología Pediátrica, Servicio de Pediatría, Hospital Clínico Universitario, Universidad de Valencia, Valencia, España
| | - Joan Figuerola Mulet
- Sección de Neumología y Alergia Pediátricas, Servicio de Pediatría, Hospital Universitario Son Espases, Palma de Mallorca, Baleares, España
| | - Maria Luz García García
- Servicio de Pediatría, Hospital Universitario Severo Ochoa, Leganés, Universidad Alfonso X El Sabio, Villanueva de la Cañada, Madrid, España
| | - Javier Korta Murua
- Sección de Neumología Pediátrica, Servicio de Pediatría, Hospital Universitario Donostia, Universidad del País Vasco (UPV/EHU), San Sebastián, Guipúzcoa, España
| | - David Moreno-Pérez
- Infectología e Inmunodeficiencias, UGC de Pediatría, Hospital Materno Infantil, Hospital Regional Universitario de Málaga, Grupo de Investigación IBIMA, Universidad de Málaga, Málaga, España
| | - Carlos Rodrigo-Gonzalo de Liria
- Servicio de Pediatría, Hospital Universitario Germans Trias i Pujol, Universidad Autónoma de Barcelona, Badalona, Barcelona, España
| | - Antonio Moreno Galdó
- Sección de Neumología y Alergia Pediátricas, Servicio de Pediatría, Hospital Vall d'Hebron, Universitat Autónoma de Barcelona, Barcelona, España; CIBER de enfermedades raras, Madrid, España
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Camacho Moreno G, Imbachi LF, Leal AL, Moreno VM, Patiño JA, Gutiérrez IF, Beltrán S, Álvarez-Olmos MI, Mariño C, Barrero R, Espinosa F, Ramos N, Castellar LP, Sánchez N, Montañez A. Emergence of Streptococcus pneumoniae serotype 19A (Spn19A) in the pediatric population in Bogotá, Colombia as the main cause of invasive pneumococcal disease after the introduction of PCV10. Hum Vaccin Immunother 2020; 16:2300-2306. [PMID: 32078398 PMCID: PMC7553689 DOI: 10.1080/21645515.2019.1710411] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 12/08/2019] [Accepted: 12/24/2019] [Indexed: 11/25/2022] Open
Abstract
Introduction: With the use of pneumococcal conjugate vaccines(PCV), the behavior of invasive pneumococcal disease(IPD) has changed relative to serotype distribution. The introduction of these vaccines in national immunization programs has reduced the incidence of IPD, with a marked decrease in the circulation of the serotypes included in the vaccine used in each country. However, the subsequent emergence of other serotypes not included in the vaccine, such 19A in case of PCV7 and PCV10, has been documented. Materials and methods: This was case series study (2008-2017) in pediatric patients admitted to 10 hospitals in Bogota who were diagnosed with IPD. It was conducted during the transitional period of implementing the PCV10 vaccine in Colombia in 2012. Cases of bacteremic pneumococcal pneumonia, meningitis, primary bacteremia and osteoarticular infection were included. A descriptive analysis of the demographic, clinical and laboratory variables of patients with IPD by Spn19A, its trend over time, profiles of antimicrobial susceptibility and clinical outcomes was performed. Results: There were 463 cases of IPD, 315(68%) with known serotypes. The prevalence of IPD by Spn19A was 17.7%(56 cases), tending to increase over time. During 2008-2011, the prevalence was 4.4%, and during 2014-2017, it was 32.4%, The most frequent diagnosis was pneumonia(80.4%). In nonmeningeal isolates, 39.6% were not susceptible to penicillin. An increase in the resistance was observed over time. Conclusion: Spn19A is a prevalent cause of IPD in the pediatric population of the analyzed cohort, with an increasing trend of this serotype during the surveillance period after the introduction of PCV10, being the most common serotype identified in recent years.
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Affiliation(s)
- Germán Camacho Moreno
- Universidad Nacional de Colombia, Bogotá, Colombia
- Fundación HOMI – Hospital Pediátrico de la Misericordia, Bogotá, Colombia
- Red Neumocolombia, Bogotá, Colombia
- Hospital Universitario Infantil San José, Bogotá, Colombia
| | - Luisa F. Imbachi
- Universidad Nacional de Colombia, Bogotá, Colombia
- Red Neumocolombia, Bogotá, Colombia
| | - Aura L. Leal
- Universidad Nacional de Colombia, Bogotá, Colombia
- Red Neumocolombia, Bogotá, Colombia
| | | | | | - Iván F. Gutiérrez
- Red Neumocolombia, Bogotá, Colombia
- Clínica Infantil Colsubsidio, Bogotá, Colombia
| | - Sandra Beltrán
- Red Neumocolombia, Bogotá, Colombia
- Clínica Universitaria Colombia-Clínica Pediátrica Colsanitas, Bogotá, Colombia
| | | | - Cristina Mariño
- Red Neumocolombia, Bogotá, Colombia
- Hospital Militar Central, Bogotá, Colombia
| | - Rocío Barrero
- Red Neumocolombia, Bogotá, Colombia
- Hospital Universitario Clínica San Rafael, Bogotá, Colombia
- Unidad de Servicios de Salud Santa Clara, Subred Centro Oriente, Bogotá, Colombia
- Hospital el Tunal, Bogotá, Colombia
| | - Fabio Espinosa
- Red Neumocolombia, Bogotá, Colombia
- Hospital Universitario Infantil San José, Bogotá, Colombia
| | - Nicolás Ramos
- Red Neumocolombia, Bogotá, Colombia
- Clínica el Bosque, Bogotá, Colombia
| | - Liliana P. Castellar
- Fundación HOMI – Hospital Pediátrico de la Misericordia, Bogotá, Colombia
- Red Neumocolombia, Bogotá, Colombia
| | - Nella Sánchez
- Red Neumocolombia, Bogotá, Colombia
- Unidad de Servicios de Salud Santa Clara, Subred Centro Oriente, Bogotá, Colombia
| | - Anita Montañez
- Universidad Nacional de Colombia, Bogotá, Colombia
- Red Neumocolombia, Bogotá, Colombia
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Hernández S, Navas E, Aznar-Lou I, Ciruela P, García-García JJ, Moraga-Llop F, Muñoz-Almagro C, Codina G, de Sevilla MF, González-Peris S, Esteva C, Planes AM, Izquierdo C, Martínez-Osorio J, Campins M, Uriona S, Salleras L, Serrano-Blanco A, Jané M, Domínguez Á. Impact of the 13-Valent Conjugated Pneumococcal Vaccine on the Direct Costs of Invasive Pneumococcal Disease Requiring Hospital Admission in Children Aged < 5 Years: A Prospective Study. Vaccines (Basel) 2020; 8:vaccines8030387. [PMID: 32679762 PMCID: PMC7564806 DOI: 10.3390/vaccines8030387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 07/05/2020] [Accepted: 07/13/2020] [Indexed: 11/16/2022] Open
Abstract
The lack of invasive pneumococcal disease (IPD) cost studies may underestimate the eect ofpneumococcal polysaccharide conjugated vaccines (PCV). The objective of this study was to estimatethe direct costs of hospitalized IPD cases. A prospective study was made in children aged <5 yearsdiagnosed with IPD in two high-tech hospitals in Catalonia (Spain) between 2007-2009 (PCV7 period)and 2012-2015 (PCV13 period). Costs were calculated according to 2014 Catalan Health Service ratesusing diagnostic-related groups. In total, 319 and 154 cases were collected, respectively. Pneumoniahad the highest cost (65.7% and 62.0%, respectively), followed by meningitis (25.8% and 26.1%,respectively). During 2007-2015, the costs associated with PCV7 serotypes (Pearson coecient (Pc) =?0.79; p = 0.036) and additional PCV13 serotypes (Pc = ?0.75; p = 0.05) decreased, but those of otherserotypes did not (Pc = 0.23 p = 0.62). The total mean cost of IPD increased in the PCV13 period by31.4% (¿3016.1 vs. ¿3963.9), mainly due to ICU stay (77.4%; ¿1051.4 vs. ¿1865.6). During the PCV13period, direct IPD costs decreased due to a reduction in the number of cases, but cases were more severe and had a higher mean cost. During 2015, IPD costs increased due to an increase in the costsassociated with non-PCV13 serotypes and serotype 3 and this requires further investigation.
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Affiliation(s)
- Sergi Hernández
- Public Health Agency of Catalonia, Generalitat de Catalunya, 08005 Barcelona, Spain; (E.N.); (P.C.); (M.J.); (C.I.)
- Correspondence:
| | - Encarna Navas
- Public Health Agency of Catalonia, Generalitat de Catalunya, 08005 Barcelona, Spain; (E.N.); (P.C.); (M.J.); (C.I.)
| | - Ignacio Aznar-Lou
- Teaching, Research & Innovation Unit, Institut de Recerca Sant Joan de Déu, Sant Boi de Llobregat, 08830 Barcelona, Spain;
- CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28029 Madrid, Spain; (J.J.G.-G.); (C.M.-A.); (C.E.); (L.S.); (A.S.-B.); (Á.D.)
| | - Pilar Ciruela
- Public Health Agency of Catalonia, Generalitat de Catalunya, 08005 Barcelona, Spain; (E.N.); (P.C.); (M.J.); (C.I.)
- CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28029 Madrid, Spain; (J.J.G.-G.); (C.M.-A.); (C.E.); (L.S.); (A.S.-B.); (Á.D.)
| | - Juan José García-García
- CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28029 Madrid, Spain; (J.J.G.-G.); (C.M.-A.); (C.E.); (L.S.); (A.S.-B.); (Á.D.)
- Hospital Sant Joan de Déu Barcelona, Universitat de Barcelona, Esplugues de Llobregat, 08950 Barcelona, Spain; (M.F.d.S.); (J.M.-O.)
- Malalties Prevenibles amb Vacunes, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, 08950 Barcelona, Spain
| | - Fernando Moraga-Llop
- Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain; (F.M.-L.); (G.C.); (S.G.-P.); (A.M.P.); (M.C.); (S.U.)
| | - Carmen Muñoz-Almagro
- CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28029 Madrid, Spain; (J.J.G.-G.); (C.M.-A.); (C.E.); (L.S.); (A.S.-B.); (Á.D.)
- Hospital Sant Joan de Déu Barcelona, Universitat de Barcelona, Esplugues de Llobregat, 08950 Barcelona, Spain; (M.F.d.S.); (J.M.-O.)
- Malalties Prevenibles amb Vacunes, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, 08950 Barcelona, Spain
- Departament de Medicina, Universitat Internacional de Catalunya, 08017 Barcelona, Spain
| | - Gemma Codina
- Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain; (F.M.-L.); (G.C.); (S.G.-P.); (A.M.P.); (M.C.); (S.U.)
| | - Mariona F. de Sevilla
- Hospital Sant Joan de Déu Barcelona, Universitat de Barcelona, Esplugues de Llobregat, 08950 Barcelona, Spain; (M.F.d.S.); (J.M.-O.)
- Malalties Prevenibles amb Vacunes, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, 08950 Barcelona, Spain
| | - Sebastià González-Peris
- Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain; (F.M.-L.); (G.C.); (S.G.-P.); (A.M.P.); (M.C.); (S.U.)
| | - Cristina Esteva
- CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28029 Madrid, Spain; (J.J.G.-G.); (C.M.-A.); (C.E.); (L.S.); (A.S.-B.); (Á.D.)
- Hospital Sant Joan de Déu Barcelona, Universitat de Barcelona, Esplugues de Llobregat, 08950 Barcelona, Spain; (M.F.d.S.); (J.M.-O.)
| | - Ana María Planes
- Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain; (F.M.-L.); (G.C.); (S.G.-P.); (A.M.P.); (M.C.); (S.U.)
| | - Conchita Izquierdo
- Public Health Agency of Catalonia, Generalitat de Catalunya, 08005 Barcelona, Spain; (E.N.); (P.C.); (M.J.); (C.I.)
| | - Johanna Martínez-Osorio
- Hospital Sant Joan de Déu Barcelona, Universitat de Barcelona, Esplugues de Llobregat, 08950 Barcelona, Spain; (M.F.d.S.); (J.M.-O.)
| | - Magda Campins
- Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain; (F.M.-L.); (G.C.); (S.G.-P.); (A.M.P.); (M.C.); (S.U.)
- Epidemiology and Public Health Research Group, Vall d’Hebron Institut de Recerca, 08035 Barcelona, Spain
| | - Sonia Uriona
- Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain; (F.M.-L.); (G.C.); (S.G.-P.); (A.M.P.); (M.C.); (S.U.)
- Epidemiology and Public Health Research Group, Vall d’Hebron Institut de Recerca, 08035 Barcelona, Spain
| | - Luis Salleras
- CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28029 Madrid, Spain; (J.J.G.-G.); (C.M.-A.); (C.E.); (L.S.); (A.S.-B.); (Á.D.)
- Departament de Medicina, Universitat de Barcelona, 08036 Barcelona, Spain
| | - Antoni Serrano-Blanco
- CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28029 Madrid, Spain; (J.J.G.-G.); (C.M.-A.); (C.E.); (L.S.); (A.S.-B.); (Á.D.)
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, 08830 Barcelona, Spain
| | - Mireia Jané
- Public Health Agency of Catalonia, Generalitat de Catalunya, 08005 Barcelona, Spain; (E.N.); (P.C.); (M.J.); (C.I.)
- CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28029 Madrid, Spain; (J.J.G.-G.); (C.M.-A.); (C.E.); (L.S.); (A.S.-B.); (Á.D.)
| | - Ángela Domínguez
- CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28029 Madrid, Spain; (J.J.G.-G.); (C.M.-A.); (C.E.); (L.S.); (A.S.-B.); (Á.D.)
- Departament de Medicina, Universitat de Barcelona, 08036 Barcelona, Spain
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Valdivielso Martínez AI, Ramos Fernández JM, Pérez Frías J, Moreno Pérez D. Influence of pneumococcal vaccination on the hospitalization of healthy pediatric patients due to typical Community-Acquired Pneumonia. Int J Infect Dis 2020; 98:194-199. [PMID: 32553718 DOI: 10.1016/j.ijid.2020.06.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 06/09/2020] [Accepted: 06/10/2020] [Indexed: 10/24/2022] Open
Abstract
INTRODUCTION Community-Acquired Pneumonia (CAP) is one of the most frequent causes of hospital admission in children. Our objective is to measure the impact of the introduction of pneumococcal conjugate vaccines on the hospitalization of previously healthy children due to CAP. METHOD From 2011 to 2016, a partially retrospective, prospective, and descriptive study was carried out on healthy pediatric patients (3 months-14 years old) with CAP, who required hospital admission. Clinical, epidemiological, and demographic characteristics were collected, and vaccination status was obtained from medical records. RESULTS A total of 292 cases were included, with a mean age of 33.4 months, 54% males. There was a progressive and significant 42% decrease in the number of admissions each year, without significant changes in the annual percentage of parapneumonic pleural effusion (PPE). Fifty-six percent of patients were immunized with a pneumococcal conjugate vaccine (PCV). The percentage of children who were not vaccinated decreased by 14%, and the coverage with PCV-13 increased by 46%. This revealed a significant increase of PPE in vaccinated patients with PCV-7 (63%) compared with unvaccinated (45%) and with PCV-13 (57%), without association with the presence of severe PPE. Moreover, no significant differences in severity or hospital stay were observed in unvaccinated patients, compared to those who were vaccinated. In >2-year-olds, we observed a significant increase in PPE (59%) compared to 45% in younger children. CONCLUSIONS The increase in vaccination coverage with PCV-13 resulted in a decrease in hospitalizations due to CAP and PPE. Vaccination with PCV-7 is associated in our sample with an increase in PPE but not with severe PPE nor an increase in the hospital stay. There was an epidemiological shift of severe forms of pneumonia and empyema at later ages (>2 years).
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Affiliation(s)
- Ana Isabel Valdivielso Martínez
- Pediatría Distrito Sanitario Málaga-Guadalhorce, Pediatría Hospital Regional Universitario de Málaga, Programa del Doctorado de Universidad de Ciencias de la Salud.
| | - Jose Miguel Ramos Fernández
- Facultativo Especialista de Área de Neuropediatría, Pediatría Hospital Materno-Infantil Regional Universitario de Málaga, Grupo de Investigación IBIMA; Departamento de Pediatría y Farmacología, Facultad de Medicina, Universidad de Málaga
| | - Javier Pérez Frías
- Facultativo Especialista de Área de Neumología pediátrica, Pediatría Hospital Materno-Infantil Regional Universitario de Málaga, Grupo de Investigación IBIMA; Profesor Catedrático del Departamento de Pediatría y Farmacología, Facultad de Medicina, Universidad de Málaga
| | - David Moreno Pérez
- Departamento de Pediatría y Farmacología, Facultad de Medicina, Universidad de Málaga; Infectología Pediátrica e Inmunodeficiencias, UGC Pediatría, Hospital Materno-Infantil, Hospital Regional Universitario de Málaga, Málaga, Spain; Grupo de Investigación IBIMA; Red de Investigación Translacional en Infectología Pediátrica (RITIP)
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Triadou D, Givon-Lavi N, Greenberg D, Ben-Shimol S. Pneumococcal conjugate vaccines decrease community-acquired alveolar pneumonia with and without pleural effusion in children <60 months in Southern Israel, 2002-2016. Infect Dis (Lond) 2019; 52:186-195. [PMID: 31774020 DOI: 10.1080/23744235.2019.1695060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Background: Radiographically-proven community-acquired alveolar pneumonia with pleural effusion (PE-CAP) has a less favourable outcome than pneumonia without pleural effusion (NPE-CAP). We assessed PE-CAP and NPE-CAP rate dynamics in children <60 months in southern Israel before and after 7- and 13-valent pneumococcal conjugate vaccine (PCV7/PCV13) implementation (2002-2016).Methods: An ongoing, prospective observational study. Our hospital serves a captive population of ∼75,000 children <60 months, enabling incidence calculation. PCV7/PCV13 were implemented in Israel in July 2009/November 2010, respectively. All chest radiographs (CXRs) were digitalized and analysed according to the WHO Standardization of Interpretation. Annual incidences of PE-CAP and NPE-CAP were calculated, 2002-2016. Incidence-rate ratios (IRRs) comparing PCV13 (2013-2016), PCV7 (2010-2011) and pre-PCV (2002-2008) periods were calculated.Results: Overall, 12,271 CAP episodes were identified; 159 (1.3%) PE-CAP and 12,112 (98.7%) NPE-CAP. In total, 65.8% and 34.2% were children <24 and 24-59 months, respectively; 61.0% and 39.0% were Bedouin and Jewish children, respectively. Following PCV7 introduction, PE-CAP rates declined by 48% (Incidence rate ratios [IRR] = 0.52; 0.26-1.03), while NPE-CAP rates declined by 20% (IRR = 0.80; 0.75-0.86). In the PCV13 period, PE-CAP and NPE-CAP rates further declined, resulting in overall 70% (IRR = 0.30; 0.18-0.50) and 55% (IRR = 0.45; 0.43-0.48) reductions, respectively, comparing the PCV13 and the pre-PCV periods. Similar trends were observed in all subgroups (Bedouin vs. Jewish and age < 24 months vs. 24-59 months).Conclusions: Following PCV7/PCV13 introduction, PE-CAP and NPE-CAP rates substantially declined. However, the rate dynamics were different, with steeper declines observed in PE-CAP rates, possibly deriving from differences in disease aetiology.
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Affiliation(s)
- Daniel Triadou
- The Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva, Israel.,The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Noga Givon-Lavi
- The Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva, Israel.,The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - David Greenberg
- The Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva, Israel.,The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Shalom Ben-Shimol
- The Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva, Israel.,The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Giménez MJ, Aguilar L, Granizo JJ. Revisiting cefditoren for the treatment of community-acquired infections caused by human-adapted respiratory pathogens in adults. Multidiscip Respir Med 2018; 13:40. [PMID: 30410757 PMCID: PMC6214181 DOI: 10.1186/s40248-018-0152-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 09/24/2018] [Indexed: 11/13/2022] Open
Abstract
Fifteen years after its licensure, this revision assesses the role of cefditoren facing the current pharmacoepidemiology of resistances in respiratory human-adapted pathogens (Streptococcus pneumoniae, Streptococcus pyogenes, Haemophilus influenzae and Moraxella catarrhalis). In the era of post- pneumococcal conjugate vaccines and in an environment of increasing diffusion of the ftsI gene among H. influenzae isolates, published studies on the cefditoren in vitro microbiological activity, pharmacokinetic/pharmcodynamic (PK/PD) activity and clinical efficacy are reviewed. Based on published data, an overall analysis is performed for PK/PD susceptibility interpretation. Further translation of PK/PD data into clinical/microbiological outcomes obtained in clinical trials carried out in the respiratory indications approved for cefditoren in adults (tonsillitis, sinusitis, acute exacerbation of chronic bronchitis and community-acquired pneumonia) is commented. Finally, the role of cefditoren within the current antibiotic armamentarium for the treatment of community respiratory tract infections in adults is discussed based on the revised information on its intrinsic activity, pharmacodynamic adequacy and clinical/bacteriological efficacy. Cefditoren remains an option to be taken into account when selecting an oral antibiotic for the empirical treatment of respiratory infections in the community caused by human-adapted pathogens, even when considering changes in the pharmacoepidemiology of resistances over the last two decades.
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Affiliation(s)
- María-José Giménez
- Research Department, PRISM-AG, Don Ramón de la Cruz 72, 28006 Madrid, Spain
| | - Lorenzo Aguilar
- Research Department, PRISM-AG, Don Ramón de la Cruz 72, 28006 Madrid, Spain
| | - Juan José Granizo
- Preventive Medicine Department, Hospital Universitario Infanta Cristina, Parla, Madrid, Spain
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Latasa Zamalloa P, Sanz Moreno JC, Ordobás Gavín M, Barranco Ordoñez MD, Insúa Marisquerena E, Gil de Miguel Á, Fernández Chávez AC, García-Comas L. Trends of invasive pneumococcal disease and its serotypes in the Autonomous Community of Madrid. Enferm Infecc Microbiol Clin 2017; 36:612-620. [PMID: 29221826 DOI: 10.1016/j.eimc.2017.10.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 10/27/2017] [Accepted: 10/31/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Streptococcus pneumoniae is an important cause of morbidity. Vaccination is the most effective measure to prevent it. The aim of this study is to analyse the evolution of invasive pneumococcal disease (IPD). MATERIAL AND METHODS Observational study of IPD cases notified to the Epidemiological Surveillance Network of the Autonomous Community of Madrid between 2008 and 2015. The IPD case was defined as the disease caused by Streptococcus pneumoniae, with isolation and DNA or antigen detection, in samples from normally sterile sites. The isolated strains were sent to the Regional Public Health Laboratory for identification of the serotype. Serotypes were classified according to their inclusion in the 7-valent conjugate vaccine (PCV7), in the 13-valent vaccine, but not in the 7-valent vaccine (PCV13-additional) and not included in the 13-valent vaccine (non-PCV). The Incidence Rate Ratios (IRRs) were calculated comparing the 2011-2012 and 2013-2015 periods with the 2008-2010 period. RESULTS 4,307 cases were reported. 86.6% were serotyped. The IRR of IPD was 0.67 and 0.67 for all serotypes; 0.43 and 0.45 for PCV7 serotypes; 0.46 and 0.25 for PCV13-additional serotypes, and 1.01 and 1.32 for non-PCV13 serotypes in the 2011-2012 and 2013-2015 periods. The incidence of serotypes 8, 9N, 10A, 23B, 24F and serogroup 33 increased significantly in the 2013-2015 period. Serotypes 15B and 24F accounted for 24% of non-PCV13 cases in children under 5years, serotypes 8 and 9N for 51% in the population aged 5 to 59years and serotypes 8 and 22F for 25% in the population aged over 59years. CONCLUSIONS The incidence of serotypes not included in conjugate vaccines has increased, especially in children under 5years, but the total incidence of IPD has decreased. It is important to continue with the epidemiological and microbiological surveillance programmes to assess the effect of vaccination on the incidence of IPD.
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Affiliation(s)
- Pello Latasa Zamalloa
- Subdirección General de Epidemiología, Dirección General de Salud Pública, Consejería de Sanidad de la Comunidad de Madrid, Madrid, España.
| | - Juan Carlos Sanz Moreno
- Laboratorio Regional de Salud Pública, Dirección General de Salud Pública, Consejería de Sanidad de la Comunidad de Madrid, Madrid, España
| | - María Ordobás Gavín
- Subdirección General de Epidemiología, Dirección General de Salud Pública, Consejería de Sanidad de la Comunidad de Madrid, Madrid, España
| | - María Dolores Barranco Ordoñez
- Subdirección General de Promoción, Prevención y Educación para la Salud, Dirección General de Salud Pública, Consejería de Sanidad de la Comunidad de Madrid, Madrid, España
| | - Esther Insúa Marisquerena
- Subdirección General de Epidemiología, Dirección General de Salud Pública, Consejería de Sanidad de la Comunidad de Madrid, Madrid, España
| | - Ángel Gil de Miguel
- Departamento de Medicina Preventiva y Salud Pública, Universidad Rey Juan Carlos, Madrid, España
| | | | - Luis García-Comas
- Subdirección General de Epidemiología, Dirección General de Salud Pública, Consejería de Sanidad de la Comunidad de Madrid, Madrid, España
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Santana Hernández M, Aguiar-Santana IA, Artiles Campelo F, Colino Gil E. Paediatric invasive pneumococcal disease on the island of Gran Canaria: 16-year prospective study (2001-2016). Enferm Infecc Microbiol Clin 2017; 36:607-611. [PMID: 29179982 DOI: 10.1016/j.eimc.2017.10.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 10/23/2017] [Accepted: 10/26/2017] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To calculate the incidence of invasive pneumococcal disease (IPD) in the paediatric population of Gran Canaria (Spain), its clinical and epidemiological characteristics, serotype distribution, antibiotic resistance, and variations in these variables before and after the introduction of the PCV13 vaccine. METHODS Prospective hospital-based study including all patients (190) aged 0-14 years admitted with confirmed IPD between January 2001-May 2010 (152 cases) and June 2010-December 2016 (38 cases). Patients were divided into 3 age groups (<2 years; 2-5 years; and >5 years). Clinical symptoms were mutually-exclusively classified as meningitis, bacteraemic pneumonia, pleural effusion (PE), empyema or bacteraemia without a focus. RESULTS Most cases occurred in boys (59.47%), during autumn-winter (65.79%), in children aged <2 years (55.79%) and with mean age increasing from the pre-PCV13 to the post-PCV13 period (2.5 vs 3.1 years). Incidence between periods reduced by 66.4% (p<0.001): from 13.1/100,000 to 4.4/100,000. PEs (3.9% vs 18.4%, p<0.005) and empyemas (1.5% vs 16.7%, p=NS) increased in the post-PCV13 period whereas all other symptoms decreased, although this was not statistically significant. Vaccine serotypes (77% vs 40.6%, p=0.000), particularly serotypes 19A (23.9% vs 12.5%) and 14 (14.2% vs 9.4%), as well as erythromycin resistance (57.2% vs 7.9%, p=0.000) decreased in the post-PCV13 period. CONCLUSION IPD incidence, vaccine serotypes and erythromycin resistance decreased in the post-PCV13 period whereas PEs increased.
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Affiliation(s)
- Milagrosa Santana Hernández
- Unidad de Urgencias de Pediatría, Hospital Universitario Materno Infantil de Canarias, Las Palmas de Gran Canaria, Spain.
| | - Ione Ahedey Aguiar-Santana
- Unidad de Urgencias de Pediatría, Hospital Universitario Materno Infantil de Canarias, Las Palmas de Gran Canaria, Spain
| | - Fernando Artiles Campelo
- Servicio de Microbiología, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Spain
| | - Elena Colino Gil
- Unidad de Enfermedades Infecciosas, Hospital Universitario Materno Infantil de Canarias, Las Palmas de Gran Canaria, Spain
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12
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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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13
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Isturiz R, Sings HL, Hilton B, Arguedas A, Reinert RR, Jodar L. Streptococcus pneumoniae serotype 19A: worldwide epidemiology. Expert Rev Vaccines 2017; 16:1007-1027. [DOI: 10.1080/14760584.2017.1362339] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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14
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Jimenez Trujillo I, Lopez de Andres A, Hernandez-Barrera V, Martinez-Huedo MA, de Miguel-Diez J, Jimenez-Garcia R. Decrease in the incidence and in hospital mortality of community-acquired pneumonia among children in Spain (2001–2014). Vaccine 2017; 35:3733-3740. [DOI: 10.1016/j.vaccine.2017.05.055] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 05/17/2017] [Accepted: 05/18/2017] [Indexed: 01/09/2023]
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15
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Picazo J, Ruiz-Contreras J, Casado-Flores J, Negreira S, Baquero F, Hernández-Sampelayo T, Otheo E, Méndez C. Effect of the different 13-valent pneumococcal conjugate vaccination uptakes on the invasive pneumococcal disease in children: Analysis of a hospital-based and population-based surveillance study in Madrid, Spain, 2007-2015. PLoS One 2017; 12:e0172222. [PMID: 28207888 PMCID: PMC5312951 DOI: 10.1371/journal.pone.0172222] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 02/01/2017] [Indexed: 12/04/2022] Open
Abstract
In the Community of Madrid, the 13-valent pneumococcal conjugate vaccine (PCV13) replaced the 7-valent (PCV7) in the fully government-funded Regional Immunization Program (RIP) in May, 2010, but was later excluded in May, 2012, and included again in January, 2015. These unique changes allowed us to assess the impact of the different pneumococcal vaccination policies on PCV13 uptake in infants and on the incidence rate (IR) of invasive pneumococcal disease (IPD) in children <15 years old. In this prospective, active, surveillance study, we estimated PCV13 uptakes, IR and incidence rate ratios (IRR) for total IPD and for IPD caused by PCV13- and non-PCV13 serotypes in children <15 years, stratified by age, in four periods with different vaccination policies: fully government-funded PCV7 vaccination, fully government-funded PCV13, mixed public/private funding and only private funding. Vaccine uptakes reached 95% in periods with public-funded pneumococcal vaccination, but fell to 67% in the private funding period. Overall, IR of IPD decreased by 68% (p<0.001) in 2014–15, due to 93% reduction in the IR of PCV13-type IPD (p<0.001) without significant changes in non-PCV13-type IPD. A fully government-funded PCV13 vaccination program lead to high vaccine uptake and dramatic reductions in both overall and PCV13-type IPD IR. When this program was switched to private PCV13 vaccination, there was a fall in vaccine coverage and stagnation in the decline of PCV13-type IPD with data suggesting a weakening of herd immunity.
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Affiliation(s)
- Juan Picazo
- Medicine Department, School of Medicine, Universidad Complutense, Madrid, Spain
- * E-mail:
| | - Jesús Ruiz-Contreras
- Pediatric Department, Hospital Universitario 12 de Octubre, Madrid, Spain
- Pediatric Department, School of Medicine, Universidad Complutense, Madrid, Spain
| | - Juan Casado-Flores
- Pediatric ICU, Hospital Universitario Infantil Niño Jesús, Madrid, Spain
- Pediatric Department, School of Medicine, Universidad Autónoma, Madrid, Spain
| | - Sagrario Negreira
- Pediatric Department, Hospital Universitario 12 de Octubre, Madrid, Spain
- Pediatric Department, School of Medicine, Universidad Complutense, Madrid, Spain
| | - Fernando Baquero
- Pediatric Department, School of Medicine, Universidad Autónoma, Madrid, Spain
- Pediatric Department, Hospital Universitario La Paz, Madrid, Spain
| | - Teresa Hernández-Sampelayo
- Pediatric Department, School of Medicine, Universidad Complutense, Madrid, Spain
- Pediatric Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain and CIBER of Respiratory Diseases, CIBERES, Madrid, Spain
| | - Enrique Otheo
- Pediatric Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
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Empyema in Children: Update of Aetiology, Diagnosis and Management Approaches. CURRENT PULMONOLOGY REPORTS 2017. [DOI: 10.1007/s13665-017-0161-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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17
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Moreira M, Castro O, Palmieri M, Efklidou S, Castagna S, Hoet B. A reflection on invasive pneumococcal disease and pneumococcal conjugate vaccination coverage in children in Southern Europe (2009-2016). Hum Vaccin Immunother 2016; 13:1-12. [PMID: 27996380 PMCID: PMC5489303 DOI: 10.1080/21645515.2016.1263409] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Higher-valent pneumococcal conjugate vaccines (PCVs) were licensed from 2009 in Europe; similar worldwide clinical effectiveness was observed for PCVs in routine use. Despite a proven medical need, PCV vaccination in Southern Europe remained suboptimal until 2015/16. We searched PubMed for manuscripts published between 2009 and mid-2016. Included manuscripts had to contain data about invasive pneumococcal disease (IPD) incidence, or vaccination coverage with higher-valent PCVs. This review represents the first analysis of vaccination coverage and impact of higher-valent PCVs on overall IPD in Southern European countries (Portugal, Spain, Italy, Greece, Cyprus). Vaccination coverage in the Portuguese private market peaked around 2008 at 75% (children ≤ 2 years) but declined to 63% in 2012. In Madrid, coverage was 95% (2007–2012) but dropped to 67% (2013/14; children ≤ 2 years) after funding termination in May 2012. PCVs were recently introduced in the national immunisation program (NIP) of Portugal (2015) and Spain (2015/16). In Italy, coverage for the complete PCV schedule (children ≤ 2 years) was 88% in 2013, although highly variable between regions (45–99%). In Greece, in 2013, 82.3% had received 3 PCV doses by 12 months, while 62.3% received the fourth dose by 24 months. Overall IPD (net benefit: effect on vaccine types, vaccine-related types, and non-vaccine types) has decreased; in Greece, pneumococcal meningitis incidence remained stable. Continued IPD surveillance or national registers using ICD-10 codes of clinically suspected IPD are necessary, with timely publicly available reports and adequate national vaccination registers to assess trends in vaccination coverage, allowing evaluation of PCVs in NIPs.
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Affiliation(s)
- Marta Moreira
- a GSK Vaccines , Global Medical affairs , Wavre , Belgium
| | - Olga Castro
- b GSK, Medical Affairs Vaccines , Algés , Portugal
| | | | | | | | - Bernard Hoet
- a GSK Vaccines , Global Medical affairs , Wavre , Belgium
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18
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Corrigendum. Hum Vaccin Immunother 2016; 12:2478-81. [DOI: 10.1080/21645515.2016.1229033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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19
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Syrogiannopoulos GA, Michoula AN, Tsimitselis G, Vassiou K, Chryssanthopoulou DC, Grivea IN. Pneumonia with empyema among children in the first five years of high coverage with 13-valent pneumococcal conjugate vaccine. Infect Dis (Lond) 2016; 48:749-53. [DOI: 10.1080/23744235.2016.1192720] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Affiliation(s)
- George A. Syrogiannopoulos
- Department of Paediatrics, University of Thessaly, School of Health Sciences, Faculty of Medicine, Larissa, Greece
| | - Aspasia N. Michoula
- Department of Paediatrics, University of Thessaly, School of Health Sciences, Faculty of Medicine, Larissa, Greece
| | - Georgios Tsimitselis
- Department of Radiology, University of Thessaly, School of Health Sciences, Faculty of Medicine, Larissa, Greece
| | - Katerina Vassiou
- Department of Radiology, University of Thessaly, School of Health Sciences, Faculty of Medicine, Larissa, Greece
- Department of Anatomy, University of Thessaly, School of Health Sciences, Faculty of Medicine, Larissa, Greece
| | - Denise C. Chryssanthopoulou
- Department of Paediatrics, University of Thessaly, School of Health Sciences, Faculty of Medicine, Larissa, Greece
| | - Ioanna N. Grivea
- Department of Paediatrics, University of Thessaly, School of Health Sciences, Faculty of Medicine, Larissa, Greece
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20
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González R, Armadans L, Rodrigo JÁ, Campins M. Incidencia de hospitalizaciones por enfermedad neumocócica en niños con condiciones de riesgo en Cataluña (2005-2012). Enferm Infecc Microbiol Clin 2016; 34:293-7. [DOI: 10.1016/j.eimc.2015.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Revised: 07/15/2015] [Accepted: 07/15/2015] [Indexed: 11/27/2022]
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21
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Medeiros MIC, Negrini BVDM, Silva JME, Almeida SCG, Leopoldo ML, Leopoldo Silva Guerra ML, Guerra S, Andrade DD. Clinical and microbiological implications of invasive pneumococcal disease in hospitalized patients (1998-2013). Braz J Infect Dis 2016; 20:242-9. [PMID: 27094236 PMCID: PMC9425451 DOI: 10.1016/j.bjid.2016.01.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Revised: 12/15/2015] [Accepted: 01/25/2016] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Infections caused by Streptococcus pneumoniae (pneumococcus) still represent a challenge for health systems around the world. OBJECTIVE The objective of this study was to assess microbiological and clinical aspects in hospitalized patients with invasive pneumococcus disease between 1998 and 2013. MATERIALS AND METHODS This was a retrospective study that analyzed the results of pneumococcus identification, serotyping, and susceptibility testing found in the Adolfo Lutz Institute databank. Personal variables, medical history and clinical outcome of patients admitted with invasive pneumococcal disease were analyzed. These were obtained from records of a public teaching hospital - Hospital das Clínicas Faculdade de Medicina Ribeirão Preto. RESULTS The sample comprised 332 patients. Patient age ranged from less than one month to 89 years old (mean 20.3 years) and the sample was predominately male. Pneumonia (67.8%) was the most common disease, accounting for 18.2% of deaths. Serotypes 14, 1, 3, 9V, 6B, 6A, 23F, 19A, 18C, 19F, 12F, and 4 were the most common (75.3%). Most patients, or 67.5%, were cured without any complication (success), 6.9% had some type of sequela (failure), and 25.6% died (failure). In the case of deaths due to meningitis, strains of fully penicillin resistant pneumococcus were isolated. Furthermore, 68.2% of patients who died presented some type of comorbidity. The 60 and older age group presented the most significant association (Odds Ratio=4.2), with outcome failure regardless of the presence of comorbidity. Serotype 18C was the most significant risk factor both in raw analysis (Odds Ratio=3.8) and when adjusted for comorbidity (Odds Ratio=5.0) or age (Odds Ratio=5.4). The same occurred with serotype 12F (respectively, Odds Ratio=5.1, Odds Ratio=5.0, and Odds Ratio=4.7) CONCLUSION: The present findings highlight the importance of IPD among young adults and older adults. In the era of conjugate vaccines, monitoring serotypes in different age groups is essential to assess the impact and adequacy of immunization.
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Affiliation(s)
| | - Bento Vidal de Moura Negrini
- Hospital Center of Epidemiology, Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo (USP), Ribeirão Preto, SP, Brazil
| | - Jorgete Maria E Silva
- Hospital Center of Epidemiology, Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo (USP), Ribeirão Preto, SP, Brazil
| | | | | | | | - Silva Guerra
- Center of Bacteriology, Instituto Adolfo Lutz, São Paulo, SP, Brazil
| | - Denise de Andrade
- Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo (USP), São Paulo, SP, Brazil
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Vaccine Failures in Patients Properly Vaccinated with 13-Valent Pneumococcal Conjugate Vaccine in Catalonia, a Region with Low Vaccination Coverage. Pediatr Infect Dis J 2016; 35:460-3. [PMID: 26658626 DOI: 10.1097/inf.0000000000001041] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Vaccine failures occurring with 13-valent pneumococcal conjugate vaccine (PCV13) in 3 pediatric hospitals in Barcelona (2012-2013) are described. PCV13 vaccine failure was defined as the occurrence of an invasive pneumococcal infection in children properly vaccinated by PCV13. Among 84 patients with invasive pneumococcal infection, 32 had received at least one dose of PCV13. Seventeen of them had invasive pneumococcal infection produced by a PCV13 serotype. Among those, 9 patients were considered to have a PCV13 vaccine failure. Serotype 3 was isolated in 6 patients, serotype 19A in 2 and serotype 6B in 1.
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Affiliation(s)
- Mohamed A Hendaus
- Hamad Medical Corporation, Doha, Qatar Weill-Cornell Medical College, Ar-Rayyan, Qatar
| | - Ibrahim A Janahi
- Hamad Medical Corporation, Doha, Qatar Weill-Cornell Medical College, Ar-Rayyan, Qatar
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Moreno-Pérez D, Martín AA, García AT, Montaner AE, Mulet JF, García JG, Moreno-Galdó A, de Liria CRG, Contreras JR, Lozano JS. Community acquired pneumonia in children: Outpatient treatment and prevention. An Pediatr (Barc) 2015. [DOI: 10.1016/j.anpede.2014.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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25
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Tin Tin Htar M, Christopoulou D, Schmitt HJ. Pneumococcal serotype evolution in Western Europe. BMC Infect Dis 2015; 15:419. [PMID: 26468008 PMCID: PMC4606906 DOI: 10.1186/s12879-015-1147-x] [Citation(s) in RCA: 102] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Accepted: 09/24/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pneumococcal diseases remain a leading cause of vaccine-preventable death worldwide in children <5 years of age. The seven-valent pneumococcal conjugate vaccine (PCV7) was approved in 2001 in Europe and was introduced into the national immunization programmes of many European countries from 2006-2008. In 2009, higher-valent PCVs (PCV10 and PCV13) became available, replacing PCV7 from 2009-2011. This article describes the evolution of vaccine and non-vaccine serotypes causing invasive pneumococcal disease (IPD) following the introduction of PCVs in Western Europe, based on data from publicly-available medical publications and national surveillance systems from January 2010 to May 2015. DISCUSSION In countries with high vaccine uptake, 5-7 years after PCV7 introduction IPD caused by vaccine serotypes has almost disappeared in children. Non-PCV7 serotypes have emerged, particularly serotypes 19A, 7 F, 3 and 1. A rapid and significant reduction of the additional serotypes included in higher-valent vaccines has been observed consistently following the introduction of these vaccines. A significant and rapid decline of serotypes 19A, 7 F, 1 and 6A in both vaccine-eligible and older age groups has been observed in countries using PCV13 while serotype 19A and 3 has increased in countries using PCV10. Serotype 3 has become one of the most prevalent serotypes in adults, with some reduction only in the UK and France. Serotype diversity increased and varied by age group, the type of vaccine in use, and the time since the introduction of higher-valent PCVs. Serotypes that are currently more frequent include 24 F, 22 F, 8 and 15A in countries that use PCV13, and serotypes 19A and 3 in countries that use PCV10. Compared with the time before the introduction of higher valent PCVs, to date, there is no single '19A-like' serotype emerging across countries and most of the newly emerging non-PCV13 vaccine types are less invasive with a low case-carrier ratio. CONCLUSIONS It is important to closely monitor not only evolving serotypes but also the magnitude of the effect in order to evaluate the overall impact of pneumococcal vaccination programmes and to initiate the appropriate vaccination strategy. Emerging serotypes may also need to be considered for the future development of new vaccines.
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Affiliation(s)
- Myint Tin Tin Htar
- Pfizer Vaccines, Medical Development Group and Scientific Affairs, 23-25 avenue du Dr. Lannelongue, F-75668, Paris, Cedex 14, France.
| | - Dina Christopoulou
- Pfizer Vaccines, Medical Development Group and Scientific Affairs, 23-25 avenue du Dr. Lannelongue, F-75668, Paris, Cedex 14, France.
| | - Heinz-Josef Schmitt
- Pfizer Vaccines, Medical Development Group and Scientific Affairs, 23-25 avenue du Dr. Lannelongue, F-75668, Paris, Cedex 14, France.
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Fenoll A, Granizo JJ, Giménez MJ, Yuste J, Aguilar L. Secular trends (1990-2013) in serotypes and associated non-susceptibility of S. pneumoniae isolates causing invasive disease in the pre-/post-era of pneumococcal conjugate vaccines in Spanish regions without universal paediatric pneumococcal vaccination. Vaccine 2015; 33:5691-5699. [PMID: 26341563 DOI: 10.1016/j.vaccine.2015.08.009] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 07/28/2015] [Accepted: 08/03/2015] [Indexed: 11/27/2022]
Abstract
This study analyzed temporal trends of non-susceptibility/serotypes in invasive pneumococci from Spanish regions where pneumococcal conjugate vaccines (PCVs) were not included in paediatric immunization programmes. All invasive pneumococcal isolates voluntarily sent to the Spanish Reference Laboratory for Pneumococci (January 1990-December 2013) from hospitals located in target study regions were analyzed by age group. The PCV estimated coverage in children <24 months was correlated with 13-valent PCV (PCV13) serotypes trends. A total of 28,124 invasive isolates were analyzed: 3138 (11.2%) from children <24 months, 2161 (7.7%) from children 24-59 months, 781 (2.8%) from children 5-14 years, and 22,044 (78.4%) from adults. The estimated coverage increased from 17.6% (2002) to around 40% (2010-2013). The percentage of PCV13 serotypes among all isolates over time followed a cubic significant trend (R(2)=0.884), with an increasing trend up to 2001 followed by a decrease (more prominent from 2010 onwards). The estimated PCVs coverage was significantly correlated with the decrease in the percentage of PCV13 isolates in children <24 months (r(2)=0.824) and in adults (r(2)=0.786), mainly due to decreases in serotypes 1 and 7F in adults, and in serogroup 6 and serotypes 7F and 19A in children <24 months. None of the non-PCV13 serotypes stood out with substantial increases in the last period. This study showed that the different serotypes (and its associated non-susceptibility trends) were not equally affected by low PCVs disposition. Lack of impact in certain serotypes as serotype 1 (in children 24-59 months), 6C (in all age groups), and 19A (in adults) suggests the need for increasing vaccine coverage in the target vaccine population to increase direct and indirect protection.
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Affiliation(s)
- Asunción Fenoll
- Spanish Reference Laboratory for Pneumococci, National Center for Microbiology, Instituto de Salud Carlos III, Carretera Majadahonda a Pozuelo Km. 2, 28220 Majadahonda, Madrid, Spain.
| | - Juan-José Granizo
- Preventive Medicine Dpt., Hospital Infanta Cristina, Avenida 9 de Junio 2, 28981 Parla, Madrid, Spain.
| | | | - José Yuste
- Spanish Reference Laboratory for Pneumococci, National Center for Microbiology, Instituto de Salud Carlos III, Carretera Majadahonda a Pozuelo Km. 2, 28220 Majadahonda, Madrid, Spain.
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de Egea V, Muñoz P, Valerio M, de Alarcón A, Lepe JA, Miró JM, Gálvez-Acebal J, García-Pavía P, Navas E, Goenaga MA, Fariñas MC, Vázquez EG, Marín M, Bouza E. Characteristics and Outcome of Streptococcus pneumoniae Endocarditis in the XXI Century: A Systematic Review of 111 Cases (2000-2013). Medicine (Baltimore) 2015; 94:e1562. [PMID: 26426629 PMCID: PMC4616835 DOI: 10.1097/md.0000000000001562] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Revised: 08/18/2015] [Accepted: 08/18/2015] [Indexed: 12/22/2022] Open
Abstract
Streptococcus pneumoniae is an infrequent cause of severe infectious endocarditis (IE). The aim of our study was to describe the epidemiology, clinical and microbiological characteristics, and outcome of a series of cases of S. pneumoniae IE diagnosed in Spain and in a series of cases published since 2000 in the medical literature. We prospectively collected all cases of IE diagnosed in a multicenter cohort of patients from 27 Spanish hospitals (n = 2539). We also performed a systematic review of the literature since 2000 and retrieved all cases with complete clinical data using a pre-established protocol. Predictors of mortality were identified using a logistic regression model. We collected 111 cases of pneumococcal IE: 24 patients from the Spanish cohort and 87 cases from the literature review. Median age was 51 years, and 23 patients (20.7%) were under 15 years. Men accounted for 64% of patients, and infection was community-acquired in 96.4% of cases. The most important underlying conditions were liver disease (27.9%) and immunosuppression (10.8%). A predisposing heart condition was present in only 18 patients (16.2%). Pneumococcal IE affected a native valve in 93.7% of patients. Left-sided endocarditis predominated (aortic valve 53.2% and mitral valve 40.5%). The microbiological diagnosis was obtained from blood cultures in 84.7% of cases. In the Spanish cohort, nonsusceptibility to penicillin was detected in 4.2%. The most common clinical manifestations included fever (71.2%), a new heart murmur (55%), pneumonia (45.9%), meningitis (40.5%), and Austrian syndrome (26.1%). Cardiac surgery was performed in 47.7% of patients. The in-hospital mortality rate was 20.7%. The multivariate analysis revealed the independent risk factors for mortality to be meningitis (OR, 4.3; 95% CI, 1.4-12.9; P < 0.01). Valve surgery was protective (OR, 0.1; 95% CI, 0.04-0.4; P < 0.01). Streptococcus pneumoniae IE is a community-acquired disease that mainly affects native aortic valves. Half of the cases in the present study had concomitant pneumonia, and a considerable number developed meningitis. Mortality was high, mainly in patients with central nervous system (CNS) involvement. Surgery was protective.
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Affiliation(s)
- Viviana de Egea
- From the Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón (VDE, PM, MV, MM, EB); Department of Medicine, Universidad Complutense, Madrid (UCM), Spain (PM, MM, EB); CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III (CIBERES), Madrid, Spain (PM, MM, EB); Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM) Madrid, Spain (PM, MV, MM, EB); Microbiology and Infectious disease department, Hospital Universitario Virgen del Rocio, Sevilla (ADA, JAL); Infectious Diseases Department. Hospital Clinic-IDIBAPS, University of Barcelona (Barcelona) (JMM); Department of Medicine, Unidad Clínica Intercentros de Enfermedades Infecciosas, Microbiolo gía y Medicina Preventiva Hospital Universitario Virgen Macarena. Departamento de Medicina. Universidad de Sevilla (JG-A); Department of Cardiology, Hospital Universitario Puerta de Hierro Majadahonda, Madrid (PG-P); Hospital Ramón y Cajal, Madrid (EN); UEI HU Donostia, San Sebastián (MAG); Hospital Marqués de Valdecilla, University of Catabria, Santander (MCF); and Hospital Clínico Universitario Virgen de la Arrixaca, Instituto Murciano de Investigación Biosanitaria (IMIB), Facultad de Medicina-Universidad de Murcia, Spain (EGV)
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Principi N, Esposito S. The impact of 10-valent and 13-valent pneumococcal conjugate vaccines on serotype 19A invasive pneumococcal disease. Expert Rev Vaccines 2015; 14:1359-66. [PMID: 26289973 DOI: 10.1586/14760584.2015.1075884] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The circulation in the community of pneumococcal serotype 19A, a highly invasive and frequently extremely resistant pneumococcal strain, has increased the focus on methods to control its presence and effect. Two vaccines have been developed: the 10-valent pneumococcal conjugate vaccine (PCV10) and the 13-valent pneumococcal conjugate vaccine (PCV13). Available data indicate that PCV13 is highly effective in reducing the risk of serotype 19A invasive pneumococcal disease (IPD) in both vaccinated children and unvaccinated adults. Positive data have also been published for PCV10 that suggest that the conjugated serotype 19F included in the vaccine could evoke a cross-reactive antibody response with serotype 19A. However, a great number of invasive pneumococcal disease (IPD) cases are associated with serotypes not included in either of the vaccines, and preparation of a vaccine containing all the serotypes is unrealistic. Protein vaccines are the real future to definitively reduce the pneumococcal disease burden.
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Affiliation(s)
- Nicola Principi
- a Department of Pathophysiology and Transplantation, Pediatric Highly Intensive Care Unit, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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29
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Rodriguez BF, Mascaraque LR, Fraile LR, Perez IC, Kuder K. Streptococcus pneumoniae: the forgotten microorganism in neonatal sepsis. Fetal Pediatr Pathol 2015; 34:202-5. [PMID: 25927681 DOI: 10.3109/15513815.2015.1033073] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
UNLABELLED Streptococcus pneumoniae is a rarely cause of neonatal sepsis. Its prevalence is low but with a mortality of 50%. Measures to prevent Streptococcus agalactiae transmission could help to increase Invasive Pneumococcal Disease (IPD) in newborns. Transmission could be from mother intrapartum; or in those cases of late onset sepsis, the community carriers. Systematic vaccination with PCV-7 and PCV-13 has reduced IPD rates. We present a case of a newborn with no perinatal risk factors for infection. In the first 24 hours after surgery of an ovarian cyst, the patient started with bad general condition with fever and regular perfusion. Empiric antibiotic treatment was started. Streptococcus pneumoniae was isolated in blood culture. CONCLUSION In neonatal sepsis, we always think in Streptococcus agalactiae. Streptococcus pneumoniae is rare but with a high morbidity and mortality. Systematic vaccination is a measure that has demonstrated a reduction in the incidence of Invasive pneumococcal disease.
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Affiliation(s)
- Beatriz Fernandez Rodriguez
- Medical Doctor (M.D.) Pediatrics/Neonatology, Department of Neonatology, Santa Elena Medical Center , Madrid , Spain
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30
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Enfermedad neumocócica invasiva en la Comunitat Valenciana. Seis años de vigilancia (2007-2012). Enferm Infecc Microbiol Clin 2015; 33:149-55. [DOI: 10.1016/j.eimc.2014.05.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Revised: 05/16/2014] [Accepted: 05/29/2014] [Indexed: 11/20/2022]
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Moreno-Pérez D, Andrés Martín A, Tagarro García A, Escribano Montaner A, Figuerola Mulet J, García García JJ, Moreno-Galdó A, Rodrigo Gonzalo de Lliria C, Ruiz Contreras J, Saavedra Lozano J. [Community acquired pneumonia in children: Outpatient treatment and prevention]. An Pediatr (Barc) 2014; 83:439.e1-7. [PMID: 25488029 DOI: 10.1016/j.anpedi.2014.10.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 10/29/2014] [Indexed: 11/17/2022] Open
Abstract
There have been significant changes in community acquired pneumonia (CAP) in children in the last decade. These changes relate to epidemiology and clinical presentation. Resistance to antibiotics is also a changing issue. These all have to be considered when treating CAP. In this document, two of the main Spanish pediatric societies involved in the treatment of CAP in children, propose a consensus concerning therapeutic approach. These societies are the Spanish Society of Paediatric Infectious Diseases and the Spanish Society of Paediatric Chest Diseases. The Advisory Committee on Vaccines of the Spanish Association of Paediatrics (CAV-AEP) has also been involved in the prevention of CAP. An attempt is made to provide up-to-date guidelines to all paediatricians. The first part of the statement presents the approach to ambulatory, previously healthy children. We also review the prevention with currently available vaccines. In a next second part, special situations and complicated forms will be addressed.
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Affiliation(s)
- D Moreno-Pérez
- Infectología Pediátrica e Inmunodeficiencias, Unidad de Gestión Clínica de Pediatría, Hospital Materno-Infantil, Hospital Regional Universitario de Málaga, Grupo de Investigación IBIMA, Departamento de Pediatría y Farmacología, Facultad de Medicina, Universidad de Málaga, Málaga, España.
| | - A Andrés Martín
- Sección de Neumología Pediátrica, Servicio de Pediatría, Hospital Universitario Virgen Macarena, Departamento de Farmacología, Pediatría y Radiología, Facultad de Medicina, Universidad de Sevilla, Sevilla, España
| | - A Tagarro García
- Servicio de Pediatría, Hospital Infanta Sofía, San Sebastián de los Reyes, Madrid, España
| | - A Escribano Montaner
- Unidad de Neumología Pediátrica y Fibrosis Quística, Servicio de Pediatría, Hospital Clínico Universitario, Universitat de València, Valencia, España
| | - J Figuerola Mulet
- Unidad de Neumología y Alergia Pediátrica, Servicio de Pediatría, Hospital Universitario Son Espases, Palma de Mallorca, Islas Baleares, España
| | - J J García García
- Servicio de Pediatría, Hospital San Joan de Dèu, Universitat de Barcelona, Barcelona, España
| | - A Moreno-Galdó
- Sección de Neumología Pediátrica y Fibrosis Quística, Hospital Universitario Vall d́Hebron, Barcelona, Universitat Autònoma de Barcelona, Barcelona, España
| | - C Rodrigo Gonzalo de Lliria
- Unidad de Enfermedades Infecciosas e Inmunología Clínica, Servicio de Pediatría, Hospital Universitario Germans Trias i Pujol, Badalona, Universitat Autònoma de Barcelona, Barcelona, España
| | - J Ruiz Contreras
- Servicio de Pediatría, Hospital 12 de Octubre, Departamento de Pediatría, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, España
| | - J Saavedra Lozano
- Unidad de Infectología Pediátrica, Servicio de Pediatría, Hospital General Universitario Gregorio Marañón, Madrid, España
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32
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Recommendations for pneumococcal immunization outside routine childhood immunization programs in Western Europe. Adv Ther 2014; 31:1011-44. [PMID: 25300593 PMCID: PMC4209094 DOI: 10.1007/s12325-014-0157-1] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Indexed: 11/16/2022]
Abstract
The global burden of pneumococcal diseases is high, with young children and adults ≥50 years of age at highest risk of infection. Two types of vaccine are available for the prevention of pneumococcal diseases caused by specific Streptococcus pneumoniae serotypes: the pneumococcal polysaccharide vaccine (PPV23) and the pneumococcal conjugate vaccine (PCV7, PCV10, and PCV13). Despite pneumococcal immunization programs in adults and children, the burden in adults has remained high. Most European countries have national or local/regional vaccination recommendations. The objective of this review was to provide an overview of the government recommendations for pneumococcal vaccination outside routine childhood vaccination programs for 16 Western European countries as of August 2014. We found that recommendations for pneumococcal immunization across Europe are complex and vary greatly among countries in terms of age groups and risk groups recommended for vaccination, as well as which vaccine should be administered. Clarifying or simplifying these recommendations and improving their dissemination could help to increase pneumococcal vaccine uptake and decrease the high burden of pneumococcal diseases in adults, both through a direct effect of the vaccine and via a herd effect in unvaccinated individuals.
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Garcia-Garcia J. No more excuses… This vaccine, yes! ANALES DE PEDIATRÍA (ENGLISH EDITION) 2014. [DOI: 10.1016/j.anpede.2014.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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34
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Garcia-Garcia J. No más excusas… Esta vacuna, sí. An Pediatr (Barc) 2014; 81:139-41. [DOI: 10.1016/j.anpedi.2014.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Accepted: 05/13/2014] [Indexed: 11/30/2022] Open
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Abstract
Since the introduction of 7-valent pneumococcal conjugate vaccine (PCV7), PCVs with extended coverage have become available, and there is emerging global evidence that these vaccines, in particular PCV13, have further reduced rates of invasive pneumococcal disease compared with PCV7. The present article aims to address emerging topics related to PCV13 use in routine clinical practice; specifically: (1) the potential role of high-valent PCVs in reducing pneumococcal disease burden; (2) the impact of PCVs on nasopharyngeal carriage and how this may contribute to reductions in otitis media and pneumonia, as well as the prevalence of resistant pneumococcal strains; (3) new PCV13 indications and (4) importance of schedule adherence for PCV in the prevention of cases of vaccine serotype-specific invasive pneumococcal disease. The beneficial effects of PCVs in protecting individuals from a wide spectrum of pneumococcal diseases can be increased by improving the vaccine coverage and adhering to the recommended vaccination schedules. There is increasing evidence that PCV13 has reduced much of the post-PCV7 burden of pneumococcal diseases in the pediatric community, including reducing pneumococcal colonization and the incidence of invasive pneumococcal disease and mucosal diseases. This has also led to a reduction in antibiotic-resistant pneumococcal diseases. The role of PCV13 in clinical practice is evolving, with PCV13 now available for children and adolescents between the ages of 6 weeks and 17 years, thus ensuring that children in all age groups can be protected against vaccine-serotype pneumococcal diseases. Continued surveillance is warranted to monitor the impact of PCV13 on disease burden.
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Guevara M, Ezpeleta C, Gil-Setas A, Torroba L, Beristain X, Aguinaga A, García-Irure JJ, Navascués A, García-Cenoz M, Castilla J. Reduced incidence of invasive pneumococcal disease after introduction of the 13-valent conjugate vaccine in Navarre, Spain, 2001-2013. Vaccine 2014; 32:2553-62. [PMID: 24674661 DOI: 10.1016/j.vaccine.2014.03.054] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2013] [Revised: 02/25/2014] [Accepted: 03/13/2014] [Indexed: 10/25/2022]
Abstract
Pneumococcal conjugate vaccines (PCVs) were licensed for use in children and became available for private purchase in Spain in 2001 (PCV7), 2009 (PCV10) and 2010 (PCV13). This study evaluates changes in the incidence of invasive pneumococcal disease (IPD) and the pattern of serotypes isolated in Navarre, Spain, between the period of use of PCV7 (2004-2009) and that of PCV13 (2010-2013). The percentage of children <2 years who received at least one dose of PCV in these periods ranged from 25 to 61% and 61 to 78%, respectively. Between the periods 2004-2009 and 2010-2013 IPD incidence declined by 37%, from 14.9 to 9.4 cases/100,000 inhabitants (p<0.001). In children <5 years it fell by 69% (p<0.001), in persons aged 5-64 years, by 34% (p<0.001), and in those ≥ 65, by 23% (p=0.024). The incidence of cases due to PCV13 serotypes declined by 81% (p<0.001) in children <5 years and by 52% (p<0.001) in the whole population. No significant changes were seen in the distribution of clinical presentations or in disease severity. The incidence of IPD has declined and the pattern of serotypes causing IPD has changed notably in children and moderately in adults following the replacement of PCV7 by PCV13.
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Affiliation(s)
- Marcela Guevara
- Instituto de Salud Pública de Navarra, Pamplona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Spain.
| | | | | | - Luis Torroba
- Complejo Hospitalario de Navarra, Pamplona, Spain
| | | | | | | | | | - Manuel García-Cenoz
- Instituto de Salud Pública de Navarra, Pamplona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Spain
| | - Jesús Castilla
- Instituto de Salud Pública de Navarra, Pamplona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Spain
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Fletcher MA, Schmitt HJ, Syrochkina M, Sylvester G. Pneumococcal empyema and complicated pneumonias: global trends in incidence, prevalence, and serotype epidemiology. Eur J Clin Microbiol Infect Dis 2014; 33:879-910. [PMID: 24563274 PMCID: PMC4110404 DOI: 10.1007/s10096-014-2062-6] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Accepted: 01/15/2014] [Indexed: 12/23/2022]
Abstract
This review evaluates the serotype epidemiology of complicated pneumococcal pneumonia (CPP) during the period 1990–2012. PubMed and EMBASE were searched using the terms “empyema”, “complicated pneumonia”, “pleural infection”, “necrotizing pneumonia”, “pleural effusion”, “parapneumonic effusion”, “pneumatocele”, or “lung abscess”; “pneumococcal” or “Streptococcus pneumoniae”; and “serotype” for studies on the epidemiology of complicated pneumonias published from January 1, 1990 to October 1, 2013. Studies with data on incidence and serotypes were included; reviews, case reports, and conference abstracts were excluded. Of 152 papers, 84 fitted the inclusion criteria. A few pneumococcal serotypes were predominant causes of CPP, particularly serotypes 1, 19A, 3, 14, and 7F. CPP was a more common manifestation of pneumococcal disease among older (>2 years old) than younger children. The data support increases in both reported incidence rates and proportions of CPP in children and adults during the period 1990–2012; specific increases varied by geographic region. The proportions of serotype 3 and, particularly in Asia, serotype 19A CPP have increased, whereas most studies show declines in serotype 14. Serotype 1 has been a predominant cause of CPP since 1990, while antibiotic resistance was infrequent among serotype 1 isolates. The reported incidence and proportions of CPP among pneumonia cases steadily increased from 1990 to 2012. Several factors might account for these increases, including enhanced disease detection due to a higher index of suspicion, more sophisticated diagnostic assays, and changes in the prevalence of serotypes with capacity to invade the pleural space that were not targeted by the 7-valent pneumococcal conjugate vaccine (PCV7).
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Affiliation(s)
- M A Fletcher
- Pfizer, Inc., 23-25, avenue du Dr Lannelongue, 75668, Paris Cedex 14, France,
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Moreno-Pérez D, Álvarez García F, Arístegui Fernández J, Cilleruelo Ortega M, Corretger Rauet J, García Sánchez N, Hernández Merino A, Hernández-Sampelayo Matos T, Merino Moína M, Ortigosa del Castillo L, Ruiz-Contreras J. Calendario de vacunaciones de la Asociación Española de Pediatría: recomendaciones 2014. An Pediatr (Barc) 2014; 80:55.e1-55.e37. [DOI: 10.1016/j.anpedi.2013.10.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Accepted: 10/01/2013] [Indexed: 01/29/2023] Open
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