1
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Nakashima K, Fukushima W. Strategies for pneumococcal vaccination in older adults in the coming era. Hum Vaccin Immunother 2024; 20:2328963. [PMID: 38517265 PMCID: PMC10962601 DOI: 10.1080/21645515.2024.2328963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 03/07/2024] [Indexed: 03/23/2024] Open
Abstract
Pneumonia, predominantly caused by Streptococcus pneumoniae, remains a leading cause of global mortality. The 23-valent Pneumococcal polysaccharide vaccine (PPSV23) and conjugate vaccines (PCVs) are vital measures to fight against it. This paper discussed the changes in pneumococcal vaccination strategies, particularly for older adults, as vaccine effectiveness and epidemiological patterns shift. While PPSV23 maintains effectiveness against invasive pneumococcal disease (IPD), its effectiveness against pneumococcal pneumonia is declining. Conversely, PCV13 consistently demonstrates effectiveness against both IPD and pneumonia. Consequently, the US Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices recommends using PCVs, notably PCV20 and PCV15, over PPSV23. Japanese studies indicate a change in the efficacy/effectiveness of PPSV23 following PCV introduction in children, likely owing to serotype replacement and herd immunity. Additionally, recent data reveals a plateau in the reduction of PCV13 and PPSV23-covered serotypes, posing a challenge to current strategies. This paper indicates a paradigm shift in pneumonia management, acknowledging its chronic nature and potential to exacerbate other diseases. The future of pneumococcal vaccination lies in broader serotype coverage through PCVs, adapting to serotype changes driven by childhood vaccination programs. Furthermore, continuous research and vaccine development are crucial in this evolving field.
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Affiliation(s)
- Kei Nakashima
- Department of Pulmonology, Kameda Medical Center, Kamogawa, Japan
- Department of Public Health, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Wakaba Fukushima
- Department of Public Health, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
- Research Center for Infectious Disease Sciences, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
- Osaka International Research Center for Infectious Diseases, Osaka Metropolitan University, Osaka, Japan
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2
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Kang DW, Kim CR, Song JY, Park SK. Cost-effectiveness of the 20-valent pneumococcal conjugate vaccine versus the 23-valent pneumococcal polysaccharide vaccine for older adults in South Korea. Vaccine 2024; 42:871-878. [PMID: 38225184 DOI: 10.1016/j.vaccine.2024.01.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 12/12/2023] [Accepted: 01/09/2024] [Indexed: 01/17/2024]
Abstract
BACKGROUND Despite the demonstrated immunogenicity and safety of the 20-valent pneumococcal conjugate vaccine (PCV20) in older adults, the cost-effectiveness of the PCV20 was not examined compared to the 23-valent pneumococcal polysaccharide vaccine (PPSV23) in South Korea. Therefore, this study aimed to evaluate the cost-effectiveness of PCV20 compared with PPSV23 in adults aged 65 years and older in South Korea. METHODS We constructed a Markov model that included susceptible states, invasive pneumococcal disease (IPD), non-bacteremic pneumonia (NBP), and death. The population was categorized by disease risk status (low risk, moderate risk, and high risk) and age group (65-74/75-84/85-99 years) at model entry. The annual incidence and mortality of IPD and NBP associated with PCV20 and PPSV23 were estimated based on serotype coverage, vaccine coverage, and vaccine effectiveness. The disease costs and utilities were obtained from previous studies. The incremental cost-effectiveness ratio (ICER) was used to evaluate cost-effectiveness within the threshold of 16,824 USD per quality-adjusted life-year (QALY). RESULTS Among the total population (n = 8,843,072), PCV20 prevented 1941 and 50,575 cases of IPDs and NBPs, respectively, and 898 and 8593 deaths due to IPDs and NBPs compared to PPSV23. The total medical cost per person was 12.11 USD higher in PCV20, with a gain of 0.0053 LYs and 0.0045 QALYs per person. The ICER for PCV20 and PPSV23 was 2270 USD/LY and 2677 USD/QALY. CONCLUSIONS In South Korea, PCV20 is a cost-effective option compared with PPSV23 for adults aged 65 years and older. These cost-effectiveness results provide evidence for decision-making regarding the approval and National Immunization Program implementation of PCV20.
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Affiliation(s)
- Dong-Won Kang
- Division of Outcomes Research and Quality, Department of Surgery, Penn State College of Medicine, Hershey, PA, United States
| | - Chae-Rin Kim
- College of Pharmacy, The Catholic University of Korea, Bucheon-si, Gyeonggi-do, Republic of Korea
| | - Joon Young Song
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea.
| | - Sun-Kyeong Park
- College of Pharmacy, The Catholic University of Korea, Bucheon-si, Gyeonggi-do, Republic of Korea.
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3
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Lee MS. Invasive Pneumococcal Diseases in Korean Adults After the Introduction of Pneumococcal Vaccine into the National Immunization Program. Infect Chemother 2023; 55:411-421. [PMID: 38183392 PMCID: PMC10771953 DOI: 10.3947/ic.2023.0112] [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: 11/24/2023] [Accepted: 12/06/2023] [Indexed: 01/08/2024] Open
Abstract
Although Streptococcus pneumoniae has been one of the most common bacterial causes of disease in humans, its impact has been blunted by the broad use of vaccines. Since 2018, the incidence of invasive pneumococcal disease in Korea decreased with effective pneumococcal vaccines but is on the rise again recently. In this paper I will review the epidemiology, risk factors, and antibiotic resistance of invasive pneumococcal disease after the introduction of the pneumococcal vaccine in Korean adults.
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Affiliation(s)
- Mi Suk Lee
- Division of Infectious Diseases, Department of Internal Medicine, Kyung Hee University College of Medicine, Kyung Hee University Hospital, Seoul, Korea.
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4
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Wang J, Wang Y, Xu R, Zhang T, Jiang Y, Wang Y, Wang Y, Du Y, Sun W, Deng K, Yang W, Wang Z, Feng L, Wang C. 13-Valent pneumococcal conjugate vaccines vaccination innovative strategy in Weifang City, China: a case study. Infect Dis Poverty 2023; 12:110. [PMID: 38037092 PMCID: PMC10691032 DOI: 10.1186/s40249-023-01165-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 11/20/2023] [Indexed: 12/02/2023] Open
Abstract
The World Health Organization (WHO) prioritizes pneumococcal disease as a vaccine-preventable disease and recommends the inclusion of pneumococcal conjugate vaccines (PCV) in national immunization programs worldwide. However, PCV is not included in the National Immunization Program in China and has low vaccination coverage due to its high cost. To address this, Weifang City implemented an innovative strategy for a 13-valent PCV (PCV13) on June 1, 2021. This strategy aimed to provide one dose of PCV13 free of charge for children aged 6 months to 2 years in registered households and to adopt a commercial insurance model with one dose of PCV13 free of charge in 2023 for children over 2 years old. The Health Commission of Weifang and other departments conducted a comprehensive investigation and considered various factors, such as vaccine effectiveness, safety, accessibility, vaccine price, and immunization schedules, for eligible children (under 5 years old). Stakeholder opinions were also solicited before implementing the policy. The Commission negotiated with various vaccine manufacturers to maximize its negotiating power and reduce vaccine prices. The implementation plan was introduced under the Healthy Weifang Strategy. Following the implementation of this strategy, the full course of vaccination coverage increased significantly from 0.67 to 6.59%. However, vaccination coverage is still lower than that in developed countries. Weifang's PCV13 vaccination innovative strategy is the first of its kind in Chinese mainland and is an active pilot of non-immunization program vaccination strategies. To further promote PCV13 vaccination, Weifang City should continue to implement this strategy and explore appropriate financing channels. Regions with higher levels of economic development can innovate the implementation of vaccine programs, broaden financing channels, improve accessibility to vaccination services, and advocate for more localities to incorporate PCV13 into locally expanded immunization programs or people-benefiting projects. A monitoring and evaluation system should also be established to evaluate implementation effects.
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Affiliation(s)
- Jiachen Wang
- School of Public Health, Weifang Medical University, Weifang, 261053, Shandong, People's Republic of China
| | - Yujue Wang
- School of Dentistry, University of California Los Angeles, Los Angeles, CA, USA
| | - Ruoyu Xu
- School of Public Health, Weifang Medical University, Weifang, 261053, Shandong, People's Republic of China
| | - Ting Zhang
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, People's Republic of China
- State Key Laboratory of Respiratory Health and Multimorbidity, Beijing, People's Republic of China
- Key Laboratory of Pathogen Infection Prevention and Control (Peking Union Medical College), Ministry of Education, Beijing, People's Republic of China
| | - Yanyan Jiang
- Division of Infectious Diseases, Center for Disease Control and Prevention, Weifang, 261072, Shandong, People's Republic of China
| | - Yuanyuan Wang
- Division of Immunization, Center for Disease Control and Prevention, Weifang, 261072, Shandong, People's Republic of China
| | - Yi Wang
- Department of Public Health, Weifang People's Hospital, Weifang, People's Republic of China
| | - Yuanze Du
- Department of Nursing, Hospital of Chengdu Office of the People's Government of Tibet Autonomous Region, Chengdu, 610041, Sichuan Province, People's Republic of China
| | - Wenxue Sun
- School of Public Health, Weifang Medical University, Weifang, 261053, Shandong, People's Republic of China
| | - Kai Deng
- School of Public Health, Weifang Medical University, Weifang, 261053, Shandong, People's Republic of China
| | - Weizhong Yang
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, People's Republic of China
- State Key Laboratory of Respiratory Health and Multimorbidity, Beijing, People's Republic of China
- Key Laboratory of Pathogen Infection Prevention and Control (Peking Union Medical College), Ministry of Education, Beijing, People's Republic of China
| | - Zengwu Wang
- Department of Neurosurgery, Weifang People's Hospital, Weifang, People's Republic of China.
| | - Luzhao Feng
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, People's Republic of China.
- State Key Laboratory of Respiratory Health and Multimorbidity, Beijing, People's Republic of China.
- Key Laboratory of Pathogen Infection Prevention and Control (Peking Union Medical College), Ministry of Education, Beijing, People's Republic of China.
| | - Chunping Wang
- School of Public Health, Weifang Medical University, Weifang, 261053, Shandong, People's Republic of China.
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Du Y, Wang Y, Zhang T, Li J, Song H, Wang Y, Xu Y, Cui J, Yang M, Wang Z, Wu X, Wang C. Economic evaluations of 13-valent pneumococcal conjugate vaccine: a systematic review. Expert Rev Vaccines 2023; 22:193-206. [PMID: 36719062 DOI: 10.1080/14760584.2023.2173176] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
INTRODUCTION Studies on economic evaluations of the 13-valent pneumococcal conjugate vaccine (PCV13) have been increasing over the last decade. No systematic reviews have synthesized the evidence of economic evaluations of the PCV13. AREAS COVERED We systematically searched the literature which published on peer-reviewed journals from January 2010 to June 2022. The literature search was conducted in the following electronic databases: PubMed, Web of Science, Embase, the Cochrane Library, CNKI, Wanfang database, VIP database. We identified 1827 records from the database search. After excluding 511 duplicates, 1314 records were screened, of which 156 records were retained for the full-text reviews. A total of 44 studies were included in the review. Among the included studies, 33 studies were economic evaluations of PCV13 among children, and 11 studies were conducted among adults. The literature search initiated in April, 2022, and updated in June 2022. EXPERT OPINION Vaccination with PCV13 was found to significantly reduce the mortality and morbidity of pneumococcal diseases and was cost-effective compared to no vaccine or several other pneumococcal vaccines (e.g. PCV10, PPV23). Future research is advised to expand economic evaluations of PCV13 combined with dynamic model to enhance methodologic rigor and prediction accuracy.
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Affiliation(s)
- Yuanze Du
- School of Public Health, Weifang Medical University, Weifang, China
| | - Yi Wang
- Division of Immunization, Center for Disease Control and Prevention, Weifang, China
| | - Ting Zhang
- School of Population Medicine & Public Health, Chinese Academy of Medical Sciences/ Peking Union Medical College, Beijing, China
| | - Juanjuan Li
- School of Public Health, Weifang Medical University, Weifang, China
| | - Hewei Song
- School of Public Health, Weifang Medical University, Weifang, China
| | - Yuanyuan Wang
- Division of Immunization, Center for Disease Control and Prevention, Weifang, China
| | - Yifei Xu
- School of Public Health, Weifang Medical University, Weifang, China
| | - Jingwen Cui
- School of Public Health, Weifang Medical University, Weifang, China
| | - Ming Yang
- School of Public Health, Weifang Medical University, Weifang, China
| | - Zengwu Wang
- Department of Neurosurgery, Weifang People's Hospital, Weifang, China
| | - Xiuyun Wu
- School of Public Health, Weifang Medical University, Weifang, China
| | - Chunping Wang
- School of Public Health, Weifang Medical University, Weifang, China
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Zhang S, Wahi-Singh P, Wahi-Singh B, Chisholm A, Keeling P, Nair H. Costs of management of acute respiratory infections in older adults: A systematic review and meta-analysis. J Glob Health 2022; 12:04096. [DOI: 10.7189/jogh.12.04096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Shanshan Zhang
- Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, UK
- Department of Preventive Dentistry, Peking University, School and Hospital of Stomatology, Beijing, China
| | - Pia Wahi-Singh
- Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Bhanu Wahi-Singh
- Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Alison Chisholm
- Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Polly Keeling
- Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Harish Nair
- Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, UK
- ReSViNET Foundation, Zeist, the Netherlands
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Tantawichien T, Hsu LY, Zaidi O, Bernauer M, Du F, Yamada E, Kim JO, Sukarom I. Systematic literature review of the disease burden and vaccination of pneumococcal disease among adults in select Asia-Pacific areas. Expert Rev Vaccines 2021; 21:215-226. [PMID: 34894996 DOI: 10.1080/14760584.2022.2016399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Pneumococcal diseases are common and cause significant morbidity and mortality, with higher rates especially in developing areas including many in the Asia-Pacific (AP) region. However, current strategies to prevent pneumococcal disease in adults are quite complicated and not well implemented among many AP areas, and vaccination coverage rates among adults are generally low or perceived as low in the region. Thus, this literature review's purpose was to summarize the disease burden and vaccination against pneumococcal diseases among adults in select AP areas (Australia, Hong Kong, India, Indonesia, South Korea, Malaysia, New Zealand, the Philippines, Singapore, Taiwan, Thailand, and Vietnam). AREAS COVERED This systematic review included published articles from January 2010 to August 2020 using MEDLINE/Embase. Grey literature websites were searched for national immunization programs and medical society vaccination recommendations from areas of interest. A total of 69 publications were identified. EXPERT OPINION In the AP region, pneumococcal disease burden and serotype prevalence are variable among adult populations, particularly among older adults. Data was provided primarily from countries with established national immunization programs (NIPs). Further research on the disease burden and emphasis on the benefits of vaccination in AP areas lacking pneumococcal vaccination programs is warranted.
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Affiliation(s)
- Terapong Tantawichien
- Department of Medicine, Faculty of Medicine and Tropical Medicine Cluster, Chulalongkorn University, Bangkok, Thailand
| | - Li Yang Hsu
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Omer Zaidi
- Evidence & Access, OPEN Health, Newton, MA, USA
| | | | - Frieda Du
- Evidence & Access, OPEN Health, Shanghai, China
| | - Eriko Yamada
- Global Medical and Scientific Affairs, MSD Singapore, Singapore
| | - Jin Oh Kim
- Global Medical and Scientific Affairs, MSD Korea, Seoul, Republic of Korea
| | - Isaya Sukarom
- Center for Observational and Real-world Evidence, MSD Thailand, Bangkok, Thailand
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Astengo M, Paganino C, Amicizia D, Trucchi C, Tassinari F, Sticchi C, Sticchi L, Orsi A, Icardi G, Piazza MF, Di Silverio B, Deb A, Senese F, Prandi GM, Ansaldi F. Economic Burden of Pneumococcal Disease in Individuals Aged 15 Years and Older in the Liguria Region of Italy. Vaccines (Basel) 2021; 9:vaccines9121380. [PMID: 34960127 PMCID: PMC8706914 DOI: 10.3390/vaccines9121380] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 11/11/2021] [Accepted: 11/20/2021] [Indexed: 11/23/2022] Open
Abstract
Despite the availability of vaccines against Streptococcus pneumoniae, the global incidence and economic cost of pneumococcal disease (PD) among adults is still high. This retrospective cohort analysis estimated the cost of emergency department (ED) visits/hospitalizations associated with non-invasive pneumonia and invasive pneumococcal disease among individuals ≥15 years of age in the Liguria region of Italy during 2012–2018. Data from the Liguria Region Administrative Health Databases and the Ligurian Chronic Condition Data Warehouse were used, including hospital admission date, length of stay, discharge date, outpatient visits, and laboratory/imaging procedures. A ≥30-day gap between two events defined a new episode, and patients with ≥1 ED or inpatient claim for PD were identified. The total mean annual number of hospitalizations for PD was 13,450, costing ~€49 million per year. Pneumonia accounted for the majority of hospitalization costs. The median annual cost of hospitalization for all-cause pneumonia was €38,416,440 (per-capita cost: €26.78) and was €30,353,928 (per-capita cost: €20.88) for pneumococcal and unspecified pneumonia. The total number and associated costs of ED visits/hospitalizations generally increased over the study period. PD still incurs high economic costs in adults in the Liguria region of Italy.
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Affiliation(s)
- Matteo Astengo
- Regional Health Agency of Liguria (ALiSa), 16121 Genoa, Italy; (C.P.); (D.A.); (C.T.); (F.T.); (C.S.); (M.F.P.); (B.D.S.); (F.A.)
- Correspondence: ; Tel.: +39-0105488257
| | - Chiara Paganino
- Regional Health Agency of Liguria (ALiSa), 16121 Genoa, Italy; (C.P.); (D.A.); (C.T.); (F.T.); (C.S.); (M.F.P.); (B.D.S.); (F.A.)
| | - Daniela Amicizia
- Regional Health Agency of Liguria (ALiSa), 16121 Genoa, Italy; (C.P.); (D.A.); (C.T.); (F.T.); (C.S.); (M.F.P.); (B.D.S.); (F.A.)
| | - Cecilia Trucchi
- Regional Health Agency of Liguria (ALiSa), 16121 Genoa, Italy; (C.P.); (D.A.); (C.T.); (F.T.); (C.S.); (M.F.P.); (B.D.S.); (F.A.)
- Department of Health Sciences (DiSSal), University of Genoa, 16132 Genoa, Italy; (L.S.); (A.O.); (G.I.)
| | - Federico Tassinari
- Regional Health Agency of Liguria (ALiSa), 16121 Genoa, Italy; (C.P.); (D.A.); (C.T.); (F.T.); (C.S.); (M.F.P.); (B.D.S.); (F.A.)
| | - Camilla Sticchi
- Regional Health Agency of Liguria (ALiSa), 16121 Genoa, Italy; (C.P.); (D.A.); (C.T.); (F.T.); (C.S.); (M.F.P.); (B.D.S.); (F.A.)
| | - Laura Sticchi
- Department of Health Sciences (DiSSal), University of Genoa, 16132 Genoa, Italy; (L.S.); (A.O.); (G.I.)
| | - Andrea Orsi
- Department of Health Sciences (DiSSal), University of Genoa, 16132 Genoa, Italy; (L.S.); (A.O.); (G.I.)
| | - Giancarlo Icardi
- Department of Health Sciences (DiSSal), University of Genoa, 16132 Genoa, Italy; (L.S.); (A.O.); (G.I.)
| | - Maria Francesca Piazza
- Regional Health Agency of Liguria (ALiSa), 16121 Genoa, Italy; (C.P.); (D.A.); (C.T.); (F.T.); (C.S.); (M.F.P.); (B.D.S.); (F.A.)
| | - Bruno Di Silverio
- Regional Health Agency of Liguria (ALiSa), 16121 Genoa, Italy; (C.P.); (D.A.); (C.T.); (F.T.); (C.S.); (M.F.P.); (B.D.S.); (F.A.)
| | - Arijita Deb
- Merck & Co., Inc., Kenilworth, NJ 07033, USA;
| | | | | | - Filippo Ansaldi
- Regional Health Agency of Liguria (ALiSa), 16121 Genoa, Italy; (C.P.); (D.A.); (C.T.); (F.T.); (C.S.); (M.F.P.); (B.D.S.); (F.A.)
- Department of Health Sciences (DiSSal), University of Genoa, 16132 Genoa, Italy; (L.S.); (A.O.); (G.I.)
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Huang H, Gao L, Engelhardt M, Saulay M, Hamed K. A post hoc analysis of two Phase III trials showing the efficacy and tolerability of ceftobiprole in East Asian patients. Future Microbiol 2021; 16:783-796. [PMID: 34155899 DOI: 10.2217/fmb-2021-0121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: To evaluate the efficacy and safety of ceftobiprole in patients from East Asia. Materials & methods: A post hoc analysis was conducted of two randomized, double-blind, Phase III studies in patients with community- or hospital-acquired pneumonia. Results: Findings for East Asian patients were consistent with the overall study populations. A trend toward higher microbiological eradication rates and numerically lower rates of all-cause mortality were reported for ceftobiprole versus comparators (all-cause mortality [intent-to-treat]: community-acquired pneumonia, 1.5 vs 2.8%; hospital-acquired pneumonia excluding ventilator-associated pneumonia, 5.9 vs 11.4%). The incidence of adverse events was similar between treatment groups. Conclusion: This post hoc analysis supports the efficacy and tolerability of ceftobiprole in East Asian patients. ClinicalTrials.gov trial identifiers: NCT00326287, NCT00210964, NCT00229008.
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Affiliation(s)
- Haihui Huang
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China
| | - Lei Gao
- Institute of Clinical Pharmacology, Peking University First Hospital, Beijing, China
| | - Marc Engelhardt
- Basilea Pharmaceutica International Ltd., Basel, Switzerland
| | - Mikael Saulay
- Basilea Pharmaceutica International Ltd., Basel, Switzerland
| | - Kamal Hamed
- Basilea Pharmaceutica International Ltd., Basel, Switzerland
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Darbà J, Marsà A. Hospital incidence, in-hospital mortality and medical costs of pneumococcal disease in Spain (2008-2017): a retrospective multicentre study. Curr Med Res Opin 2021; 37:523-530. [PMID: 33459058 DOI: 10.1080/03007995.2021.1876007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The aim of this study was to analyze the characteristics of the patients attended with a pneumococcal disease in Spanish hospitals, to evaluate trends in hospital incidence and in-hospital mortality and to quantify patients' use of resources and medical costs. METHODS Medical admission records of patients admitted due to pneumococcal disease between 1 January 2008 and 31 December 2017 were obtained from a Spanish hospital discharge database. Records were identified with the International Statistical Classification of Diseases and Related Health Problems, 9th and 10th version codes corresponding to pneumococcal pneumonia, bacteraemia, pyogenic arthritis, endocarditis, meningitis, peritonitis and unspecified pneumococcal infections. RESULTS Admissions of 168,074 patients were analyzed, with a mean age of 63.5 years (median = 72; interquartile range = 28). Pneumococcal pneumonia was responsible for 64.1% of all admissions, with a hospital incidence of 31.1 per 10,000 patients that decreased significantly over the study period (p = .002). Hospital incidence of meningitis also displayed a decreasing trend over the study period (p = .003), whereas incidence of bacteraemia and pyogenic arthritis increased significantly (p = .001; p = .004). Mean Charlson Comorbidity Index was 3.3 (standard deviation = 2.2). In-hospital mortality was 7.0% over the study period, being the highest in patients admitted with endocarditis (17.2%). Sepsis, acute renal failure, disorders of fluid electrolyte and acid-base balance, heart failure and acute respiratory failure were strongly associated with in-hospital mortality. Mean length of hospital stay was of 11.1 days (median = 22; interquartile range = 26) and there was a majority of urgent admissions (95.0%); the most extended stays were registered in patients with endocarditis, meningitis and pyogenic arthritis. The mean hospital admission cost was €5676, €104.2 million annually for all registered patients; 50.3% of all costs were associated with pneumonia, whereas the highest admission costs were registered in patients with endocarditis (€15,991) and meningitis (€11,934). Mean admission costs increased significantly over the study period for pneumonia and bacteraemia and decreased for endocarditis. CONCLUSIONS The incidence of pneumococcal pneumonia and meningitis decreased over the study period after the introduction of vaccination in Spain. The advanced age of patients and presence of chronic comorbid conditions that are associated to in-hospital mortality must be taken into account when improving care protocols and upcoming vaccination plans.
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Affiliation(s)
- Josep Darbà
- Department of Economics, Universitat de Barcelona, Barcelona, Spain
| | - Alicia Marsà
- BCN Health Economics & Outcomes Research S.L., Barcelona, Spain
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11
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Li MC, Wang Y, Zhang H, Liu Y, Chen XJ, Yang HW, Ma P, Wang DC, Zhang BC, Dong AY, Wang CX, Li Y, Bai P, Tang WM, Wang J, Shao ZJ, Xu YC. Serotype distribution and clinical characteristics associated with streptococcus pneumoniae among Chinese children and adults with invasive pneumococcal disease: a multicenter observational study. Hum Vaccin Immunother 2021; 17:146-156. [PMID: 32530720 PMCID: PMC7872053 DOI: 10.1080/21645515.2020.1757996] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Accepted: 04/14/2020] [Indexed: 11/30/2022] Open
Abstract
Few studies in China focused on serotypes of Streptococcus pneumoniae in patients with invasive pneumococcal disease (IPD). We aimed at investigating the serotype distribution for IPD-causing S. pneumoniae and vaccine coverage among Chinese children and adults. This was a multicenter, observational study to collect S. pneumoniae isolates from normal sterile sites and IPD-related clinical information among children and adults. Serotyping was performed by a Capsule-Quellung reaction test using type-specific antisera. The study collected a total of 300 eligible isolates (pediatric = 148, adult = 152) were serotyped in a central laboratory. The most prevalent serotypes were 19A (20.9%) and 23 F (20.3%) in the pediatric group; 3 (21.7%) and 19 F (11.8%) in the adult group. PCV10 had low-to-moderate serotype coverage rates for children (60.8%) and adults (34.2%). PCV13 and PPV23 had high coverage rates for children (89.9%, 93.2%) and adults (70.4%, 82.9%), respectively, Investigational PCVs including PCV15 and PCV20 had high estimated coverage rates in children (89.9%, 93.9%). The study identified 269 subjects with IPD reported as the primary diagnosis in the medical records. Sepsis (48/136, 35.3%) and pneumonia (48/133, 36.1%) had the highest occurrence in the pediatric and adult groups, respectively. Study findings showed that non-PCV7 S. pneumoniae 19A and 3 were the most prevalent serotypes in Chinese children and adults, respectively. High-valent vaccines had similar coverage rates and may have a greater potential in preventing IPD.
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Affiliation(s)
- Ma-Chao Li
- State Key Laboratory for Infectious Diseases Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yao Wang
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
- Beijing Key Laboratory for Mechanisms Research and Precision Diagnosis of Invasive Fungal Diseases, Beijing, China
| | - Hong Zhang
- Department of Laboratory Medicine, Children’s Hospital of Shanghai, Shanghai, China
| | - Yong Liu
- Department of Laboratory Medicine, Shengjing Hospital of China Medical University, Shenyang, China
| | - Xue-Jun Chen
- Department of Clinical Laboratory, The Children’s Hospital, Zhenjiang University School of Medicine, Hangzhou, China
| | - Hong-Wei Yang
- Department of Laboratory Medicine, Taihe Hospital, Hubei University of Medicine Shiyan, Shiyan, China
| | - Ping Ma
- Department of Laboratory Medicine, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Ding-Cheng Wang
- Department of Laboratory Medicine, Tangdu Hospital, Fourth Military Medical University, Xian, China
| | - Bing-Chang Zhang
- Department of Clinical Laboratory, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Ai-Ying Dong
- Department of Laboratory Medicine, North China University of Science and Technology Affiliated Hospital, Tangshan, China
| | - Chun-Xin Wang
- Department of Medical Laboratory, Wuxi People’s Hospital, Wuxi, China
| | - Yan Li
- Department of Clinical Laboratory, Renmin Hospital of Wuhan University, Wuhan, China
| | - Peng Bai
- Global Medical Affairs, Merck Sharp & Dohme China, Shanghai, China
| | - Wen-Min Tang
- Global Medical Affairs, Merck Sharp & Dohme China, Shanghai, China
| | - Jue Wang
- Global Medical Affairs, Merck Sharp & Dohme China, Shanghai, China
| | - Zhu-Jun Shao
- State Key Laboratory for Infectious Diseases Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Ying-Chun Xu
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
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12
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Kim HY, Park SB, Kang ES, Lee SM, Kim HJ, Wasserman M. Cost-effectiveness of a national immunization program with the 13-valent pneumococcal conjugate vaccine compared with the 10-valent pneumococcal conjugate vaccine in South Korea. Hum Vaccin Immunother 2020; 17:909-918. [PMID: 32783576 PMCID: PMC7993233 DOI: 10.1080/21645515.2020.1796426] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Introduction Globally, pneumococcal disease represents a significant burden. South Korea implemented the 7-valent pneumococcal conjugate vaccine (PCV7) in 2003, replaced with the 10-valent (PCV10) and 13-valent (PCV13) vaccine in 2010. In 2014, both vaccines were introduced in the national immunization program (NIP) for infants with 3 primary doses and one booster dose We performed a cost-effectiveness evaluation to elucidate which vaccine may be expected to provide greater impact if included in a NIP. Methodology Using an established model, we estimated the impact of introducing either PCV13 or PCV10 into the South Korean NIP in 2015. Vaccine impact was based on historic observed impact of PCV13 from 2010 to 2015 in Korea given high uptake of PCV13, and PCV10 impact was estimated based on experiences in countries using PCV10. Incidence and costs for all ages and including invasive pneumococcal disease, pneumonia, and acute otitis media were derived from the literature and Health Insurance Review and Assessment database. Results In the base-case, over 5-years PCV13 was estimated to avert 550,000 more cases of pneumococcal disease compared to PCV10, driven by broader serotype coverage and less replacement due to serotypes 3 and 19A. This translated to a cost-savings of $47.4 million USD despite PCV13’s higher cost. Sensitivity analysis found incremental cost-effectiveness ratios (ICERs) ranged from cost-saving to $7,300 USD per quality-adjusted life year (QALY). Conclusion A NIP using PCV13 was estimated to have a more substantial public health impact and be cost-saving compared to a program with PCV10 due to broader serotype coverage.
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Affiliation(s)
| | | | - Eun-Sil Kang
- Health Economics and Outcomes Research, Pfizer Ltd, Seoul, Korea
| | - Sang-Min Lee
- Health Economics and Outcomes Research, Pfizer Ltd, Seoul, Korea
| | | | - Matt Wasserman
- Health Economics and Outcomes Research, Pfizer Inc, New York, NY, USA
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13
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Zakiyah N, Insani WN, Suwantika AA, van der Schans J, Postma MJ. Pneumococcal Vaccination for Children in Asian Countries: A Systematic Review of Economic Evaluation Studies. Vaccines (Basel) 2020; 8:vaccines8030426. [PMID: 32751569 PMCID: PMC7564215 DOI: 10.3390/vaccines8030426] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 07/21/2020] [Accepted: 07/27/2020] [Indexed: 12/19/2022] Open
Abstract
Background: Evidence on costs and health benefits of pneumococcal conjugate vaccine (PCV) for children in Asian countries is limited but growing. As a region with a considerably high burden of pneumococcal disease, it is prominent to have a comprehensive overview on the cost-effectiveness of implementing and adopting a PCV vaccination program. Methods: We conducted a systematic review from Pubmed and Embase to identify economic evaluation studies of PCV for children in Asian countries up to May 2020. Data extraction included specific characteristics of the study, input parameters, cost elements, cost-effectiveness results, and key drivers of uncertainty. The Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) statement was followed for this systematic review. The reporting quality of the included studies was evaluated using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement. Results: After the screening process on both the title and abstract and full text of 518 records, a total of 25 studies fulfilled the inclusion criteria, and were included in the review. The majority of included studies demonstrates that PCV for children is cost-effective in most of the Asian region, and even cost-saving in some countries. Most of the included studies implemented cost utility analysis (CUA) using either quality-adjusted life years (QALYs) or disability-adjusted life years (DALYs). Overall, the main drivers affecting the cost effectiveness were vaccine price, burden regarding pneumonia-related parameters, and the inclusion of herd effects. Conclusion: The children pneumococcal vaccination program appears to be a cost-effective intervention in Asia, and even cost-saving in certain conditions. Vaccine price, pneumonia-related disease burden, and the inclusion of the herd effect are observed as important key drivers in estimating cost-effectiveness in this region. Incorporating PCV in vaccination programs in this region was found to be highly favorable.
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Affiliation(s)
- Neily Zakiyah
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Padjadjaran University, Bandung 40132, Indonesia; (W.N.I.); (A.A.S.)
- Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Padjadjaran University, Bandung 40132, Indonesia;
- Correspondence: ; Tel.: +62-22-7796200
| | - Widya N. Insani
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Padjadjaran University, Bandung 40132, Indonesia; (W.N.I.); (A.A.S.)
- Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Padjadjaran University, Bandung 40132, Indonesia;
- Research Department of Practice and Policy, School of Pharmacy, University College London, London WC1N 1AX, UK
| | - Auliya A. Suwantika
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Padjadjaran University, Bandung 40132, Indonesia; (W.N.I.); (A.A.S.)
- Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Padjadjaran University, Bandung 40132, Indonesia;
- Center for Health Technology Assessment, Universitas Padjadjaran, Bandung 40132, Indonesia
| | - Jurjen van der Schans
- Unit of Global Health, Department of Health Sciences, University Medical Center Groningen, University of Groningen, 9713 AV Groningen, The Netherlands;
- Unit of PharmacoTherapy, Epidemiology and Economics (PTE2), Department of Pharmacy, University of Groningen, 9713 AV Groningen, The Netherlands
- Department of Economics, Econometrics and Finance, Faculty of Economics and Business, University of Groningen, 9747 AE Groningen, The Netherlands
| | - Maarten J. Postma
- Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Padjadjaran University, Bandung 40132, Indonesia;
- Unit of Global Health, Department of Health Sciences, University Medical Center Groningen, University of Groningen, 9713 AV Groningen, The Netherlands;
- Unit of PharmacoTherapy, Epidemiology and Economics (PTE2), Department of Pharmacy, University of Groningen, 9713 AV Groningen, The Netherlands
- Department of Economics, Econometrics and Finance, Faculty of Economics and Business, University of Groningen, 9747 AE Groningen, The Netherlands
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14
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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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15
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Wijayasri S, Hillier K, Lim GH, Harris TM, Wilson SE, Deeks SL. The shifting epidemiology and serotype distribution of invasive pneumococcal disease in Ontario, Canada, 2007-2017. PLoS One 2019; 14:e0226353. [PMID: 31834926 PMCID: PMC6910703 DOI: 10.1371/journal.pone.0226353] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 11/25/2019] [Indexed: 11/23/2022] Open
Abstract
Background Ontario, Canada introduced a publicly-funded 13-valent pneumococcal conjugate vaccine (PCV13) for infants in 2010, replacing the 10-valent (PCV10, 2009–2010) and the 7-valent (PCV7, 2005–2009) conjugate vaccine programs; a 23-valent pneumococcal polysaccharide vaccine (PPV23) has been available for older adults since 1996. We examined the epidemiology and serotype distribution of invasive pneumococcal disease (IPD) in Ontario in the context of provincial immunization programs. Methods We included confirmed IPD cases reported in Ontario between 2007 and 2017. We grouped serotypes according to Ontario’s current immunization program (PCV13, PPV23, and non-vaccine-preventable) and calculated incidence rates (per 100,000 population) using population data. Results Between 2007 and 2017, annual incidence of IPD in Ontario ranged between 7.3 and 9.7/100,000 per year. Measures of illness severity were high throughout the period of surveillance. After PCV13 program implementation in 2010, incidence due to PCV13 serotypes decreased significantly across all age groups, with the greatest reductions in children <5 years and adults ≥65 years. Conversely, incidence due to PPV23 unique serotypes increased significantly between 2007 and 2017, with the greatest increases observed in adults 50–64 years (1.4 to 3.5/100,000) and ≥65 years (2.3 to 7.2/100,000). Similar increases were observed in incidence due to non-vaccine-preventable serotypes among all age groups, except infants <1 year. Within specific serotypes, incidence due to serotypes 3 (0.42 to 0.98/100,000) and 22F (0.31 to 0.72/100,000) increased significantly between 2007 and 2017, while incidence due to serotypes 19A and 7F decreased significantly during the PCV13 period (2010–2017). Conclusions Eight years after PCV13 implementation in Ontario, our data suggest both direct and indirect effects on serotype-specific incidence in young children and older adults. However, overall provincial rates have remained unchanged, and IPD continues to be a severe burden on the population. The rising incidence of IPD due to PPV23 unique and non-vaccine-preventable serotypes, and the growing burden of serotypes 3 and 22F, require further study.
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Affiliation(s)
- Shinthuja Wijayasri
- Communicable Diseases, Emergency Preparedness and Response, Public Health Ontario, Toronto, Ontario, Canada
- * E-mail:
| | - Kelty Hillier
- Communicable Diseases, Emergency Preparedness and Response, Public Health Ontario, Toronto, Ontario, Canada
| | - Gillian H. Lim
- Communicable Diseases, Emergency Preparedness and Response, Public Health Ontario, Toronto, Ontario, Canada
| | - Tara M. Harris
- Communicable Diseases, Emergency Preparedness and Response, Public Health Ontario, Toronto, Ontario, Canada
| | - Sarah E. Wilson
- Communicable Diseases, Emergency Preparedness and Response, Public Health Ontario, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Shelley L. Deeks
- Communicable Diseases, Emergency Preparedness and Response, Public Health Ontario, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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16
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Michelin L, Weber FM, Scolari BW, Menezes BK, Gullo MC. Mortality and costs of pneumococcal pneumonia in adults: a cross-sectional study. ACTA ACUST UNITED AC 2019; 45:e20180374. [PMID: 31644703 PMCID: PMC8653114 DOI: 10.1590/1806-3713/e20180374] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 03/14/2019] [Indexed: 12/27/2022]
Abstract
Objective Pneumococcal pneumonia is a significant cause of morbidity and mortality among adults. The study’s main aim was to evaluate the in-hospital mortality and related costs of community-acquired pneumococcal pneumonia in adults. Methods This cross-sectional study used medical records of adult patients with pneumococcal pneumonia hospitalized in a university hospital in Brazil from October 2009 to April 2017. All patients aged ≥ 18 years diagnosed with pneumococcal pneumonia were included. Risk factors, intensive care unit admission, length of hospital stay, in-hospital mortality, and direct and indirect costs were analyzed. Results In total, 186 patients were selected. The mean in-hospital mortality rate was 18% for adults aged < 65 years and 23% for the elderly (≥ 65 years). Bacteremic pneumococcal pneumonia affected 20% of patients in both groups, mainly through chronic respiratory disease (adjusted OR: 3.07, 95% CI: 1.23–7.65, p < 0.01). Over 7 years, annual total direct and indirect costs were USD 28,188 for adults < 65 years (USD 1,746 per capita) and USD 16,350 for the elderly (USD 2,119 per capita). Conclusion Pneumococcal pneumonia remains an important cause of morbidity and mortality among adults, significantly affecting direct and indirect costs. These results suggest the need for prevention strategies for all adults, especially for patients with chronic respiratory diseases.
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Affiliation(s)
| | | | - Bruna W Scolari
- Programa de Pós-graduação em Ciências da Saúde, Universidade de Caxias do Sul, Caxias do Sul (RS), Brasil
| | | | - Maria Carolina Gullo
- Departamento de Ciências Econômicas, Universidade de Caxias do Sul, Caxias do Sul (RS), Brasil
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Koirala B, Phillips NR, Tal-Gan Y. Unveiling the Importance of Amide Protons in CSP:ComD Interactions in Streptococcus pneumoniae. ACS Med Chem Lett 2019; 10:880-886. [PMID: 31223442 DOI: 10.1021/acsmedchemlett.9b00038] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 04/30/2019] [Indexed: 01/06/2023] Open
Abstract
Streptococcus pneumoniae is an opportunistic pathogen that can cause diseases ranging from mild respiratory infections to life-threatening conditions such as pneumonia, meningitis, and bacteremia. S. pneumoniae pathogenicity is dependent on the action of a 17-amino acid peptide pheromone, termed competence stimulating peptide (CSP) that controls the competence regulon, a quorum sensing (QS) circuit. Therefore, intercepting QS could have therapeutic implications in treating pneumococcal infections while avoiding emerging antimicrobial resistance. In this study, we set out to evaluate the impact of amide protons on CSP activity and metabolic stability through systematic N-methylation. Our results indicate that the majority of amide protons are critical for CSP activity, either through direct interactions with the cognate receptor or by stabilizing the bioactive conformation. Importantly, we identified several N-methyl CSP analogs, namely, CSP1(15)-N-Me-K6 and CSP1(15)-N-Me-F7, that retain their biological activity while exhibiting enhanced metabolic stability. These analogs are privileged scaffolds for the design of CSP-based QS modulators with drug-like properties.
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Affiliation(s)
- Bimal Koirala
- Department of Chemistry, University of Nevada, Reno, 1664 North Virginia Street, Reno, Nevada 89557, United States
| | - Naiya R. Phillips
- Department of Chemistry, University of Nevada, Reno, 1664 North Virginia Street, Reno, Nevada 89557, United States
| | - Yftah Tal-Gan
- Department of Chemistry, University of Nevada, Reno, 1664 North Virginia Street, Reno, Nevada 89557, United States
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18
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Park SB, Kim HJ, Cheong HJ. Environmental factors which can affect the burden of pneumococcal disease and the immune response to pneumococcal vaccines: the need for more precisely delineated vaccine recommendations. Expert Rev Vaccines 2019; 18:587-596. [PMID: 30998430 DOI: 10.1080/14760584.2019.1607303] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Introduction: Precision medicine describes the customization of healthcare tailored to the individual patient. Generally, vaccines are considered as public health tools rather than from the individual patient perspective. However, adult vaccination programs in particular should consider many different factors, at the individual level and also from societal, cultural and country-specific perspectives. Currently, most immunization programs, including those for pneumococcal vaccines, have only been adopted on the basis of age or medical risk. Areas covered: Based on a broad literature search, this review addresses possible environmental factors which can affect the burden of pneumococcal disease and the immune response to pneumococcal vaccines. Expert opinion: Factors which influence the incidence of pneumococcal disease and the reaction against pneumococcal vaccination, including personal conditions, geographic/ethnic factors and social risks, are diverse. To maximize the effects of pneumococcal vaccination, not only for public health but also to induce optimal effects at the individual level, vaccines need to be verified under diverse situations and with collaboration among relevant medical societies, governments, and the pharmaceutical industry. Whereas vaccines are generally considered only from the public health perspective, flexible, comprehensive and tailored pneumococcal immunization programs, with appropriate policy support, can generate a greater positive impact on public health.
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Affiliation(s)
- Seong-Beom Park
- a Pfizer Pharmaceuticals Korea Ltd ., Seoul , Republic of Korea
| | - Hyun-Jin Kim
- a Pfizer Pharmaceuticals Korea Ltd ., Seoul , Republic of Korea
| | - Hee-Jin Cheong
- b Division of Infectious Diseases, Department of Internal Medicine , Guro Hospital, Korea University College of Medicine , Seoul , Republic of Korea
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Choi MJ, Noh JY, Cheong HJ, Kim WJ, Kim MJ, Jang YS, Lee SN, Choi EH, Lee HJ, Song JY. Spread of ceftriaxone non-susceptible pneumococci in South Korea: Long-term care facilities as a potential reservoir. PLoS One 2019; 14:e0210520. [PMID: 30699137 PMCID: PMC6353129 DOI: 10.1371/journal.pone.0210520] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 12/22/2018] [Indexed: 11/19/2022] Open
Abstract
Despite the availability of a pneumococcal National Immunization Program, which provides free PPSV23 vaccination for older adults aged ≥65 years in South Korea, pneumococcal pneumonia remains one of the most common respiratory infections, with increasing antimicrobial resistance. From January to December in 2015, all pneumococcal isolates were collected from a 1,050-bed teaching hospital in South Korea. All isolates were analyzed for serotype, genotype, and antimicrobial susceptibility. Demographic, clinical and microbiological data were compared between ceftriaxone susceptible and non-susceptible cases. Among 92 microbiologically identified pneumococcal isolates, ceftriaxone non-susceptible pneumococci (CNSP) accounted for 32 cases (34.8%). Some of these cases also showed levofloxacin resistance (25%, 8/32 isolates) and all CNSP cases were multidrug resistant. Compared to patients with ceftriaxone susceptible pneumococci (CSP), long-term care facility residents (odds ratio [OR] 7.0, 95% confidence interval [CI] 0.8-62.1) and patients with chronic lung (OR 4.1, 95% CI 1.1-15.0) and renal diseases (OR 9.1, 95% CI 1.2-70.5) were more common among those with CNSP on multivariate analysis. PPSV23-unique serotypes not included in PCV13 were more common in CNSP than in CSP (34.4% versus 13.3%, p = 0.02). Regarding genotypes, ST320 (10 cases), ST166 (7 cases) and ST8279 (3 cases) were dominant in CNSP, and ST8279 was only detected in previous long-term care facility residents. Clonal expansion and spread of CNSP strains should be monitored among patients with chronic lung/renal diseases and residents of long-term care facilities.
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Affiliation(s)
- Min Joo Choi
- Division of Infectious Disease, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Ji Yun Noh
- Division of Infectious Disease, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Hee Jin Cheong
- Division of Infectious Disease, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Woo Joo Kim
- Division of Infectious Disease, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Min Ja Kim
- Division of Infectious Disease, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Ye Seul Jang
- Division of Infectious Disease, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Saem Na Lee
- Division of Infectious Disease, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Eun Hwa Choi
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hoan Jong Lee
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Joon Young Song
- Division of Infectious Disease, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
- * E-mail:
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20
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Shpagina LA, Kotova OS, Shpagin IS, Loktin EM, Rukavitsyna AA, Kuznetsova GV, Kamneva NV, Laletina MA. Efficacy of 13-valent pneumococcal conjugate vaccine in healthcare workers. TERAPEVT ARKH 2018. [DOI: 10.26442/terarkh201890114-61] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Aim. To establish the efficacy of 13-valent pneumococcal conjugate vaccine (PCV13) for healthcare workers protection from occupational acquired infection and impact of healthcare staff vaccination on the risk of transmission to patients. Materials and methods. Healthcare personnel (n=157 of whom 105 critical care department staff) and 1770 patients of that critical care department observed. Healthcare workers received PCV13. Infections caused by Str. pneumoniae, respiratory infections regardless of etiology, work absenteeism in healthcare workers during 12 month before and after vaccination assessed. In the same time monitoring of hospital-acquired infections in patients of critical care department performed. Statistical analysis was done using SPSS 24, relationships were assessed by rate ratio, Cox regression, logistic regression and Kaplan-Meier estimator. Results. Healthcare workers' vaccine coverage in critical care department was 97.2%. In healthcare personnel the rate of all pneumococcal infections, asymptomatic carriage of Str. pneumoniae and respiratory pneumococcal infections were decreased after vaccination by 2.1, 2.2 and 2.1 times accordingly. The rate of respiratory infections regardless of etiology was decreased by 30%, р
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21
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Kim JH, Baik SH, Chun BC, Song JY, Bae IG, Kim HY, Kim DM, Choi YH, Choi WS, Jo YM, Kwon HH, Jeong HW, Kim YS, Kim JY, Lee J, Kee SY, Hur J, Chung JW, Hwang KE, Kim MJ. Adult invasive pneumococcal disease in the Republic of Korea: Risk medical conditions and mortality stratified by age group. Int J Infect Dis 2018; 74:136-144. [PMID: 30055332 DOI: 10.1016/j.ijid.2018.07.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 07/18/2018] [Accepted: 07/19/2018] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES This study aimed to characterize the risk factors for mortality in adult patients with invasive pneumococcal disease (IPD) stratified by age groups, after implementation of the national immunization program of 23-valent polysaccharide vaccine (PPSV23) for those aged ≥65 years in the Republic of Korea (ROK). METHODS Clinical data and pneumococcal isolates from adult patients with IPD (≥18 years of age) were collected prospectively from 20 hospitals through the nationwide surveillance program from March 2013 to October 2015. RESULTS A total of 319 patients with IPD were enrolled. Median age was 69 years. Overall in-hospital mortality was 34.2%: 17.1% in those aged 18-49 years, 23.7% in those aged 50-64 years, 33.0% in those aged 65-74 years, and 51.0% in those aged ≥75 years (p<0.001). In particular, early death within 7days of hospitalization accounted for 60.6% (66/109). While old age (≥65 years), higher Pitt bacteremia score (≥4), and bacteremic pneumonia were independently associated with IPD mortality in all age groups, an additional mortality risk factor of immunocompromised status was identified for patients aged 50-64 years. PPSV23 serotypes accounted for 64.4% (122/189) of the pneumococcal isolates serotyped. CONCLUSIONS This study suggests that vaccine-type IPD continues to place a substantial burden on older adults in the ROK, necessitating an effective vaccination strategy for those at higher risk.
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Affiliation(s)
- Jong Hun Kim
- Division of Infectious Diseases, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Seung Hee Baik
- Department of Internal Medicine, Cheju Halla General Hospital, Jeju-si, Republic of Korea
| | - Byung Chul Chun
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Joon Young Song
- Division of Infectious Diseases, Department of Internal Medicine, Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - In-Gyu Bae
- Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| | - Hyo Youl Kim
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Dong-Min Kim
- Department of Internal Medicine, College of Medicine, Chosun University, Gwangju, Republic of Korea
| | - Young Hwa Choi
- Department of Internal Medicine, Ajou University Hospital, Suwon, Republic of Korea
| | - Won Suk Choi
- Division of Infectious Diseases, Department of Internal Medicine, Ansan Hospital, College of Medicine, Korea University, Ansan, Gyeonggi-do, Republic of Korea
| | - Yu Mi Jo
- Department of Internal Medicine, Konyang University College of Medicine, Daejeon, Republic of Korea
| | - Hyun Hee Kwon
- Department of Internal Medicine, Daegu Catholic University, Daegu, Republic of Korea
| | - Hye Won Jeong
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, Chungbuk National University, Cheongju, Chungcheongbuk-do, Republic of Korea
| | - Yeon-Sook Kim
- Division of Infectious Diseases, Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Republic of Korea
| | - Jeong Yeon Kim
- Division of Infectious Diseases, Department of Internal Medicine, Sahmyook Medical Center, Seoul, Republic of Korea
| | - Jacob Lee
- Division of Infectious Diseases, Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Sae Yoon Kee
- Division of Infectious Diseases, Department of Internal Medicine, Konkuk University Chungju Hospital, Chungju, Republic of Korea
| | - Jian Hur
- Department of Internal Medicine, Yeungnam University Medical Center, Daegu, Republic of Korea
| | - Jin Won Chung
- Division of Infectious Diseases, Department of Internal Medicine, Chung-Ang University Hospital, Seoul, Republic of Korea
| | - Ki-Eun Hwang
- Department of Internal Medicine, School of Medicine, Wonkwang University, Iksan, Republic of Korea
| | - Min Ja Kim
- Division of Infectious Diseases, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Republic of Korea; The Research Institute of Emerging Infectious Diseases, Korea University, Seoul, Republic of Korea.
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22
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Choi MJ, Kang SO, Oh JJ, Park SB, Kim MJ, Cheong HJ. Cost-effectiveness analysis of 13-valent pneumococcal conjugate vaccine versus 23-valent pneumococcal polysaccharide vaccine in an adult population in South Korea. Hum Vaccin Immunother 2018; 14:1914-1922. [PMID: 29953307 PMCID: PMC6149703 DOI: 10.1080/21645515.2018.1456602] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 03/07/2018] [Accepted: 03/18/2018] [Indexed: 10/28/2022] Open
Abstract
In South Korea, the National Immunization Program offers a 23-valent pneumococcal polysaccharide vaccine (PPSV23) for the elderly; however, the 13-valent pneumococcal conjugate vaccine (PCV13) is not included, and vaccination is not offered to younger, at-risk populations. This study offers a comparative analysis of PCV13 and PPSV23 in Korea's adults, stratified by age and risk group. A Markov model with a lifetime horizon was developed from the healthcare perspective. Data sources included the Health Insurance Review & Assessment Service, Korea Centre for Disease Control & Prevention and Korean medical institutions. An expert panel tested data validity. The CAPiTA trial and Cochrane meta-analysis were used to obtain vaccine effectiveness data. Regardless of co-morbidity, when the sequential PCV13-PPSV23 strategy was compared to that using PPSV23-only, in elderly populations, the incremental cost-effectiveness ratio (ICER) was 3,300 USD per quality-adjusted life years (QALY). For the risk group aged ≥65 years, the ICER of the addition of PCV13 over the existing PPSV23-only strategy was 3,404 USD/QALY. However, on replacing PPSV23 with PCV13, for all elderly populations, an ICER of 1,421 USD/QALY resulted; for the risk group aged ≥65 years, the ICER was 1,736 USD/QALY. For the 18-64 year-old risk group, the sequential PCV13-PPSV23 strategy yielded an ICER of 3,629 USD/QALY over the PPSV23-only strategy, and 6,643 USD/QALY compared to no vaccination. Thus, the PCV13→PPSV23 combination strategy for elderly populations was found to be a cost-effective alternative to the current National Immunization Program regardless of co-morbidity. This finding was the same as that for younger, at-risk populations.
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Affiliation(s)
- Min-Joo Choi
- Division of Infectious Disease, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | | | | | | | - Min-Ja Kim
- Division of Infectious Disease, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Hee-Jin Cheong
- Division of Infectious Disease, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
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23
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Bou Ghanem EN, Maung NHT, Siwapornchai N, Goodwin AE, Clark S, Muñoz-Elías EJ, Camilli A, Gerstein RM, Leong JM. Nasopharyngeal Exposure to Streptococcus pneumoniae Induces Extended Age-Dependent Protection against Pulmonary Infection Mediated by Antibodies and CD138 + Cells. THE JOURNAL OF IMMUNOLOGY 2018; 200:3739-3751. [PMID: 29661828 DOI: 10.4049/jimmunol.1701065] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 03/22/2018] [Indexed: 11/19/2022]
Abstract
Streptococcus pneumoniae commonly resides asymptomatically in the nasopharyngeal (NP) cavity of healthy individuals but can cause life-threatening pulmonary and systemic infections, particularly in the elderly. NP colonization results in a robust immune response that protects against invasive infections. However, the duration, mechanism, and cellular component of such responses are poorly understood. In this study, we found that repeated NP exposure of mice to S. pneumoniae TIGR4 strain results in pneumococcal-specific Ab responses that protect against lethal lung challenge. Abs were necessary and sufficient for protection because Ab-deficient μMT mice did not develop postexposure protection, only becoming resistant to lung infection after transfer of immune sera from NP-exposed mice. T cells contributed to immunity at the time of NP exposure, but neither CD4+ nor CD8+ T cells were required. The protective activity was detectable 20 wk after exposure and was maintained in irradiated mice, suggesting involvement of long-lived Ab-secreting cells (ASC), which are radioresistant and secrete Abs for extended periods of time in the absence of T cells or persistent Ag. CD138+ bone marrow cells, likely corresponding to long-lived ASC, were sufficient to confer protection. NP exposure of aged mice failed to protect against subsequent lung infection despite eliciting a robust Ab response. Furthermore, transfer of CD138+ bone marrow cells or sera from NP-exposed old mice failed to protect naive young mice. These findings suggest that NP exposure elicits extended protection against pneumococcal lung infection by generating long-lived CD138+ ASC and that the protective efficacy of these responses declines with age.
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Affiliation(s)
- Elsa N Bou Ghanem
- Department of Microbiology and Immunology, University at Buffalo School of Medicine, Buffalo, NY 14203
| | - Nang H Tin Maung
- Department of Microbiology and Physiological Systems, University of Massachusetts Medical School, Worcester, MA 01655
| | - Nalat Siwapornchai
- Department of Molecular Biology and Microbiology, Tufts University School of Medicine, Boston, MA 02111
| | - Aaron E Goodwin
- Department of Microbiology and Physiological Systems, University of Massachusetts Medical School, Worcester, MA 01655
| | - Stacie Clark
- Department of Molecular Biology and Microbiology, Tufts University School of Medicine, Boston, MA 02111.,Graduate Program in Molecular Microbiology, Sackler School of Graduate Biomedical Sciences, Tufts University School of Medicine, Boston, MA 02111
| | | | - Andrew Camilli
- Department of Molecular Biology and Microbiology, Tufts University School of Medicine, Boston, MA 02111.,Howard Hughes Medical Institute, Boston, MA 02111
| | - Rachel M Gerstein
- Department of Microbiology and Physiological Systems, University of Massachusetts Medical School, Worcester, MA 01655
| | - John M Leong
- Department of Molecular Biology and Microbiology, Tufts University School of Medicine, Boston, MA 02111;
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Heo JY, Seo YB, Choi WS, Lee J, Yoon JG, Lee SN, Choi MJ, Noh JY, Ahn JY, Jeong HW, Cheong HJ, Kim WJ, Lee HY, Song JY. Incidence and case fatality rates of community-acquired pneumonia and pneumococcal diseases among Korean adults: Catchment population-based analysis. PLoS One 2018; 13:e0194598. [PMID: 29596444 PMCID: PMC5875769 DOI: 10.1371/journal.pone.0194598] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 02/20/2018] [Indexed: 11/21/2022] Open
Abstract
Background Pneumonia is a leading infectious cause of morbidity and mortality among adults. Pneumococcal pneumonia (PP) is the most common vaccine-preventable bacterial etiology of pneumonia. In this study, we estimated the incidence of community-acquired pneumonia (CAP) and pneumococcal diseases among Korean adults. Methods Clinical and microbiological databases from three hospitals were retrospectively reviewed to determine the incidence and case fatality rates of CAP and pneumococcal diseases in Korean adults aged ≥19 years from 2011 to 2014. Incidence and case fatality rates of CAP, PP and invasive pneumococcal diseases (IPD) were evaluated based on the catchment population. Catchment population was calculated using national health insurance data, estimating the proportion of patients with pneumonia that were medically attended at each hospital. Results Among 5,783 patients with medically attended CAP, 833 (14.4%) had PP. For IPD, a total of 91 culture-confirmed cases were identified. The overall incidence of CAP was 307.7 cases per 100,000 persons per year with an in-hospital mortality rate of 6.2%. The estimated annual incidence of pneumococcal pneumonia was 42.2–49.4 cases per 100,000 persons per year, increasing with age to >280 per 100,000 persons per year in older patients over 70 years. The annual incidence of IPD had a range of 4.1–6.5 cases per 100,000 persons per year. The overall case fatality rate for invasive pneumococcal diseases was 30.8% with the highest rate of 66.7% in patients over 80 years. Conclusion Over the study period, incidences of CAP, PP and IPD were consistently high, particularly in older people. These results provide baseline data to establish healthcare strategies and estimate their impact among Korean adults.
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Affiliation(s)
- Jung Yeon Heo
- Department of Infectious Diseases, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Yu Bin Seo
- Division of Infectious Diseases, Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Republic of Korea
| | - Won Suk Choi
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Jacob Lee
- Division of Infectious Diseases, Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Republic of Korea
| | - Jin Gu Yoon
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Saem Na Lee
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Min Joo Choi
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Ji Yun Noh
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
- Asian Pacific Influenza Institute (APII), Korea University Guro Hospital, Seoul, Korea
| | - Jin-Young Ahn
- Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Hye Won Jeong
- Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
- Division of Infectious Diseases, Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Hee Jin Cheong
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
- Asian Pacific Influenza Institute (APII), Korea University Guro Hospital, Seoul, Korea
| | - Woo Joo Kim
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
- Asian Pacific Influenza Institute (APII), Korea University Guro Hospital, Seoul, Korea
| | - Hee Young Lee
- Center for Preventive Medicine and Public Health, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
- * E-mail: (HYL); (JYS)
| | - Joon Young Song
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
- Asian Pacific Influenza Institute (APII), Korea University Guro Hospital, Seoul, Korea
- * E-mail: (HYL); (JYS)
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25
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John J, Kasudhan KS, Kanungo R, Sharma S, Dohe V, Prashanth K. Distribution of different genes responsible for invasive characteristics, detection of point mutations in capsular gene wchA and biofilm production among the invasive and non-invasive isolates of Streptococcus pneumoniae. Indian J Med Microbiol 2018; 35:511-517. [PMID: 29405142 DOI: 10.4103/ijmm.ijmm_17_183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Streptococcus pneumoniae continues to cause morbidity and mortality across the globe, with developing countries bearing the brunt of the disease. It is mainly responsible for meningitis, pneumonia and septicaemia primarily in children, elderly and immunocompromised persons. Colonisation and persistence in the human nasopharynx occur during early childhood, and it appears to be prerequisite for invasive pneumococcal disease (IPD). Factors that help in persistent colonisation and subsequent invasion are ill understood. Several virulence factors have been incriminated for nasopharyngeal carriage (NC) as well as for the manifestation of the pathogenesis of IPD. MATERIALS AND METHODS This study attempts to characterise the S. pneumoniae isolates through analysing the distribution of different virulence markers such as lytA, ply, pbpA, eno, psaA, amiA, ciaR and wchA among the isolates obtained from disease and NC. A total of 37 isolates which include 14 invasive and 23 non-invasive isolates were investigated by polymerase chain reaction to detect the genes. Eight representative isolates were investigated for mutations in wchA by DNA sequencing that may responsible for capsular variation. RESULTS Ply, pbpA, amiA and eno were observed in a greater percentage of invasive isolates than non-invasive isolates though these differences are not statistically significant. Other two genes ciaH and psaA did not show any significant difference between two groups of isolates. Biofilm production was significantly higher in than non-invasive isolates when compared to invasive isolates. Sequence analysis of wchA revealed three significant point mutations or single-nucleotide polymorphisms (SNPs) among the isolates of one particular cluster (cluster III). These SNPs are responsible for a non-synonymous mutation in wchA bringing in an amino acid change in WchA protein, which is a part of the capsule of S. pneumoniae. Notably, all the three isolates present in cluster III had these SNPs and all of them were isolated from ocular infections. CONCLUSION The results of our study implies a possible capsular variations among the isolates and this may have an impact on capsular typing.
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Affiliation(s)
- James John
- Department of Biotechnology, School of Life Sciences, Pondicherry University, Puducherry, India
| | - Kripa Shanker Kasudhan
- Department of Biotechnology, School of Life Sciences, Pondicherry University, Puducherry; Department of Pharmacology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Reba Kanungo
- Department of Microbiology, Pondicherry Institute of Medical Sciences, Puducherry, India
| | - Savitri Sharma
- Jhaveri Microbiology Centre, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Vaishali Dohe
- Department of Microbiology, Byramjee Jeejeebhoy Government Medical College, Pune, Maharashtra, India
| | - K Prashanth
- Department of Biotechnology, School of Life Sciences, Pondicherry University, Puducherry, India
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Lourenço J, Watkins ER, Obolski U, Peacock SJ, Morris C, Maiden MCJ, Gupta S. Lineage structure of Streptococcus pneumoniae may be driven by immune selection on the groEL heat-shock protein. Sci Rep 2017; 7:9023. [PMID: 28831154 PMCID: PMC5567354 DOI: 10.1038/s41598-017-08990-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 07/20/2017] [Indexed: 12/29/2022] Open
Abstract
Populations of Streptococcus pneumoniae (SP) are typically structured into groups of closely related organisms or lineages, but it is not clear whether they are maintained by selection or neutral processes. Here, we attempt to address this question by applying a machine learning technique to SP whole genomes. Our results indicate that lineages evolved through immune selection on the groEL chaperone protein. The groEL protein is part of the groESL operon and enables a large range of proteins to fold correctly within the physical environment of the nasopharynx, thereby explaining why lineage structure is so stable within SP despite high levels of genetic transfer. SP is also antigenically diverse, exhibiting a variety of distinct capsular serotypes. Associations exist between lineage and capsular serotype but these can be easily perturbed, such as by vaccination. Overall, our analyses indicate that the evolution of SP can be conceptualized as the rearrangement of modular functional units occurring on several different timescales under different pressures: some patterns have locked in early (such as the epistatic interactions between groESL and a constellation of other genes) and preserve the differentiation of lineages, while others (such as the associations between capsular serotype and lineage) remain in continuous flux.
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Affiliation(s)
- José Lourenço
- Department of Zoology, University of Oxford, Oxford, United Kingdom.
| | | | - Uri Obolski
- Department of Zoology, University of Oxford, Oxford, United Kingdom
| | - Samuel J Peacock
- Department of Zoology, University of Oxford, Oxford, United Kingdom
| | | | | | - Sunetra Gupta
- Department of Zoology, University of Oxford, Oxford, United Kingdom
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27
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Heo JY, Seo YB, Choi WS, Lee J, Noh JY, Jeong HW, Kim WJ, Kim MJ, Lee HY, Song JY. Cost-effectiveness of pneumococcal vaccination strategies for the elderly in Korea. PLoS One 2017; 12:e0177342. [PMID: 28498857 PMCID: PMC5428995 DOI: 10.1371/journal.pone.0177342] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 04/26/2017] [Indexed: 11/19/2022] Open
Abstract
Background Although the 13-valent pneumococcal conjugate vaccine (PCV13) showed good efficacy against pneumococcal disease in the the CAPiTA trial, the 23-valent pneumococcal polysaccharide vaccination (PPSV23) program has been ongoing for older adults aged ≥ 65 years in Korea since May of 2013. This study aimed to evaluate the cost-effectiveness of the current vaccination strategy (a single-dose PPSV23 vaccination) compared to a single-dose PCV13 vaccination and sequential PCV13-PPSV23 vaccinations in the elderly population aged ≥ 65 years. Methods Using a Markov model, the incremental cost-effectiveness ratios (ICERs) of three vaccination strategies were assessed in a societal context. The transition probabilities, utility weights to estimate quality adjusted life year (QALY), and disease treatment costs were either calculated or cited from published data and the Health Insurance Review and Assessment Service. Simulations were performed in hypothetical cohorts of Korean adults aged ≥ 19 years. The vaccine effectiveness of PPSV23 was cited from a Cochrane Review report, while PCV13 effectiveness data were gathered from the CAPiTA trial. Results Current PPSV23 vaccination strategies were cost-effective (ICER, $25,786 per QALY). However, the administration of PCV13 as a substitute for PPSV23 was shown to be more cost-effective than PPSV23 vaccination (ICER, $797 per QALY). Sequential PCV13-PPSV23 vaccination was also more cost-effective than PPSV23 for elderly people aged ≥ 65 years. In sensitivity analysis assuming significant PPSV23 effectiveness (50%) against non-bacteremic pneumococcal pneumonia, the PCV13 vaccination strategy was superior to the PPSV23 vaccination strategy in terms of cost-effectiveness. Conclusion The results suggest that PCV13 vaccination is more cost-effective in elderly subjects aged ≥ 65 years compared to the current PPSV23 vaccination strategy. When complete data is obtained in 2018 on the maximal herd effects of childhood PCV13 immunization, the incidence of pneumococcal pneumonia and the cost-effectiveness of vaccination strategies need to be reassessed.
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Affiliation(s)
- Jung Yeon Heo
- Division of Infectious Diseases, Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
- Division of Infectious Diseases, Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Yu Bin Seo
- Division of Infectious Diseases, Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Republic of Korea
| | - Won Suk Choi
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Jacob Lee
- Division of Infectious Diseases, Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Republic of Korea
| | - Ji Yun Noh
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Hye Won Jeong
- Division of Infectious Diseases, Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
- Division of Infectious Diseases, Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Woo Joo Kim
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Min Ja Kim
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Hee Young Lee
- Center for Preventive Medicine and Public health, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
- * E-mail: (HYL); (JYS)
| | - Joon Young Song
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
- * E-mail: (HYL); (JYS)
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Song JH, Huh K, Chung DR. Community-Acquired Pneumonia in the Asia-Pacific Region. Semin Respir Crit Care Med 2016; 37:839-854. [PMID: 27960208 PMCID: PMC7171710 DOI: 10.1055/s-0036-1592075] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Community-acquired pneumonia (CAP) is an important cause of mortality and morbidity worldwide. Aging population, dense urbanization, and poor access to health care make the Asia-Pacific region vulnerable to CAP. The high incidence of CAP poses a significant health and economic burden in this region. Common etiologic agents in other global regions including Streptococcus pneumoniae, Mycoplasma pneumoniae, Haemophilus influenzae, Chlamydophila pneumoniae, Staphylococcus aureus, and respiratory viruses are also the most prevalent pathogens in the Asia-Pacific region. But the higher incidence of Klebsiella pneumoniae and the presence of Burkholderia pseudomallei are unique to the region. The high prevalence of antimicrobial resistance in S. pneumoniae and M. pneumoniae has been raising the need for more prudent use of antibiotics. Emergence and spread of community-acquired methicillin-resistant S. aureus deserve attention, while the risk has not reached significant level yet in cases of CAP. Given a clinical and socioeconomic importance of CAP, further effort to better understand the epidemiology and impact of CAP is warranted in the Asia-Pacific region.
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Affiliation(s)
- Jae-Hoon Song
- Division of Infectious Diseases, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyungmin Huh
- Division of Infectious Diseases, Department of Internal Medicine, Armed Forces Capital Hospital, Seongnam, Korea
| | - Doo Ryeon Chung
- Division of Infectious Diseases, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Abstract
PURPOSE OF REVIEW Pneumococcal diseases (invasive diseases, pneumonia, otitis media, and sinusitis) are among the most frequent preventable infectious diseases carrying a very high morbidity and case fatality rate worldwide. Pneumococcal vaccination is a key element to reduce the global burden of the disease in children and adult population. Our aim is to discuss current knowledge of the epidemiology of pneumococcal disease and pneumococcal vaccines. RECENT FINDINGS After the introduction of conjugate vaccines (PCV7 and PCV13), rates of pneumococcal diseases because of vaccine serotypes have decreased considerably among children in the vaccine target and among nonvaccinated children and adults. Results of the Community-Acquired Pneumonia Immunization Trial in Adults demonstrated 45.6% efficacy of PCV13 against the first episode of pneumonia, 45% against first-episode nonbacteremic pneumococcal pneumonia, and 75% against the first episode of invasive pneumococcal diseases in adults older than 65 years. Recommendations for pneumococcal vaccination have changed recently in both the United States and Europe. SUMMARY The changing epidemiology of pneumococcal diseases should be closely investigated to assess the effectiveness and the usefulness of the current vaccination policies, and to identify future directions for preventing pneumococcal infections.
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Desai S, Policarpio ME, Wong K, Gubbay J, Fediurek J, Deeks S. The epidemiology of invasive pneumococcal disease in older adults from 2007 to 2014 in Ontario, Canada: a population-based study. CMAJ Open 2016; 4:E545-E550. [PMID: 27730119 PMCID: PMC5047806 DOI: 10.9778/cmajo.20160035] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND In Ontario, pneumococcal conjugate vaccines (PCVs) have been sequentially introduced into the publicly funded childhood vaccination program since 2005. A 23-valent polysaccharide pneumococcal vaccine (PPV23) has been routinely recommended for adults aged 65 years and older since 1996. To determine the effect of herd immunity, we examined the epidemiology of invasive pneumococcal disease in adults aged 65 years and older. METHODS Invasive pneumococcal disease is a provincially reportable disease. We were therefore able to conduct a descriptive epidemiologic analysis that included assessing time trends for patients aged 65 years and older using surveillance data from 2007 to 2014. Using serotype information within the surveillance data, cases were grouped into categories according to vaccine type and periods and then compared using Poisson regression. RESULTS A total of 3825 cases of invasive pneumococcal disease were reported among adults aged 65 years and older, for an overall annualized incidence of 25.4 cases per 100 000 population. There was a decrease in incidence due to serotypes included in 7-valent PCV (3.0 to 0.7 cases per 100 000 population) (p < 0.001). For 13-valent PCV serotypes, there was a decrease in incidence between 2011 and 2014 (9.8 to 5.3 cases per 100 000 population (p < 0.001)). Serotypes unique to PPV23 and those not included in a vaccine increased from 2.3 to 5.8 and from 2.4 to 7.2 cases per 100 000 population, respectively (p < 0.001). INTERPRETATION In older adults, among serotypes contained in PCVs, we have shown a decrease in incidence of invasive pneumococcal disease. This is likely due to herd immunity from the childhood program. A burden of illness due to unique PPV23 serotypes and those that are not covered by a vaccine exists and has increased over time.
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Affiliation(s)
- Shalini Desai
- Immunization and Vaccine Preventable Diseases Division (Desai, Policarpio, Wong, Fediurek, Deeks), Public Health Ontario; Public Health Ontario Laboratories (Gubbay), Public Health Ontario; Department of Laboratory Medicine and Pathobiology (Gubbay) and Dalla Lana School of Public Health (Deeks), University of Toronto, Toronto, Ont
| | - Michelle E Policarpio
- Immunization and Vaccine Preventable Diseases Division (Desai, Policarpio, Wong, Fediurek, Deeks), Public Health Ontario; Public Health Ontario Laboratories (Gubbay), Public Health Ontario; Department of Laboratory Medicine and Pathobiology (Gubbay) and Dalla Lana School of Public Health (Deeks), University of Toronto, Toronto, Ont
| | - Kenney Wong
- Immunization and Vaccine Preventable Diseases Division (Desai, Policarpio, Wong, Fediurek, Deeks), Public Health Ontario; Public Health Ontario Laboratories (Gubbay), Public Health Ontario; Department of Laboratory Medicine and Pathobiology (Gubbay) and Dalla Lana School of Public Health (Deeks), University of Toronto, Toronto, Ont
| | - Jonathan Gubbay
- Immunization and Vaccine Preventable Diseases Division (Desai, Policarpio, Wong, Fediurek, Deeks), Public Health Ontario; Public Health Ontario Laboratories (Gubbay), Public Health Ontario; Department of Laboratory Medicine and Pathobiology (Gubbay) and Dalla Lana School of Public Health (Deeks), University of Toronto, Toronto, Ont
| | - Jill Fediurek
- Immunization and Vaccine Preventable Diseases Division (Desai, Policarpio, Wong, Fediurek, Deeks), Public Health Ontario; Public Health Ontario Laboratories (Gubbay), Public Health Ontario; Department of Laboratory Medicine and Pathobiology (Gubbay) and Dalla Lana School of Public Health (Deeks), University of Toronto, Toronto, Ont
| | - Shelley Deeks
- Immunization and Vaccine Preventable Diseases Division (Desai, Policarpio, Wong, Fediurek, Deeks), Public Health Ontario; Public Health Ontario Laboratories (Gubbay), Public Health Ontario; Department of Laboratory Medicine and Pathobiology (Gubbay) and Dalla Lana School of Public Health (Deeks), University of Toronto, Toronto, Ont
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Yang TU, Kim E, Park YJ, Kim D, Kwon YH, Shin JK, Park O. Successful introduction of an underutilized elderly pneumococcal vaccine in a national immunization program by integrating the pre-existing public health infrastructure. Vaccine 2016; 34:1623-1629. [PMID: 26850759 DOI: 10.1016/j.vaccine.2016.01.043] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 01/17/2016] [Accepted: 01/19/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND Although pneumococcal vaccines had been recommended for the elderly population in South Korea for a considerable period of time, the coverage has been well below the optimal level. To increase the vaccination rate with integrating the pre-existing public health infrastructure and governmental funding, the Korean government introduced an elderly pneumococcal vaccination into the national immunization program with a 23-valent pneumococcal polysaccharide vaccine in May 2013. OBJECTIVE The aim of this study was to assess the performance of the program in increasing the vaccine coverage rate and maintaining stable vaccine supply and safe vaccination during the 20 months of the program. METHODS We qualitatively and quantitatively analyzed the process of introducing and the outcomes of the program in terms of the systematic organization, efficiency, and stability at the national level. RESULTS A staggered introduction during the first year utilizing the public sector, with a target coverage of 60%, was implemented based on the public demand for an elderly pneumococcal vaccination, vaccine supply capacity, vaccine delivery capacity, safety, and sustainability. During the 20-month program period, the pneumococcal vaccine coverage rate among the population aged ≥65 years increased from 5.0% to 57.3% without a noticeable vaccine shortage or safety issues. A web-based integrated immunization information system, which includes the immunization registry, vaccine supply chain management, and surveillance of adverse events following immunization, reduced programmatic errors and harmonized the overall performance of the program. CONCLUSION Introduction of an elderly pneumococcal vaccination in the national immunization program based on strong government commitment, meticulous preparation, financial support, and the pre-existing public health infrastructure resulted in an efficient, stable, and sustainable increase in vaccination coverage.
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Affiliation(s)
- Tae Un Yang
- Division of Vaccine-Preventable Diseases Control and National Immunization Program, Korea Centers for Disease Control and Prevention, Osong Health Technology Administration Complex, 187 Osongsaengmyeong 2-ro, Osong-eup, Heungduk-gu, Cheongju, Chungcheongbuk-do 363-951, South Korea.
| | - Eunsung Kim
- Division of Vaccine-Preventable Diseases Control and National Immunization Program, Korea Centers for Disease Control and Prevention, Osong Health Technology Administration Complex, 187 Osongsaengmyeong 2-ro, Osong-eup, Heungduk-gu, Cheongju, Chungcheongbuk-do 363-951, South Korea.
| | - Young-Joon Park
- Division of Vaccine-Preventable Diseases Control and National Immunization Program, Korea Centers for Disease Control and Prevention, Osong Health Technology Administration Complex, 187 Osongsaengmyeong 2-ro, Osong-eup, Heungduk-gu, Cheongju, Chungcheongbuk-do 363-951, South Korea.
| | - Dongwook Kim
- Division of Vaccine-Preventable Diseases Control and National Immunization Program, Korea Centers for Disease Control and Prevention, Osong Health Technology Administration Complex, 187 Osongsaengmyeong 2-ro, Osong-eup, Heungduk-gu, Cheongju, Chungcheongbuk-do 363-951, South Korea.
| | - Yoon Hyung Kwon
- Division of Vaccine-Preventable Diseases Control and National Immunization Program, Korea Centers for Disease Control and Prevention, Osong Health Technology Administration Complex, 187 Osongsaengmyeong 2-ro, Osong-eup, Heungduk-gu, Cheongju, Chungcheongbuk-do 363-951, South Korea.
| | - Jae Kyong Shin
- Division of Vaccine-Preventable Diseases Control and National Immunization Program, Korea Centers for Disease Control and Prevention, Osong Health Technology Administration Complex, 187 Osongsaengmyeong 2-ro, Osong-eup, Heungduk-gu, Cheongju, Chungcheongbuk-do 363-951, South Korea.
| | - Ok Park
- Division of Vaccine-Preventable Diseases Control and National Immunization Program, Korea Centers for Disease Control and Prevention, Osong Health Technology Administration Complex, 187 Osongsaengmyeong 2-ro, Osong-eup, Heungduk-gu, Cheongju, Chungcheongbuk-do 363-951, South Korea.
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Hifumi T, Fujishima S, Abe T, Kiriu N, Inoue J, Kato H, Koido Y, Kawakita K, Kuroda Y, Sasaki J, Hori S. Prognostic factors of Streptococcus pneumoniae infection in adults. Am J Emerg Med 2015; 34:202-6. [PMID: 26508390 DOI: 10.1016/j.ajem.2015.10.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Revised: 10/10/2015] [Accepted: 10/13/2015] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES The mortality of severe sepsis has markedly decreased since the implementation of the Surviving Sepsis Campaign guidelines. The next logical step is to examine the necessity of individualized management guidelines for targeted therapy against specific bacteria. Streptococcus pneumoniae is the leading cause of community-acquired severe sepsis; however, little is known regarding the prognostic factors in adult patients with S pneumoniae sepsis. We aimed to identify prognostic factors in patients with S pneumoniae sepsis and to explore a subgroup of patients at high risk for death with detailed Sequential Organ Failure Assessment (SOFA) score analysis. METHODS We retrospectively reviewed the records of patients with S pneumoniae infection treated between 1st January 2006 and 31st July 2012. We identified prognostic factors for 28-day mortality using univariate and multivariate logistic regression models. RESULTS Of 171 patients (median age, 72 years) with S pneumoniae infection who were included in this study, the 28-day mortality was 17% (29/171). The SOFA score (odds ratio, 2.25; 95% confidence interval, 1.60-3.18; P < .001) and bacteremia (odds ratio, 19.0; 95% confidence interval, 4.06-90.20; P < .001) were identified as prognostic factors for the 28-day mortality. In a subgroup analysis with a cutoff value of the SOFA score determined by receiver operating characteristic analysis, patients with bacteremia and a SOFA score of at least 7 had a significantly higher mortality than did patients without bacteremia and a SOFA score lower than 7 (84% vs 0%, respectively). CONCLUSIONS Bacteremia and a SOFA score at least 7 were independent prognostic factors of poor outcome in S pneumoniae sepsis.
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Affiliation(s)
- Toru Hifumi
- Emergency Medical Center, Kagawa University Hospital, Miki, Kita, Kagawa, Japan.
| | - Seitaro Fujishima
- Center for General Internal Medicine and Education, Keio University Hospital, Shinjuku-ku, Tokyo, Japan
| | - Takayuki Abe
- Center for Clinical Research, Department of Preventive Medicine and Public Health, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Nobuaki Kiriu
- Division of Critical Care Medicine and Trauma, National Hospital Organization Disaster Medical Center, Tachikawa, Tokyo, Japan
| | - Junichi Inoue
- Division of Critical Care Medicine and Trauma, Yamanashi Prefectural Central Hospital, Kofu, Yamanashi, Japan
| | - Hiroshi Kato
- Division of Critical Care Medicine and Trauma, National Hospital Organization Disaster Medical Center, Tachikawa, Tokyo, Japan
| | - Yuichi Koido
- Division of Critical Care Medicine and Trauma, National Hospital Organization Disaster Medical Center, Tachikawa, Tokyo, Japan
| | - Kenya Kawakita
- Emergency Medical Center, Kagawa University Hospital, Miki, Kita, Kagawa, Japan
| | - Yasuhiro Kuroda
- Emergency Medical Center, Kagawa University Hospital, Miki, Kita, Kagawa, Japan
| | - Junichi Sasaki
- Department of Emergency Medicine and Critical Care Medicine, Keio University Hospital, Shinjuku-ku, Tokyo, Japan
| | - Shingo Hori
- Department of Emergency Medicine and Critical Care Medicine, Keio University Hospital, Shinjuku-ku, Tokyo, Japan
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Fronczek CF, Yoon JY. Biosensors for Monitoring Airborne Pathogens. ACTA ACUST UNITED AC 2015; 20:390-410. [DOI: 10.1177/2211068215580935] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Indexed: 01/15/2023]
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Abstract
Early diagnosis of pneumococcal pneumonia facilitates appropriate antibiotic therapy. The urinary antigen test (UAT) is known to be useful for the diagnosis of pneumococcal pneumonia. This study aimed to evaluate the usefulness of UAT in the 13-valent pneumococcal conjugated vaccine (PCV13) era. Community-acquired pneumonia (CAP) cases aged ≥19 years were reviewed retrospectively. This study evaluated the utility of Streptococcus pneumoniae UAT (BinaxNOW® assay) for diagnosis of pneumococcal CAP, and the relation of the UAT positive rate to age, comorbidities, pneumonia severity, and pneumococcal serotypes. Among 752 microbiologically identified CAP cases, S. pneumoniae (36.7%) was the most common isolate, and of those cases, 56.4% were positive for UAT. UAT positivity varied by pneumococcal serotype (serotype 3, 50%; 9V/9A, 85%; 11A/11E, 54%; 14, 36.4%; 19A, 50%; and 23F, 37.5%), and was significantly increased since 2012, two years after introduction of PCV13. The positive rate of UAT was significantly related to CRP level (P = 0.007) and lobar pneumonia (P = 0.006), but not to age, co-morbidities or prior antibiotic therapy. In conclusion, urinary antigen detection varied depending on the S. pneumoniae serotype. In the PCV13 era, the serotype distribution of pneumococcal pneumonia may be changing, and the clinical usefulness of UAT needs to be monitored. The positive rate of UAT may be influenced by a localized bacterial burden and host reactions.
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Yang TU, Song JY, Noh JY, Cheong HJ, Kim WJ. Influenza and Pneumococcal Vaccine Coverage Rates among Patients Admitted to a Teaching Hospital in South Korea. Infect Chemother 2015; 47:41-8. [PMID: 25844262 PMCID: PMC4384449 DOI: 10.3947/ic.2015.47.1.41] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Revised: 03/08/2015] [Accepted: 03/08/2015] [Indexed: 12/19/2022] Open
Abstract
Background Influenza and pneumococcal vaccinations can reduce morbidity and mortality especially in the elderly and patients with chronic medical disease. The purpose of this study was to estimate vaccination coverage of these populations in a hospital setting. Materials and Methods We conducted a cross-sectional, descriptive study involving adult patients admitted to a 1,000-bed teaching hospital on April 15, 2013. We ascertained the information on whether the patient had received influenza vaccination within a year prior to admission or pneumococcal vaccination by interviewing each patient. Results A total of 491 eligible patients aged ≥50 years or with chronic medical illnesses were analyzed. The overall vaccination rate for influenza was 57.2%, and that of pneumococcus was 17.6% among the vaccine-eligible subjects. Influenza/pneumococcal vaccination rates of patients by disease were 62.8%/17.2% for diabetes, 53.3%/15.6% for malignancy, 67.6%/23.5% for chronic pulmonary disease, 66.7%/15.3% for chronic cardiovascular disease, 68.7%/26.9% for chronic renal disease, and 51.2%/18.6% for chronic hepatic disease. Young adult patients with chronic medical conditions were consistently less likely to receive influenza and pneumococcal vaccines irrespective of the underlying disease. Conclusion The influenza and pneumococcal vaccine coverage rates among hospitalized patients were low in South Korea. This was especially the case for young adult patients with chronic medical illnesses.
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Affiliation(s)
- Tae Un Yang
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Joon Young Song
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Ji Yun Noh
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Hee Jin Cheong
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Woo Joo Kim
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
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Choi WS, Choi JH, Kwon KT, Seo K, Kim MA, Lee SO, Hong YJ, Lee JS, Song JY, Bang JH, Choi HJ, Choi YH, Lee DG, Cheong HJ. Revised adult immunization guideline recommended by the korean society of infectious diseases, 2014. Infect Chemother 2015; 47:68-79. [PMID: 25844267 PMCID: PMC4384453 DOI: 10.3947/ic.2015.47.1.68] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Indexed: 11/24/2022] Open
Affiliation(s)
- Won Suk Choi
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Jung-Hyun Choi
- Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Ki Tae Kwon
- Department of Internal Medicine, Daegu Fatima Hospital, Daegu, Korea
| | - Kyung Seo
- Department of Obstetrics and Gynecology, Yonsei University College of Medicine, Seoul, Korea
| | - Min A Kim
- Department of Obstetrics and Gynecology, Yonsei University College of Medicine, Seoul, Korea
| | - Sang-Oh Lee
- Department of Internal Medicine, Ulsan University College of Medicine, Ulsan, Korea
| | - Young Jin Hong
- Department of Pediatrics, Inha University College of Medicine, Incheon, Korea
| | - Jin-Soo Lee
- Department of Internal Medicine, Inha University College of Medicine, Incheon, Korea
| | - Joon Young Song
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Ji Hwan Bang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Hee-Jung Choi
- Department of Internal Medicine, Ewha Woman's University School of Medicine, Seoul, Korea
| | - Young-Hwa Choi
- Department of Internal Medicine, Ajou University College of Medicine, Suwon, Korea
| | - Dong Gun Lee
- Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Hee Jin Cheong
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
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Lee JY, Yoo CG, Kim HJ, Jung KS, Yoo KH. Disease burden of pneumonia in Korean adults aged over 50 years stratified by age and underlying diseases. Korean J Intern Med 2014; 29:764-73. [PMID: 25378975 PMCID: PMC4219966 DOI: 10.3904/kjim.2014.29.6.764] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 05/17/2014] [Accepted: 05/27/2014] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/AIMS This study was conducted to assess the disease burden of pneumonia according to age and presence of underlying diseases in patients admitted with community-acquired pneumonia (CAP). METHODS We performed a retrospective, observational study and collected data targeting patients with CAP (≥ 50 years) from 11 hospitals. Disease burden was defined as total per-capita medical fee, severity (CURB-65), hospital length of stay (LOS), and mortality. RESULTS Of the 693 enrolled subjects, elderly subjects (age, ≥ 65 years) had a higher mean CURB-65 score (1.56 vs. 0.25; p < 0.01) and higher mortality than nonelderly subjects (4.4% [n = 21] vs. 0.5% [n = 1]; p = 0.00). In addition, the total cost of pneumonia treatment was higher in elderly patients compared to in nonelderly patients (KRW 2,088,190 vs. US $1,701,386; p < 0.01). Those with an underlying disease had a higher CURB-65 score (1.26 vs. 0.68; p < 0.01), were much older (mean age, 71.24 years vs. 64.24 years; p < 0.01), and had a higher mortality rate than those without an underlying disease (3.5% [n = 20] vs. 1.7% [n = 2]; p = 0.56). Total per-capita medical fees were higher (KRW 2,074,520 vs. US $1,440,471; p < 0.01) and hospital LOS was longer (mean, 8.38 days vs. 6.42 days; p < 0.01) in patients with underlying diseases compared to those without. CONCLUSIONS Due to the relatively high disease burden in Korea, particularly in the elderly and in those with an underlying disease, closer and more careful observation is needed to improve the outcomes of patients with CAP.
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Affiliation(s)
- Jung Yeon Lee
- Department of Internal Medicine, Konkuk University Chungju Hospital, Chungju, Korea
| | - Chul Gyu Yoo
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Hyo-Jin Kim
- Outcomes Research/Evidence Based Medicine Team, Market Access Department, Pfizer Pharmaceuticals Korea Ltd., Seoul, Korea
| | - Ki Suck Jung
- Division of Pulmonary Medicine, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Kwang Ha Yoo
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Konkuk University Medical Center, Seoul, Korea
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Drijkoningen JJC, Rohde GGU. Pneumococcal infection in adults: burden of disease. Clin Microbiol Infect 2014; 20 Suppl 5:45-51. [PMID: 24313448 DOI: 10.1111/1469-0691.12461] [Citation(s) in RCA: 231] [Impact Index Per Article: 23.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
To overview the present global burden of pneumococcal disease is important because new preventive measures such as the pneumococcal conjugate vaccine 13 are currently being evaluated. Pneumococcal disease is roughly divided into non-invasive and invasive disease. The burden of non-invasive pneumococcal disease in adults is mainly determined by community-acquired pneumonia. Pneumococcal pneumonia has high incidence rates and carries a high mortality risk, especially in the elderly. Within the cluster of invasive pneumococcal diseases, pneumonia also represents the most common infectious source. Incidence and mortality rates of both non-invasive and invasive disease have changed as a result of pneumococcal vaccination in children. However, especially elderly patients with comorbidities remain vulnerable to morbidity and mortality caused by pneumococcal disease. The current review summarizes the current knowledge on the epidemiology including outcome of the main clinical forms of pneumococcal disease, with a special focus on elderly patients. Furthermore, the economic burden and future vaccine strategies are briefly discussed.
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Affiliation(s)
- J J C Drijkoningen
- Department of Respiratory Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands
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Le Polain de Waroux O, Flasche S, Prieto-Merino D, Edmunds WJ. Age-dependent prevalence of nasopharyngeal carriage of streptococcus pneumoniae before conjugate vaccine introduction: a prediction model based on a meta-analysis. PLoS One 2014; 9:e86136. [PMID: 24465920 PMCID: PMC3900487 DOI: 10.1371/journal.pone.0086136] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Accepted: 12/04/2013] [Indexed: 11/18/2022] Open
Abstract
Introduction Data on the prevalence of nasopharyngeal carriage of S.pneumoniae in all age groups are important to help predict the impact of introducing pneumococcal conjugate vaccines (PCV) into routine infant immunization, given the important indirect effect of the vaccine. Yet most carriage studies are limited to children under five years of age. We here explore the association between carriage prevalence and serotype distribution in children aged ≥5 years and in adults compared to children. Methods We conducted a systematic review of studies providing carriage estimates across age groups in healthy populations not previously exposed to PCV, using MEDLINE and Embase. We used Bayesian linear meta-regression models to predict the overall carriage prevalence as well as the prevalence and distribution of vaccine and nonvaccine type (VT and NVT) serotypes in older age groups as a function of that in <5 y olds. Results Twenty-nine studies compromising of 20,391 individuals were included in the analysis. In all studies nasopharyngeal carriage decreased with increasing age. We found a strong positive linear association between the carriage prevalence in pre-school childen (<5 y) and both that in school aged children (5–17 y olds) and in adults. The proportion of VT serotypes isolated from carriers was consistently lower in older age groups and on average about 73% that of children <5 y among 5–17 y olds and adults respectively. We provide a prediction model to infer the carriage prevalence and serotype distribution in 5–17 y olds and adults as a function of that in children <5 years of age. Conclusion Such predictions are helpful for assessing the potential population-wide effects of vaccination programmes, e.g. via transmission models, and thus assist in the design of future pneumococcal conjugate vaccination strategies.
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Affiliation(s)
- Olivier Le Polain de Waroux
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
- * E-mail:
| | - Stefan Flasche
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - David Prieto-Merino
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - W. John Edmunds
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Affiliation(s)
- Joon Young Song
- Division of Infectious Disease, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
- Asian Pacific Influenza Institute, Seoul, Korea
| | - Hee Jin Cheong
- Division of Infectious Disease, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
- Asian Pacific Influenza Institute, Seoul, Korea
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