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Wong A, Kramer SC, Piccininni M, Rohmann JL, Kurth T, Escolano S, Grittner U, Domenech de Cellès M. Using LASSO Regression to Estimate the Population-Level Impact of Pneumococcal Conjugate Vaccines. Am J Epidemiol 2023; 192:1166-1180. [PMID: 36935107 PMCID: PMC10326487 DOI: 10.1093/aje/kwad061] [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: 03/01/2022] [Revised: 12/12/2022] [Accepted: 03/13/2023] [Indexed: 03/21/2023] Open
Abstract
Pneumococcal conjugate vaccines (PCVs) protect against diseases caused by Streptococcus pneumoniae, such as meningitis, bacteremia, and pneumonia. It is challenging to estimate their population-level impact due to the lack of a perfect control population and the subtleness of signals when the endpoint-such as all-cause pneumonia-is nonspecific. Here we present a new approach for estimating the impact of PCVs: using least absolute shrinkage and selection operator (LASSO) regression to select variables in a synthetic control model to predict the counterfactual outcome for vaccine impact inference. We first used a simulation study based on hospitalization data from Mexico (2000-2013) to test the performance of LASSO and established methods, including the synthetic control model with Bayesian variable selection (SC). We found that LASSO achieved accurate and precise estimation, even in complex simulation scenarios where the association between the outcome and all control variables was noncausal. We then applied LASSO to real-world hospitalization data from Chile (2001-2012), Ecuador (2001-2012), Mexico (2000-2013), and the United States (1996-2005), and found that it yielded estimates of vaccine impact similar to SC. The LASSO method is accurate and easily implementable and can be applied to study the impact of PCVs and other vaccines.
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Affiliation(s)
- Anabelle Wong
- Correspondence to Anabelle Wong, Infectious Disease Epidemiology Research Group, Max Planck Institute for Infection Biology, Charitéplatz 1, 10117 Berlin, Germany (e-mail: )
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Amicizia D, Astengo M, Paganino C, Piazza MF, Sticchi C, Orsi A, Varlese F, Hu T, Petigara T, Senese F, Prandi GM, Icardi G, Ansaldi F. Economic burden of pneumococcal disease in children in Liguria, Italy. Hum Vaccin Immunother 2022; 18:2082205. [PMID: 35695748 PMCID: PMC9621055 DOI: 10.1080/21645515.2022.2082205] [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] [Indexed: 11/15/2022] Open
Abstract
Vaccinations against Streptococcus pneumoniae are included in infant immunization programs globally. However, a substantial burden due to pneumococcal disease (PD) remains. This study aimed to estimate the cost of emergency department (ED) visits and hospitalizations associated with invasive pneumococcal disease, all-cause pneumonia, and acute otitis media in children <15 years of age in the Liguria region of Italy between 2012 and 2018. The retrospective cohort study used data from the Liguria Region Administrative Health Databases and the Ligurian Chronic Condition Data Warehouse, which contain information on hospital stays, outpatient visits, laboratory/imaging techniques, surgical procedures, and pharmaceutical prescriptions. Patients with one or more ED or inpatient claim for PD (based on International Classification of Diseases, Ninth Revision, Clinical Modification codes) were included. Cost of ED visits and hospitalizations were estimated from the diagnosis-related group system and procedures performed in the ED. In Ligurian children <15 years of age during 2012–2018, the median annual number of hospitalizations plus ED visits due to PD was 4,009, and the median estimated annual cost was €3.6 million. All-cause pneumonia accounted for the majority of hospitalization costs during the study period. Number and costs of ED visits and hospitalizations increased from 2012 to 2018. Despite widespread infant immunization in Liguria, economic costs due to PD-associated ED visits and hospitalizations remained high in children 0–14 years of age.
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Affiliation(s)
- Daniela Amicizia
- Planning, Epidemiology and Prevention Unit, Regional Health Agency of Liguria (ALiSa), Genoa, Italy.,Department of Health Sciences (DiSSal), University of Genoa, Genoa, Italy
| | - Matteo Astengo
- Planning, Epidemiology and Prevention Unit, Regional Health Agency of Liguria (ALiSa), Genoa, Italy
| | - Chiara Paganino
- Planning, Epidemiology and Prevention Unit, Regional Health Agency of Liguria (ALiSa), Genoa, Italy
| | - Maria Francesca Piazza
- Planning, Epidemiology and Prevention Unit, Regional Health Agency of Liguria (ALiSa), Genoa, Italy
| | - Camilla Sticchi
- Planning, Epidemiology and Prevention Unit, Regional Health Agency of Liguria (ALiSa), Genoa, Italy
| | - Andrea Orsi
- Department of Health Sciences (DiSSal), University of Genoa, Genoa, Italy
| | - Federica Varlese
- Planning, Epidemiology and Prevention Unit, Regional Health Agency of Liguria (ALiSa), Genoa, Italy
| | - Tianyan Hu
- Center for Observational and Real World Evidence (CORE), Merck & Co, Inc, Rahway, NJ, USA
| | - Tanaz Petigara
- Center for Observational and Real World Evidence (CORE), Merck & Co, Inc, Rahway, NJ, USA
| | | | | | - Giancarlo Icardi
- Department of Health Sciences (DiSSal), University of Genoa, Genoa, Italy
| | - Filippo Ansaldi
- Planning, Epidemiology and Prevention Unit, Regional Health Agency of Liguria (ALiSa), Genoa, Italy.,Department of Health Sciences (DiSSal), University of Genoa, Genoa, Italy
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Vadlamudi NK, Patrick DM, Rose C, Sadatsafavi M, Hoang L, Marra F. A population-based analysis to determine the impact of the 13-valent pneumococcal conjugate vaccine on community-acquired pneumonia in British Columbia, Canada. Vaccine 2022; 40:1047-1053. [PMID: 35012778 DOI: 10.1016/j.vaccine.2021.12.065] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 12/20/2021] [Accepted: 12/28/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Pneumonia is a leading cause of morbidity and mortality globally. We determined the impact of 13-valent pneumococcal conjugate vaccine (PCV13) use on community-acquired pneumonia (CAP) rates eight years after the vaccine was introduced in the infant immunization program. METHODS Using diagnostic codes from administrative databases, we calculated the overall and age-specific CAP incidence per month (2000-2018). Changes in the CAP incidence before and after the PCV13 vaccine program introduction were evaluated using negative binomial regression model adjusting for 7-valent pneumococcal conjugate vaccine program. RESULTS The PCV13 vaccine infant immunization program was associated with declining CAP incidence among children aged 0-2 years (adjusted Incidence Rate Ratio (aIRR): 0.91; 95% CI: 0.87-0.96). Overall CAP incidence did not decrease in those aged 3-5 years (0.98; 95% CI: 0.93-1.04), 6-17 years (1.02; 95% CI: 0.97-1.08), 18-49 years (1.02; 95% CI:0.98-1.05), 50-64 years (1.07; 95% CI: 1.04-1.11), ≥65 years (1.05; 95% CI:1.02-1.08). CONCLUSIONS The PCV13 infant immunization program is temporally associated with a reduction in CAP incidence in vaccine target age group. However, no significant decrease in CAP incidence in other age groups warrants further study of the etiology of CAP to develop and implement effective prevention programs.
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Affiliation(s)
- Nirma K Vadlamudi
- Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver V6T 1Z3, Canada
| | - David M Patrick
- School of Population and Public Health, Faculty of Medicine, The University of British Columbia, Vancouver, Canada; British Columbia Centre for Disease Control, Vancouver, Canada
| | - Caren Rose
- School of Population and Public Health, Faculty of Medicine, The University of British Columbia, Vancouver, Canada; British Columbia Centre for Disease Control, Vancouver, Canada
| | - Mohsen Sadatsafavi
- Centre for Heart Lung Innovation, The University of British Columbia, Vancouver, Canada; Department of Medicine, Institute for Heart and Lung Health, The University of British Columbia, Vancouver, Canada
| | - Linda Hoang
- British Columbia Centre for Disease Control, Vancouver, Canada
| | - Fawziah Marra
- Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver V6T 1Z3, Canada; School of Population and Public Health, Faculty of Medicine, The University of British Columbia, Vancouver, Canada.
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Evaluation of the indirect impact of the 10-valent pneumococcal Haemophilus influenzae protein D conjugate vaccine in a cluster-randomised trial. PLoS One 2022; 17:e0261750. [PMID: 34986178 PMCID: PMC8730423 DOI: 10.1371/journal.pone.0261750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 10/22/2021] [Indexed: 11/24/2022] Open
Abstract
Background In the nation-wide double-blind cluster-randomised Finnish Invasive Pneumococcal disease trial (FinIP, ClinicalTrials.gov NCT00861380, NCT00839254), we assessed the indirect impact of the 10-valent pneumococcal Haemophilus influenzae protein D conjugate vaccine (PHiD-CV10) against five pneumococcal disease syndromes. Methods Children 6 weeks to 18 months received PHiD-CV10 in 48 clusters or hepatitis B/A-vaccine as control in 24 clusters according to infant 3+1/2+1 or catch-up schedules in years 2009―2011. Outcome data were collected from national health registers and included laboratory-confirmed and clinically suspected invasive pneumococcal disease (IPD), hospital-diagnosed pneumonia, tympanostomy tube placements (TTP) and outpatient antimicrobial prescriptions. Incidence rates in the unvaccinated population in years 2010―2015 were compared between PHiD-CV10 and control clusters in age groups <5 and ≥5 years (5―7 years for TTP and outpatient antimicrobial prescriptions), and in infants <3 months. PHiD-CV10 was introduced into the Finnish National Vaccination Programme (PCV-NVP) for 3-month-old infants without catch-up in 9/2010. Results From 2/2009 to 10/2010, 45398 children were enrolled. Vaccination coverage varied from 29 to 61% in PHiD-CV10 clusters. We detected no clear differences in the incidence rates between the unvaccinated cohorts of the treatment arms, except in single years. For example, the rates of vaccine-type IPD, non-laboratory-confirmed IPD and empyema were lower in PHiD-CV10 clusters compared to control clusters in 2012, 2015 and 2011, respectively, in the age-group ≥5 years. Conclusions This is the first report from a clinical trial evaluating the indirect impact of a PCV against clinical outcomes in an unvaccinated population. We did not observe consistent indirect effects in the PHiD-CV10 clusters compared to the control clusters. We consider that the sub-optimal trial vaccination coverage did not allow the development of detectable indirect effects and that the supervening PCV-NVP significantly diminished the differences in PHiD-CV10 vaccination coverage between the treatment arms.
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Zhu X, Li X. Pneumococcal vaccine effect on hospitalisation rates of pneumonia in children: A meta-analysis. Int J Clin Pract 2021; 75:e14739. [PMID: 34388857 DOI: 10.1111/ijcp.14739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 03/28/2021] [Accepted: 06/27/2021] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Since the appearance of the pneumococcal conjugate vaccine, the frequency of community-acquired pneumonia hospitalisations was decreased significantly especially in children below the age of 2 years, but its effects are still conflicting. This meta-analysis study was performed to assess the relationship between the effects of different types of pneumococcal conjugate vaccines compared with each other on the frequency of community-acquired pneumonia hospitalisations in children aged below 2 years. METHODS Through a systematic literature search up to December 2020, 20 studies were found recording relationships between the effects of different types of pneumococcal conjugate vaccines compared with each other on the frequency of community-acquired pneumonia hospitalisations in children aged below 2 years. Odds ratio (OR) with 95% confidence intervals (CIs) was calculated between different types of pneumococcal conjugate vaccines compared with each other on the frequency of community-acquired pneumonia hospitalisations in children below the age of 2 years using the dichotomous methods with a random or fixed-effect model. RESULTS The pneumococcal conjugate vaccine 10 was significantly related to a lower hospitalisation rate for pneumonia (OR, 0.64; 95% CI, 0.51-0.81, P < .001) compared with no vaccine and (OR, 0.78; 95% CI, 0.68-0.90, P < .001) compared with pneumococcal conjugate vaccine 7. The pneumococcal conjugate vaccine 13 was significantly related to a lower hospitalisation rate for pneumonia (OR, 0.63; 95% CI, 0.56-0.71, P < .001) compared with no vaccine and (OR, 0.56; 95% CI, 0.36-0.89, P = .01) compared with pneumococcal conjugate vaccine 7. The pneumococcal conjugate vaccine 13 was significantly related to a lower hospitalisation rate for pneumonia (OR, 0.67; 95% CI, 0.48-0.93, P = .02) compared with pneumococcal conjugate vaccine 10. CONCLUSIONS The pneumococcal conjugate vaccines 10 or 13 may have independent relationships in reducing the frequency of community-acquired pneumonia hospitalisations in children aged below 2 years compared with no vaccine or pneumococcal conjugate vaccines 7. Also, the pneumococcal conjugate vaccine 13 may have the same independent relationship compared with pneumococcal conjugate vaccines 10. Further studies are needed to solidify the findings to other vaccines to have evidence-based information that could help in establishing future immunisation strategies.
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Affiliation(s)
- Xiuling Zhu
- Department of Pediatrics, Yiwu Central Hospital, Zhejiang, China
| | - Xiaofei Li
- Department of Infectious Diseases, Yiwu Central Hospital, Zhejiang, China
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Shen CF, Chen JL, Su CC, Lin WL, Hsieh ML, Liu CC, Cheng CL. Decrease of Pneumococcal Community-Acquired Pneumonia Hospitalization and Associated Complications in Children after the Implementation of the 13-Valent Pneumococcal Conjugate Vaccine (PCV13) in Taiwan. Vaccines (Basel) 2021; 9:vaccines9091043. [PMID: 34579280 PMCID: PMC8471531 DOI: 10.3390/vaccines9091043] [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: 07/29/2021] [Revised: 09/12/2021] [Accepted: 09/16/2021] [Indexed: 11/16/2022] Open
Abstract
The impact of the 13-valent pneumococcal conjugate vaccine (PCV13) on overall community-acquired pneumonia (CAP) and disease severity still needs thorough evaluation. In this study, we retrieve both pneumococcal CAP (P-CAP) and unspecific CAP (U-CAP) inpatient data from the Taiwan National Health Insurance Database (NHID) between 2005 and 2016. The interrupted time-series (ITS) analysis was performed to compare the incidence trend before and after the implementation of PCV13. After PCV13 implementation, there is a significant decreasing trend of P-CAP hospitalization, especially in children <1 year, 2-5 years, adults aged 19-65 years, 66 years, or older (all p value < 0.05). This corresponds to a 59% reduction in children <1 year, 47% in children aged 2-5 years, 39% in adult aged 19-65 years, and 41% in elderly aged 66 years or older. The intensive care rate (6.8% to 3.9%), severe pneumonia cases (21.7 to 14.5 episodes per 100,000 children-years), and the need for invasive procedures (4.3% to 2.0%) decreased in children aged 2-5 years (p value < 0.0001) with P-CAP. This PCV13 implementation program in Taiwan not only reduced the incidence of P-CAP, but also attenuated disease severity, especially in children aged 2-5 years.
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Affiliation(s)
- Ching-Fen Shen
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70101, Taiwan; (C.-F.S.); (M.-L.H.); (C.-C.L.)
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan 70101, Taiwan
| | - Ju-Ling Chen
- Department of Pharmacy, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70101, Taiwan; (J.-L.C.); (C.-C.S.); (W.-L.L.)
- School of Pharmacy & Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan 70101, Taiwan
| | - Chien-Chou Su
- Department of Pharmacy, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70101, Taiwan; (J.-L.C.); (C.-C.S.); (W.-L.L.)
| | - Wen-Liang Lin
- Department of Pharmacy, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70101, Taiwan; (J.-L.C.); (C.-C.S.); (W.-L.L.)
| | - Min-Ling Hsieh
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70101, Taiwan; (C.-F.S.); (M.-L.H.); (C.-C.L.)
| | - Ching-Chun Liu
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70101, Taiwan; (C.-F.S.); (M.-L.H.); (C.-C.L.)
- Center of Infectious Disease and Signaling Research, National Cheng Kung University, Tainan 70101, Taiwan
| | - Ching-Lan Cheng
- Department of Pharmacy, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70101, Taiwan; (J.-L.C.); (C.-C.S.); (W.-L.L.)
- School of Pharmacy & Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan 70101, Taiwan
- Correspondence: ; Tel.: +886-6-2353535 (ext. 5688)
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Yu Q, Li X, Fan M, Qiu H, Wong AYS, Tian L, Chui CSL, Li PH, Lau LKW, Chan EW, Goggins WB, Ip P, Lum TY, Hung IFN, Cowling BJ, Wong ICK, Jit M. The impact of childhood pneumococcal conjugate vaccine immunisation on all-cause pneumonia admissions in Hong Kong: A 14-year population-based interrupted time series analysis. Vaccine 2021; 39:2628-2635. [PMID: 33858719 DOI: 10.1016/j.vaccine.2021.03.090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 03/25/2021] [Accepted: 03/29/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Nine years after the introduction of pneumococcal conjugate vaccine (PCV) in the United States, Hong Kong (HK) introduced the vaccine to its universal childhood immunisation programme in 2009. We aimed to assess the impact of childhood PCV immunisation on all-cause pneumonia (ACP) admissions among the overall population of HK. METHODS In this population-based interrupted time series analysis, we used territory-wide population-representative electronic health records in HK to evaluate the vaccine impact. We identified hospitalised patients with a diagnosis of pneumonia from any cause between 2004 and 2017. We applied segmented Poisson regression to assess the gradual change in the monthly incidence of ACP admissions between pre- and post-vaccination periods. Negative outcome control, subgroup and sensitivity analyses were used to test the robustness of the main analysis. FINDINGS Over the 14-year study period, a total of 587,607 ACP episodes were identified among 357,950 patients. The monthly age-standardised incidence of ACP fluctuated between 33.42 and 87.44 per 100,000-persons. There was a marginal decreasing trend in pneumonia admissions after PCV introduction among overall population (incidence rate ratio [IRR]: 0·9965, 95% confidence interval [CI]: 0·9932-0·9998), and older adults (≥65 years, IRR: 0·9928, 95% CI: 0·9904-0·9953) but not in younger age groups. INTERPRETATION There was a marginally declining trend of overall ACP admissions in HK up to eight years after childhood PCV introduction. The significance disappeared when fitting sensitivity analyses. The results indicate the complexities of using non-specific endpoints for measuring vaccine effect and the necessity of enhancing serotype surveillance systems for replacement monitoring. FUNDING Health and Medical Research Fund, Food and Health Bureau of the Government of Hong Kong (Reference number: 18171272).
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Affiliation(s)
- Qiuyan Yu
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China; Laboratory of Data Discovery for Health (D²4H), Hong Kong, China
| | - Xue Li
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China; Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong; Laboratory of Data Discovery for Health (D²4H), Hong Kong, China.
| | - Min Fan
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Hong Qiu
- Institute of Environment, Energy and Sustainability, The Chinese University of Hong Kong, Hong Kong, China
| | - Angel Y S Wong
- Department of Non-communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Linwei Tian
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Celine S L Chui
- Laboratory of Data Discovery for Health (D²4H), Hong Kong, China; School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China; School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Philip H Li
- Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Lauren K W Lau
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Esther W Chan
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China; Laboratory of Data Discovery for Health (D²4H), Hong Kong, China
| | - William B Goggins
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Patrick Ip
- Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Terry Y Lum
- Department of Social Work and Social Administration, Faculty of Social Sciences, The University of Hong Kong, Hong Kong, China; Sau Po Centre on Ageing, The University of Hong Kong, Hong Kong, China
| | - Ivan F N Hung
- Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Benjamin J Cowling
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Ian C K Wong
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China; Laboratory of Data Discovery for Health (D²4H), Hong Kong, China; Research Department of Policy and Practice, University College London School of Pharmacy, London, UK
| | - Mark Jit
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China; Centre for Mathematical Modelling of Infectious Diseases, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
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Eythorsson E, Ásgeirsdóttir TL, Erlendsdóttir H, Hrafnkelsson B, Kristinsson KG, Haraldsson Á. The impact and cost-effectiveness of introducing the 10-valent pneumococcal conjugate vaccine into the paediatric immunisation programme in Iceland-A population-based time series analysis. PLoS One 2021; 16:e0249497. [PMID: 33831049 PMCID: PMC8031404 DOI: 10.1371/journal.pone.0249497] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 03/19/2021] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Streptococcus pneumoniae is a cause of infections that range in severity from acute otitis media (AOM) to pneumonia and invasive pneumococcal disease (IPD). The 10-valent pneumococcal conjugate vaccine (PHiD-CV10) was introduced into the Icelandic paediatric immunisation programme in 2011. The aim was to estimate the population impact and cost-effectiveness of PHiD-CV10 introduction. METHODS Data on primary care visits from 2005-2015 and hospitalisations from 2005-2017 were obtained from population-based registries. A Bayesian time series analysis with synthetic controls was employed to estimate the number of cases of AOM, pneumonia and IPD that would have occurred between 2013-2017, had PHiD-CV10 not been introduced. Prevented cases were calculated by subtracting the observed number of cases from this estimate. The cost of the programme was calculated accounting for cost-savings due to prevented cases. RESULTS The introduction of PHiD-CV10 prevented 13,767 (95% credible interval [CI] 2,511-29,410) visits for AOM from 2013-2015, and prevented 1,814 (95%CI -523-4,512) hospitalisations for pneumonia and 53 (95%CI -17-177) admissions for IPD from 2013-2017. Visits for AOM decreased both among young children and among children 4-19 years of age, with rate ratios between 0.72-0.89. Decreases were observed in both pneumonia hospitalisations (rate ratios between 0.67-0.92) and IPD (rate ratios between 0.27-0.94). The total cost of implementing PHiD-CV10 in Iceland was -7,463,176 United States Dollars (USD) (95%CI -16,159,551-582,135) with 2.1 USD (95%CI 0.2-4.7) saved for every 1 USD spent. CONCLUSIONS The introduction of PHiD-CV10 was associated with large decreases in visits and hospitalisations for infections commonly caused by pneumococcus and was cost-saving during the first five years of the immunisation programme.
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Affiliation(s)
| | | | - Helga Erlendsdóttir
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
- Department of Clinical Microbiology, Landspitali–The National University Hospital of Iceland, Reykjavik, Iceland
| | | | - Karl G. Kristinsson
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
- Department of Clinical Microbiology, Landspitali–The National University Hospital of Iceland, Reykjavik, Iceland
| | - Ásgeir Haraldsson
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
- Children’s Hospital Iceland, Landspitali–The National University Hospital of Iceland, Reykjavik, Iceland
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Ben Fredj M, Dhouib W, Kacem M, Bennasrallah C, Mehrez O, Abroug H, Zemni I, Gardabou A, Jamel K, Chouchene S, Rouatbi N, Belguith Sriha A. Trends and health burden of hospitalized acute respiratory infections and impact of Haemophilus influenza immunization in a Tunisian university hospital: a twelve-year study. Libyan J Med 2020; 15:1783048. [PMID: 32552441 PMCID: PMC7482779 DOI: 10.1080/19932820.2020.1783048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 06/09/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND We aimed to describe the episodes and trends of admissions for community-acquired Respiratory Infections (RI) over a 12-year period and to assess the impact of Haemophilus influenza type b (Hib) vaccine on RI admissions in children aged up to 3 years. METHODS We conducted a twelve-year retrospective observational study on all community-acquired RI admitted to Fattouma Bourguiba Hospital in Monastir Governorate (Tunisia) from 1 January 2002 to 31 December 2013. RI cases were selected from the Regional Registry of Hospital Morbidity. Data were coded according to ICD-10. To assess the impact of the Hib vaccine, three cohorts were defined based on vaccine status (unvaccinated cohort, first vaccinated cohort (VC) by monovalent form and second VC by pentavalent combination). RESULTS Admissions for RI represented 17.6% (CI95%: 17.3-18.1) of all communicable diseases hospitalizations (n = 6 061/34 289). The crude incidence rates (CIR) per 100,000 inh were 24.2 for upper RI (URI) and 77.5 and for Lower RI (LRI) (p < 0.0001). Pneumonias represented 53.9% of LRI. Sex-ratio (male/female) was 1.12 for URI and 1.64 for LRI (p < 0.0001). At admission, the median age was 22 years (IQR: 3-52). Admission for Pneumonia increased significantly during study period (slope 'b' = 5.16; p < 0.0001) especially in children up to 5 years old (slope 'b' = 5.53) and in elderly (slope 'b' = 2.13). Among children up to 3 years old, the CIRs per 100,000 for Hib pneumonia admission were 11.6 in Non-Vaccinated Cohort (NVC), 10.6 in Vaccinated Cohort (VC) by protocol 1 (Hib Vaccine monovalent) and 0.80 in VC by protocol 2 (pentavalent vaccine combination).The relative risk reduction was 99% for protocol 2 (p < 0.001). CONCLUSION Admissions for RI in a tertiary level hospital were common with an increasing trend. The Hib immunization program, in particular the pentavalent combination, has had a positive impact on the reduction of related acute diseases.
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Affiliation(s)
- Manel Ben Fredj
- Faculty of Medicine of Monastir, University of Monastir, Monastir, Tunisia
- Department of Preventive and Community Medicine, University Hospital Fattouma Bourguiba, Monastir, Tunisia
- Research Laboratory “Technology and Medical Imaging” 12ES06, Tunisia
| | - Wafa Dhouib
- Faculty of Medicine of Monastir, University of Monastir, Monastir, Tunisia
- Department of Preventive and Community Medicine, University Hospital Fattouma Bourguiba, Monastir, Tunisia
- Research Laboratory “Technology and Medical Imaging” 12ES06, Tunisia
| | - Meriem Kacem
- Faculty of Medicine of Monastir, University of Monastir, Monastir, Tunisia
- Department of Preventive and Community Medicine, University Hospital Fattouma Bourguiba, Monastir, Tunisia
- Research Laboratory “Technology and Medical Imaging” 12ES06, Tunisia
| | - Cyrine Bennasrallah
- Faculty of Medicine of Monastir, University of Monastir, Monastir, Tunisia
- Department of Preventive and Community Medicine, University Hospital Fattouma Bourguiba, Monastir, Tunisia
- Research Laboratory “Technology and Medical Imaging” 12ES06, Tunisia
| | - Ons Mehrez
- Faculty of Medicine of Monastir, University of Monastir, Monastir, Tunisia
| | - Hela Abroug
- Faculty of Medicine of Monastir, University of Monastir, Monastir, Tunisia
- Department of Preventive and Community Medicine, University Hospital Fattouma Bourguiba, Monastir, Tunisia
- Research Laboratory “Technology and Medical Imaging” 12ES06, Tunisia
| | - Imen Zemni
- Faculty of Medicine of Monastir, University of Monastir, Monastir, Tunisia
- Department of Preventive and Community Medicine, University Hospital Fattouma Bourguiba, Monastir, Tunisia
- Research Laboratory “Technology and Medical Imaging” 12ES06, Tunisia
| | - Aicha Gardabou
- Faculty of Medicine of Monastir, University of Monastir, Monastir, Tunisia
| | - Koubaa Jamel
- Faculty of Medicine of Monastir, University of Monastir, Monastir, Tunisia
- Otorhinolaryngology Department, University Hospital Fattouma Bourguiba, Monastir, Tunisia
| | - Slaheddine Chouchene
- Faculty of Medicine of Monastir, University of Monastir, Monastir, Tunisia
- Pediatric Department, University Hospital Fattouma Bourguiba, Monastir, Tunisia
| | - Naceur Rouatbi
- Faculty of Medicine of Monastir, University of Monastir, Monastir, Tunisia
- Pneumology Department, University Hospital Fattouma Bourguiba, Monastir, Tunisia
| | - Asma Belguith Sriha
- Faculty of Medicine of Monastir, University of Monastir, Monastir, Tunisia
- Department of Preventive and Community Medicine, University Hospital Fattouma Bourguiba, Monastir, Tunisia
- Research Laboratory “Technology and Medical Imaging” 12ES06, Tunisia
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10
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Reyburn R, Tuivaga E, Nguyen CD, Ratu FT, Nand D, Kado J, Tikoduadua L, Jenkins K, de Campo M, Kama M, Devi R, Rafai E, Weinberger DM, Mulholland EK, Russell FM. Effect of ten-valent pneumococcal conjugate vaccine introduction on pneumonia hospital admissions in Fiji: a time-series analysis. LANCET GLOBAL HEALTH 2020; 9:e91-e98. [PMID: 33227258 DOI: 10.1016/s2214-109x(20)30421-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 09/04/2020] [Accepted: 09/15/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND In October, 2012, Fiji introduced routine infant immunisation with a ten-valent pneumococcal conjugate vaccine (PCV10) using three primary doses and no booster dose (3 + 0 schedule). Data are scarce for the effect of PCV in the Asia and Pacific region. We aimed to evaluate the effect of PCV10 on pneumonia hospital admissions in children younger than 5 years and adults aged 55 years and older in Fiji, 5 years after vaccine introduction. METHODS We did a time-series analysis assessing changes in pneumonia hospital admissions at three public tertiary hospitals in Fiji. Four pneumonia outcomes were evaluated: all-cause pneumonia, severe or very severe pneumonia, hypoxic pneumonia, and radiological pneumonia. Participants aged younger than 2 months, 2-23 months, 24-59 months, and 55 years and older were included. Data were extracted from the national hospital admission database according to International Classification of Diseases-tenth revision codes J10·0-18·9, J21, and J22 for all-cause pneumonia. Medical records and chest radiographs were reviewed for the main tertiary hospital to reclassify hospital admissions in children aged younger than 2 years as severe or very severe, hypoxic, or radiological pneumonia as per WHO definitions. Time-series analyses were done using the synthetic control method and multiple imputation to adjust for changes in hospital usage and missing data. FINDINGS Between Jan 1, 2007, and Dec 31, 2017, the ratio of observed cases to expected cases for all-cause pneumonia was 0·92 (95% CI 0·70-1·36) for children aged younger than 2 months, 0·86 (0·74-1·00) for children aged 2-23 months, 0·74 (0·62-0·87) for children aged 24-59 months, and 1·90 (1·53-2·31) in adults aged 55 years and older, 5 years after PCV10 introduction. These findings indicate a reduction in all-cause pneumonia among children aged 24-59 months and an increase in adults aged 55 years and older, but no change among children aged younger than 2 months. Among children aged 2-23 months, we observed declines of 21% (95% CI 5-35) for severe or very severe pneumonia, 46% (33-56) for hypoxic pneumonia, and 25% (9-38) for radiological pneumonia. Mortality reduced by 39% (95% CI 5-62) for all-cause pneumonia, bronchiolitis, and asthma admissions in children aged 2-23 months. INTERPRETATION The introduction of PCV10 was associated with a decrease in pneumonia hospital admissions in children aged 2-59 months. This is the first study in a middle-income country in the Asia and Pacific region to show the effect of PCV on pneumonia, filling gaps in the literature on the effects of PCV10 and 3 + 0 schedules. These data support decision making on PCV introduction for other low-income and middle-income countries in the region. FUNDING Department of Foreign Affairs and Trade of the Australian Government.
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Affiliation(s)
- Rita Reyburn
- Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | | | - Cattram D Nguyen
- Murdoch Children's Research Institute, Melbourne, VIC, Australia; Department of Paediatrics, The University of Melbourne, The Royal Children's Hospital, Melbourne, VIC, Australia
| | | | - Devina Nand
- Ministry of Health and Medical Services, Suva, Fiji
| | - Joe Kado
- Fiji National University, Suva, Fiji
| | | | - Kylie Jenkins
- Australia's support to the Fiji Health Sector, Suva, Fiji
| | | | - Mike Kama
- Ministry of Health and Medical Services, Suva, Fiji
| | - Rachel Devi
- Ministry of Health and Medical Services, Suva, Fiji
| | - Eric Rafai
- Ministry of Health and Medical Services, Suva, Fiji
| | - Daniel M Weinberger
- Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
| | - E Kim Mulholland
- Murdoch Children's Research Institute, Melbourne, VIC, Australia; Department of Paediatrics, The University of Melbourne, The Royal Children's Hospital, Melbourne, VIC, Australia; London School of Hygiene & Tropical Medicine, London, UK
| | - Fiona M Russell
- Murdoch Children's Research Institute, Melbourne, VIC, Australia; Department of Paediatrics, The University of Melbourne, The Royal Children's Hospital, Melbourne, VIC, Australia.
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11
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Vadlamudi NK, Patrick DM, Hoang L, Sadarangani M, Marra F. Incidence of invasive pneumococcal disease after introduction of the 13-valent conjugate pneumococcal vaccine in British Columbia: A retrospective cohort study. PLoS One 2020; 15:e0239848. [PMID: 32997698 PMCID: PMC7526878 DOI: 10.1371/journal.pone.0239848] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 09/14/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND A significant reduction in invasive pneumococcal disease (IPD) has been reported, across all ages, following the implementation of 7-valent conjugate pneumococcal vaccine (PCV7) globally, as part of infant immunization programs. We explored the additional impact of PCV13 on IPD over a 14-year period. METHODS Using provincial laboratory surveillance and hospitalization data (N = 5791), we calculated the annual incidence of IPD following the implementation of PCV13 vaccine. Poisson regression was used to evaluate changes in the overall incidence of IPD, and serotype-specific IPD between PCV7 (2004-10) and PCV13 (2011-2015) eras. RESULTS Overall, IPD rates have seen a modest decline in the PCV13 compared to the PCV7 era (IRR 0.84; 95% CI: 0.79-0.89); this was seen in children ≤2 years of age, and the majority of the adult cohort. Rates of vaccine-type IPD (PCV7 and PCV13) also decreased in the PCV13 era. In contrast, IPD incidence related to non-PCV13 (IRR: 1.56; 95%CI:1.43-1.72) and non-vaccine serotypes (IRR: 2.12; 95%CI:1.84-2.45) increased in the PCV13 era compared to the PCV7 era. CONCLUSIONS A modest reduction in IPD from the PCV13 vaccine was observed, with gains limited to the immunized cohort and adults. However, a significant increase in non-vaccine serotypes emphasizes the need for continued surveillance.
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Affiliation(s)
| | - David M. Patrick
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, Canada
- British Columbia Centre for Disease Control, Vancouver, Canada
| | - Linda Hoang
- British Columbia Centre for Disease Control, Vancouver, Canada
- Department of Pathology and Laboratory Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Manish Sadarangani
- Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, Canada
- Vaccine Evaluation Center, BC Children’s Hospital Research Institute, Vancouver, Canada
| | - Fawziah Marra
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, Canada
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12
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Vadlamudi NK, Chen A, Marra F. Impact of the 13-Valent Pneumococcal Conjugate Vaccine Among Adults: A Systematic Review and Meta-analysis. Clin Infect Dis 2020; 69:34-49. [PMID: 30312379 DOI: 10.1093/cid/ciy872] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 10/05/2018] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND A notable reduction of the pneumococcal disease burden among adults was observed after the introduction of a 7-valent pneumococcal conjugate vaccine (PCV7) in childhood immunization programs. In 2010, a 13-valent pneumococcal conjugate vaccine (PCV13) replaced PCV7 in many jurisdictions; a comparative assessment of PCV13's impact was missing. Our objective was to summarize the available data and assess the change in the incidence of invasive pneumococcal disease (IPD) in adults after the introduction of PCV13 in childhood immunization programs. METHODS We conducted a systematic literature search from January 1946 to May 2017 of randomized, controlled trials and observational studies OBS reporting the incidence of IPD, non-invasive pneumococcal disease, hospitalizations, and mortality in adults for the periods before and after the introduction of PCV13. Incidence rate ratios (IRRs) were pooled across studies using restricted, maximum-likelihood, random-effects models. RESULTS From 3306 records,we included 29 OBS studies and 2033961 cases. Significantly lower IPD rates were seen after PCV13 introduction in adults aged <65 years (IRR 0.78, 95% confidence interval [CI] 0.72-0.85) and those aged ≥65 years (IRR 0.86, 95% CI 0.81-0.91). Lower rates of IPD were seen with PCV7 (IRR 0.45, 95% CI 0.38-0.54) and PCV13 serotypes (IRR 0.60, 95% CI 0.54-0.68). A significantly higher IRR of 1.10 (95% CI 1.04-1.17) for non-vaccine serotypes was observed, especially among those aged 65 years and older (IRR 1.20, 95% CI 1.11-1.29). CONCLUSIONS PCV13 use in children had a moderate impact on reducing the overall and vaccine-type IPDs, but there was a significant increase in non-vaccine type IPDs among adults, especially in those over 65 years.
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Affiliation(s)
| | - Anna Chen
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada
| | - Fawziah Marra
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada
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13
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Sigurdsson S, Eythorsson E, Erlendsdóttir H, Hrafnkelsson B, Kristinsson KG, Haraldsson Á. Impact of the 10-valent pneumococcal conjugate vaccine on hospital admissions in children under three years of age in Iceland. Vaccine 2020; 38:2707-2714. [PMID: 32063434 DOI: 10.1016/j.vaccine.2020.01.094] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 01/28/2020] [Accepted: 01/30/2020] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Pneumococcus is an important respiratory pathogen. The 10-valent pneumococcal vaccine (PHiD-CV) was introduced into the Icelandic vaccination programme in 2011. The aim was to estimate the impact of PHiD-CV on paediatric hospitalisations for respiratory tract infections and invasive disease. METHODS The 2005-2015 birth-cohorts were followed until three years of age and hospitalisations were recorded for invasive pneumococcal disease (IPD), meningitis, sepsis, pneumonia and otitis media. Hospitalisations for upper- and lower respiratory tract infections (URTI, LRTI) were used as comparators. The 2005-2010 birth-cohorts were defined as vaccine non-eligible cohorts (VNEC) and 2011-2015 birth-cohorts as vaccine eligible cohorts (VEC). Incidence rates (IR) were estimated for diagnoses, birth-cohorts and age groups, and incidence rate ratios (IRR) between VNEC and VEC were calculated assuming Poisson variance. Cox regression was used to estimate the hazard ratio (HR) of hospitalisation between VNEC and VEC. RESULTS 51,264 children were followed for 142,315 person-years, accumulating 1,703 hospitalisations for the respective study diagnoses. Hospitalisations for pneumonia decreased by 20% (HR 0.80, 95%CI:0.67-0.95) despite a 32% increase in admissions for LRTI (HR 1.32, 95%CI:1.14-1.53). Hospital admissions for culture-confirmed IPD decreased by 93% (HR 0.07, 95%CI:0.01-0.50) and no hospitalisations for IPD with vaccine-type pneumococci were observed in the VEC. Hospitalisations for meningitis and sepsis did not change. A decrease in hospital admissions for otitis media was observed, but did not coincide with PHiD-CV introduction. CONCLUSION Following the introduction of PHiD-CV in Iceland, hospitalisations for pneumonia and culture confirmed IPD decreased. Admissions for other LRTIs and URTIs increased during this period.
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Affiliation(s)
| | | | - Helga Erlendsdóttir
- University of Iceland, Faculty of Medicine, Iceland; Department of Clinical Microbiology, Landspítali University Hospital, Iceland
| | | | - Karl G Kristinsson
- University of Iceland, Faculty of Medicine, Iceland; Department of Clinical Microbiology, Landspítali University Hospital, Iceland
| | - Ásgeir Haraldsson
- University of Iceland, Faculty of Medicine, Iceland; Children's Hospital Iceland, Landspítali University Hospital, Iceland.
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14
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Naucler P, Henriques-Normark B, Hedlund J, Galanis I, Granath F, Örtqvist Å. The changing epidemiology of community-acquired pneumonia: nationwide register-based study in Sweden. J Intern Med 2019; 286:689-701. [PMID: 31278792 DOI: 10.1111/joim.12956] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND There is limited evidence on the impact of pneumococcal conjugate vaccine childhood immunization programmes (PCV-CIP) on community-acquired pneumonia (CAP) in individuals with underlying diseases. METHODS A nationwide cohort study using Swedish health registers to assess the incidence of hospitalization with all-cause (AC-CAP) and pneumococcal or lobar (PL-CAP) CAP between 2005 and 2015, in relation to PCV-CIP introduction in 2007-09. RESULTS In total, 303 691 episodes of AC-CAP occurred, of which 14 225 were PL-CAP. Comparing before (2005-06) with after (2014-15) PCV-CIP, relative incidence reductions were 36% (95% Confidence Interval 32-40), 20% (14-25) and 16% (11-22) of AC-CAP for age groups < 2, 2-4 and 5-17 years, respectively, with similar reductions in young children with and without comorbidities. The reductions were more pronounced for PL-CAP. In the age groups 40-64, 65-74, 75-84 and ≥85 years there were relative increases of 11% (8-14), 18% (15-22), 15% (12-17) and 30% (27-34) of AC-CAP, respectively, but these increases were attenuated after adjustment for admittance practices using four control conditions. In adults with comorbidities, there was an increase in incidence of AC-CAP, and PL-CAP, in contrast to adults without reported underlying diseases where the incidence was stable or diminished for some age groups. Over the study period, there was an increased proportion of pneumonia patients with underlying diseases in all ages. CONCLUSION This emphasizes that direct preventive interventions should be targeted towards individuals with underlying diseases. Future studies should investigate reasons for the observed increased risk in adults with comorbidities, for example due to pneumococcal nonvaccine serotypes, or other pathogens, preferentially affecting subjects with underlying diseases.
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Affiliation(s)
- P Naucler
- From the, Division of Infectious Diseases, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.,Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - B Henriques-Normark
- Public Health Agency of Sweden, Solna, Sweden.,Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden.,Department of Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden.,SCELSE and LKC, Nanyang Technological University, NTU, Singapore, Singapore
| | - J Hedlund
- From the, Division of Infectious Diseases, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.,Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - I Galanis
- Public Health Agency of Sweden, Solna, Sweden
| | - F Granath
- Department of Medicine Solna, Clinical Epidemiology Unit, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Å Örtqvist
- From the, Division of Infectious Diseases, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.,Department of Communicable Disease Control and Prevention, Stockholm County Council, Stockholm, Sweden
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15
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Population-based estimates of the burden of pneumonia hospitalizations in Hong Kong, 2011-2015. Eur J Clin Microbiol Infect Dis 2019; 38:553-561. [PMID: 30684165 DOI: 10.1007/s10096-018-03459-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 12/17/2018] [Indexed: 12/11/2022]
Abstract
Up-to-date data on the burden of disease are important to identify patients with unmet needs and to optimize healthcare resources. We aimed to characterize the burden of pneumonia hospitalizations in Hong Kong and inform targeted healthcare policies for pneumonia control in the era of global aging. This was a population-based study using a territory-wide administrative electronic health record system that covers all public hospitals of Hong Kong. Patients admitted to public hospitals, from 2011 to 2015, with a diagnosis of pneumonia at discharge were identified based on the International Classification of Diseases-Ninth Revision-Clinical Modification Codes (480-486 and 487.0). Incidence, inpatient case-fatality, all-cause fatality, 28-day readmission, hospital length of stay, and healthcare costs were assessed for seven age strata. We identified 323,992 patients (median age 80 years, 44.4% female) with hospitalized pneumonia (organism unspecified 84.2%; bacterial pneumonia 12.3%; viral pneumonia 2.5%; others 1.0%). Annual incidence was 955.1 per 100,000 population, with a 10.6% decrease from 2011 to 2015. Case-fatality, all-cause fatality, and 28-days readmission risks were 13.8, 21.6, and 19.5%, respectively. The average hospital length of stay was 14.1 days with corresponding direct costs of $9348 USD per episode in the monetary value of 2015. Individuals aged ≥ 65 years accounted for over 75% of pneumonia-related hospitalizations, 90% of deaths, and the majority of healthcare costs. Hospitalized pneumonia represents a considerable health and economic burden in Hong Kong, especially in older adults. The study provides a population-level baseline estimate for further cost-effective evaluation of targeted strategies for pneumonia control.
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16
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Kislaya I, Rodrigues AP, Sousa-Uva M, Gómez V, Gonçalves P, Froes F, Nunes B. Indirect effect of 7-valent and 13-valent pneumococcal conjugated vaccines on pneumococcal pneumonia hospitalizations in elderly. PLoS One 2019; 14:e0209428. [PMID: 30650091 PMCID: PMC6334925 DOI: 10.1371/journal.pone.0209428] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Accepted: 12/05/2018] [Indexed: 01/15/2023] Open
Abstract
Background Pneumonia is one of the leading causes of mortality and has a high burden in morbidity. In Portugal, 7-valent pneumococcal conjugated vaccine (PCV) was used since 2001 and PCV10/13 since 2009, being the last introduced into the National Immunization Program in 2015. Methods We conducted an ecological study to evaluate the impact of PCV7 and PCV13 on pneumococcal pneumonia (PP) hospitalizations in adults aged 65 years or more in Portugal. National hospital discharge registry data from 1998/99 to 2015/16 were used, and PP hospitalization was defined as any hospitalization coded in primary diagnosis as 481 (ICD-9-CM) or J18 (ICD-10-CM). Poisson regression models adjusted for seasonality, influenza-like illness and allowing for overdispersion was used to estimate annual average change of PP hospitalization rate. To assess PP hospitalization trends before and after PCV7 and PCV13 introduction interrupted time series analysis was performed. Results In 1998/99 PP hospitalization rate was 7.0 per 10,000 inhabitants, varying between 3.2 (females, 65–74 years) to 20.7 (males, +85 years), and annually increasing by 16% during the pre-PCV7 period. Statistically significant reduction of 14% per year in PP hospitalization rate was observed after PCV7 introduction. Between 2004/05 and 2009/10 PP hospitalization rate decreased annually by 4% and after PCV13 introduction by 11% per year. In 2015/16 we found an overall reduction of 2.9 (CI 95%: 2.7; 3.1) PP hospitalizations per 10,000 inhabitants (598 hospitalizations) attributable to PCV13, varying from 2.2 (CI 95%: 1.3; 3.1) (female, 65–74 years) to 5.6 (CI 95%: 3.8; 7.5) (female, +85 years). Conclusions Our results suggest that introduction of both PCV7 and PCV13 vaccines resulted in the reduction of PP hospitalizations rates among older adults.
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Affiliation(s)
- Irina Kislaya
- Departamento de Epidemiologia, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisboa, Portugal
- Centro de Investigação em Saúde Pública, Escola Nacional de Saúde Pública, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Ana Paula Rodrigues
- Departamento de Epidemiologia, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisboa, Portugal
- * E-mail:
| | - Mafalda Sousa-Uva
- Departamento de Epidemiologia, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisboa, Portugal
- Centro de Investigação em Saúde Pública, Escola Nacional de Saúde Pública, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Verónica Gómez
- Departamento de Epidemiologia, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisboa, Portugal
| | - Paulo Gonçalves
- Departamento de Doenças Infecciosas, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisboa, Portugal
| | - Filipe Froes
- Thorax Department, Centro Hospitalar Lisboa Norte, Lisboa, Portugal
| | - Baltazar Nunes
- Departamento de Epidemiologia, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisboa, Portugal
- Centro de Investigação em Saúde Pública, Escola Nacional de Saúde Pública, Universidade Nova de Lisboa, Lisboa, Portugal
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17
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Pedrazzoli P, Piralla A, Valentino F, Cinieri S, Baldanti F. Update of the recommendations of the Italian Society of Medical Oncology on vaccination for seasonal influenza and pneumococcal infection in patients with cancer: Focus on prevention of pneumonia. Eur J Cancer Care (Engl) 2018; 27:e12817. [PMID: 29575267 DOI: 10.1111/ecc.12817] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2017] [Indexed: 11/26/2022]
Affiliation(s)
- P. Pedrazzoli
- Medical Oncology; Department of Oncology and Precision Medicine; Fondazione IRCCS Policlinico San Matteo; Pavia Italy
| | - A. Piralla
- Molecular Virology Unit, Microbiology and Virology Department; Fondazione IRCCS Policlinico San Matteo; Pavia Italy
| | - F. Valentino
- Medical Oncology; Department of Oncology and Precision Medicine; Fondazione IRCCS Policlinico San Matteo; Pavia Italy
| | - S. Cinieri
- Medical Oncology Division; Antonio Perrino Hospital; Brindisi Italy
| | - F. Baldanti
- Molecular Virology Unit, Microbiology and Virology Department; Fondazione IRCCS Policlinico San Matteo; Pavia Italy
- Department of Clinical; Surgical, Diagnostic and Pediatric Sciences; University of Pavia; Pavia Italy
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18
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Trends in Pediatric Complicated Pneumonia in an Ontario Local Health Integration Network. CHILDREN-BASEL 2018; 5:children5030036. [PMID: 29510484 PMCID: PMC5867495 DOI: 10.3390/children5030036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2017] [Revised: 02/08/2018] [Accepted: 02/26/2018] [Indexed: 11/17/2022]
Abstract
Following the introduction of 7-valent pneumococcal vaccine (PCV7), while overall rates of invasive pneumococcal disease and pneumococcal pneumonia in children declined, rates of empyema increased. We examined changes in the incidence of hospitalization for pediatric complicated pneumonia (PCOMP) in Eastern Ontario, Canada, particularly since the introduction of the 13-valent vaccine (PCV13). A retrospective chart review was carried out evaluating previously healthy children admitted with PCOMP, which included empyema, parapneumonic effusion, necrotizing pneumonia, and lung abscess between 2002 and 2015. Three-hundred seventy-one children were included. Subjects had a median age of four years, and 188/370 (50.8%) required a chest tube. Admission rates changed markedly during this time period. The number of admissions per year rose most sharply between 2009 and 2012, corresponding to the period following introduction of PCV7 and then the occurrence of pandemic influenza A (H1N1). In children who likely received PCV13, the incidence of PCOMP returned to approximately pre-PCV7 levels. In contrast, rates of PCOMP in older children (who would not have received PCV13) remained elevated during the post-PCV13 time period. While rates of PCOMP, particularly in older children, remain elevated following the introduction of PCV13, this might be expected to resolve with more widespread vaccine coverage with PCV13 and herd immunity.
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19
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Thorrington D, Andrews N, Stowe J, Miller E, van Hoek AJ. Elucidating the impact of the pneumococcal conjugate vaccine programme on pneumonia, sepsis and otitis media hospital admissions in England using a composite control. BMC Med 2018; 16:13. [PMID: 29415741 PMCID: PMC5804014 DOI: 10.1186/s12916-018-1004-z] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 01/02/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The seven-valent pneumococcal conjugate vaccine (PCV) was introduced in England in September 2006, changing to the 13-valent vaccine in April 2010. PCV impact on invasive pneumococcal disease (IPD) has been extensively reported, but less described is its impact on the burden of pneumonia, sepsis and otitis media in the hospital. METHODS Using details on all admissions to hospitals in England, we compared the incidence of pneumococcal-specific and syndromic disease endpoints in a 24-month pre-PCV period beginning April 2004 to the 24-month period ending March 2015 to derive incidence rate ratios (IRRs). To adjust for possible secular trends in admission practice, IRRs were compared to the IRRs for five control conditions over the same period and the relative change assessed using the geometric mean of the five control IRRs as a composite, and individually for each control condition to give the min-max range. Relative changes were also compared with IRRs for IPD from the national laboratory database. The effect of stratifying cases into those with and without clinical risk factors for pneumococcal infection was explored. RESULTS Relative reductions in pneumococcal pneumonia were seen in all age groups and in those with and without risk factors; in children under 15 years old reductions were similar in magnitude to reductions in IPD. For pneumonia of unspecified cause, relative reductions were seen in those under 15 years old (maximum reduction in children under 2 years of 34%, min-max: 11-49%) with a relative increase in 65+ year olds most marked in those with underlying risk conditions (41%, min-max: 0-82%). Reductions in pneumococcal sepsis were seen in all age groups, with the largest reduction in children younger than 2 years (67%, min-max 56-75%). Reductions in empyema and lung abscess were also seen in under 15 year olds. Results for other disease endpoints were varied. For disease endpoints showing an increase in raw IRR, the increase was generally reduced when expressed as a relative change. CONCLUSIONS Use of a composite control and stratification by risk group status can help elucidate the impact of PCV on non-IPD disease endpoints and in vulnerable population groups. We estimate a substantial reduction in the hospitalised burden of pneumococcal pneumonia in all age groups and pneumonia of unspecified cause, empyema and lung abscess in children under 15 years of age since PCV introduction. The increase in unspecified pneumonia in high-risk 65+ year olds may in part reflect their greater susceptibility to develop pneumonia from less pathogenic serotypes that are replacing vaccine types in the nasopharynx.
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Affiliation(s)
| | | | | | | | - Albert Jan van Hoek
- Public Health England, London, UK.,London School of Hygiene and Tropical Medicine, London, UK
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20
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Impact of infant pneumococcal conjugate vaccination on community acquired pneumonia hospitalization in all ages in the Netherlands. Vaccine 2017; 35:7107-7113. [DOI: 10.1016/j.vaccine.2017.10.090] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 09/27/2017] [Accepted: 10/30/2017] [Indexed: 11/21/2022]
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21
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Alicino C, Paganino C, Orsi A, Astengo M, Trucchi C, Icardi G, Ansaldi F. The impact of 10-valent and 13-valent pneumococcal conjugate vaccines on hospitalization for pneumonia in children: A systematic review and meta-analysis. Vaccine 2017; 35:5776-5785. [DOI: 10.1016/j.vaccine.2017.09.005] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 08/28/2017] [Accepted: 09/01/2017] [Indexed: 10/18/2022]
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22
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Andrade AL, Afonso ET, Minamisava R, Bierrenbach AL, Cristo EB, Morais-Neto OL, Policena GM, Domingues CMAS, Toscano CM. Direct and indirect impact of 10-valent pneumococcal conjugate vaccine introduction on pneumonia hospitalizations and economic burden in all age-groups in Brazil: A time-series analysis. PLoS One 2017; 12:e0184204. [PMID: 28880953 PMCID: PMC5589174 DOI: 10.1371/journal.pone.0184204] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 08/18/2017] [Indexed: 01/15/2023] Open
Affiliation(s)
- Ana Lucia Andrade
- Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiânia, Goiás, Brazil
- * E-mail:
| | - Eliane T. Afonso
- Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiânia, Goiás, Brazil
- Faculty of Medicine, Federal University of Goiás, Goiânia, Goiás, Brazil
- Department of Medicine, Pontifical Catholic University of Goiás, Goiânia, Goiás, Brazil
| | - Ruth Minamisava
- School of Nursing, Federal University of Goiás, Goiânia, Goiás, Brazil
| | - Ana Luiza Bierrenbach
- Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiânia, Goiás, Brazil
| | | | - Otaliba L. Morais-Neto
- Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiânia, Goiás, Brazil
| | - Gabriela M. Policena
- Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiânia, Goiás, Brazil
| | - Carla M. A. S. Domingues
- National Immunization Program, Secretariat for Health Surveillance, Ministry of Health, Brasília, Federal District, Brazil
| | - Cristiana M. Toscano
- Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiânia, Goiás, Brazil
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Cohen R, Cohen JF, Chalumeau M, Levy C. Impact of pneumococcal conjugate vaccines for children in high- and non–high-income countries. Expert Rev Vaccines 2017; 16:625-640. [DOI: 10.1080/14760584.2017.1320221] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Robert Cohen
- Université Paris Est, IMRB-GRC GEMINI, Créteil, France
- ACTIV, Association Clinique et Thérapeutique Infantile du Val de Marne, Saint-Maur des Fossés, France
- Clinical Research Center (CRC), Centre Hospitalier Intercommunal Créteil, France
- Unité Court Séjour, Petits Nourrissons, Service de Néonatologie, Centre Hospitalier Intercommunal Créteil, France
| | - Jérémie François Cohen
- Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Paris Descartes University, INSERM U1153, Paris, France
- Service de Pédiatrie Générale, Hôpital Necker-Enfants Malades; AP-HP; Université Paris Descartes, Paris, France
| | - Martin Chalumeau
- Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Paris Descartes University, INSERM U1153, Paris, France
- Service de Pédiatrie Générale, Hôpital Necker-Enfants Malades; AP-HP; Université Paris Descartes, Paris, France
| | - Corinne Levy
- Université Paris Est, IMRB-GRC GEMINI, Créteil, France
- ACTIV, Association Clinique et Thérapeutique Infantile du Val de Marne, Saint-Maur des Fossés, France
- Clinical Research Center (CRC), Centre Hospitalier Intercommunal Créteil, France
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Anderson R, Feldman C. Pneumolysin as a potential therapeutic target in severe pneumococcal disease. J Infect 2017; 74:527-544. [PMID: 28322888 DOI: 10.1016/j.jinf.2017.03.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 03/09/2017] [Accepted: 03/11/2017] [Indexed: 12/13/2022]
Abstract
Acute pulmonary and cardiac injury remain significant causes of morbidity and mortality in those afflicted with severe pneumococcal disease, with the risk for early mortality often persisting several years beyond clinical recovery. Although remaining to be firmly established in the clinical setting, a considerable body of evidence, mostly derived from murine models of experimental infection, has implicated the pneumococcal, cholesterol-binding, pore-forming toxin, pneumolysin (Ply), in the pathogenesis of lung and myocardial dysfunction. Topics covered in this review include the burden of pneumococcal disease, risk factors, virulence determinants of the pneumococcus, complications of severe disease, antibiotic and adjuvant therapies, as well as the structure of Ply and the role of the toxin in disease pathogenesis. Given the increasing recognition of the clinical potential of Ply-neutralisation strategies, the remaining sections of the review are focused on updates of the types, benefits and limitations of currently available therapies which may attenuate, directly and/or indirectly, the injurious actions of Ply. These include recently described experimental therapies such as various phytochemicals and lipids, and a second group of more conventional agents the members of which remain the subject of ongoing clinical evaluation. This latter group, which is covered more extensively, encompasses macrolides, statins, corticosteroids, and platelet-targeted therapies, particularly aspirin.
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Affiliation(s)
- Ronald Anderson
- Department of Immunology and Institute of Cellular and Molecular Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.
| | - Charles Feldman
- Division of Pulmonology, Department of Internal Medicine, Charlotte Maxeke Johannesburg Academic Hospital and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Olarte L, Barson WJ, Barson RM, Romero JR, Bradley JS, Tan TQ, Givner LB, Hoffman JA, Lin PL, Hultén KG, Mason EO, Kaplan SL. Pneumococcal Pneumonia Requiring Hospitalization in US Children in the 13-Valent Pneumococcal Conjugate Vaccine Era. Clin Infect Dis 2017; 64:1699-1704. [DOI: 10.1093/cid/cix115] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Accepted: 01/31/2017] [Indexed: 11/13/2022] Open
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